Predicting distal radius fracture healing
An interesting study design was developed by researchers at the University of Oulu in Finland: Who has the best ability to predict distal radius fracture healing: one individual surgeon (expert opinion, EO), a group of surgeons (majority rule, MR), or a statistically derived clinical prediction formula called the “Edinburgh wrist calculator” (EWC)? According to the results, one surgeon’s opinion is neither reliable nor accurate for predicting loss of alignment of a distal radius fracture.
The authors asked 18 surgeons to assess the probability of healing above a threshold malalignment (frequently called fracture “instability”) of 71 fractures with the help of radiographs taken initially and after closed reduction and cast application. The probability of losing alignment according to the EWC was dichotomized: likely to lose alignment ≥ 0.5 vs. unlikely < 0.5. The main outcome measures were accuracy parameters of prediction of the three groups.
Regarding the prediction of healing above threshold malalignment, both the EWC formula and the MR demonstrated higher accuracy (0.77 and 0.75, respectively) and sensitivity (0.95 and 0.79, respectively) than EO (0.66 and 0.58). With respect to reliability, the MR group had a higher value (kappa 0.88) than both EWC (0.63) and EO (0.44). The negative predictive value of the EWC for healing above a threshold of malalignment was deemed “excellent” (0.97).
The authors conclude that one surgeon’s opinion is not reliable or accurate for predicting loss of alignment of a distal radius fracture above a threshold malalignment after closed reduction and immobilization. They also suggest using dichotomized EWC as a tool in predicting loss of alignment of a distal radius fracture.