Validity of conventional radiography in determining scaphoid waist fracture displacement

Stephanie A. Bernard, Peter M. Murray, Michael G. Heckman

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective: This study examines interpreter accuracy and interobserver agreement in evaluating conventional radiographs for scaphoid waist fracture displacement. Methods: Six fresh-frozen cadaver arms were obtained transected above the elbow. A waist fracture was created in each scaphoid. In a random fashion, three of the fractures were displaced 1 mm in the radial-ulnar plane, whereas the other three were reapproximated to anatomic position before all fractures were stabilized with radiolucent adhesive glue. A three-view conventional radiography series consisting of a posterior-anterior, lateral, and ulnar-deviated elongated scaphoid view was obtained for each wrist. Each radiograph was then presented in the same sequence for interpretation to six independent observers: two hand surgeons, two musculoskeletal radiologists, and two senior orthopaedic surgery residents who were all blinded to the actual fracture pattern. Results: In 14 of the 18 (78%) displaced fracture radiographic series, the interpreters correctly recognized displacement being present. However, displacement was also reported in six of the 18 (33%) nondisplaced fracture series. The estimated overall accuracy of all readings for distinguishing between displaced and nondisplaced fractures was 72%. Of the 90 total possible pairwise agreements between interpreters regarding fracture displacement, there were 54 actual agreements (60%), and kappa was estimated to be 0.31. Taken together, these two measures of agreement can be interpreted as indicating poor to moderate agreement. Conclusion: Our results suggest that conventional radiography is not reliable in determining 1-mm scaphoid waist fracture displacement in the radioulnar plane and also indicated a lack of strong interobserver agreement.

Original languageEnglish (US)
Pages (from-to)448-451
Number of pages4
JournalJournal of orthopaedic trauma
Issue number7
StatePublished - Jul 2010

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine


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