DOS 2016

DOS Kongressen 2016 ·

169

Which Colles’ fracture requires an operation?

Jan Duedal Rölfing, Mette Normann Lund, Lars Borris, Daniel

Wæver, Rikke Thorninger

Dept. of Orthopaedics, Aarhus University Hospital, Aalborg University Hospital;

Dept. of Orthopaedics, Aarhus University Hospital; Dept. of Orthopaedics,

Aarhus University Hospital; Dept. of Orthopaedics, Aarhus University Hospital;

Dept. of Orthopaedics, Aarhus University Hospital, Randers Regional Hospital

Background:

The Danish guidelines regarding distal radius fractures (DRF) (AO

type 23-A2-3, 23-C1-3) warrant operation, if one of the following 5 criteria

is met after closed reduction: dorsal tilt >10 degrees; ulnar variance >2 mm;

articular step-off >2 mm; incongruence of the distal radioulnar joint (DRUJ);

substantial comminution of the dorsal cortex. Many DRF classification systems

exist and their inter-rater agreement varies widely, however the inter- rater

agreement of the Danish DRF guidelines has not yet been determined.

Purpose / Aim of Study:

To estimate the inter-rater agreement of the Danish

DRF guidelines.

Materials and Methods:

A trauma consultant and a medical officer indepen-

dently rated 176 radiographs of Colles’ fractures after closed reduction accord-

ing to the 5 criteria. All 176 cases were operated at our institution between

2009 and 2013. Kappa statistics were applied.

Findings / Results:

The inter-rater agreement regarding acceptable reduction

(yes/no) was “poor”, because in only 49/176 cases the raters agreed on all five

criteria. The agreement was “good” for dorsal tilt (kappa=0.67) and 120 patients

were operated based on this indication. The observers agreed in 149/176 cases

regarding articular step-off >2mm; 144/176 incongruence of DRUJ; 127/176

ulnar variance >2mm; and 90/176 substantial dorsal bone loss.

Conclusions:

Careful consideration is necessary when one decides, which

Colles’ fracture requires operation. For patients with high functional demands,

the Danish DRF guidelines stipulate indications for ORIF. In the present study,

unacceptable dorsal tilt was the primary indication for ORIF. However, in cases

with less than 10 degrees dorsal tilt or if the observers did not agree about the

dorsal tilt, the poor inter-rater agreement of the remaining 4 indications, high-

lights the subjective decision-making.

No conflicts of interest reported

120.