Reliability of using radius union scoring system among general practitioners, orthopedic residents and orthopedic surgeons for distal end radius fracture healing evaluation

Abstract

Background: Fractures of distal end of radius are common fractures in adults. They were commonly treated by general practitioners (GPs) in rural Thailand. Inadequate time for immobilization and casting may reach more complications such as failure to maintain reduction or stiffness. There has been no publication of objective tools for diagnosing of fracture union to date. Radius union scoring system (RUSS) may be a good diagnostic tool and easy to use. However, there is no study about the reliability between GPs and orthopedic surgeons. Objective: To study the reliability of using RUSS score between different evaluators-GPs and orthopedic surgeons. Material and Method: Anteroposterior and lateral view of plain wrist radiographs from 20 distal end radius fractured patients were used for reviewing. RUSS was used for rating of radiographs by 6 GPs, 6 orthopedic residents and 3 orthopedic surgeons. Interobserver reliability was determined and calculated. Results: This study found low level of interobserver between GPs and orthopedic surgeons (ICC = 0.39, 95% CI) and low level of interobserver reliability in inexperienced groups of physicians in this study (ICC = 0.37 and 0.48 in GPs and junior residents’ group). Level of interobserver reliability has been associated with rater’s experience. Conclusion: Level of interobserver reliability between general practitioners and orthopedic surgeons was low due to experiences of the raters. RUSS may not be a proper tool for inexperienced physicians. © 2017 Medical Association of Thailand. All rights reserved.