Intraobserver and interobserver variability of Gilula’s lines in the diagnosis of carpal dislocations
DOI:
https://doi.org/10.1016/j.rccot.2022.04.011Keywords:
Carpal joints, Joint dislocations, Observer variation, Carpal bonesAbstract
Objective: Alteration of Gilula’s lines in the posteroanterior (PA) radiology of the wrist is a sign of perilunate dislocation. Our objective is to evaluate the intraobserver and interobserver variability of the Gilula lines in perilunate dislocations and the agreement between general orthopaedic surgeons, hand surgeons and residents of orthopaedic surgery, who participated in the study.
Materials and methods: Six observers evaluated 30 PA carpal X-rays, including 15 with a diagnosis of perilunate dislocation and 15 without carpal lesions. These observers were the residents of orthopaedic surgery; orthopaedic surgeons not specialised in hand pathology and hand surgeons. All had to classify the X-rays as normal or pathological attending only to Gilula’s lines. We calculated the intraobserver and interobserver variability using the Kappa coefficient. In this study, we have discussed indistinctively of concordance, agreement and variability as synonyms.
Results: Intraobserver concordance was very good (0.867-1.000) in residents and in hand surgeons, and moderate or good (0.553-0.795) in general orthopaedic surgeons. Interobserver concordance was very good (0.875) among hand surgeons, while it was good among general orthopaedic surgeons (0.679) and residents (0.751). Interobserver concordance was greater among residents and hand surgeons (Kappa 0.875, very good agreement) than among residents and general orthopaedic surgeons (Kappa 0.702, good agreement).
Conclusion: The observation of Gilula lines is a good diagnostic method in case of suspicion of perilunate dislocation, with good intraobserver and interobserver agreement both in traumatologists in training and those who are already trained, whether or not they are specialists in hand surgery.
Downloads
References
Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: Pathomecanics and progressive perilunar instability. J Hand Surg Am. 1980;5:226-41.
Bhatia DN. Arthroscopic reduction and stabilization of chronic perilunate wrist dislocations. Arthrosc Tech. 2016;5:281-90.
Gilula LA. Carpal injuries: Analytic approach and case exercises. AJR Am J Roentgenol. 1979;133:503-17.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159-74.
Siegert JJ, Frassica FJ, Amadio PC. Treatment of chronic perilunate dislocations. J Hand Surg Am. 1988;13:206-12.
Inoue G, Shionoya K. Late treatment of unreduced perilunate dislocations. J Hand Surg Br. 1999;24:221-5.
Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic pitfalls in the ED: Lunate and perilunate injuries. Am J Emerg Med. 2001;19:157-62.
Kailu L, Zhou X, Fuguo H. Chronic perilunate dislocations treated with open reduction and internal fixation: results of medium-term follow-up. Int Orthop. 2010;34:1315-20.
Ramamoorthy EN. Red flag symptoms and signs for diagnosing perilunate dislocations. Surgeon. 2011;9:356-7.
Muppavarapu RC, Capo JT. Perilunate dislocations and fracture dislocations. Hand Clin. 2015;31:399-408.
Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: a multicenter studr. J Hand Surg Am. 1993;18:768-79.
Rettig ME, Raskin KB. Long term assessment of proximal row carpectomy for chronic perilunate dislocations. J Hand Surg Am. 1999;24:1231-6.
Kumar S, Ayachit A, Varman M, Maddukuri SB. Imaging a neglected transradial, trans-scaphoid volar perilunate fracture dislocation in a skeletally mature adult: a novel constellation. BMJ Case Rep. 2015:2015.
Komurku M, Kürklü M, Ozturan KE, Mahirogullari M, Basbozkurt M. Early and delayed treatmentof dorsal transscaphoid perilunate fracture-dislocations. J Orthop Trauma. 2008;22:535-40.
Gellman H, Schwartz SD, Botte MJ, Feiwell L. Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate. Clin Orthop Relat Res. 1988;237:196-203.
Sochart DH, Birdsall PD, Paul AS. Perilunate fracturedislocation: a continually missed injury. J Accid Emerg Med. 1996;13:213-6.
Garg B, Goyal T, Kotwal PP. Staged reduction of neglected transscaphoid perilunate fracture dislocation: a report of 16 cases. J Orthop Surg Res. 2012;7:19.
Newberry JA, Garmel GM. Image diagnosis: perilunate and lunate dislocations. Perm J. 2012;16:70-1.
Scalcione LR, Gimber LH, HO AH, Johnston SS, Sheppard JE, Taljanovic MS. Spectrum of carpal dislocations and fracturedislocations: imaging and management. AJR Am J Roentgenol. 2014;203:541-50.
Kardashian G, Christoforou DC, Lee SK. Perilunate dislocations. Bull NYU Hosp Jt Dis. 2011;69:87-96.
