Reliability of Routine Radiographs for Conservatively Treated Metacarpal Shaft and Neck Fractures

To investigate the reliability of orthopedic hand surgeons to evaluate radiographic healing in initial andfollow-up radiographs of the conservatively treated metacarpal shaft and neck fractures. The rationale for this studywas to reduce the rate of unnecessary, routine radiographs when treating metacarpal fractures. Forty sets of digital x-rays, twenty at the initial visit and twenty at the 4-week follow-up, were randomlyselected and reviewed. Three hand surgeons evaluated the x-rays for (1) fracture location, (2) radiograph timing,(3) healing status, (4) percentage healed, (5) angulation, and (6) confidence in healing status. Observers reviewedstudies in random order and evaluated the same set of radiographs one month after the initial review. Intra- andinterobserver agreements were analyzed using Fleiss’ kappa (κ) for all parameters and all possible observerpairings. Interobserver and intraobserver reliability was highest when evaluating fracture location and lowest whenassessing the percentage healed. The interobserver reliability was fair for radiograph timing and healing status andfair-to-moderate for angulation. The intraobserver reliability was moderate for radiograph timing and healing status andmoderate-to-substantial for angulation. Observers correctly differentiated initial vs. follow-up images 62% of the timeand reported to feel somewhat certain in their evaluation of healing status. When evaluating initial and 4-week follow-up radiographs, hand surgeons were somewhat confidentin their assessment of healing but had less than substantial intra- and interobserver reliability following radiographicevaluation. Due to their poor reproducibility, routine radiographs may be unnecessary when evaluating conservativelytreated metacarpal fractures. Further studies and guidelines that identify clear indications for the use of routine imagingin metacarpal fracture care are warranted.Level of evidence: II