Abstract
Category:
Lesser Toes; Trauma
Introduction/Purpose:
Because lateral toes are anatomically on the distal aspect of foot, they are more exposed to axial load (stubbed toe) and crushing injuries. In this context, correct obtainment of imaging exams is fundamental for proper diagnosis of MSI. In the X-ray room, however, due to overlapping of smaller fingers or because the patient`s pain, most common practice is to suppress the lateral view. The purpose of this study is to demonstrate the importance of toe radiographs in diagnosis of interphalangeal fractures and dislocations, emphasizing need for lateral view for diagnosis of these injuries.
Methods:
378 radiographs of 126 patients treated between Jan/2018 and Mar/2018 in an emergency care clinic of a Brazilian hospital were retrospectively evaluated for presence of fractures. Patients were selected from a search on medical records using ICD. After, the radiographs of the same patient were duplicated and divided in two groups: standard group (AP and Oblique) and complete profile group (standard views plus lateral view). They were examined by four independent examiners of different degrees of experience. Each examiner randomly evaluated the same patient twice (1 in each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two-proportion equality test was used to calculate statistical significance.
Results:
Mean age of patients was 37,2 years (4-85yr). 144 fractures were diagnosed in standard group (28,6%) and 266 fractures (52,8%) in complete profile group (p < 0,001). Individually evaluating each examiner, everyone had had an improvement in number of fracture diagnostics when compared the complete profile group with the other (p < 0,001). Kappa index was superior to 0,60 for all examiners in pattern group.
Conclusion:
Addition of true lateral view was able to improve the number of diagnosed fractures on patients with lesser toes trauma.