• Stephan Metz, Volker Kuhn, Mark Kettler, Martin Hudelmaier, Harald M Bonel, Simone Waldt, Regina Hollweck, Bernhard Renger, Ernst J Rummeny, and Thomas M Link.
• Department of Diagnostic Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany. smetz@roe.med.tu-muenchen.de
• Invest Radiol. 2006 Sep 1;41(9):681-90.

ObjectivesWe sought to compare the diagnostic performance of screen-film radiography, storage-phosphor radiography, and a flat-panel detector system in detecting forearm fractures and to classify distal radius fractures according to the Müller-AO and Frykman classifications compared with the true extent, depicted by anatomic preparation.Materials And MethodsA total of 71 cadaver arms were fractured in a material testing machine creating different fractures of the radius and ulna as well as of the carpal bones. Radiographs of the complete forearm were evaluated by 3 radiologists, and anatomic preparation was used as standard of reference in a receiver operating curve analysis.ResultsThe highest diagnostic performance was obtained for the detection of distal radius fractures with area under the receiver operating curve (AUC) values of 0.959 for screen-film radiography, 0.966 for storage-phosphor radiography, and 0.971 for the flat-panel detector system (P > 0.05). Exact classification was slightly better for the Frykman (kappa values of 0.457-0.478) compared with the Müller-AO classification (kappa values of 0.404-0.447), but agreement can be considered as moderate for both classifications.ConclusionsThe 3 imaging systems showed a comparable diagnostic performance in detecting forearm fractures. A high diagnostic performance was demonstrated for distal radius fractures and conventional radiography can be routinely performed for fracture detection. However, compared with anatomic preparation, depiction of the true extent of distal radius fractures was limited and the severity of distal radius fractures tends to be underestimated.

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