Tomography versus computed tomography for assessing step off in intraarticular distal radial fractures

Computed tomography scans have supplanted conventional tomography for many applications and often are considered the imaging study of choice for asses sing intraarticular distal radial fractures, Concern about cost containment in healthcare delivery prompts the question of whether the tno studies pro vide comparable information and at what cost. Common intraarticular distal radial fractures were created in 12 lightly embalmed cadaveric specimens. T he fractures were fixed with radiolucent Kirschner wires. Articular step of f was measured with a caliper. Plain radiographs, computed tomography scans , and trispiral tomograms were obtained of each specimen. Maximal step off was measured blindly by two musculoskeletal radiologists and four hand surg eons. The radiographic measurements were compared with the actual step off and expressed as a positive or negative deviation from the actual value. Th ere was no statistically significant difference between computed tomography scans and tomograms in predicting step off. In addition, the difference be tween actual and radiographic measurements was insignificant in tomogram re adings and different in one of the computed tomography measurements. In the authors' institution, a tomogram costs $200, and a computed tomography sca n costs $562. Trispiral tomography is more accurate and cost effective than computed tomography, and thus when available should be considered the imag ing modality of choice for assessing articular step off in distal radius fr actures.