Clinicians' recognition of 10 different types of distal radial fractures

This study concerned baseline performance in recognition of 10 different ty pes of distal radial fractures. Verbal tasks of admitting knowing about fra ctures and Visual tasks were designed for each fracture type. The Verbal ta sk of admitting knowing consisted of a description with the relevant distin ctive features of the fracture. The surgical resident was asked whether he admitted knowing the particular fracture described. The Visual task consist ed of X-rays for which the subject had to label the fracture or identify it s distinctive features. The test was presented to 30 surgical trainees work ing in five teaching hospitals. On the Verbal task of admitting knowing, sc ores were statistically significantly higher (68% "yes") than on the Visual task (33% correct). Responses met our criterion of 80% correct for the fol lowing fracture types: Colles's, distal forearm, and Smith's fracture. For seven other fracture types (combination radius and scaphoid, radial styloid process, dorsal Barton's, volar Barton's, pilon, chauffeur's, and lunate l oad fracture), the 80% criterion was not met. Analysis of the incorrect ans wers on the Visual task indicated that the surgical residents tended to lab el unknown fracture types as Colles's or Smith's fractures. Furthermore, th e residents tended to overestimate their own diagnostic competence (overcon fidence bias) for several fracture types. It was concluded that to improve diagnosis, the relevant distinctive features of distal radial fractures sho uld be taught.