The impact of two-dimensional and three-dimensional computed tomography on the decision to operate in distal radius fractures: a multicenter survey-based study

OBJECTIVE: Imaging modalities play a critical role in determining surgical versus conservative management for distal radius fractures. This study aimed to evaluate the impact of two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) on the decision to operate in distal radius fractures and to compare their influence between AO Type B and Type C fractures. METHODS: This cross-sectional, survey-based study included 97 orthopedic and traumatology specialists. Twelve distal radius fracture cases classified according to the AO system (six Type B and six Type C) were selected. Participants were sequentially presented with plain radiographs, post-reduction radiographs in cast, 2D CT images, and 3D CT reconstructions for each case. After each imaging stage, participants were asked to indicate their decision to operate (surgical or conservative). Changes in the decision to operate were statistically analyzed. RESULTS: Among AO Type B fractures, the addition of CT imaging to plain and post-reduction radiographs did not significantly change the decision to operate in most cases (p > 0.05). In contrast, among AO Type C fractures, the addition of 2D CT imaging significantly changed the decision to operate in favor of surgical management (p < 0.05), whereas the subsequent addition of 3D CT did not produce a further significant change (p > 0.05). CONCLUSION: For AO Type B distal radius fractures, the addition of CT imaging to plain and post-reduction radiographs had limited impact on the decision to operate. In AO Type C fractures, 2D CT imaging significantly influenced the decision to operate, whereas the subsequent addition of 3D CT did not provide an additional impact on the decision to operate. LEVEL OF EVIDENCE III: Descriptive survey study.