Radiography and computed tomography for the diagnosis of distal limb fractures in equines: a
comparative study.
Casper P. Crijns, Ingrid M.V.L. Gielen, Hendrik-Jan Bergman, Ann Martens, Henk van der Veen,
Luc Duchateau, Henri J.J. van Bree.
Take Home Message
Computed tomography offers added value in diagnosing distal limb
fractures in horses. Relative to radiography, the detection of a fracture, defining the fracture
orientation and the other fracture characteristics can more appropriately be determined using
computed tomography.
1. Introduction Distal limb fractures constitute a relatively common problem in equines.
Radiography is a first-line investigation; several projections are needed, and superimposition is a
problem. Computed tomography (CT) is a cross-sectional modality, with a higher contrast
resolution and no superimposition.
2. Materials & Methods
A retrospective study of 27 horses with suspected distal limb
fracture and 3 negative controls that underwent radiographic and CT evaluation was conducted.
The level of agreement between four observers for a predefined set of radiological
characteristics, for radiography and CT separately, and between the two imaging modalities was
documented, using Cohen kappa.
3. Results
The detection of a fracture and the anatomic localization showed very good
intermodality (IM) and interobserver (IO) agreement levels (0.8 <  < 1). Fracture displacement
showed good IM and IO agreement levels (0.6 <  < 0.8). For visualization of articular
involvement, fracture comminution, and the number of fracture fragments, all agreement levels
bordered on the lower limit of good agreement. Documentation of fracture orientation, fracture
width, and coalescing cracks showed poor (0 <  < 0.2) to fair (0.2 <  < 0.4) IM agreement
levels; for each of these three parameters, IO agreement levels were higher for CT than for
radiography.
4. Discussion
Being able to visualize a presumed fracture or fissure is important, and
accurately describing the fracture characteristics is necessary for a proper diagnosis and
treatment.