{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:26:34Z","timestamp":1786112794027,"version":"build-2736575974"},"reference-count":18,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Distal ulnar fractures (DUFs) remain under-investigated, primarily due to limited statistical power resulting from the low incidence. The present classification systems are difficult to use and are not validated for new radiological methods such as cone beam computed tomography (CBCT). We aimed to analyze the reliability and reproducibility of the 2 classification systems, Arbeitsgemeinschaft f\u00fcr Osteosynthesefragen foundation\/Orthopaedic Trauma Association (AO\/OTA) and Biyani, for fractures of the distal ulnar head and neck using CBCT images.Methods:\u00a076 patients with DUF who underwent a CBCT scan during the years 2016\u20132022 were included retrospectively. The CBCT images were reviewed twice by 6 observers of different medical specialties and levels of experience. All fractures were classified according to AO\/OTA and Biyani. The reliability and reproducibility of each classification system were analyzed using kappa value analysis.Results:\u00a0The reliability was fair to moderate for AO\/OTA, Light\u2019s \u0138 0.41 (95% confidence interval [CI] 0.38\u20130.45) and moderate for Biyani, Light\u2019s \u0138 0.45 (CI 0.42\u20130.49), and the reproducibility was substantial for both AO\/OTA, mean \u0138 0.65 (CI 0.49\u20130.80), and Biyani, \u0138 0.69 (CI 0.60\u20130.79).Conclusion:\u00a0Both existing classification systems were perceived to be difficult to use and do not match existing fracture patterns. Using CBCT images, they both showed substantial reproducibility but not satisfactory reliability for clinical use.<\/jats:p>","DOI":"10.2340\/17453674.2026.46344","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T16:17:23Z","timestamp":1785946643000},"source":"Crossref","is-referenced-by-count":0,"title":["Reliability and reproducibility of classification of distal ulnar fractures using cone beam computed tomography (CBCT)"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6071-4481","authenticated-orcid":false,"given":"Linn\u00e9a","family":"Wret\u00f6","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2077-8445","authenticated-orcid":false,"given":"Lotta","family":"Fornander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"K\u00e4mmerling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Nyman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Moloney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"164932","doi-asserted-by":"crossref","unstructured":"Moloney M, Farnebo S, Adolfsson L. Incidence of distal ulna fractures in a Swedish county: 74\/100,000 person-years, most of them treated non-operatively. Acta Orthop 2020; 91(1): 104-8. doi: 10.1080\/17453674.2019.1686570.","DOI":"10.1080\/17453674.2019.1686570"},{"key":"164933","doi-asserted-by":"crossref","unstructured":"Cha S M, Shin H D, Kim K C, Park E. Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older. J Hand Surg Am 2012; 37: 2481-7. doi: 10.1016\/j.jhsa.2012.07.031.","DOI":"10.1016\/j.jhsa.2012.07.031"},{"key":"164934","doi-asserted-by":"crossref","unstructured":"Sato K, Murakami K, Mimata Y, Numata N, Shiraishi H, Doita M. Conservative treatment of distal ulna metaphyseal fractures associated with distal radius fractures in elderly people. 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Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures. Acta Orthop 2022; 93: 438-43. doi: 10.2340\/17453674.2022.2509.","DOI":"10.2340\/17453674.2022.2509"},{"key":"164938","doi-asserted-by":"crossref","unstructured":"Fitzpatrick E, Sharma V, Rojoa D, Raheman F, Singh H. The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis. Skeletal Radiol 2022; 51(5): 923-34. doi: 10.1007\/s00256-021-03883-9.","DOI":"10.1007\/s00256-021-03883-9"},{"key":"164939","doi-asserted-by":"crossref","unstructured":"Jacques T, Morel V, Dartus J, Badr S, Demondion X, Cotten A. Impact of introducing extremity cone-beam CT in an emergency radiology department: a population-based study. Orthop Traumatol Surg Res 2021; 107(2): 102834. doi: 10.1016\/j.otsr.2021.102834.","DOI":"10.1016\/j.otsr.2021.102834"},{"key":"164940","doi-asserted-by":"crossref","unstructured":"Koivisto J, van Eijnatten M, Kiljunen T, Shi X Q, Wolff J. Effective radiation dose in the wrist resulting from a radiographic device, two CBCT devices and one MSCT device: a comparative study. Radiat Prot Dosimetry 2018; 179(1): 58-68. doi: 10.1093\/rpd\/ncx210.","DOI":"10.1093\/rpd\/ncx210"},{"key":"164941","doi-asserted-by":"crossref","unstructured":"Harness N G, Ring D, Zurakowski D, Harris G J, Jupiter J B. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am 2006; 88(6): 1315-23. doi: 10.2106\/JBJS.E.00686.","DOI":"10.2106\/JBJS.E.00686"},{"key":"164942","doi-asserted-by":"crossref","unstructured":"Eriksson S, Rasool F, D\u00e5nmark I, Weber Lensing C, Werner J, Fornander L. Cone-beam computed tomography influences the classification and choice of treatment for distal radius fractures. J Wrist Surg 2024; 14(4): 333-341. doi: 10.1055\/s-0044-1782236.","DOI":"10.1055\/s-0044-1782236"},{"key":"164943","doi-asserted-by":"crossref","unstructured":"Meinberg E G, Agel J, Roberts C S, Karam M D, Kellam J F. Fracture and dislocation classification compendium\u20142018. J Orthop Trauma 2018; 32(Suppl 1): S1-s170.","DOI":"10.1097\/BOT.0000000000001063"},{"key":"164944","doi-asserted-by":"crossref","unstructured":"Biyani A, Simison A J, Klenerman L. Fractures of the distal radius and ulna. J Hand Surg Br 1995; 20(3): 357-64. doi: 10.1016\/s0266-7681(05)80094-4.","DOI":"10.1016\/S0266-7681(05)80094-4"},{"key":"164945","doi-asserted-by":"crossref","unstructured":"Schneider C A, Rasband WS, Eliceiri K W. NIH Image to ImageJ: 25 years of image analysis. 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