Fractures of the Clavicle: Which X-Ray Projection Provides the Greatest Accuracy in Determining Displacement of the Fragments?

Recent studies favor surgical management of displaced clav-icle fractures. Displacement is measured using anterior-posterior (AP) X-rays. Since displacement can occur in all three dimensions, however, standard methods of evaluation can be difficult and inaccurate. This study was conducted to determine the X-ray angle that provides the most accurate assessment. Nine CT scans of acute displaced clavicle fractures were analyzed with AmiraDev imaging software. 3D measurements for degrees of shortening and fracture displacement of the fracture clavicle were taken. Using a segmentation and manipulation module, five digitally reconstructed radiographs (DRRs) mimicking AP X-rays were created for every CT, with each DDR differing slightly by projection angle. After comparison to the original CTs, all samples using an AP view with a 20° downward tilt yielded displacements closest to the 3D " gold standard " or true measurements. Therefore, it is suggested that using this projection would provide the most accurate indication of fracture displacement.