Visual Estimation of Length by Orthopaedic Surgeons: How Accurate Are Lengths Estimated in Digital Images Compared to In-Person Estimations?

Orthopaedic surgeons are frequently required to make estimations, often without the use of measuring tools, including the lengths of wounds, incisions, bone fragments, and soft tissue defects. To evaluate the accuracy of these estimations, simulated wounds of randomized lengths were drawn on a healthy volunteer. Resident and attending physicians estimated the length of each wound via digital photograph and subsequently in person. Comparison of digital photograph versus in-person estimation was completed with paired t-test. The accuracy of estimation by experience level was assessed using Spearman rank. Accuracy was higher with in-person measurement compared with digital photographs, but overall low in both settings. There was no correlation between better accuracy and more experience in either setting. In order to properly guide treatment decisions and document physical exam findings, a ruler should be used rather than visual estimation alone. Likewise, clinical photographs used for patient care should always include a ruler. (Journal of Surgical Orthopaedic Advances 30(2):108–111, 2021)

Key words: visual estimations, digital images, estimation, wound length, open fracture

S. Craig Morris, MD; Joshua N. Speirs, MD; Christopher K. Heinrich, BS; and M. Daniel Wongworawat, MD