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Jensen J, Graumann O, Gerke O, Torfing T, Precht H, Rasmussen BS, Tromborg HB. Accuracy of radiographic measurements of fracture-induced deformity in the distal radius. Acta Radiol Open 2023; 12:20584601231205986. [PMID: 37767057 PMCID: PMC10521277 DOI: 10.1177/20584601231205986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Background Management of the distal radius fracture (DRF) is to some extent based on radiographic characterization of fracture displacement. It remains unclear, however, if the measurements used to quantify displacement are accurate. Purpose To quantify accuracy of two radiographic measurements: dorsal/volar tilt and fracture compression, measured indirectly as ulnar variance (UV), using radiostereometric analyses (RSA) as reference standard. Material and Methods Twenty-one fresh frozen non-fractured human cadaveric forearms (right = 11, left = 10) were thawed and eligible for inclusion. The forearms were mounted on a custom made platform that allowed for controlled forearm rotation, and they underwent two rounds of imaging (both rounds consisted of RSA and radiographs). In round one, the non-fractured forearms were radiographed. In round two, artificial DRF´s with compression and dorsal angulation were created and imaging procedures repeated. Change in tilt and UV between the non-fractured and later fractured forearms was defined as fracture-induced deformity. Deformity was measured radiographically and additionally calculated using RSA. Bland Altman analyses were used to estimate agreement between radiographically measured, and RSA calculated, fracture-induced deformity. Results Our results indicated that radiographs underestimate the amount of fracture-induced deformity. Mean measured differences (bias) in dorsal tilt deformity between radiographs and RSA were -2.5° for both observers. The corresponding values for UV were -1.4 mm and -1.5 mm. Conclusion Quantifying fracture-induced deformity on radiographs underestimated the actual deformity when compared to RSA calculated deformity. These findings suggest that clinicians, at least in part, base fracture management and potentially corrective surgery on inaccurate measurements.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Torfing
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Helle Precht
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Radiology, Kolding, Lillebaelt Hospital, University Hospitals of Southern, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin S Rasmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence), University of Southern, Odense, Denmark
| | - Hans B Tromborg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
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Johnson NA, Dias R, Dias JJ. Ulnar variance in distal radial fractures: assessment and interpretation. J Hand Surg Eur Vol 2022; 47:597-604. [PMID: 35000492 DOI: 10.1177/17531934211070375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We explored patterns of shortening of the distal radius and investigated the effect of displacement on 'ulnar variance' in 250 patients with distal radial fractures. A small number of patients (5%) had a fracture that resulted in true shortening. Thirty-two per cent had fractures that appeared short, but lateral radiographs revealed that the articular surface was tilted, with either the anterior or dorsal rim of the articular surface being proximal to the distal ulna but the other rim was distal to it. We recommend initial assessment of variance on lateral radiographs. If the anterior and dorsal rims of the distal radial articular surface are proximal to the distal ulna, then true shortening is present and lengthening and stabilization, to hold the radius distracted, should be considered. If only one rim is proximal to the distal ulna, then correction of the tilt will lessen the apparent positive variance.Level of evidence: IV.
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Affiliation(s)
- Nick A Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.,Pulvertaft Hand Centre, Derby, UK
| | - Rachel Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.,Kings College London, London, UK
| | - Joseph J Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair. J Am Acad Orthop Surg 2021; 29:518-525. [PMID: 34078841 DOI: 10.5435/jaaos-d-20-00998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/25/2021] [Indexed: 02/01/2023] Open
Abstract
Triangular fibrocartilage complex (TFCC) tears, whether acute or chronic, can result in persistent ulnar-sided wrist pain. Although diagnosis and nonsurgical management of TFCC tears is well described, there remains ongoing discussion about the optimal surgical technique, specifically open or arthroscopic. This article reviews the most up-to-date literature regarding TFCC injury including demographics, risk factors for TFCC injury, classification of acute and chronic TFCC tears, history and physical examination, appropriate diagnostic imaging, surgical indications, pertinent surgical anatomy, open and arthroscopic TFCC repair, fixation biomechanics and techniques, postoperative rehabilitation, and clinical outcomes.
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Kang JW, Cha SM, Kim SG, Choi IC, Suh DH, Park JW. Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy. J Orthop Surg Res 2021; 16:110. [PMID: 33541409 PMCID: PMC7863478 DOI: 10.1186/s13018-021-02266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Parallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO. METHODS Between June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated. RESULTS The baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy. CONCLUSIONS The minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.
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Affiliation(s)
- Jong Woo Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-gyun Kim
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Dong Hun Suh
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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Suojärvi N, Lindfors N, Höglund T, Sippo R, Waris E. Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians' radiograph interpretation. J Hand Surg Eur Vol 2021; 46:176-183. [PMID: 33148107 DOI: 10.1177/1753193420968399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examined the reliability of a computer-aided cone-beam CT analysis of radiographic parameters of 50 normal distal radii and compared it with interobserver agreement of measurements made by three groups of physicians on two-dimensional plain radiographs. The intra-rater reliability of the computer-aided analysis was evaluated on 33 wrists imaged twice by cone-beam CT. The longitudinal axis, anterior tilt, radial inclination and ulnar variance were measured. The reliability of computer-aided analysis was excellent (intraclass correlation coefficient (ICC) 0.94-0.96) while the interobserver agreement of two-dimensional radiograph interpretation was good (ulnar variance, ICC 0.80-0.84) to poor (anterior tilt and radial inclination, ICC 0.20-0.42). We conclude that computer-aided cone-beam CT analysis was a reliable tool for radiographic parameter determination, whereas physicians demonstrated substantial variability especially in interpreting the angular parameters.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Nina Lindfors
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Robert Sippo
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Öztürk S, Kahraman F, Salim H, Acar B, Calguner E, Oğuz Yolcular B, Sindel T, Sindel M. Importance of measurement methods and demographic characteristics in evaluating ulnar variance: A retrospective comparative study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:62-66. [PMID: 33650514 DOI: 10.5152/j.aott.2021.20064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age). METHODS UV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18-79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods: the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group. RESULTS The mean UV of the right and left wrists was measured as 0.33 (range=-4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=-5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001). CONCLUSION The results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Serra Öztürk
- Department of Anatomy, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Fulya Kahraman
- Department of Radiology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Hande Salim
- Department of Anatomy, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Baver Acar
- Unıversıty of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Engin Calguner
- Department of Anatomy, University of Kyrenia, School of Medicine, Kyrenia, Cyprus
| | - Başak Oğuz Yolcular
- Department of Biostatistics and Medical Informatics, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Timur Sindel
- Department of Radiology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Muzaffer Sindel
- Department of Anatomy, Akdeniz University, School of Medicine, Antalya, Turkey
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Snaith B, Raine S, Fowler L, Osborne C, House S, Holmes R, Tattersall E, Pierce E, Dobson M, Harcus JW. Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections. HAND THERAPY 2020. [DOI: 10.1177/1758998320935920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% ( n = 40/238), and this improved to 47.8% ( n = 77/161) post-intervention, but declined to 32.8% ( n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort ( p < 0.001) and the late post-intervention group ( p = 0.002) but not in the examinations performed two weeks after staff education ( p = 0.239). Conclusion Assessment of image quality is critical for diagnosis and treatment monitoring. Yet poor compliance with standard anatomical principles was evident. A simple educational intervention resulted in a transient improvement in wrist positioning, but the impact was not sustained over time.
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Affiliation(s)
- Beverly Snaith
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Scott Raine
- North Lincolnshire and Goole NHS Trust, Scunthorpe, UK
| | | | | | - Sophie House
- The Rotherham NHS Foundation Trust, Moorgate Rd, Rotherham, UK
| | - Ryan Holmes
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Emma Tattersall
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
- Barnsley Hospitals NHS Foundation Trust, Barnsley, UK
| | - Emma Pierce
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
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Arik A, Tanrikulu S, Demiray T, Leblebicioglu G. Radial Reference Points for Measuring Palmar Tilt and Ulnar Variance on Lateral Wrist Radiographs. J Hand Surg Asian Pac Vol 2020; 25:95-103. [PMID: 32000593 DOI: 10.1142/s2424835520500137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Palmar tilt and ulnar variance are crucial parameters for evaluating the distal radius. Identifying suitable reference points for these parameters on lateral wrist radiographs remains challenging. The purpose of this study was to establish reference points for measuring palmar tilt and ulnar variance on lateral wrist radiographs and to evaluate the reliability of these two parameters using the newly defined reference points. Methods: The distal articular surfaces of 25 cadaver radii were marked at four different locations using thin wires. These bones were radiographed and constant landmarks were recorded. The reliability of the palmar tilt and ulnar variance measurements was assessed using the new reference points and two serial measurements recorded by three observers on 27 standardized lateral wrist radiographs. Results: The reference points for palmar tilt on lateral radiograph were the dorsal and volar end points of the subchondral line. The subchondral line was connected to two of five metaphyseal cortical lines. The reference point for lateral ulnar variance was easily defined on the midpoint of the proximal aspect of the subchondral line. The corresponding posteroanterior central reference point for ulnar variance was at the ulnar corner of the subchondral line. Inter- and intra-observer reliabilities were overall good for the palmar tilt measurements, and excellent for the ulnar variance measurements. Conclusions: Palmar tilt can be determined accurately with a good understanding of the radiographic landmarks on lateral radiographs, and by addressing the problems caused by ulnar inclination of the articular surface of the distal radius. Lateral wrist radiographs can provide a complete picture of the ulnar border of the radius for measuring ulnar variance.
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Affiliation(s)
- Atilla Arik
- Department of Orthopedics and Traumatology, Hand Surgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Seval Tanrikulu
- Department of Orthopedics and Traumatology, Hand Surgery, Koç University Faculty of Medicine, Istanbul, Turkey
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Farr S. Commentary on Trehan et al. Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients. J Hand Surg Eur Vol 2019; 44:587-588. [PMID: 31210601 DOI: 10.1177/1753193419828925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
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