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Suojärvi N, Waris E. Radiographic measurements in distal radius fracture evaluation: a review of current techniques and a recommendation for standardization. Acta Radiol 2024:2841851241266369. [PMID: 39043232 DOI: 10.1177/02841851241266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Radiographic measurements play a crucial role in evaluating the alignment of distal radius fractures (DRFs). Various manual methods have been used to perform the measurements, but they are susceptible to inaccuracies. Recently, computer-aided methods have become available. This review explores the methods commonly used to assess DRFs. The review introduces the different measurement techniques, discusses the sources of measurement errors and measurement reliability, and provides a recommendation for their use. Radiographic measurements used in the evaluation of DRFs are not reliable. Standardizing the measurement techniques is crucial to address this and automated image analysis could help improve accuracy and reliability.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Geeta Anasuya D, Kumar A, Arasu S, Shanmugam J, Vijaianand M, Praveen D. Radiographic Morphometric Analysis of the Distal Radius in the Tamil Nadu Population: A Retrospective Study. Cureus 2024; 16:e62226. [PMID: 39006631 PMCID: PMC11244725 DOI: 10.7759/cureus.62226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Background and objectives Morphometric parameters such as radial inclination, palmar tilt, radial height, and ulnar variance exhibit considerable variations influenced by geographical, ethnic, racial, and individual factors. These parameters are pivotal in the context of distal radius fractures, distal radius plate design, and kinesiology. Understanding these variations is crucial for surgical precision and predicting complications. Methods This observational, retrospective study, conducted in a single hospital, aimed to determine the morphometric values of the distal end radius, specifically in the South Indian population. We analyzed 300 plain radiographs, encompassing 53.7% males and 46.3% females, with ages ranging from 17 to 89 years (mean age: 41.05 ± 15.8). Radial inclination, radial height, palmar tilt, and ulnar variance were measured on posteroanterior views, while palmar tilt was assessed on lateral wrist X-rays. Results In our study, significant gender-based and side-specific differences were observed. The mean length of the styloid process, palmar tilt, ulnar variance, anteroposterior diameter of the radius, transverse diameter of the radius, oblique width of the radius, and carpal height of the radius exhibited notable variations between males and females. Similarly, significant differences were noted between the right and left sides concerning ulnar variance and teardrop angle. Among males, a significant difference was observed only in the teardrop angle between the right and left sides (59.11 ± 7.25 vs. 62.01 ± 7.97). Conclusion The findings underscore the importance of recognizing local morphometric variations in the South Indian population. This knowledge not only enhances the ability to restore normal alignment post-distal radius fractures but also provides fundamental values for future research endeavors within the local demographic. The study acts as a foundational resource for advancing our understanding of the normal anatomy and variations in the distal radius, facilitating improved clinical outcomes and tailored surgical interventions.
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Affiliation(s)
- Daliparthi Geeta Anasuya
- Department of Anatomy, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Arun Kumar
- Department of Radiology, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Sabari Arasu
- Department of Radiology, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Jeevithan Shanmugam
- Department of Community Medicine, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - M Vijaianand
- Department of Anatomy, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Duraisamy Praveen
- Department of Orthopedics, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
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Kitidumrongsook P, Luangjarmekorn P, Kuptniratsaikul V, Teeragananan T, Chaitantipongse S. Measurement of Radiological Parameters of Distal Radius Fracture Using the Ulnar Axis Compared with the Radial Axis. J Hand Surg Asian Pac Vol 2024; 29:140-147. [PMID: 38494166 DOI: 10.1142/s2424835524500164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background: The long axis of the radius is a standard reference for measuring radiological parameters in distal radius fractures. However, in patients with severe comminution and anatomical variation with distal radius bowing, it is challenging to assess using the long axis of the radius. The long axis of the ulna can be used as an alternative reference. The aim of this study is to assess the reliability and level of agreement using the long axis of the ulna as an alternative reference in comparison to the long axis of the radius. Methods: Posteroanterior (PA) radiography of the wrist in patients with acute distal radius fractures was evaluated in two rounds by four observers. Radial height, radial inclination and ulnar variance were measured using radial and ulnar long axis as references. The intraobserver and interobserver reliability of the measurements with two reference axes was assessed using intraclass correlation coefficient (ICC). The level of agreement was determined using the Bland-Altman plot. Results: In total, 59 patients who underwent PA radiography of the wrist were included in this study. All parameters exhibited good agreement between the two methods, with a mean difference of nearly zero (radial height = -0.03 mm, radial inclination = -0.14° and ulnar variance = 0.03 mm). The limits of agreement in radial height (-2.87, 2.82 mm) and ulnar variance (-0.81, 0.87 mm) were narrow. However, for the radial inclination, it was wider (-6.21, 5.94°). Intraobserver reliability between the long axis of radius and ulna (ICC = 0.85-0.99 and 0.84-0.98, respectively) was good to excellent. The interobserver reliability of each parameter was excellent (ICC = 0.94-0.97). Conclusions: The ulnar long axis can be used as an alternative reference for measuring radial height, radial inclination and ulnar variance in PA radiography of the wrist in acute distal radius fracture, particularly if the radial long axis is distorted. Level of Evidence: Level III (Diagnostic).
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Affiliation(s)
- Pravit Kitidumrongsook
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Pobe Luangjarmekorn
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Vanasiri Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Theephop Teeragananan
- Department of Orthopaedics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sirisak Chaitantipongse
- Department of Orthopaedics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Tan C, Wang Z, Li L. Association between imaging parameter changes and triangular fibrocartilage complex injury after distal radius fractures. J Orthop Surg Res 2023; 18:946. [PMID: 38071283 PMCID: PMC10709925 DOI: 10.1186/s13018-023-04438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) injury is a frequent soft tissue injury that has been observed to accompany distal radius fractures (DRFs) with concomitant changes in radiologic parameters. The aim of this study was to investigate the relevance of distal radial radiologic parameters associated with DRF and traumatic TFCC injury. METHODS A total of 172 patients with distal radius fractures who underwent X-ray, CT, and MRI before undergoing volar locking plate or external splint fixation between October 2021 and December 2022 were included in this study. An analysis of various radiologic parameters and the classification of fracture type and TFCC injuries by CT and MRI was performed. All patients were divided into the TFCC uninjured group and the injured group. The incidence and relevant radiologic parameters were compared. RESULTS This study included 76 males and 96 females with a mean age of 56.1 years. Among all patients, 33 (19.2%), 40 (23.2%), and 99 (57.6%) had DRF with A, B, and C fractures, respectively, according to the AO/OTA classification. In patients with fractures, the TFCC was found to be injured in 54.1% (93/172) of patients (type 1A in 21, 1B in 46, 1C in 39, and 1D in 35) but uninjured in 45.9% (79/172). There were significant differences between the TFCC injured and uninjured groups regarding the radius length (p = 0.044) and DRUJ distance (p = 0.040) of radiologic parameters that changed with DRF, although there were no differences between the two groups regarding gender, age, injured side, intra- and extra-articular, radius inclination and palmer tilt angle, or sagittal translation. Within the TFCC injured group, the radius length and DRUJ distance were 4.83 mm and 2.95 mm less or wider than 7.19 mm and 1.83 mm of the uninjured group. Moreover, shorter radius length was related to type lB TFCC injury (p = 0.041). Both radius length (AUC = 0.658) and DRUJ distance (AUC = 0.582) had no convincing predictive value for TFCC injury in DRF. CONCLUSION 1B TFCC injury is most common in patients with DRF and concomitant TFCC injury. Both radius length and DRUJ distance have a significant statistical correlation with TFCC injury, and patients with TFCC injury tend to have a shortened radius and wider DRUJ distance, although they have no predictive value for TFCC injury in DRF. In addition, a shorter radius length was related to type lB TFCC injury.
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Affiliation(s)
- Chunye Tan
- First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Zeyu Wang
- First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Linwei Li
- First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, Jiangsu, People's Republic of China.
- Department of Trauma Center and Orthopedic Surgery, The First People's Hospital of Changzhou Affiliated to Soochow University, Juqian Road 185, Changzhou, 213000, Jiangsu, People's Republic of China.
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Esworthy G, Johnson N, Group DRM, Dias J. Reliability and reproducibility of methods for measurement of distal radius fracture intra-articular displacement. J Hand Surg Eur Vol 2023; 48:1087-1089. [PMID: 37211795 DOI: 10.1177/17531934231173248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
| | - Nick Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
- Pulvertaft Hand Centre, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | | | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Rambau GM, Sgromolo N, Rhee PC. Radiographic Outcomes for Comminuted, Intra-articular Distal Radius Fractures Treated with Primary Distraction Bridge Plate Fixation. Indian J Orthop 2023; 57:543-551. [PMID: 37006735 PMCID: PMC10050499 DOI: 10.1007/s43465-022-00812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/22/2022] [Indexed: 01/08/2023]
Abstract
Purpose To determine if distraction bridge plate (DBP) fixation as the primary method of stabilization can effectively correct and maintain acceptable radiographic parameters in the treatment of comminuted, intra-articular distal radius fractures while allowing early load-bearing. Methods A retrospective review was performed of all consecutive intra-articular distal radius fractures that underwent DBP fixation with or without supplemental fixation methods (fragment-specific implants or K-wires). Patients treated with a volar locked plate in addition to DBP were excluded. Radiographic outcomes measures included volar tilt (°), radial height (mm), radial inclination (°), articular step-off (mm), lunate-lunate facet ratio (LLFR), and teardrop angle (°) measured on post-reduction, immediately post-operative, prior to and after DBP removal. Results Twenty-three comminuted, intra-articular distal radius fractures were treated with primary DBP fixation. Supplemental fixation was utilized in 10 fractures and included fragment-specific implants (n = 6) and/or K-wires (n = 5). Distraction bridge plates were removed after a mean of 13.6 weeks. At a mean radiographic follow-up of 11.4 weeks (range: 2-45 weeks) following DBP removal, all fractures had united with a mean volar tilt of 6.3° ± 5.8°, radial height of 11.3 ± 2.3 mm, radial inclination of 20.2° ± 4.5°, articular step-off of 0.6 mm ± 0.8, and LLFR of 1.05 ± 0.06. However, the teardrop angle could not be restored to a normal value with DBP fixation. Complications included 1 plate breakage and 1 peri-hardware radial shaft fracture. Conclusion Distraction bridge plate fixation is a reliable method to stabilize highly comminuted, intra-articular distal radius fractures in patients with a well-aligned volar rim fragment of the lunate facet. Graphical Abstract
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Affiliation(s)
- Genevieve M. Rambau
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78261 USA
| | - Nicole Sgromolo
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78261 USA
| | - Peter C. Rhee
- Department of Orthopaedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
- Department of Orthopedic Surgery, Clinical Investigation Facility, 101 Bodin Circle, Travis Air Force Base, CA USA
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Schmidt V, Mellstrand-Navarro C, Mukka S, Wadsten M. Marginal secondary displacement in fractures of the distal radius at follow-up - an important predictor for late displacement and malunion. J Hand Surg Eur Vol 2023; 48:524-531. [PMID: 36624929 PMCID: PMC10363931 DOI: 10.1177/17531934221146063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Treatment recommendations in fractures of the distal radius are often based on the degree of displacement and functional demands. The fracture may be within an acceptable radiological range, but a marginal deterioration in alignment then occurs between the initial visit and follow-up. This may pose a risk for late displacement that may require further treatment. We secondarily analysed prospectively collected data and included 165 patients. We found that marginal secondary displacement (odds ratio (OR) 9.7), anterior comminution (OR 8.8), loss of anterior apposition (OR 6.8) and dorsal comminution (OR 2.6) were predictors of late displacement. Marginal secondary displacement is an important predictor of late displacement and malunion in fractures of the distal radius. Clinicians should not unequivocally accept general guidelines on alignment but also assess a deterioration in fracture alignment on radiographic follow-up and be aware of the potential need for surgery to avoid malunion in cases that show early secondary displacement, even when radiographic measures are within acceptable limits.Level of evidence: III.
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Affiliation(s)
- Viktor Schmidt
- Department of Surgical and Perioperative Sciences at Umeå University, Sweden
| | - Cecilia Mellstrand-Navarro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences at Umeå University, Sweden
| | - Mats Wadsten
- Department of Surgical and Perioperative Sciences at Umeå University, Sweden
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Roelofs LJM, Meesters AML, Assink N, Kraeima J, Van der Meulen TD, Doornberg JN, De Vries JPPM, Hoekstra J, ten Duis K, IJpma FFA. A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability. PLoS One 2022; 17:e0275206. [PMID: 36166437 PMCID: PMC9514643 DOI: 10.1371/journal.pone.0275206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Gap and step-off measurements are generally used in the surgical decision-making process of distal radius fractures. Unfortunately, there is no consensus on treatment choice as these measurements are prone to inter- and intraobserver variability. In this study, we aim to introduce a new 3D fracture quantification method and compare it to conventional fracture analysis. Methods Forty patients with a minimally displaced intra-articular distal radius fracture that was treated nonoperatively between 2008–2015 were included. 2D-CT images were reassessed by three orthopedic trauma surgeons who performed gap and step-off measurements. Subsequently, 3D models were created and a 3D measurement method for fracture displacement was developed. For each fracture, the ‘3D gap area’ (3D surface between all fracture fragments) was determined by three observers. Interobserver agreements were calculated for all measurements, and the intraobserver agreement was calculated for the new 3D measurement. All patients completed two questionnaires in order to link our measurements to functional outcome. Results The interobserver agreement of the 2D measurements was fair (ICC = 0.54) for the gap and poor (ICC = 0.21) for the step-off. The median gap was 2.8 (IQR: 1.9–3.5) mm and step-off was 0.9 (IQR: 0.0–1.6) mm. Interobserver agreement on 3D gap area measurements was excellent (ICC = 0.81), with a median difference between measurements of 6.0 (IQR: 2.0–19.0) mm2, which indicates reliable assessment of 3D fracture displacement. Intraobserver agreement was also excellent (ICC = 0.98), with a median difference of 4.0 (IQR: 1.5–5.5) mm2. No significant differences in clinical outcome were found between the above and below 2mm displacement groups. The score of the DASH was 3.4 (IQR: 0.4–8.8) versus 4.2 (IQR: 0.0–11.6) respectively. Results from the PRWE questionnaire shows a similar result of 3.5 (IQR: 0.0–12.6) versus 5.0 (IQR: 0.0–25.5). Conclusion 3D gap area is a more objective measurement method compared to the conventional gap and step-off measurements to quantify the level of fracture displacement of distal radius fractures. 3D fracture assessment can be used in addition to the currently used classification systems of distal radius fractures.
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Affiliation(s)
- Lisanne J. M. Roelofs
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M. L. Meesters
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim D. Van der Meulen
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job N. Doornberg
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Subdivision of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P. M. De Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost Hoekstra
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaj ten Duis
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank F. A. IJpma
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
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Cross GW, Saini RS, Monem M, Sofat R. Analysis of Our Open Reduction and Internal Fixation of Distal Radius Fractures in Adults: Are We Over Operating? J Wrist Surg 2022; 11:48-53. [PMID: 35127264 PMCID: PMC8807089 DOI: 10.1055/s-0041-1731384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
Background Fractures of the distal radius are a common injury. The British Orthopaedic Association (BOA) and The British Society for Surgery of the Hand (BSSH) have released new guidelines outlining the management of these fractures, specifically identifying "thresholds for intervention," based on radiological parameters for management with open reduction and internal fixation (ORIF). Questions/Purposes Have our distal radius fractures (DRFs), previously managed with ORIF, met the new guidelines' thresholds for intervention, based on radiological parameters? Patients and Methods A retrospective assessment of DRFs treated with ORIF was performed between January 2017 and August 2018. Patients were categorized into three cohorts based on their age. The five radiological parameters of ulnar variance, dorsal tilt, radial inclination, radial height, and intra-articular step were measured on the initial plain radiograph, "pre-manipulation film," postplaster application radiograph, and "post-manipulation film." These were compared with the "thresholds for intervention" outlined in the BOA/BSSH guidelines. Results A total of 94 patients underwent an ORIF with a mean age of 56 years (range 17-86 years). As many as 75.74% of patients on the "pre-manipulation film" met the "threshold for intervention" on at least one radiological parameter, while 53.57% of patients on the "post-manipulation" met at least one "threshold for intervention." Dorsal tilt was the parameter that most often met the threshold in both films at 53.37% and 40.11%, respectively. Conclusion Within our trust, there is a tendency to over manage the distal radius fracture with ORIF, potentially resulting in unnecessary operations. Education surrounding the new guidelines will better serve our decision-making. Level of Evidence This is a level III study.
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Affiliation(s)
- George W.V. Cross
- Department of Trauma & Orthopaedic Surgery, East and North Hertfordshire NHS Trust, England, United Kingdom
| | - Ramandeep S. Saini
- Department of Trauma & Orthopaedic Surgery, East and North Hertfordshire NHS Trust, England, United Kingdom
| | - Mohammed Monem
- Department of Trauma & Orthopaedic Surgery, East and North Hertfordshire NHS Trust, England, United Kingdom
| | - Rajesh Sofat
- Department of Trauma & Orthopaedic Surgery, East and North Hertfordshire NHS Trust, England, United Kingdom
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10
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Berger AC, Barvelink B, Reijman M, Gosens T, Kraan GA, De Vries MR, Verhofstad MHJ, Lansink KWW, Hannemann PFW, Colaris JW. Does circumferential casting prevent fracture redisplacement in reduced distal radius fractures? A retrospective multicentre study. J Orthop Surg Res 2021; 16:722. [PMID: 34930350 PMCID: PMC8686220 DOI: 10.1186/s13018-021-02866-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study evaluates whether a circumferential cast compared to a plaster splint leads to less fracture redisplacement in reduced extra-articular distal radius fractures (DRFs). Methods This retrospective multicentre study was performed in four hospitals (two teaching hospitals and two academic hospitals). Adult patients with a displaced extra-articular DRF, treated with closed reduction, were included. Patients were included from a 5-year period (January 2012–January 2017). According to the hospital protocol, fractures were immobilized with a below elbow circumferential cast (CC) or a plaster splint (PS). The primary outcome concerned the difference in the occurrence of fracture redisplacement at one-week follow-up. Results A total of 500 patients were included in this study (PS n = 184, CC n = 316). At one-week follow-up, fracture redisplacement occurred in 52 patients (17%) treated with a CC compared to 53 patients (29%) treated with a PS. This difference was statistically significant (p = 0.001). Conclusion This study suggests that treatment of reduced DRFs with a circumferential cast might cause less fracture redisplacement at 1-week follow-up compared to treatment with a plaster splint. Level of Evidence Level III, Retrospective study.
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Affiliation(s)
- A C Berger
- Department of Orthopedic Surgery, Erasmus MC Rotterdam, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - B Barvelink
- Department of Orthopedic Surgery, Erasmus MC Rotterdam, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - M Reijman
- Department of Orthopedic Surgery, Erasmus MC Rotterdam, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - T Gosens
- Department of Orthopedic Surgery, Elisabeth Tweesteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, The Netherlands
| | - G A Kraan
- Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - M R De Vries
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - K W W Lansink
- Department of Surgery, Elisabeth Tweesteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, The Netherlands
| | - P F W Hannemann
- Department of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - J W Colaris
- Department of Orthopedic Surgery, Erasmus MC Rotterdam, University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Eikrem M, Brannsten H, Bjørkøy D, Lian T, Madsen JE, Figved W. Volar Locking Plate Versus Dorsal Locking Nail-Plate Fixation for Dorsally Displaced Unstable Extra-Articular Distal Radial Fractures: Functional and Radiographic Results from a Randomized Controlled Trial. JB JS Open Access 2021; 6:JBJSOA-D-21-00068. [PMID: 34651093 PMCID: PMC8509916 DOI: 10.2106/jbjs.oa.21.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The use of low-profile dorsal and volar locking plates for distal radial fracture surgery has improved results and lowered the complication rate compared with older plate designs. The purpose of the present randomized controlled trial was to compare patient-reported outcomes as well as radiographic and functional results between patients who underwent stabilization with a volar locking plate or a dorsal locking nail-plate for the treatment of dorsally displaced unstable extra-articular distal radial fractures.
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Affiliation(s)
- Morten Eikrem
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.,Orthopaedic Department, Aalesund Hospital, Moere and Romsdal Hospital Trust, Aalesund, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hege Brannsten
- Department of Radiology, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Dagfinn Bjørkøy
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Tom Lian
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan Erik Madsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Wender Figved
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Cheng MF, Chiang CC, Lin CC, Chang MC, Wang CS. Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation. Orthop Traumatol Surg Res 2021; 107:102842. [PMID: 33548565 DOI: 10.1016/j.otsr.2021.102842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Radial height is an important prognostic factor in treating distal radius fracture. However, does further collapse of radial height in distal radius fractures after with volar locking plate fixation have a great impact on the prognosis? The present study aimed to elucidate radial height loss and determine the associated risk factors after open reduction and internal fixation with volar locking plate in patients with extra-articular distal radius fractures. HYPOTHESIS Patients with radial height collapse after fracture reduction and internal fixation with a volar locking plate may have poor outcomes. METHODS Data of 87 patients (21 male) undergoing surgery for acute extra-articular distal radius fractures (AO: 23-A2 or 23-A3) between February 2014 and July 2016 were evaluated retrospectively. Patients were divided into two groups by radial height loss. Potential risk factors were tested by Pearson correlation coefficients. Stepwise multiple regression logistic analysis determined significant independent risk factors for extra-articular distal radius fractures. Clinical evaluation was performed by the same surgeon by determining wrist ROM. Grip strength was measured with a Jamar dynamometer and compared with non-affect wrist in percentage. In addition, all the patients were asked to grade modified Mayo wrist score and Visual Analogue Scale (VAS) score. These findings were recorded postoperative 1 year of follow-up. RESULTS Mean radial height loss was 1.3±0.9mm. Age (ß=0.002, p=0.003), postoperative ulnar-positive deformity (ß=0.107, p<0.001), DEXA (ß=-0.015, p=0.008), and shortest diameter of distal fracture fragment in AP and lateral views (ß=-0.050, p=0.037; ß=-0.080, p=0.043) were significantly associated with radial height loss. As for the outcome of clinical prognosis, though radial height collapse group had poorer wrist range of motion, there was no statistical difference. Besides, there were no significant differences in grips strength and VAS score between these two groups. However, in regards of modified Mayo wrist score, the percentage of patients with poor outcomes is significant higher in radial height collapse group (p=0.039). Moreover, all patients with poor outcomes in radial height collapse groups were older than 65-year-old. DISCUSSION Radial height loss is noted in patients undergoing open reduction and internal fixation with volar locking plate for extra-articular distal radius fractures. Risk factors for radial height collapse include advanced age, poor bone quality, shortest distance between fracture site and articular surface and postoperative ulnar-positive deformity. LEVEL OF EVIDENCE IV; non-comparative prospective study.
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Affiliation(s)
- Ming Fai Cheng
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and national Yang Ming University, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Ching Chiang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and national Yang Ming University, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Cheng Lin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and national Yang Ming University, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and national Yang Ming University, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Shun Wang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and national Yang Ming University, Taipei, Taiwan; Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Pace V, Lanzetti RM, Venditto T, Park C, Kim WJ, Rinonapoli G, Caraffa A. Dorsally displaced distal radius fractures: introduction of Pacetti's line as radiological measurement to predict dorsal fracture displacement. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021200. [PMID: 34212906 PMCID: PMC8343761 DOI: 10.23750/abm.v92i3.11392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK In the best of our knowledge there is not yet in the literature a measurement able to assess post reduction stability of distal radius fractures. AIM to study the relationship between our newly introduced Pacetti's line, anatomical reduction of DRFs and post-reduction stability of fractures. METHODS Patients/Participants: 230 patients (122men, 108women) who sustained a dorsally displaced distal radius fracture. Close reduction procedures attempted; below elbow cast applied. FOLLOW-UP Pacetti's line used on true AP and lateral view xrays after reduction and casting (T0) and at 7-14 days (T1-T2). MAIN OUTCOME MEASUREMENTS Assessment and prediction of early displacement of DRFs. RESULTS The Pacetti's line intersected the lunate bone in 162 cases (70.4%) after anatomical reduction, of which 20.4% (N=33) lost anatomical reduction. Cramer's V test: significant relationship between transition of Pacetti's line through the semilunar bone and stability of anatomical reduction at T0 follow-up (p<0.001, Cramer's value=0.83). The Pacetti's line intersected the lunate bone in 119 cases (51.7%) at 7-14 days follow-up. None of patients lost anatomical reduction. Cramer's V test: significant relationship between transition of Pacetti's line through the semilunar bone and stability anatomical reduction at T1 and T2 follow-up (p<0.001, Cramer's value=0.73). CONCLUSIONS We strongly recommend the use of the Pacetti's line as it seems to provide reliable prediction of further fracture displacement and consequently of definitive management. The Pacetti's line seems to represent a very useful tool providing simple, feasible, efficient and reliable information on DRFs characteristics and natural course.
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Affiliation(s)
| | | | - Teresa Venditto
- Neuromotor Rehabilitation - Hospital Service Policlinico Italia SRL Rome (Italy).
| | - Chang Park
- North West Thames London (United Kingdom).
| | - Woo Jae Kim
- St. Mary's Hospital London (United Kingdom).
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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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Fox S, Johnston G, Stewart S. Improved precision of radiographic measurements for distal radius fractures after a technique-teaching tutorial. Can J Surg 2020; 63:E261-E271. [PMID: 32436686 DOI: 10.1503/cjs.001419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background For the management of distal radius fractures, surgical decision-making depends on radiographic measurements of indicators including radial inclination (RI), ulnar variance (UV) and radial tilt (RT). Evaluation of the inter- and intrarater reliability of surgeons' measurements of these criteria has been limited. Methods Twelve physicians were invited to participate in this study. Anonymously, they measured RI, UV and RT on 30 digitally stored radiographs of distal radius fractures on 3 occasions, each at least 1 week apart, using online measuring tools. After taking the third set of measurements, the participants were given a tutorial by the senior author (G.J.) on a single technique to measure all 3 indicators. The participants then took 3 more sets of measurements using only the technique they had been taught. Intraclass correlation coefficients (ICCs) were used to evaluate interrater reliability each week. Multiple logistic regression was used to calculate the effect of the tutorial, controlling for week of study along with reader (participant) and patient variance. Results The ICCs indicated that the participants' measurement precision improved promptly after the tutorial, and this improvement was sustained through subsequent readings. The odds of an "accurate" measurement (within 2° of the senior author's measurements for RI, 1 mm for UV and 4° for RT) was 1.7 times higher for RI, 2.7 times higher for UV and 2.3 times higher for RT after the tutorial; all of these results were statistically significant. Conclusion Surgeons ought to be familiar with a method to reproducibly measure the indicators used in the published guidelines for surgical intervention. The tutorial on a single standardized technique for online measurement of RI, UV and RT in distal radius fractures improved measurement precision.
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Affiliation(s)
- Shandy Fox
- From the Winnipeg Spine Program, Department of Surgery, University of Manitoba, Winnipeg, Man. (Fox); RebalanceMD, Victoria, B.C. (Johnston); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, N.S. (Stewart)
| | - Geoffrey Johnston
- From the Winnipeg Spine Program, Department of Surgery, University of Manitoba, Winnipeg, Man. (Fox); RebalanceMD, Victoria, B.C. (Johnston); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, N.S. (Stewart)
| | - Samuel Stewart
- From the Winnipeg Spine Program, Department of Surgery, University of Manitoba, Winnipeg, Man. (Fox); RebalanceMD, Victoria, B.C. (Johnston); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, N.S. (Stewart)
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Child C, Müller A, Allemann F, Pape HC, Welter J, Breiding P, Hess F. A retrospective comparison of clinical and radiological outcomes using palmar or dorsal plating to treat complex intraarticular distal radius fractures (AO 2R3 C3). Eur J Trauma Emerg Surg 2020; 48:4357-4364. [PMID: 32415367 DOI: 10.1007/s00068-020-01389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Complex intraarticular distal radius fractures are common, and treatment with open reduction and internal fixation (ORIF) can be done through either the palmar or dorsal approach. There is scant evidence, however, indicating which approach is more suitable. We compared clinical and radiological outcomes of patients with AO 2R3 C3 fractures surgically treated with one of these approaches. MATERIALS AND METHODS From January 2015 to November 2018, 72 surgically treated patients with AO 2R3 C3 fractures were radiologically (12 months) and clinically (mean 26 months) evaluated. Forty-one patients underwent ORIF using the palmar approach (Group 1), and the dorsal approach was used in 31 patients (Group 2). Radiological parameters were measured using the AO scoring system immediately following surgery and 12 months later. Clinical assessments included the range of motion, PRWE and DASH scores. RESULTS At the immediate postoperative assessment, the median AO score was 5.5 (IQR 2-9.5, range 0-30.5) for Group 1 and 8 (IQR 5-15, range 0-27) for Group 2, and 12-month follow-up results were 4.5 (IQR 1.5-10, range 0-41) and 6.5 (IQR 5-11, range 0-29.5), respectively. Group 1 had more favorable results for the flexion, extension, radial abduction, PRWE and DASH parameters. The plate removal and reoperation rates were higher in Group 2. DISCUSSION When treating complex intraarticular distal radius fractures, we found the palmar approach was more advantageous for this fracture pattern. Nevertheless, a dorsal approach may still be suitable for intraarticular comminuted distal radius fractures with dorsally displaced joint fragments.
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Affiliation(s)
- Christopher Child
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Annika Müller
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Florin Allemann
- Department of Trauma Surgery, University of Zurich, Zurich, Switzerland
| | | | - JoEllen Welter
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Philipe Breiding
- Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Florian Hess
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
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Hashimoto S, Yamazaki H, Hayashi M, Isobe F, Miyaoka S, Kitamura Y, Kato H. Radiographic Change in Articular Reduction After Volar Locking Plating for Intra-Articular Distal Radius Fractures. J Hand Surg Am 2020; 45:335-340. [PMID: 31668645 DOI: 10.1016/j.jhsa.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 05/13/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the stability of the articular reduction 12 weeks after intra-articular distal radius fracture (DRF) fixation with a volar locking plate (VLP). METHODS We prospectively assessed for losses in articular reduction, including gap and step, during the 12 weeks following surgery for intra-articular DRF treated with a VLP in 68 wrists. The mean patient age was 62 years (range, 16-88 years). Frontal and lateral digital tomosynthesis, a recently developed form of digital tomography, was employed to measure articular gap and step in the lunate and scaphoid fossa of the radius. The average time between surgery and imaging was 1.2 days (range, 0-2 days) for the first evaluation and 87.0 days (range, 74-105 days) for the second examination. RESULTS The mean gap and step were similar at the first and second examinations: 0.4 mm (SD, 0.8) and 0.3 mm (SD, 0.6) and 0.3 mm (SD, 0.7) and 0.3 mm (SD, 0.5), respectively. CONCLUSIONS There was no change in the alignment of the fragments in cases treated with VLP. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Shun Hashimoto
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan.
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihiro Isobe
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Shunsuke Miyaoka
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Yo Kitamura
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Dias R, Johnson NA, Dias JJ. Prospective investigation of the relationship between dorsal tilt, carpal malalignment, and capitate shift in distal radial fractures. Bone Joint J 2020; 102-B:137-143. [DOI: 10.1302/0301-620x.102b1.bjj-2019-0738.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. Methods Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment. Results A total of 250 consecutive patients with 252 distal radial fractures were identified. All measures of carpal alignment were significantly associated with dorsal tilt at each timepoint. This relationship persisted after adjustment for age, sex, and the position of the wrist. Capitate shift consistently had the strongest relationship with dorsal tilt and was the only parameter that was not influenced by age or the position of the wrist. ROC curve analysis identified that abnormal capitate shift was seen with > 9° of dorsal tilt. Conclusion Carpal malalignment is related to dorsal tilt following a distal radial fracture. Reducing the fracture and improving dorsal tilt will reduce carpal malalignment. Capitate shift is easy to assess visually, unrelated to age and sex, and appears to be the most useful measure of carpal malalignment. The aim during reduction of a distal radial fracture should be to realign the capitate with the axis of the radius and prevent carpal malalignment. Cite this article: Bone Joint J 2020;102-B(1):137–143
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Affiliation(s)
- Rachel Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
- Kings College London, London, UK
| | - Nick A. Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
- Consultant Hand Surgeon, Pulvertaft Hand Centre, Derby, UK
| | - Joseph J. Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Johnson NA, Jeffery J, Stirling E, Thompson J, Dias JJ. Effects of deprivation, ethnicity, gender and age on distal radius fracture incidence and surgical intervention rate. Bone 2019; 121:1-8. [PMID: 30599298 DOI: 10.1016/j.bone.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Social deprivation has been shown to be associated with increased incidence of many types of fracture but the causes for this have not been established. The aim of this study was to establish if distal radius fracture was associated with deprivation and investigate reasons for this. METHOD Data was reviewed of 4463 adult patients who attended our Emergency Department over a four year period. The Index of Multiple Deprivation was used to measure deprivation for each patient. Modelling techniques were used to investigate the relationship between fracture rate and deprivation, gender, ethnicity and age. RESULTS Distal radius fracture rate was higher for patients in more deprived quintiles. Mean age in the most deprived two quintiles was 54.4 years compared to 60.1 years in the least deprived three quintiles. Modelling showed important differences between ethnic groups. Deprivation was an independent risk factor for distal radius fracture only in white patients. Deprived white women had a lower second metacarpal cortical index than women of other ethnicities suggesting increased bone fragility. Being male is a risk factor for fracture when deprivation, ethnicity and age are taken into account. Incidence rate ratio of the least deprived quintile compared to the most deprived was 0.33 (95% CI: 0.30-0.37) for white men and 0.47 (95% CI: 0.44-0.49) for white women. CONCLUSION Effective interventions exist to prevent further fragility fracture and this work allows geographical areas at risk to be identified. Presentation with a distal radius fracture provides an opportunity to implement interventions. In the current economic climate resources are scarce and must be used prudently. Resources should be targeted to those at risk patients from deprived areas and preventative strategies put in place.
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Affiliation(s)
- Nick A Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
| | - John Jeffery
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - Euan Stirling
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Joseph J Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK
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Ultrasound-Guided Nerve Blocks as Analgesia for Nonoperative Management of Distal Radius Fractures-Two Consecutive Randomized Controlled Trials. J Orthop Trauma 2019; 33:e124-e130. [PMID: 30893220 DOI: 10.1097/bot.0000000000001388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate whether a conventional fracture hematoma block (FHB) or an ultrasound-guided peripheral nerve block has more superior analgesic effect during nonoperative management of distal radius fractures in an emergency department setting. Two peripheral nerve block types were investigated, one at the level of the elbow, or cubital nerve block (CNB), and another an axillary nerve block (ANB). DESIGN Two prospective randomized controlled studies were performed to compare the difference in pain intensity during closed reduction of a distal radius fracture between FHB-, CNB-, and, ANB-treated patients. SETTING Level 2 trauma center. PATIENTS One hundred ten patients with radiographic displaced distal radius fractures were randomized. Fifty patients were randomized between FHB and CNB, and 60 patients were randomized between CNB and ANB. INTERVENTION FHB, CNB, or ANB. These were performed by 3 physicians new to ultrasound-guided peripheral nerve blocks and trained before onset of this study. MAIN OUTCOME MEASUREMENT Pain was sequentially measured using an NRS during closed distal radius fracture reduction. RESULTS CNB patients experienced less pain during block procedure (P = 0.002), finger trap traction (P = 0.007), fracture reduction (P = 0.00001), after plaster cast application (P = 0.01), and after control radiography (P = 0.01). In our second study, ANB-treated patients reported less pain during block procedure (P = 0.04), during finger trap traction (P < 0.0001), fracture reduction (P < 0.0001), after plaster cast application (P = 0.0001), and after control radiography (P = 0.0005). CONCLUSIONS Although participating clinicians had minimal expertise using ultrasound-guided peripheral nerve blocks, nonoperative management of distal radius fracture using an ANB was less painful. These block types are expected to completely eradicate sensation the best. Future studies should address technical factors including adequate placement and time to let the block set up, as well as issues such as resource utilization including time and clinician availability to better determine the relative advantages and disadvantages to other analgesia techniques such as the FHB. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Comparison of fracture healing and long-term patient-reported functional outcome between dorsal and volar plating for AO C3-type distal radius fractures. Eur J Trauma Emerg Surg 2019; 46:591-598. [PMID: 30810768 DOI: 10.1007/s00068-019-01100-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to evaluate the differences in long-term functional outcome and radiographic fracture healing between volar and dorsally approached comminuted intra-articular distal radius fractures (DRF) (AO C3-type). METHODS A retrospective, age-matched, case-control study with a 1:2 allocation ratio was conducted in 84 patients C3-type DRFs patients who underwent either dorsal locking plating (DLP) group (n = 28) or volar locking plating (VLP) group (n = 56). Standardized wrist radiographs (posterior-anterior and 15° lateral) were assessed immediately postoperative and at final follow. To evaluate for loss of reduction standard radiographic measurements were performed. Fracture healing was assessed radiologically. Patient-reported outcomes were assessed with the patient-related wrist evaluation and the EQ-5D-3L for health-related quality of life. Patient satisfaction was assessed with the use of a numeric analog scale ranging from 0 (not satisfied) to 100 (very satisfied). RESULTS All fractures united within 3 months postoperatively. Average age was 59 ± 12 years. Fifty-five patients (66%) participated in the follow-up survey at an average of 76.6 ± 23.8 months. DLP group showed a significant change in sagittal tilt compared with VLP group (3.4 ± 3.0° vs - 0.4 ± 4.1°, p < 0.001). No significant difference in other radiographic and long-term functional outcome was found between both groups (p > 0.05). CONCLUSION Dorsal locking plating fixation in C3-type DRFs resulted in a minimal, but statistically significant, volar collapse of sagittal tilt compared with volar locking plating fixation. However, this difference in volar collapse did not significantly influence the long-term clinical outcome.
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Dailey SK, Miller AR, Kakazu R, Wyrick JD, Stern PJ. The Effectiveness of Mini-C-Arm Fluoroscopy for the Closed Reduction of Distal Radius Fractures in Adults: A Randomized Controlled Trial. J Hand Surg Am 2018; 43:927-931. [PMID: 29573894 DOI: 10.1016/j.jhsa.2018.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 01/12/2018] [Accepted: 02/13/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Most distal radius (DR) fractures are initially managed with closed reduction and orthosis application. Mini-C-arm fluoroscopy provides assessment of reduction quality in real time. Our null hypothesis was that there would be no difference in the reduction quality of DR fractures in the emergency department when using mini-C-arm fluoroscopy during reduction compared with standard reduction techniques (evaluating reduction quality with orthogonal radiographs taken in an orthosis). METHODS Sixty-three consecutive patients with closed DR fractures requiring reduction between April 2015 and April 2017 were prospectively randomized to standard versus fluoroscopically aided reductions. Reductions were performed by orthopedic surgery residents. The primary outcome measurement was reduction quality (radial height, radial inclination, ulnar variance, and volar tilt) as measured on postreduction radiographs. RESULTS Standard reductions were performed in 34 patients and fluoroscopically aided reductions in 29 patients. The 2 groups were similar in regards to all potential confounders that were analyzed. No differences in postreduction radial height, radial inclination, ulnar variance, or volar tilt were noted. Overall reduction attempts and subjective difficulty of fracture reduction were increased when using fluoroscopy. The rate of initial operative management did not differ between groups. CONCLUSIONS The use of mini-C-arm fluoroscopy during the initial closed reduction of adult DR fractures results in equivalent postreduction radiographic parameters when compared with conventional reduction techniques. Additional research regarding time spent in the emergency department and overall cost could elucidate potential benefits of fluoroscopically aided DR fracture reduction. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Steven K Dailey
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH.
| | - Ashley R Miller
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH
| | - Rafael Kakazu
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH
| | - John D Wyrick
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH
| | - Peter J Stern
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH
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Walton TR, Layton DM. Intra- and inter-examiner agreement when assessing radiographic implant bone levels: Differences related to brightness, accuracy, participant demographics and implant characteristics. Clin Oral Implants Res 2018; 29:756-771. [DOI: 10.1111/clr.13290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/02/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Terry R. Walton
- University of Sydney; Sydney New South Wales Australia
- Specialist Prosthodontist; Private Practice; Sydney New South Wales Australia
| | - Danielle M. Layton
- University of Queensland; Brisbane Queensland Australia
- Specialist Prosthodontist; Private Practice; Brisbane Queensland Australia
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Zhang Y, Chen Y, Qiang M, Zhang K, Li H, Jiang Y, Jia X. Comparison between three-dimensional CT and conventional radiography in proximal tibia morphology. Medicine (Baltimore) 2018; 97:e11632. [PMID: 30045306 PMCID: PMC6078714 DOI: 10.1097/md.0000000000011632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To provide morphological parameters of the normal tibial plateau by using three-dimensional (3D) CT and conventional radiography.We performed morphological measurements of tibial plateau on 157 consecutive adults using radiographic and 3D computed tomography (CT). Gender differences as well as differences in measurement techniques were statistically compared. Intraclass correlation coefficient (ICC) was used to evaluate intra- and interobserver reproducibility.The mediolateral dimensions, anteroposterior dimensions of tibial plateau showed significant differences according to gender, but no statistical differences were observed in coronal tibial slope as well as in posterior slope. There were significant differences in all parameters between 2 measurement techniques. 3D-CT measurements had a higher ICC in all parameters than that in the radiographs.This study confirmed that 3D morphological measurements of tibial plateau have more reproducibility than radiographs. Our data will be helpful for tibial component design and placement.
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Stinton SB, Graham PL, Moloney NA, Maclachlan LR, Edgar DW, Pappas E. Longitudinal recovery following distal radial fractures managed with volar plate fixation. Bone Joint J 2017; 99-B:1665-1676. [PMID: 29212691 DOI: 10.1302/0301-620x.99b12.bjj-2017-0348.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022]
Abstract
AIMS To synthesise the literature and perform a meta-analysis detailing the longitudinal recovery in the first two years following a distal radius fracture (DRF) managed with volar plate fixation. MATERIALS AND METHODS Three databases were searched to identify relevant articles. Following eligibility screening and quality assessment, data were extracted and outcomes were assimilated at the post-operative time points of interest. A state-of-the-art longitudinal mixed-effects meta-analysis model was employed to analyse the data. RESULTS The search identified 5698 articles, of which 46 study reports met the selection criteria. High levels of disability and impairment were reported in the immediate post-operative period with subsequently a rapid initial improvement followed by more gradual improvement for up to one year. The results highlight that the period associated with the greatest physical recovery is in the first three months and suggest that the endpoint of treatment outcomes is best measured at one year post-surgery. CONCLUSION Clinically meaningful improvements in outcomes can be expected for 12 months, after which progress plateaus and reaches normal values. This paper adopted a novel approach to meta-analyses in that the research question was of a longitudinal nature, which required a unique method of statistical analysis. Cite this article: Bone Joint J 2017;99-B:1665-76.
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Affiliation(s)
- S B Stinton
- Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East St, O204, Lidcombe NSW 2141, Australia, and Westmead Private Physiotherapy Services, 16 Mons Rd, Westmead NSW 2145, Australia
| | - P L Graham
- Macquarie University, 12 Wally's Walk, Building E7A, Level 6, Macquarie University, NSW 2109, Australia
| | - N A Moloney
- Macquarie University, 75 Talavera Road, Macquarie Park, NSW 2113, Australia
| | - L R Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia QLD 4072, Australia
| | - D W Edgar
- Fiona Stanley Hospital, Fiona Wood Foundation and The University of Notre Dame Australia, 11 Robin Warren Drive, Murdoch, WA 6150, Australia, Fiona Wood Foundation, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia, and The University of Notre Dame Australia, 19 Mouat Street, Fremantle WA 6160, Australia
| | - E Pappas
- Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East St, O204, Lidcombe NSW 2141, Australia
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