The factors affecting the redisplacement in distal radius fractures

Yıl 2022, Cilt: 8 Sayı: 2, 218 - 224, 04.03.2022

Ali Okan Tarlacık Mustafa Kavak , Abdurrahman Özçelik

https://doi.org/10.18621/eurj.990434

Öz

Objectives: Many instability criteria have been described in the literature to predict loss of reduction in distal radius fractures. However, the effect of the column location of the fracture on loss of reduction has not been investigated. The aim of this study is to investigate the effect of fracture column location and other radiological parameters on the loss of reduction of the distal radius fractures.

Methods: A total of 106 patients who were treated conservatively for displaced distal radius fractures were included in the study. The average age of the patients included in the study is 54.9 years (range: 18-91 years). Anteroposterior and lateral radiographs of the wrist were taken in each patient at the time of first admission, immediately after reduction and casting, and at the 1st, 2nd and 6th weeks. Intraarticular fracture were evaluated by computed tomography (CT). Radial length, volar tilt angle and column location of the fracture were obtained by evaluating the radiographs and CT. The effects of post-reduction radiological parameters and column location of the fracture on loss of reduction were analyzed.

Results: Reduction loss was detected in 23 (21.7%) of 106 patients. Metaphyseal fracture in 83 (78.3%) patients, intermediate volar column fracture in 76 (71.7%) patients, intermediate dorsal column fracture in 86 (81.1%) patients, ulnar column fracture in 52 (49.1%) patients and radial column fracture in 25 (23.6%) patients were determined. It was observed that having a fracture in the ulnar column or radial column caused a significant loss in radial length (p < 0.05). Metaphyseal and the intermediate column fractures did not make a statistically significant difference in reduction loss.

Conclusions: Column location of the fracture can also be used to predict loss of reduction in the conservative treatment of distal radius fractures.

Anahtar Kelimeler

distal radius fracture, instability, loss of reduction, redisplacement, column theory

Kaynakça

• 1. MacDermid JC, Roth JH, Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskelet Disord 2003;4:24.
• 2. Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011;93:2146-53.
• 3. Kumar S, Penematsa SR, Sadri M, Deshmukh SC. How many clinic visits does it take to treat distal radial fractures? Int Orthop 2008;32:91-6.
• 4.Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg 2008;33:1301-8.
• 5. Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury 1989;20:208-10.
• 6. Melone CP Jr. Articular fractures of the distal radius. Orthop Clin North Am 1984;15:217-36.
• 7. Tahririan MA, Javdan M, Nouraei MH, Dehghani M. Evaluation of instability factors in distal radius fractures. J Res Med Sci 2013;18: 892-6.
• 8. Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am 2006;88:1944-51.
• 9. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004;29:1128-38.
• 10. Walenkamp MM, Aydin S, Mulders MA, Goslings JC, Schep NW. Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg Eur Vol 2016;41:501-15.
• 11. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996;78:588-92.
• 12. Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring M, Slutsky DJ, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg 2010;18:180-9.
• 13. Jung HW, Hong H, Jung HJ, Kim JS, Park HY, Bae KH, et al. Redisplacement of distal radius fracture after initial closed reduction: analysis of prognostic factors. Clin Orthop Surg 2015;7:377-82.
• 14. Zengin EC, Ozcan C, Aslan C, Bulut T, Sener M. Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older. Acta Orthop Traumatol Turc 2019;53:15-8.
• 15. Shauver MJ, Clapham PJ, Chung KC. An economic analysis of outcomes and complications of treating distal radius fractures in the elderly. J Hand Surg Am 2011;36:1912-18.
• 16. Toon DH, Premchand RAX, Sim J, Vaikunthan R. Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management. J Orthop Traumatol 2017;18:229-34.
• 17. Wu YS, Yang J, Xie LZ, Zhang JY, Yu XB, Hu W, et al. Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly. ANZ J Surg 2019;89:E428-32.
• 18. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986;68:647-59.
• 19. Leone J, Bhandari M, Adili A, McKenzie S, Moro JK, Dunlop RB. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg 2004;124:38-41.
• 20. Alluri R, Longacre M, Pannell W, Stevanovic M, Ghiassi A. Volar, intramedullary, and percutaneous fixation of distal radius fractures. J Wrist Surg 2015;4:292-300.
• 21. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg 2009;17:369-77.
• 22. Cai L, Zhu S, Du S, Lin W, Wang T, Lu D, et al. The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly. Orthop Traumatol Surg Res 2015;101:827-31.
• 23. Perugia D, Guzzini M, Civitenga C, Guidi M, Dominedò C, Fontana D, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury 2014;45:S21-6.
• 24. Daneshvar P, Chan R, MacDermid J, Grewal R. The effects of ulnar styloid fractures on patients sustaining distal radius fractures. J Hand Surg Am 2014;39:1915-20.
• 25. Lyu JM, Lin XY, Lin JH. [Risk factors of radius shortening in adult with distal radius fracture after conservative treatment]. Zhongguo Gu Shang 2017;30:513-17. [Article in Chinese]