An Evaluation of Two Scoring Systems to Predict Instability in Fractures of the Distal Radius

Jeong, Gerard K.; Kaplan, F. Thomas D.; Liporace, Frank A.; Paksima, Nader; Koval, Kenneth J.

doi:10.1097/01.ta.0000105886.89776.82

Cited by 15 publications

(6 citation statements)

References 21 publications

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“…After prospectively reviewing 105 patients, it was found that both scoring systems underestimated the degree of fracture instability. 18 In an attempt to determine signs of early (1 week) and late (6 weeks) instability of conservatively treated extraarticular distal radius fractures in the elderly, an observational study of 71 patients showed that radial shortening and volar tilt greater than 20°were the best predictors of early instability, whereas radial inclination less than 10°, radial shortening, age older than 65 years, and dorsal tilt greater than 20°were predictive of late instability. 19 A prospective, randomized study analyzing 90 patients with displaced intra-articular distal radius fractures with an average of 4-year follow up looked at functional outcomes based on mode of treatment (plaster immobilization, external fixation, plate and screw fixation).…”

Section: Nonoperative Management Closed Treatment With Castingmentioning

confidence: 99%

Distal Radius Fractures

Liporace¹,

Adams²,

Capo³

et al. 2009

Journal of Orthopaedic Trauma

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Distal radius fractures are a common injury, particularly in the elderly population. Severity of these fractures is directly related to the bone mineral density of the patient, and clinical results are dependent on this parameter as well. In terms of treatment, several options exist. Nonoperative management consists of closed treatment with casting. Operative treatment options include intrafocal pinning, nonbridging and bridging external fixation, arthroscopic-assisted external fixation, and various methods of open reduction internal fixation. When operative intervention is indicated, considerations include the characteristics of the fracture and the experience of the surgeon with the treatment modalities.

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Section: Nonoperative Management Closed Treatment With Castingmentioning

confidence: 99%

Distal Radius Fractures

Liporace¹,

Adams²,

Capo³

et al. 2009

Journal of Orthopaedic Trauma

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“…Multiple studies have set out to assess the factors that influence fracture displacement. 2,[4][5][6][7][8][9]12,17 In their 1989 paper, Lafontaine et al studied 112 consecutive cases of displaced distal radius fractures that were managed conservatively. 13 Five criteria were identified that predicted malunion (dorsal comminution, initial dorsal angulation greater than 20 degrees, an intra-articular fracture, an associated ulnar styloid fracture, and patient age greater than 60), and their research suggested that patients with three or more of these factors had an increased risk of loss of reduction.…”

Section: Discussionmentioning

confidence: 99%

The Volar Cortical Hinge: An Independent Risk Factor for Distal Radius Fracture Displacement

Mathews,

Martyn,

Rao

et al. 2023

J Wrist Surg

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Background Displaced distal radius fractures are prone to redisplacement after manipulation. This can result in the need for delayed surgery. Several criteria have been studied to predict the likelihood of redisplacement. We hypothesized that reduction in the volar cortex would be an additional predictive factor. Purpose The aim of this study was to assess whether the quality of the volar cortex reduction predicts the subsequent need for further intervention (surgery or remanipulation). As a secondary outcome, we assessed whether the quality of the reduction predicts the rate of malunion. Methods A retrospective review was performed of displaced adult distal radius fractures over a 2-year period that had undergone closed reduction at presentation. We identified 105 patients and a review of their electronic notes and radiographs was then performed. The volar cortex reduction was defined as “anatomical,” “opposed,” or “displaced.” We assessed the radial height, radial inclination, radial/ulnar translation, volar/dorsal angulation, teardrop angle, presence of dorsal comminution, quality of the cast (molding, cast index), and volar cortex reduction. These measurements were taken at five time points (prereduction, postreduction, 1 week, 2 weeks, and 6 weeks). All patients that subsequently required surgical fixation or repeat reduction were identified as the primary outcome measure. The 6-week radiographs were assessed for radiographic malunion as our secondary outcome measure. A statistical analysis was then performed to assess the factors that influenced a loss of position and the need for delayed surgical intervention. Results Of the 105 patients, 22 patients required delayed surgery, 3 patients underwent a repeat manipulation, and 12 patients had a radiographic malunion at 6 weeks. During the study period, the proportion of patients requiring surgery or repeat manipulation in the displaced group was 10/21 (47.6%), in the opposed group it was 11/50 (23.4%), and in the anatomic group it was 4/36 (11.1%; p = 0.008). We then included the patients with a radiographic malunion and found the proportion of patients with an adverse outcome in the displaced group was 14/21 (66.7%), in the opposed group it was 17/47 (36.2%), and in the anatomic group it was 6/36 (16.7%; p = 0.001). At the 1-week time point, this association was equally significant, as the proportion in the displaced group was 17/33 (51.5%), in the opposed group it was 15/45 (33.3%) and in the anatomic group it was 1/22 (4.5%; p = 0.001). The patients' age, quality of cast, presence of dorsal comminution, and degree of initial displacement did not predict the subsequent need for surgery or remanipulation. Conclusion The most important factor in our study for significant redisplacement of an initially dorsally displaced distal radius fracture is the association of the volar cortex. This parameter maintains significance at the 1-week time point. This data shows that volar cortex reduction is a useful clinical measurement in assessing which distal radius fractures will undergo delayed displacement requiring intervention. Level of evidence Level 3–Retrospective comparative study.

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“…The existence of various classifications demonstrates that there is a need to obtain a single ideal classification that would be very wide-ranging and would provide support for therapeutic and prognostic conduct. 17 More than 20 classification systems for fractures of the distal extremity of the radius have been described. If a classification system has fulfilled all the premises for supplying support, it will still need to present intra and interobserver reproducibility.…”

Section: Discussionmentioning

confidence: 99%

Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction

Machado

Lima

Mathias

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThe objective of this study was to evaluate the current classifications for fractures of the distal extremity of the radius, since the classifications made using traditional radiographs in anteroposterior and lateral views have been questioned regarding their reproducibility. In the literature, it has been suggested that other options are needed, such as use of preoperative radiographs on fractures of the distal radius subjected to traction, with stratification by the evaluators. The aim was to demonstrate which classification systems present better statistical reliability.ResultsIn the Universal classification, the results from the third-year resident group (R3) and from the group of more experienced evaluators (Staff) presented excellent correlation, with a statistically significant p-value (p < 0.05). Neither of the groups presented a statistically significant result through the Frykman classification. In the AO classification, there were high correlations in the R3 and Staff groups (respectively 0.950 and 0.800), with p-values lower than 0.05 (respectively <0.001 and 0.003).ConclusionIt can be concluded that radiographs performed under traction showed good concordance in the Staff group and in the R3 group, and that this is a good tactic for radiographic evaluations of fractures of the distal extremity of the radius.

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An Evaluation of Two Scoring Systems to Predict Instability in Fractures of the Distal Radius

Cited by 15 publications

References 21 publications

Distal Radius Fractures

Distal Radius Fractures

The Volar Cortical Hinge: An Independent Risk Factor for Distal Radius Fracture Displacement

Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction

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