Analyses of fracture line distribution in intra-articular distal radius fractures

Abstract

Purpose To assess the association between the fracture line distribution and the location of comminution in intra-articular distal radius fractures by building fracture mapping. Patients/methods Forty cases with intra-articular fractures of distal radius were enrolled in the current prospective clinical study. Fracture lines and comminution zones were identified by reduced three-dimensional computed tomography reconstructions and then graphically superimposed onto a standard template to create two-dimensional fracture maps, followed by the conversion into heating maps. Based on qualitative descriptive fracture mapping analyses, the patterns of intra-articular distal radius fractures were determined. Results It was observed that the highest fracture line intensity was located as an inverted “T” shape zone in the dorsal aspect of the joint with high incidence of fractures and the prominently intense color in heat mapping. The keystone projected area, the radial styloid process and the metacarpal radial side articular surface were found to be the least involved parts of the fracture. According to the mapping of the number and distribution of fracture lines, a new classification method for intra-articular fractures of the distal radius was redefined. Different surgical approaches and internal fixation techniques were proposed for different types. In this paper, we retrospectively compared the preoperative X-ray findings between different types. Based on the preoperative X-ray prediction, the distal intra-articular radius fractures were classified, so as to develop effective surgical strategies. In this study, a new surgical approach was attempted, but due to the lack of evidence-based evidence, long-term postoperative complications and hand function should be further evaluated. Conclusion This study redefines a new method for the classification of intra-articular fractures of the distal radius, which allows doctors to have a clearer understanding of the characteristics of distal radius fractures. Moreover, the application value in fracture diagnosis is more significant, and the best surgical approach is selected for different types.

Melone’s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping

“…Failure to achieve and maintain anatomic restoration can lead to post-traumatic arthritis, distal radioulnar joint instability, and ulnar impaction syndrome, with resultant pain, joint stiffness, and decreased motion and strength [11,12]. These are primarily procedure-related when the surgeon holds a vague recognition of the characteristics of comminuted intraarticular fractures, and the morphology of the fracture fragments [13].…”

Clinical Utility of 3-Dimensional Reconstruction Images to Predict Conservative Treatment Outcomes of Intra-Articular Distal Radius Fractures

“…Through 3D studies of the osteoarticular surface, steps or gaps resulting from fracture lines can be investigated stereoscopically [ 19 ], which led to a new method for assessing the severity of intra-articular DRFs. By analyzing accurate morphometric information, we set a semiquantitative standard, in which the fracture severity was divided into 3 levels to assess the smoothness of the wrist joint.…”

Translational Medicine: What Orthopaedic Perspectives and Challenges Does the Mapping Technology?

“…Among the included studies, the most often reported application was that fracture MT can guide preoperative planning (n=12, 42.86%). In this regard, several surgeons said that fracture MT could optimize preoperative planning, such as surgical approach and setting specificity fixation structure [8], [10], [11], [14], [15], [16], [17], [18], [19] , [20], [21]. Others said that the understanding of fracture patterns through the MT of fractures leads to the possibility of the development of new classifications and implant designs [22].…”

“…Through fracture MT, surgeons can more accurately anticipate fracture patterns by superimposing fracture lines with zones of comminution and articular involvement. This provides previously unavailable mechanistic insights [8], more clearly illustrates the location and frequency of fracture lines, and helps to identify specific fracture patterns [9]. The two-dimensional or three-dimensional MT of fractures can also help surgeons to better understand the mechanical characteristics of these fractures, improving surgeons' preoperative diagnosis, preoperative planning, and execution of surgical strategies [10], [11].…”