Comminution of the dorsal metaphysis and its effects on the radiographic outcomes of distal radius fractures

Abstract

Comminution of the dorsal metaphysis is a relatively common feature of distal radius fractures. However, its effects on the radiographic outcomes of these fractures are not entirely understood. One hundred and twenty-four conservatively managed distal radius fractures were analysed retrospectively to assess the effect of dorsal metaphyseal comminution on fracture stability, especially with respect to initial displacement (minimally displaced versus displaced) and age group. Seventy-seven fractures (62%) had radiographic evidence of dorsal comminution. The secondary displacement rate of these fractures was 75%, compared to 45% in non-comminuted counterparts (P<0.001). In minimally displaced fractures, the secondary displacement rate was higher in those with dorsal comminution as compared to those without (57% vs. 31%, P=0.086). Dorsal metaphyseal comminution was found in 75% of fractures in patients 65+years old (P=0.05). Among those with dorsal comminution, the secondary displacement rates were similar for both men and women (63% vs. 79%; P=0.20). In conclusion, distal radius fractures with dorsal metaphyseal comminution had significantly higher rates of secondary displacement compared to non-comminuted counterparts, and there exists a correlation with this displacement and increasing patient age but not gender.

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly

“…Our research also verified that volar tilt, ulnar variance, volar/dorsal metaphyseal comminution and intra‐articular displacement/step‐off were significant factors influencing the recommendation for operative treatment. In the absence of definitive evidence to direct treatment recommendations for distal radius fractures in the elderly, surgeons were strongly influenced by radiographic factors . We found that elderly patients with associated orthopaedic injuries requiring surgery ( P = 0.020) were more likely to undergo operative treatment of their distal radius fracture.…”

Closed Reduction and Cast Immobilization for the Treatment of Distal Radius Fracture: Does Dorsal Metaphyseal Comminution Predict Radiographic and Functional Outcomes?

“…Dorsal metaphyseal comminution in the metaphysis is believed to be important for ensuring fracture stability 4 , thus the primary purpose of our present study was to evaluate the relationship between initial dorsal metaphyseal comminution and final radiographic and functional outcomes. In contrast to the huge number of reports describing surgical treatment for this type of fracture, our current study provides some insight into the use of conservative treatment.…”

“…Although, there are a few reports in the literature on the relationship between dorsal metaphyseal comminution and radiographic parameters 4,5 there are fewer articles that describe both the radiographic and functional outcomes at the same time.…”

“…This challenging fracture pattern will most likely result in the loss of alignment and poor functional outcomes. Dorsal metaphyseal comminution has also been reported as a predictor of fracture stability 4 . Dorsal cortical comminution is defined as the presence of free-floating dorsal fragments, which are considered as an important buttress for maintaining dorsal displacement forces.…”

A Structured Review Addressing the Use of Radiographic Measures of Alignment and the Definition of Acceptability in Patients with Distal Radius Fractures

“…Makhni et al 2010 [36], Stein et al 1990 [51] Mann et al 1993 [37] (Radial Height) "Measurement of radial height (also known as radial length) can be used to assess radial shortening due to impaction or displacement." "Method of measuring radial height.…”