Distal radius fractures are difficult to classify

Wæver, Daniel; Madsen, Mette Lund; Rölfing, Jan Duedal; Borris, Lars C.; Henriksen, Mads; Nagel, Lise Loft; Thorninger, Rikke

doi:10.1016/s0020-1383(18)30299-7

Cited by 39 publications

(46 citation statements)

References 19 publications

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“…Fractures of the distal radius have many types and classifications. These classifications include the following: Frykman, Melone, AO/OTA, and Fernandez classification [14,15]. Each type will require a specific understanding of the classification and management of the fractures (not all of them can be treated with a cast).…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2020

J Orthop Surg Res

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Background: There is no consensus in the literature about the ideal classification of the distal radius fracture for the clinical practice. The traditional Melone classification system divides the distal radius into four basic components, the shaft, radial styloid, dorsal medial fragment, and volar medial fragment. The aim of this study was to identify fracture lines in comminuted distal radius fractures using three-dimensional mapping of computed tomography (CT) images to test the hypothesis that fracture fragments can be divided according to the Melone classification. Methods: Fifty-nine consecutive OTA/AO 23C3 fractures presented at the hospital between January 2018 and October 2019 were retrospectively reviewed. The fracture lines were characterized in the axial, sagittal, and coronal CT planes. After reducing the fractures in a three-dimensional (3D) model, the fracture lines were plotted from the CT images and were then superimposed on one another and oriented to fit a standard template. The area of articular surfaces was measured and compared to quantify the differences between the radial bone fragments. Results: Thirty-five cases (59.3%) in this study fit the Melone classification and 24 cases (40.7%) did not. On the radiocarpal surface, there was a greater concentration of fracture lines in the dorsal area of the radius than in the volar area. On the distal radioulnar joint (DRUJ), the fracture lines were focused around two specific concentrated regions. For the articular surface area, the mean area of the radial styloid, volar medial fragment, and dorsal medial fragment was 141.13 ± 90.16 mm 2 , 147.79 ± 75.94 mm 2 , and 79.05 ± 70.73 mm 2 , respectively. There was a significant difference in articular surface area for the Melone fragments (P = 0.002). Conclusions: The Melone classification system is not suitable for characterizing all C3 fractures. The findings of this study confirm that the dorsal medial fragments are relatively comminuted and small. Extra care should be given to these small fragments when reducing the fracture.

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Section: Discussionmentioning

confidence: 99%

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

Zhang

Wang

et al. 2020

J Orthop Surg Res

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“…2018, Waever et al. 2018). Non-orthopedic surgeons or young radiologists at emergency departments, where urgent decision-making is often required, are usually the first doctors to assess radiographs.…”

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confidence: 99%

Artificial intelligence detection of distal radius fractures: a comparison between the convolutional neural network and professional assessments

et al. 2019

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“…We can expect easily that patients with high-energy trauma will have a higher rate of complex fractures than those with low-energy trauma, which subsequently results in worse functional outcomes. However, previous studies have reported no correlation between the extent of trauma and AO/OTA classification [7]. This is due to the involvement of various factors, including osteoporosis, concomitant injuries, the degree of external trauma, and the mechanism [1][2][3].…”

Section: Discussionmentioning

confidence: 94%

Epidemiologic Features of Distal Radius Fractures in Severe Trauma Patients at the Busan Regional Trauma Center

Kim¹,

Kwak²,

Jang³

et al. 2020

Arch Hand Microsurg

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Purpose: Distal radius fractures (DRFs) are often observed in simple trauma in older women with osteoporosis, and severe trauma caused by traffic or fall accidents. In this study, we aim to classify the DRFs according to injury mechanism, and statistically compare epidemiologic factors, radiological characteristics, and functional scores.Methods: From 2013 to 2018, 112 cases of trauma in 104 patients (70 monotrauma and 42 severe traumas) diagnosed with DRFs were included. Patients were divided into the low-energy monotrauma (ML), high-energy monotrauma (MH), and severe trauma (ST) groups and analyzed for differences in sex, Injury Severity Score (ISS), accompanying ipsilateral injuries, radiologic indices, AO classification, and functional outcome scores (disabilities of the arm, shoulder, and hand and Modified Mayo Wrist Score). Results: Significant differences were observed in sex, age, ISS, and accompanying ipsilateral injury among three group (p < 0.001). Distribution of AO classification was not significantly different among the groups. Especially, sex, age, and accompanying ipsilateral injury were significantly different between the ML and MH groups (p<0.001). postoperative DASH and MMWS were significantly different between the mono- and severe trauma groups (p<0.001).Conclusions: Severe trauma with DRFs was observed at a lower age and more frequently accompanied by ipsilateral injury and high ISS. Additionally, the functional outcomes were lower after severe trauma than after monotrauma. Therefore, for DRF patients with severe trauma, attention should be paid to the pattern of fracture as well as the accompanying injury and postoperative management and rehabilitation associated with it.

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Distal radius fractures are difficult to classify

Cited by 39 publications

References 19 publications

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

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

Artificial intelligence detection of distal radius fractures: a comparison between the convolutional neural network and professional assessments

Epidemiologic Features of Distal Radius Fractures in Severe Trauma Patients at the Busan Regional Trauma Center

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