Effect of the Articular Surface Incongruency on Surgical Outcome of the Distal Radius Fracture

Abstract

Purpose. The aim of this study was to demonstrate the joint fragment that mostly affects the outcome of the distal radius fracture surgically treated with a volar locking plate (VLP). Methods. The outcomes of 69 patients with the distal radius fractures were evaluated at their final follow-up. The articular surface was divided into six specific fragments, and computed tomography (CT) was used to evaluate the degree of mismatch of each fragments. A plain radiograph was also obtained for evaluation of the distal radius alignment. Clinical outcomes were measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS). Univariate analyses were performed, with subsequent multiple logistic regression analyses. Results. The mean follow-up period was 14.8 (range, 12 to 52) months. The group with a worse DASH score showed significantly greater mismatch in the volar and dorsal lunate facets, as well as the central depression of the distal radius ( p = 0.042 , 0.031, and 0.023, respectively). There was a significant positive correlation between the DASH score and degree of mismatch of the dorsal lunate facet and central depression of the distal radius ( p = 0.040 and 0.011, respectively). Groups with worse MMWS showed significantly greater mismatch in the dorsal lunate facet ( p = 0.025 ). There was a significant negative correlation between MMWS and abnormal ulnar variance and mismatch of the dorsal lunate facet and central depression of the distal radius ( p = 0.041 , 0.004, and 0.018, respectively). The result of multiple logistic regression analysis demonstrated that a mismatch of the dorsal lunate facet is a significant predictor for a worse MMWS ( odds ratio = 3.072 , p = 0.043 ). Conclusions. Articular surface mismatch of the dorsal lunate facet appears to mostly affect the surgical outcomes of the distal radius fractures using VLP. In cases where the dorsal lunate facet is heavily involved, surgeons should be cautious about its reduction and fixation.

Clinical Results of Distal Radius Intraarticular Comminuted Fractures in the Elderly: A Retrospective Comparative Analysis of Different Fixation Methods

“…There are different treatment options for comminuted, intraarticular fractures of the distal radius. It's mandatory to analyze patient characteristics, activity demands, fracture stability, and displacement for making a decision to choose the best approach [1,[5][6][7][8][9][10][11][12][13][14]. To date, it's seen that open reduction and fixation via a volar approach is the most common approach for these fractures.…”

“…Men are more prone to be affected by high-energy trauma-related DRF. Despite this, the overall incidence of DRF is greater in women than in men [1][2][3][4][5]. However, the incidence of comminuted intraarticular fractures increases with advancing age [1][2].…”

“…Surgical treatment options are external fixation, dorsal plate fixation, volar plating, bridge plating, and fragment-specific fixation. There is no advised exact surgery approach and fixation type for fractures, therefore surgeons should be familiar with all methods and choose the appropriate fixation method according to fracture type [1,5,[8][9].…”

“…Complications such as tendon irritation and ruptures caused by plate prominence are very rarely seen [15]. However, the easy application and availability of most of the DRFs that are severely comminuted with dorsal shear fragments and involving the dorsal ulnar corner may not be suitable for VLP [5,[8][9]. We use VLP for volar shear fractures, with radial shortening of more than 3 mm, a dorsal tilt greater than 10º, and more than a 2 mm articular step-off.…”

“…The overall age-adjusted incidence of distal radius fractures is greater in women than men. An increase in life expectancy in the elderly population results in a higher incidence of distal radius fractures and the need for surgical or nonsurgical management increased over time [5][6][7].…”