Use of Plain Radiography of Uninjured Wrists as Patient-Specific Markers of Successful Reduction of Unilateral Distal Radius Fractures

Abstract

Background: The standard of care of distal radius fractures requiring operative intervention involves restoration of anatomical alignment radiologically by comparing preoperative films and intraoperative fluoroscopy with established values based on population norms. The objective of this study is to evaluate the use of plain radiographs obtained from the uninjured wrist of patients who present with unilateral displaced distal radius fractures as a measure of successful achievement of anatomical realignment. Methods: A retrospective review was performed on 133 consecutive patients who presented from August 2020 to August 2021 with a diagnosis of unilateral distal radius fracture as confirmed on 3-view plain radiography. Patients who had bilateral radiographs and underwent open reduction and internal fixation were included. The primary outcome measure was comparison of radial inclination, radial height, tilt, and ulnar variance measured by 3 observers on preoperative, 1-week postoperative, and uninjured contralateral wrist films. Results: Twenty-one patients were included for analysis. Comparison of postoperative radiologic parameters with the contralateral uninjured extremity revealed a mean radial inclination difference of 3.8°, radial height difference of 2.0 mm, volar tilt difference of 6.3°, and ulnar variance difference of 0.9 mm. The average postreduction radial height was found to deviate from contralateral radial height significantly more than from the historic radial height parameter (2.0 vs 0.6 mm, P < .001). Conclusion: Attempts at achieving distal radius fracture reduction to within historical normal limits may result in an increased deviation from patient-specific anatomical parameters, especially with respect to radial height.

Distal Radius Fracture Subsidence after Nonoperative Treatment

“…However, the exact radiographic parameter that offers the best correlation remains controversial. 15,16 Changes in one of the aforementioned posttreatment parameters, following DRF treatment, that are determined to be unacceptable can be termed subsidence. Even within the patient population with nonoperatively treated DRFs, the incidence of reported subsidence varies in the literature.…”