Volar Cortical Integrity in Non-Operatively Treated Adult Distal Radius Fractures

Abstract

Background: We sought to independently validate published data that volar cortical integrity (VCI) is an independent predictor of maintenance of closed reduction in a series of non-surgically treated distal radius fractures, while simultaneously investigating previously reported predictors of instability. Our null hypothesis was that volar cortical integrity would not affect maintenance of reduction. Methods: Four hundred thirty-three adult distal radius fractures were screened from our Orthopedic database with 112 meeting inclusion criteria. Two groups were determined on the basis of maintenance of reduction (MOR) or loss of reduction (LOR) at 5–6 weeks post-reduction. Bivariate analysis was applied to previously published instability factors along with VCI. A forward stepwise logistic regression was then used to identify instability factors that, as a group, are most predictive of outcome. Results: Results of 112 patients were collected. Reduction was maintained in 62 patients (55.35%) at 5–6 weeks Biivariate analysis showed a statistically significant difference in volar cortical integrity between the 2 groups (80.6% MOR vs 59.2% LOR). Forward stepwise logistic regression analysis of subgroups revealed that post-reduction radial height and VCI were together statistically significant in the model. The presence of VCI, post-reduction radial height greater than or equal to ulnar neutral at the time of initial reduction resulted in a 67.8% successful MOR. Conclusions: We were able to confirm the importance of volar cortical integrity as a predictor of successful maintenance of reduction in non-surgically managed distal radius fractures. When combined with post-reduction radial height greater than or equal to ulnar neutral at the time of initial reduction, it showed a 67.8% MOR with non-operative management in our data-set.

Radiographic prediction of Colles fracture displacement after splint fixation-a prospective study of 97 patients

“…Phillips believed that anatomical alignment of the volar cortex can effectively prevent axial compression of the fracture end, and restoration of the volar cortical hinge was a necessary step to allow external xation to function under the "three-point index" condition and if the volar cortex did not recover, the rate of surgery was 7.5 times higher [14] . Combined with the mechanism of action of splint external xation [15] , we believe that good anatomical alignment of the volar cortex may play four important roles in the treatment of Colles fractures with splint external xation: (1) The volar cortex can resist axial compressive stress and thus avoid short fractures; (2) The contact mechanism of the volar cortex enhances the meshing force of the fracture end; (3) The volar cortex provides the fulcrum of the fracture lever force to avoid slippage of the distal end of the fracture; (4) The volar cortex and the splint produce restricted and stable physiological stress which may help promote fracture healing. Dorsal comminution is common in Colles fractures, and in this study, dorsal comminution was also one of the risk factors for predicting fracture redisplacement after splinting.…”