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Archives of Orthopaedic and Trauma Surgery

, Volume 136, Issue 3, pp 425–432 | Cite as

1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures

  • Renata GologanEmail author
  • V. M. Ginter
  • A. Haeffner
  • U. Obertacke
  • U. Schreiner
Handsurgery
  • 212 Downloads

Abstract

Introduction

Ligamentous lesions are concomitant to dislocated distal radius fractures in a high percentage. The purpose of this study was to evaluate the relevance of intracarpal lesions.

Methods

Seventy eight of an original cohort of 104 distal radius fractures (74 %) were studied over a follow-up period of one year after surgery with complete data (X-rays, CT, MRI, follow-up X-rays and questionnaire).

Results

Most of our radius fractures (AO 23 type: A 39, B 9, C 30) present additional lesions: 97 %. One-year evaluation showed an average Castaing score of 4.5 ± 2.5 points, means a “good” result of a scale of 0–27. Fifty five of seventy eight had an “excellent” or “good” result (<6 points). No patient had more than 12 points (“fair”).

Conclusions

The dislocated distal radial fracture implies severe and complex injury to the whole wrist, mostly concerning intracarpal concomitant lesions (MRI). Surgical therapy of dislocated radius fractures followed by 6 weeks relief through thermoplastic splint seems to be sufficient to achieve good 1-year results. MRI-detectable carpal lesions at the time of the radial fracture are common, but only a few of them seem to decompensate later, give symptoms and became of therapeutic relevance.

Keywords

Distal radius fracture Concomitant ligament lesions Intracarpal lesions Outcome distal radius fracture 

Notes

Compliance with ethical standards

Ethics Committee of the Ruprecht-Karls-University Heidelberg, Medical Faculty Mannheim on 11/26/2004, reference number 225/04.

Conflict of interest

Renata Emiliana Gologan, Vera Maria Ginter, Astrid Haeffner, Udo Obertacke, Ute Schreiner declare that they have no conflict of interest.

References

  1. 1.
    Chen NC, Jupiter JB (2007) Management of distal radial fractures. J Bone Joint Surg Am 89:2051–2062CrossRefPubMedGoogle Scholar
  2. 2.
    Poigenfürst L (1980) Brüche am distalen Unterarmende. Einteilung der Bruchformen und Indikation. H Unfallheilkunde 148:53–59Google Scholar
  3. 3.
    Fernandez DL, Jupiter JB (2002) Fractures of the distal radius—a practical approach to management. In: Fractures of the distal radius 2. Aufl. Springer, New YorkGoogle Scholar
  4. 4.
    Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21:316–322CrossRefPubMedGoogle Scholar
  5. 5.
    Campbell DA (2000) Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate. J Hand Surg (Br) 25:528–534CrossRefGoogle Scholar
  6. 6.
    Fischer M, Denzler C, Sennwald G (1996) Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases. Swiss Surg 2:269–272PubMedGoogle Scholar
  7. 7.
    Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg [Br] 22:638–643CrossRefGoogle Scholar
  8. 8.
    Herbert TJ, Faithfull RG, McCann DJ, Ireland J (1990) Bilateral arthrography of the wristGoogle Scholar
  9. 9.
    Pilný J, Kubes J, Hoza P et al (2007) Scapholunate instability of the wrist following distal radius fracture. Acta Chir Orthop Traumatol Cech 74(1):55–58PubMedGoogle Scholar
  10. 10.
    Gologan R, Ginter VM, Ising N, Kilian AK, Obertacke U, Schreiner U (2014) Unfallchirurg 117(1):48–53. doi: 10.1007/s00113-012-2264-2.German CrossRefPubMedGoogle Scholar
  11. 11.
    Laulan J, Bismuth JP (1999) Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year. A prospective study of 95 cases. Acta Orthop Belg 65:418–423PubMedGoogle Scholar
  12. 12.
    Tang JB, Shi D, Gu YQ, Zhang QG (1996) Can cast immobilization successfully treat scapho—lunate dissociation associated with distal radius fractures? J Hand Surg (Am) 21:583–590CrossRefGoogle Scholar
  13. 13.
    Ehalt W (1935) Die Bruchformen am unteren Ende der Speiche und Elle. Arch OrthopUnf Chir Z5:397–465Google Scholar
  14. 14.
    Bacorn RW, Kurtzke JF (1953) Colles’ fracture: a study of two thousand cases from the New York State workmen’s compensation board. JBJS 35-A:643–658Google Scholar
  15. 15.
    Pechlaner S, Gabl M, Lutz M, Krappinger D, Leixnering M, Krulis B, Ulmer H, Rudisch A (2007) Distal radius fractures-aetiology, treatment and outcome. Handchir Mikrochir Plast Chir 39:19–28CrossRefPubMedGoogle Scholar
  16. 16.
    Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. S2e Leitlinie: Distale Radiusfraktur vom 10.02.2015. http://www.awmf.org/uploads/tx_szleitlinien/012-015l_S2e_Distale_Radiusfraktur_2015-02.pdf
  17. 17.
    Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697CrossRefPubMedGoogle Scholar
  18. 18.
    Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg (Am) 22:792–800CrossRefGoogle Scholar
  19. 19.
    Rose S, Frank J, Marzi I (1999) Diagnostic and therapeutic significance of arthroscopy in distal radius fracture. Zentralbl Chir 124:984–992PubMedGoogle Scholar
  20. 20.
    Rappold G, Leixnering M, Pezzei C (2001) Carpal injuries associated with distal radius fractures. Diagnosis and therapy. Handchir Mikrochir Plast Chir 33:221–228CrossRefPubMedGoogle Scholar
  21. 21.
    Kordasiewicz B, Pomianowski S, Orlowski J, Rapala K (2006) Interosseous ligaments and TFCC lesions in intraarticular distal radius fractures—radiographic versus arthroscopic evaluation. Ortop Traumatol Rehabil 8:263–267PubMedGoogle Scholar
  22. 22.
    Castaing J (1964) Les fractures récentes de l'extrémité inférieure du radius chez l'adulte. Rev Chir Orthop Reparatrice Appar Mot 50:581–696PubMedGoogle Scholar
  23. 23.
    Gartland John J, Werley Charles W (1951) Evaluation of healed Colles fracture. JBJS 33-A(4):895–907Google Scholar
  24. 24.
    Changulani M, Okonkwo U, Keswani T, Kalairajah Y (2008) Outcome evaluation measures for wrist and hand: which one to choose? Int Orthop 32(1):1–6 (Epub 2007 May 30. Review) PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Seifert J, Müller C, Schauwecker HH (1998) Studying minimally invasive osteosynthesis methods for distal radius fractures. Intra-focal vs. conventional wire osteosynthesis. Unfallchirurgie 24(1):18–24PubMedGoogle Scholar
  26. 26.
    Gruber G, Zacherl M, Giessauf C, Glehr M, Fuerst F, Liebmann W, Gruber K, Bernhardt GA (2010) Quality of life after volar plate fixation of articular fractures of the distal part of the radius. J Bone Joint Surg Am 92(5):1170–1178CrossRefPubMedGoogle Scholar
  27. 27.
    Figl M, Weninger P, Liska M, Hofbauer M, Leixnering M (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129(5):661–669CrossRefPubMedGoogle Scholar
  28. 28.
    Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS (2009) Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 91(8):1837–1846CrossRefPubMedGoogle Scholar
  29. 29.
    MacKay BJ, Montero N, Paksima N, Egol KA (2013) Outcomes following operative treatment of open fractures of the distal radius: a case control study. Iowa Orthop J 33:12–18PubMedCentralPubMedGoogle Scholar
  30. 30.
    Gliatis JD, Plessas SJ, Davis TR (2000) Outcome of distal radial fractures in young adults. J Hand Surg (Br) 25:535–543CrossRefGoogle Scholar
  31. 31.
    Schädel-Hopfner M, Bohringer G, Junge A, Celik I, Gotzen L (2001) Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius. Handchir Mikrochir Plast Chir 33:229–233CrossRefPubMedGoogle Scholar
  32. 32.
    Schädel-Hopfner M, Iwinska-Zelder J, Bohringer G, Braus T, Klose KJ, Gotzen L (2001) MRI or arthroscopy in the diagnosis of scapholunate ligament tears in fractures of the distal radius? Handchir Mikrochir Plast Chir 33:234–238CrossRefPubMedGoogle Scholar
  33. 33.
    Spies CK, Prommersberger KJ, Langer M, Müller LP, Hahn P, Unglaub F (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg 118(8):701–717CrossRefPubMedGoogle Scholar
  34. 34.
    Spies CK, Müller LP, Oppermann J, Hahn P, Unglaub F (2014) Instability of the distal radioulnar joint—an overview of clinical and radiological procedures regarding their efficacies. Handchir Mikrochir Plast Chir 46(3):137–150CrossRefPubMedGoogle Scholar
  35. 35.
    Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger KJ (2009) Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 41(5):295–299CrossRefPubMedGoogle Scholar
  36. 36.
    Jakob M, Rikli DA, Regazzoni P (2000) Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br 82(3):340–344CrossRefPubMedGoogle Scholar
  37. 37.
    Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89(11):2334–2340CrossRefPubMedGoogle Scholar
  38. 38.
    Frank J, Pralle H, Lehnert M, Marzi I (2010) Begleitverletzungen distaler Radiusfrakturen. Unfallchirurg 113(10):796, 797–803Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Renata Gologan
    • 1
    Email author
  • V. M. Ginter
    • 1
  • A. Haeffner
    • 2
  • U. Obertacke
    • 1
  • U. Schreiner
    • 1
  1. 1.Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität HeidelbergMannheimGermany
  2. 2.Alameda County Medical CenterOaklandUSA

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