Abstract
The purpose of this study was to assess the frequency of carpal instability as a concomitant lesion in distal radius fractures and identify other factors including carpal malalignment in an attempt to predict the final radiological outcome more accurately following conservative treatment of distal radius fractures. An observational study from patient records and standardised radiological follow-up examinations as data sources was used. The alignment of each wrist was checked radiographically immediately post-reduction and subsequently at 1- and 6-week follow-up assessments. Serial measurements of radial length, dorsal tilt, radial inclination, scapho-lunate, radio-lunate, radioscaphoid, scapho-capitate angles and effective radiolunate flexion angle were made. Regression analysis showed high correlation among the severity of axial shortening, pre-reduction dorsal angulation and radio-carpal malalignment pattern with early loss of reduction at 1 week. We found the age, severity of axial radial shortening, dorsal angulation, presence of dorsal comminution and radio-carpal malalignment pattern to be significant predictors of adverse radiological outcome at 6 weeks (late instability). Our study highlights the importance of radio-carpal instability pattern on post-reduction radiographs as a predictor of early and late instability.
Résumé
Le but de cette étude est de mesurer la fréquence des instabilités du carpe en tant que lésions associées aux fractures du radius distal, de délimiter les facteurs prédictifs de déplacement secondaire précoce et tardif comme les désaxations du carpe, dans le but de prédire le résultat radiologique final de manière plus précise après un traitement orthopédique d’une fracture du radius distal. Il s’agit d’une étude clinique sur dossiers et suivis radiologiques standards. La réduction de chaque poignet a été contrôlée radiographiquement, immédiatement après celle-ci et ensuite à une et six semaines. Des mesures en série de la longueur du radius, de l’inclinaison dorsale, de l’inclinaison radiale, des angles scapholunaires, radiolunaires, radioscaphoidiens et scaphocapital ainsi que l’angle de flexion radiolunaire effectif ont été mesurés. Une analyse de type régression statistique a montré une corrélation élevée entre l’importance du raccourcissement axial, de l’angulation dorsale avant réduction et de la désaxation radiocarpienne avec la perte de correction à une semaine. Nous avons trouvé que l’âge, l’importance du raccourcissement axial, l’angulation dorsale, la présence d’une comminution dorsale et la désaxation radiocarpienne étaient significativement prédictifs d’un mauvais résultat radiologique à six semaines (déplacement tardif). Notre étude met en lumière l’importance du morphotype radiocarpien sur les clichés post-réduction pour prédire les déplacements secondaires précoces et tardifs en association avec d’autres facteurs.
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Batra, S., Debnath, U. & Kanvinde, R. Can carpal malalignment predict early and late instability in nonoperatively managed distal radius fractures?. International Orthopaedics (SICO 32, 685–691 (2008). https://doi.org/10.1007/s00264-007-0386-x
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DOI: https://doi.org/10.1007/s00264-007-0386-x