Distal Radius Fracture Outcome Factors in Younger Patients
Distal Radius Fracture Outcome Factors in Younger Patients
It is known that distal radius fractures in patients of the non-osteoporotic age usually result from high energy trauma and often have intra-articular involvement. Furthermore, they are associated with a higher incidence of cartilage, inter-carpal ligament and TFCC lesions. These fractures are correlated with a worse outcome when instability of the distal radioulnar joint is present. This instability does not correlate with radiographic features at the time of the trauma or at follow-up but to the presence of arthroscopically diagnosed peripheral TFCC-tears.
In order to predict, and thereby hopefully prevent, a bad outcome in non-osteoporotic fractures it is important to find the earliest prognostic markers for general bad outcome. These are patient characteristics and radiographic measurements on the traumaradiograph. The aim of this study was to assess the most objective parameters on the initial radiograph; these are i.e. radiocarpal joint surface tilt, radial length, radial inclination, ulnar variance. Furthermore we assessed more subjective radiologic parameters such as comminution as described in the subclasses of the AO-classification and fractures through the ulnar styloid or the distal radio-ulnar or radiocarpal joint surfaces. In order to correlate these findings with functional outcome these findings were correlated with objective and subjective clinical outcome as assessed with the modified Gartland and Werley score at 2 years (middle long) follow-up of distal radius fractures in a younger than osteoporotic age group. We correlated the radiological findings with both the subjective part as well as the complete modified Gartland and Werley score to assess whether the subjective part alone could be used as a patient reported outcome measure.
Background
It is known that distal radius fractures in patients of the non-osteoporotic age usually result from high energy trauma and often have intra-articular involvement. Furthermore, they are associated with a higher incidence of cartilage, inter-carpal ligament and TFCC lesions. These fractures are correlated with a worse outcome when instability of the distal radioulnar joint is present. This instability does not correlate with radiographic features at the time of the trauma or at follow-up but to the presence of arthroscopically diagnosed peripheral TFCC-tears.
In order to predict, and thereby hopefully prevent, a bad outcome in non-osteoporotic fractures it is important to find the earliest prognostic markers for general bad outcome. These are patient characteristics and radiographic measurements on the traumaradiograph. The aim of this study was to assess the most objective parameters on the initial radiograph; these are i.e. radiocarpal joint surface tilt, radial length, radial inclination, ulnar variance. Furthermore we assessed more subjective radiologic parameters such as comminution as described in the subclasses of the AO-classification and fractures through the ulnar styloid or the distal radio-ulnar or radiocarpal joint surfaces. In order to correlate these findings with functional outcome these findings were correlated with objective and subjective clinical outcome as assessed with the modified Gartland and Werley score at 2 years (middle long) follow-up of distal radius fractures in a younger than osteoporotic age group. We correlated the radiological findings with both the subjective part as well as the complete modified Gartland and Werley score to assess whether the subjective part alone could be used as a patient reported outcome measure.
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