What are the radiological predictors of functional outcome following fractures of the distal radius?

The fracture most commonly treated by orthopaedic surgeons is that of the distal radius. However, as yet there is no consensus on what constitutes an 'acceptable' radiological position before or after treatment. This should be defined as the position that will predict good function in the majority of cases. In this paper we review the radiological indices that can be measured in fractures of the distal radius and try to identify potential predictors of functional outcome. In patients likely to have high functional demands, we recommend that the articular reconstruction be achieved with less than 2 mm of gap or step-off, the radius be restored to within 2 mm of its normal length, and that carpal alignment be restored. The ultimate aim of treatment is a pain-free, mobile wrist joint without functional limitation.

[1]  J. Yao.  Effect of an Unrepaired Fracture of the Ulnar Styloid Base on Outcome After Plate-and-Screw Fixation of a Distal Radial Fracture , 2010 .

[2]  V. Tan,et al.  The Effect of Rotational Malalignment on X-rays of the Wrist , 2009, The Journal of hand surgery, European volume.

[3]  T. Rozental.  Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis? , 2009 .

[4]  A. Sakai,et al.  The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. , 2009, The Journal of bone and joint surgery. British volume.

[5]  K. Azari.  Fifteen-Year Outcome of Displaced Intra-Articular Fractures of the Distal Radius , 2008 .

[6]  Z. Földhazy,et al.  Long-term outcome of nonsurgically treated distal radius fractures. , 2007, The Journal of hand surgery.

[7]  H. Abbaszadegan,et al.  Patient-perceived outcome after displaced distal radius fractures. A comparison between radiological parameters, objective physical variables, and the DASH score. , 2007, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[8]  J. Macdermid,et al.  The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. , 2007, The Journal of hand surgery.

[9]  D. Bynum,et al.  Malunion of the distal radius. , 2007, The Journal of the American Academy of Orthopaedic Surgeons.

[10]  C. Court-Brown,et al.  Epidemiology of adult fractures: A review. , 2006, Injury.

[11]  E. Panagiotopoulos,et al.  Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. , 2005, Injury.

[12]  R. Medoff.  Essential radiographic evaluation for distal radius fractures. , 2005, Hand clinics.

[13]  D. Ring,et al.  Corrective osteotomy for intra-articular malunion of the distal part of the radius. , 2005, The Journal of bone and joint surgery. American volume.

[14]  P. Leung,et al.  Low BMD Is a Risk Factor for Low-Energy Colles’ Fractures in Women before and after Menopause , 2005, Clinical orthopaedics and related research.

[15]  P. Johnson,et al.  Angle measurements of the distal radius: a cadaver study , 2004, Skeletal Radiology.

[16]  M. McQueen,et al.  Fractures of the distal radius in low-demand elderly patients: Closed reduction of no value in 53 of 60 wrists , 2003, Acta orthopaedica Scandinavica.

[17]  P. Blazar,et al.  Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. , 2002, The Journal of hand surgery.

[18]  J L Marsh,et al.  Articular fractures: does an anatomic reduction really change the result? , 2002, The Journal of bone and joint surgery. American volume.

[19]  S. Batra,et al.  The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. , 2002, Injury.

[20]  Jesse B. Jupiter,et al.  Fractures of the Distal Radius , 2002, Springer New York.

[21]  J. Gliatis,et al.  Outcome of Distal Radial Fractures in Young Adults , 2000, Journal of hand surgery.

[22]  S. C. Nicolaidis,et al.  Acute injuries of the distal radioulnar joint. , 2000, Hand clinics.

[23]  P. Broos,et al.  The Importance of the Distal Radioulnar Joint in Distal Radial Fractures , 1998, Journal of hand surgery.

[24]  L. Gilula,et al.  Displaced Intra-Articular Fractures of the Distal Aspect of the Radius. Long-Term Results in Young Adults after Open Reduction and Internal Fixation* , 1997, The Journal of bone and joint surgery. American volume.

[25]  A. Tencer,et al.  Effects of intra-articular distal radius depression on wrist joint contact characteristics. , 1996, The Journal of hand surgery.

[26]  C. Court-Brown,et al.  Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. , 1996, The Journal of bone and joint surgery. British volume.

[27]  D. Ring,et al.  A Comparison of Early and Late Reconstruction of Malunited Fractures of the Distal End of the Radius* , 1996, The Journal of bone and joint surgery. American volume.

[28]  M. Baratz,et al.  Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. , 1996, The Journal of hand surgery.

[29]  A. Azzará,et al.  The reliability of classification of articular fractures of the distal radius , 1996 .

[30]  N. Gerostathopoulos,et al.  The iliac crest graft and the Herbert screw for treatment of non-union of the scaphoid , 1996 .

[31]  A. Palmer,et al.  The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation. , 1996, The Journal of hand surgery.

[32]  M F Swiontkowski,et al.  X-ray film measurements for healed distal radius fractures. , 1996, The Journal of hand surgery.

[33]  H. Bouman,et al.  Measurement of Ulnar Translation and Carpal Height , 1994, Journal of hand surgery.

[34]  T. Trumble,et al.  Factors affecting functional outcome of displaced intra-articular distal radius fractures. , 1994, The Journal of hand surgery.

[35]  B. Adams.  Effects of radial deformity on distal radioulnar joint mechanics. , 1993, The Journal of hand surgery.

[36]  U. Bengnér,et al.  Fractures of the Distal End of the Radius in Young Adults: A 30-Year Follow-Up , 1993, Journal of hand surgery.

[37]  W. Cooney,et al.  Open reduction and internal fixation for distal radius fractures. , 1992, The Journal of hand surgery.

[38]  J. Shaw,et al.  Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation. , 1990, The Journal of hand surgery.

[39]  M. McQueen,et al.  Colles fracture: does the anatomical result affect the final function? , 1988, The Journal of bone and joint surgery. British volume.

[40]  N. Jenkins,et al.  Mal-union and dysfunction in Colles' fracture. , 1988, Journal of hand surgery.

[41]  F W Werner,et al.  A biomechanical study of distal radial fractures. , 1987, The Journal of hand surgery.

[42]  T. Davis.  Intra-articular fractures of the distal end of the radius in young adults. , 1987, The Journal of bone and joint surgery. American volume.

[43]  R Antenucci,et al.  Long-term results of conservative treatment of fractures of the distal radius. , 1986, Clinical orthopaedics and related research.

[44]  S. Solgaard.  Classification of distal radius fractures. , 1985, Acta orthopaedica Scandinavica.

[45]  F W Werner,et al.  Ulnar variance determination. , 1982, The Journal of hand surgery.

[46]  W. B. Guilford,et al.  Ulnar variance--the effect of wrist positioning and roentgen filming technique. , 1982, The Journal of hand surgery.

[47]  R. Ericson,et al.  Colles' fracture. How should its displacement be measured and how should it be immobilized? , 1981, The Journal of bone and joint surgery. American volume.

[48]  S. Friberg,et al.  Radiographic Measurements on the Radio-Carpal Joint in Distal Radial Fractures , 1976, Acta radiologica: diagnosis.

[49]  S Friberg,et al.  Radiographic Measurements of the Radio-Carpal Joint in Normal Adults , 1976, Acta radiologica: diagnosis.

[50]  G. Frykman.  Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radioulnar joint and impairment of nerve function , 1967 .

[51]  J. Gartland,et al.  Evaluation of healed Colles' fractures. , 1951, The Journal of bone and joint surgery. American volume.