Concomitant Carpal Injuries in Distal Radius Fractures: Retrospective Analysis by Plain Radiographs and Computed Tomography

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure.

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A retrospective analysis of the number of therapy visits after distal radius fractures using a new provider-scored clinical severity scale

Journal of Hand Therapy ◽

10.1016/j.jht.2017.06.008 ◽

2018 ◽

Vol 31 (4) ◽

pp. 480-485 ◽

Cited By ~ 1

Author(s):

Eric Kirby ◽

Sean Sparrow

Keyword(s):

Retrospective Analysis ◽

Distal Radius ◽

Distal Radius Fractures ◽

Clinical Severity ◽

Severity Scale ◽

Radius Fractures

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Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0039-3402424 ◽

2019 ◽

Vol 09 (02) ◽

pp. 129-135

Author(s):

Evan D. Nigh ◽

Christopher P. Emerson ◽

David To ◽

Spencer Barnhill ◽

Michael G. Rizzo ◽

...

Keyword(s):

Computed Tomography ◽

Distal Radius ◽

Motor Vehicle ◽

Ct Imaging ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Level Of Evidence ◽

Extensor Pollicis Longus ◽

Tendon Entrapment

Abstract Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

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Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Hand ◽

10.1177/1558944719862644 ◽

2019 ◽

pp. 155894471986264

Author(s):

Michael C. Daly ◽

Taylor A. Horst ◽

Chaitanya S. Mudgal

Keyword(s):

Distal Radius ◽

Null Hypothesis ◽

Independent Predictor ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Fracture Geometry ◽

Plain Radiographs ◽

Fracture Patterns ◽

Discrete Fracture ◽

Surgical Fixation

Background: Volar Barton fractures involve the volar articular margin of the distal radius with proximal and volar subluxation of the carpus. Although traditionally conceptualized as partial articular, some volar Barton fractures are complete articular injuries due to a dorsal cortical break in the distal radial metaphysis. While dorsal cortical breaks can affect surgical strategy, they may be difficult to identify on plain radiographs and their epidemiology remains poorly characterized. Some authors have hypothesized an association with osteoporosis; however, this hypothesis remains untested. To better characterize volar Barton fractures, we analyzed fracture geometry on pre-operative computed tomography (CT) scans to: (1) determine the frequency of a dorsal cortical break; and (2) test the null hypothesis that a dorsal cortical break is not associated with age or gender. Methods: We retrospectively reviewed adults with a volar Barton distal radius fracture and an available pre-operative CT who underwent surgical fixation. Using multivariable logistic regression, we assessed whether age or gender was an independent predictor of a dorsal cortical break. Results: Forty patients (mean age 52 years, 57% female) were identified. Including the shaft as a fragment, 32 (80%) had 3 or more discrete fracture fragments. Thirty patients (75%) had a dorsal cortical break. Dorsal cortical breaks were not associated with either age or gender ( P > 0.05). Conclusions: Most (75%) patients with volar Barton distal radius fractures had a dorsal cortical break. Dorsal cortical breaks were not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously hypothesized.

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