Arch Hand Microsurg.  2024 Sep;29(3):154-162. 10.12790/ahm.24.0028.

Intra-articular fracture reduction: a comparative observational study of clinical results after the surgical treatment of distal radius fractures

• Kim DS
• Kim SJ
• Shim JW

• KMID: 2558739
• DOI: http://doi.org/10.12790/ahm.24.0028

Abstract

Purpose
This study compared the outcomes of intra-articular fracture reduction for distal radius fractures.
Methods
Among 180 patients who underwent open reduction and plate fixation, the exclusion criteria were as follows: non-acute fracture (>1 month), an accompanying ulnar neck fracture, a distal ulnar fracture requiring fixation, fixation through the dorsal approach, other accompanying hand fractures, the absence of preoperative or postoperative computed tomography (CT), and follow-up for <1 year. Intra-articular fractures were evaluated through CT. Forty-eight patients with intra-articular fractures were studied. Displaced intra-articular fractures were defined as: (1) articular step-off ≥1 mm, (2) fracture gap ≥2 mm, or (3) gross incongruence. Reduction was classified as good (n=23) or poor (n=25) based on postoperative CT. The pain visual analogue scale (pVAS), the quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and range of motion of the wrist joint were compared between both groups.
Results
No significant between-group differences were found in the preoperative demographic data and the postoperative pVAS and quick DASH scores (pVAS: 0.6 vs. 0.8 and quick DASH: 9.4 vs. 10.2 in the good vs. poor reduction groups, respectively). However, the flexion-extension arc was significantly restricted in the poor reduction group (162° in the good reduction group vs. 146° in the poor reduction group, p<0.001).
Conclusion
The reduction of the articular surface was not related to pain and functional results at the mid-term follow-up after the surgical treatment of intra-articular distal radius fractures. However, insufficient fracture reduction affected the postoperative range of motion.

Keyword

Wrist fractures; Intra-articular fractures; Comparative study; Computed tomography; X ray; Radius fracture

Figure

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  Fig. 1. Patient selection in this study: preoperative displaced intra-articular fractures in 48 out of 180 surgical cases. During the study period, 180 patients underwent surgery. Patients were assessed to determine whether they met the study criteria, and ultimately, 48 patients with preoperative displaced intra-articular fractures were included in the study. CT, computed tomography.

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  Fig. 2. Preoperative and postoperative X-ray and computed tomography (CT) images of the good reduction group. (A) Preoperative X-rays. (B) Preoperative CT. (C) Postoperative X-rays. (D) Postoperative CT.

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  Fig. 3. Preoperative and postoperative X-ray and computed tomography (CT) images of the poor reduction group. (A) Preoperative X-rays. (B) Preoperative CT. (C) Postoperative X-rays. (D) Postoperative CT. In the sagittal view, a 2.88-mm step-off (arrow) can be observed.

Reference

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