Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator?

Trine Ludvigsen, Kjell Matre, Nils Vetti, Per Martin Kristoffersen, Monika Kolskår Toppe, Rakel Gudmundsdottir, Yngvar Krukhaug, Eva Dybvik, Jonas Meling Fevang, Trine Ludvigsen, Kjell Matre, Nils Vetti, Per Martin Kristoffersen, Monika Kolskår Toppe, Rakel Gudmundsdottir, Yngvar Krukhaug, Eva Dybvik, Jonas Meling Fevang

Abstract

The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome.

Methods: The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters.

Results: At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (-15°, 25°), reduced radial inclination 2.3° (-6°, 12°), radial height 1.3 mm (-4 mm, 7 mm), and ulnar variance -0.5 mm (-6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found.

Conclusions: We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013.

Keywords: PRWHE; displaced extra-articular fracture; distal radius fracture; external fixation; radiographic measurements; volar locking plate.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.

Figures

Figure 1
Figure 1
PA views of the wrist. PA = posterior-anterior.
Figure 2
Figure 2
Lateral views of the wrist.
Figure 3
Figure 3
Result volar/dorsal tilt at 1 year.
Figure 4
Figure 4
Result radial inclination at 1 year.
Figure 5
Figure 5
Result radial height at 1 year.
Figure 6
Figure 6
Ulnar variance at 1 year.

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Source: PubMed

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