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Bone Mineral Density is not a Predictor of Loss of Alignment Following Distal Radius Fracture Fixation
Minal D. Tapadia, JD, MD, MA1; William Dahl, MD2; Hillard T. Spencer, MD3; Neil Gregory Harness, MD3
1University of California, Irvine, Orange, CA; 2United Orthopaedic and Spine Center, Bridgeport, WV; 3Orthopedic Surgery, Kaiser Permanente Orange County, Anaheim, CA

Introduction: Osteoporosis increases the risk for distal radius fractures and makes it more difficult to maintain a closed reduction. Recent studies have reported preserved functional outcomes following operative fixation of distal radius fractures in patients with osteoporosis. However, few studies have explored whether low bone mineral density (BMD) predicts loss of alignment following operative fixation. Given that strong links have been noted between poor bone quality, screw cutout and loss of reduction in other contexts such as femoral neck fractures, we hypothesized that low BMD may similarly predict loss of alignment following distal radius fracture fixation.
Materials and Methods: A prospective cohort analysis of 116 patients (103 females, 13 males) was conducted between 2007 and 2012 at Kaiser Permanente in Orange County, in which patients were stratified into three groups based on DEXA score: normal (n = 21, T-score > -1), osteopenic (n =67, T-score -2.5 to 1), or osteoporotic (n = 28, T-score < -2.5). Patients were identified in a prospectively collected distal radius operative fracture registry. The AO classification of each fracture and radiographic parameters including palmar tilt, radial inclination and ulnar variance were measured on immediate postoperative films as well as on final 6-week postoperative films and recorded in the registry. In cases where immediate postoperative films were not available, 2-week postoperative films were used. For each group, the average immediate postoperative value for each radiographic parameter was compared to the average final value using paired t-tests (p<0.05).
Results: Several patients did have changes noted between their individual postoperative and final alignments. But the group as a whole exhibited no significant changes in radiographic parameters (radial inclination, 0.078 0.57 degrees; ulnar variance, -0.03 0.15 mm; and palmar tilt 0.09 0.20 degrees). Additionally, after controlling for age, sex, and AO classification in a multivariate analysis, the presence of osteoporosis or osteopenia had no statistically significant relationship with the average change in radial inclination, ulnar variance, or palmar tilt.
Conclusion: Low BMD does not exhibit a significant correlation with loss of reduction following internal fixation of distal radius fractures. Other factors such as bone geometry or trabecular structure and also surgical technique may be more responsible for loss of alignment after surgery than bone density alone.

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