Which Radiographic Parameters for Reduction Are Clinically Relevant Following Surgical Treatment of Distal Radius Fractures
Nicholas James Dantzker, MD; William P Abblitt, MD; Mihir J Desai, MD;
Vanderbilt University, Nashville, TN
Anatomic reduction of distal radius fractures with restoration of specific radiographic parameters is thought essential to achieving superior functional outcomes. Classically accepted radiographic parameters include volar tilt, radial inclination, ulnar variance, and radial height, all of which have been reported to correlate with functional outcomes. Among these measurements, however, certain parameters have proven to be more predictive of functional recovery than others. Moreover, novel radiographic parameters, most notably radial translation and teardrop angle (TDA), may be superior predictors of functional outcomes in distal radius fractures treated with volar locking plates. The aim of this study was to establish which anatomic radiographic parameters in distal radius fractures treated with volar locking plates are most important to satisfactory outcomes.
Medical records of patients who underwent operative fixation of a distal radius fracture at our level 1 trauma center between 1/1/2000 and 6/30/2016 were retrospectively reviewed for objective measurements of range of motion at the final postoperative visit. Injury films were reviewed and fracture severity was graded based on AO classification. Postoperative radiographs were reviewed to measure palmar tilt, ulnar variance, radial height, radial inclination, radial translation, and volar teardrop angle (TDA). Patients were contacted via mail and prospectively asked to fill out a QuickDASH survey and a VAS Pain Scale to assess their functional ability and pain level. A dominance analysis and a relative-weight analysis were performed to identify which radiographic parameters were most strongly predictive of patient-reported outcomes, range of motion, and maintenance of fracture reduction at final follow-up.
50 patients were included in the final statistical analysis. The average time from surgery to completion of the patient-reported outcome surveys was 5.6 years. The mean VAS score was 1.4 ±2.6. The mean QuickDash score was 13.4 ± 17.9. There was no significant difference in patient-reported outcomes based on initial injury severity. TDA the most important radiographic parameter in predicting superior Quickdash scores (p-value 0.076) and ulnar variance was the most important radiographic parameter in predicting superior VAS scores (p-value 0.107). These parameters were consistently found to be the most important predictors of patient-reported outcomes in both the dominance and the relative weight analysis.
The classically accepted radiographic parameters used to gauge adequacy of reduction of distal radius fractures are not all equally predictive of patient-reported outcomes. Ulnar variance and volar teardrop angle are the most important predictors of patient-reported outcomes in patients treated with volar locking plates.
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