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Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures
Mark Vitale, MD, MPH1; David M. Brogan2; Alexander Shin2; Richard A. Berger, MD, PhD2
1ONS, PC, ONS Foundation for Clinical Research and Education, Greenwich, CT; 2Orthopedic Surgery, Mayo Clinic, Rochester, MN

Introduction: Studies have established increased risk of radiocarpal joint post-traumatic arthritis (PTA) in patients with displaced intra-articular fractures of the distal radius, although this has yet to be evaluated in the distal radioulnar joint (DRUJ). We hypothesize that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ PTA and greater upper extremity dysfunction compared to fractures without sigmoid notch involvement.

Methods: A retrospective review was conducted on surgically treated patients with distal radius fractures with preoperative computed tomography (CT) scans. Patients were divided into those with and without involvement of the articular margin of the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch stepoff and diastasis in axial and coronal planes (mm), and volar or dorsal DRUJ subluxation (%). At final follow-up patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) scores and AP and lateral XRs were obtained to grade DRUJ PTA based on the Kellgren Lawrence (KL) scale.

Results: Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.4 years. DASH scores were available for all patients, and long-term radiographic follow-up was available in 24 patients. There was a trend towards poorer average DASH in those with sigmoid notch involvement (mean=53.4, SD=26.5) versus those without (mean=42.43, SD=22.9), but this was not statistically different (p>0.05). Similarly, there was a trend towards higher grade of DRUJ arthritis in those with sigmoid notch involvement (mean KL score=1.6, SD=1.1) versus those without (mean KL score=1.1, SD=0.8), but this was not significantly different (p>0.05). There were no significant correlations between sigmoid notch stepoff, diastasis or DRUJ subluxation with DASH scores or KL grade. Within the subset of patients with sigmoid notch involvement there were poorer DASH scores in patients with coronal stepoff > 1.0-mm (mean=94.0, SD=15.6) versus those with stepoff ? 1.0-mm (mean=49.4, SD=23.9, p=0.022).

Conclusion: Fractures involving the sigmoid notch did not appear to have a greater prevalence of DRUJ PTA in operatively treated patients at greater than 6 years of follow-up. Postoperative stepoff, diastasis and subluxation did not correlate with subsequent risk of DRUJ PTA. While overall there appeared to be a minimal effect of postoperative sigmoid notch stepoff, diastasis or DRUJ subluxation on postoperative upper extremity function, fractures with a coronal stepoff of > 1.0-mm had poorer upper extremity function.

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