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The Capitate-to-axis-of-radius distance (CARD) as a Predictor of Clinical Outcomes Following Distal Radius Fracture
Brandon J Ball, MD; Ruby Grewal, MD, MSc; Kevin Chan, MD; Joy Macdermid, BSc, BScPT, MSc, PhD; Nina Suh, MD
University of Western Ontario, Roth MacFarlane Hand and Upper Limb Centre, Canada, London, ON, Canada
Introduction: The Capitate-to-axis-of-radius distance (CARD) is a new radiographic index to assess sagittal radiocarpal alignment. The purpose of the present study was to determine whether CARD measurements correlated with clinical outcomes following a distal radius fracture.
Materials & Methods: A retrospective review using our institutional database was performed of all patients from 2002-2006 with a minimum follow-up of 6 months post distal radius fracture. All treatment methods were included but any patients aged >65 or <18 were excluded from our study. Collection of demographic data and clinical outcomes were then performed to include range of motion (ROM), grip strength, and PRWE scores. Additionally, radiographic measurements including CARD, volar tilt, ulnar variance, and radial length were measured on plain radiographs. Statistical comparisons were performed using linear regression and ANOVA to compare means.
Results: A total of 204 patients were included in the database with a mean age of 50 years (range 19-64). Females comprised 69% of the patients (n=141) and 51% of patients fractured the radius in their dominant hand (n=101). Workmens compensation claims were associated with 9% of the patients (n= 14). The mean CARD for all distal radius fractures included was 7.0 ± 5.5mm (normal = 2.2) and the mean volar tilt was -0.7 ± 8.9° (range = -36-17°). Malunion occurred in 12% of the fractures (n=25). The average PRWE score was 18 ± 20. CARD demonstrated a positive correlation with wrist extension (R=0.337, p<0.001). However, there was a negative correlation between CARD and wrist flexion (r=-0.386, p<0.001), pronation (r=0.272, p<0.01), and volar tilt (r=0.695, p<0.001). Furthermore, the CARD was similar between groups when PRWE was categorized to scores or 0-25, 25-50, and 50-100 (p=0.670).
Conclusion: CARD was measured for a subset of patients <65 years of age and compared to clinical outcomes. CARD did relate to some physical impairment measures such as pronation, extension and flexion. However in this cohort CARD nor volar tilt related to PRWE scores. This may have been related to the relatively low number of malunions and good outcomes in most patients. Further research is needed to determine the significance of the CARD.
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