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American Association for Hand Surgery

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Use of Plain Radiography of Uninjured Wrists as Patient-Specific Markers of Successful Reduction of Unilateral Distal Radius Fractures
Lyahn Hwang, MD1, Joseph Yi, B.A.1, Fei Wang, B.A.1, Nicolas Greige, BS2, Matthew David Treiser, M.D., Ph.D.3 and Joseph A Ricci, MD4, (1)Montefiore Medical Center, Bronx, NY, (2)Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, (3)The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD, (4)Montefiore Health System, Bronx, NY

Purpose:
The standard of care of distal radius fractures requiring operative intervention involves re-establishing anatomic alignment radiologically by comparing pre-operative films and intra-operative fluoroscopy to established values based on population norms. We aim to retrospectively evaluate the use of plain radiographs obtained from the uninjured wrist of patients who present with unilateral displaced distal radius fractures requiring operative intervention as a measure of successful achievement of anatomic realignment. We hypothesize that comparison of radiographs of the injured wrist after operative fixation to the patient's own contralateral films is superior to, or at least not inferior to, comparison to population norms.
Methods:
A retrospective review was performed on 123 consecutive patients who presented to our institution from August 2020 to April 2021 with diagnosis of unilateral distal radius fracture as confirmed on three-view plain radiography. Patients who had bilateral three-view wrist plain radiographs and underwent open reduction and internal fixation were included. Primary outcome measure was comparison of a set of distinct radiological parameters (radial inclination, radial height, tilt, ulnar variance) measured by three observers on preoperative, 1-week post-operative, and uninjured contralateral wrist films. Secondary outcome measure includes the Disabilities of the Arm, Shoulder and Hand (DASH) Score. Statistical analysis was performed using paired t test and intraclass correlation coefficient (ICC).
Results:
Seventeen patients were included for analysis. The median age of participants was 54 years. The majority of participants (64.7%) were female. 70.6% of patients underwent open reduction and internal fixation with only a volar locking plate. Radiologic examination of the uninjured extremity revealed a mean radial inclination of 24.0°, radial height of 11.7 mm, volar tilt of 8.9°, and ulnar variance of 1.0 mm. Comparison of postoperative radiologic parameters to the contralateral uninjured extremity revealed a mean radial inclination difference of 4.1°, radial height difference of 2.1 mm, volar tilt difference of 6.3°, and ulnar variance difference of 0.9 mm. Average post-reduction radial height was found to deviate from contralateral radial height significantly more than from the historic radial height parameter (2.1 vs. 0.7 mm, p<0.01). Of note, ICC equaled 0.93, indicating excellent reliability between observers. DASH surveys were obtained one month post-operatively from seven patients with an average score of 64.9.
Conclusion:
Normal radiologic reduction parameters likely vary between patients. Attempts at achieving distal radius fracture reduction to within historic normal limits may result in an increased deviation from patient-specific anatomic parameters, especially with respect to radial height.


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