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Two Wrongs Make a Right - Understanding the Link Between Distal Radius Alignment and Outcomes
Ruby Grewal, MD, MSc
1, Joy MacDermid, BScPT, MSc, PhD
2; Gilad Rotam, MD
3(1)Hand and Upper Limb Center, Western University, London, ON, Canada, (2)Hand and Upper Limb Center, University of Western Ontario, Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada, (3)Fellow, London, ON, Canada
Purpose:
The link between distal radius fracture alignment and outcome has been long debated, particularly in elderly patients. The purpose of this study was to determine whether integrating multiple radiographic parameters more accurately reflects the three-dimensional alignment of the wrist than assessing each parameter in isolation. Specifically, in the setting of positive ulnar variance (UV), the purpose was to determine if loss of radial inclination (RI) improves patient outcomes, compared to those subjects that maintain RI.
Methods:
This study included 216 patients from an existing database of distal radius fractures. Patients underwent radiographic evaluation and completed the standardized patient-reported outcome questionnaires. Acceptable alignment was defined as RI >15° and UV ?3 mm. We then combined the parameters to create four groups: unacceptable UV and RI (two wrongs), unacceptable UV + acceptable RI, acceptable UV + unacceptable RI and acceptable UV and RI (ideal alignment).
Results:
This study included 216 patients with a mean age of 55.2 years (range 18-89), 78% were female. Subjects with two abnormal alignment parameters (RI ?15? and UV >3mm) had significantly lower DASH and PRWE scores than those who lost radial height, but maintained radial inclination [DASH 10.5 point advantage, PRWE 11.8 point advantage, effect size 0.63 (DASH) and 0.57 (PRWE)]. With normal ulnar variance, there was no significant difference between acceptable and unacceptable radial inclination.
Conclusion:
Patients with both unacceptable UV and RI reported better outcomes than those with positive ulnar variance and maintained radial inclination. Furthermore, patients with unacceptable UV and RI had similar outcomes to those with ideal alignment. The findings of this study highlight the importance of considering the three-dimensional deformity seen with distal radius malunions rather than evaluating radiographic parameters in isolation. These findings may account for some of the discrepancies seen in existing literature when conflicting correlations between isolated radiographic parameters and outcomes occur.
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