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Carpal alignment in distal radial fractures
Ajay Gupta1, Sumit Batra, Pankaj Jain
1Department of Orthopaedic Surgery, Maulana Azad Medical College and associated LN Hospital New Delhi-110002, India. drajaygupta@hotmail.com
BMC Musculoskeletal Disorders
|June 8, 2002
Summary
Carpal malalignment after distal radial fractures often corrects with reduction, indicating it develops during immobilization, not as a later adaptation. Early assessment on post-reduction films is crucial for accurate diagnosis.
Area of Science:
- Orthopedic surgery
- Radiology
- Biomechanics
Background:
- Carpal malalignment can develop after distal radial fractures as an adaptive response.
- This malalignment may worsen over time due to wrist loading or develop during immobilization.
Purpose of the Study:
- To investigate the natural course and quantify adaptive carpal realignment after distal radial fractures.
- To understand the timing and patterns of carpal malalignment development.
Main Methods:
- A prospective study followed 118 distal radial fractures treated with various methods.
- Serial radiographs were taken for one year to assess radiological parameters and carpal alignment.
Main Results:
- Two patterns of carpal malalignment were identified based on pre-reduction radio-lunate flexion (ERLF).
- Midcarpal malalignment (ERLF < 25°) occurred in 83% of fractures, with the lunate following the distal radius fragment.
- Radio-carpal malalignment (ERLF > 25°) showed the distal radius fragment moving independently of the lunate.
Conclusions:
- Carpal malalignments often resolve with successful fracture reduction, suggesting they develop during immobilization.
- Assessing wrist ligamentous injury on post-reduction films is more reliable than pre-reduction films.
- Malalignments can reappear with fracture redisplacement, challenging the notion of a purely compensatory mechanism for malunion.