Are Radiographic Characteristics Associated With Outcome in Surgically Treated Distal Radius Fractures?

Area of Science:

• Orthopedic Surgery
• Radiology
• Biomedical Engineering

Background:

• Distal radius fracture displacement on standard radiographs often fails to predict patient outcomes.
• Quantitative 3-dimensional computed tomography (Q3DCT) offers a more precise assessment of fracture displacement.
• Understanding the relationship between residual displacement and functional recovery is crucial for treatment optimization.

Purpose of the Study:

• To evaluate the association between radiographic, CT, and Q3DCT measures of residual displacement and patient outcomes.
• To assess the impact of fracture displacement on disability, quality of life, range of motion (ROM), and grip strength.
• To determine predictors of functional recovery after volar plating for intra-articular distal radius fractures.

Main Methods:

• Secondary analysis of a prospective multicenter trial involving 71 patients with distal radius fractures treated with volar plating.
• Collection of demographic data and detailed radiographic and CT measurements of fracture displacement (gap, step-off, fragment characteristics).
• Assessment of patient-reported outcomes (PRWE, EQ5D), grip strength, and composite wrist ROM at 12 weeks and 1 year post-surgery.

Main Results:

• Older age was associated with greater recovery in patient-reported wrist evaluation scores at 1 year.
• Injury to the dominant side and less posteroanterior (PA) radiographic step-off were linked to improved composite wrist ROM at 1 year.
• Q3DCT measures did not show an independent association with functional outcomes in this cohort.

Conclusions:

• Minimal PA step-off on radiographs may be associated with a modest improvement in wrist ROM.
• These findings are important for patient counseling regarding surgical treatment, especially for older, low-demand individuals.
• Radiographic assessment of step-off provides prognostic information for wrist ROM recovery.