Abstract
PurposeTo assess the association between the fracture line distribution and the location of comminution in intra-articular distal radius fractures by building fracture mapping.Patients/methodsForty cases with intra-articular fractures of distal radius were enrolled in the current prospective clinical study. Fracture lines and comminution zones were identified by reduced three-dimensional computed tomography reconstructions and then graphically superimposed onto a standard template to create two-dimensional fracture maps, followed by the conversion into heating maps. Based on qualitative descriptive fracture mapping analyses, the patterns of intra-articular distal radius fractures were determined.ResultsIt was observed that the highest fracture line intensity was located as an inverted “T” shape zone in the dorsal aspect of the joint with high incidence of fractures and the prominently intense color in heat mapping. The keystone projected area, the radial styloid process and the metacarpal radial side articular surface were found to be the least involved parts of the fracture. According to the mapping of the number and distribution of fracture lines, a new classification method for intra-articular fractures of the distal radius was redefined. Different surgical approaches and internal fixation techniques were proposed for different types. In this paper, we retrospectively compared the preoperative X-ray findings between different types. Based on the preoperative X-ray prediction, the distal intra-articular radius fractures were classified, so as to develop effective surgical strategies. In this study, a new surgical approach was attempted, but due to the lack of evidence-based evidence, long-term postoperative complications and hand function should be further evaluated.ConclusionThis study redefines a new method for the classification of intra-articular fractures of the distal radius, which allows doctors to have a clearer understanding of the characteristics of distal radius fractures. Moreover, the application value in fracture diagnosis is more significant, and the best surgical approach is selected for different types.
Highlights
Distal radius fracture (DRF) is one of the most common types of fractures presented in emergency clinics, among which intra-articular fractures account for approximately 25% of all DRFs [1]
The current study aimed to explore the distribution characteristics of the fracture lines in DRFs by building fracture maps reconstructed using axial computed tomography (CT) scan images of patients with intra-articular fractures of distal radius
In the current qualitative descriptive research, it was observed that the highest fracture line intensity was located as an inverted “T” shape zone in the dorsal aspect of the joint, which has the prominently intense color in heat mapping and divides the distal radius into three parts (Fig. 3)
Summary
Distal radius fracture (DRF) is one of the most common types of fractures presented in emergency clinics, among which intra-articular fractures account for approximately 25% of all DRFs [1]. Due to the unexposed joint capsule through the volar locking approach, the location and dependence of internal fixation for fractures of the distal radius articular surface is principally relied on X-ray examinations and surgeons’ experience, requiring precise and effective methods. It has become a strong interest for surgeons to know how to achieve the articular surface fracture fixation after restoring the articular surface and whether to add other screws when volar locking plate distal screws are used to fix important fracture fragments, especially for the elderly patients with osteoporosis [2]. Wrist arthroscopy may be an effective method to observe the fracture line of distal fractures but not popular because of technique and expense [3]
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