Description de fractures avec fragments laminaires ostéochondraux inhabituels dans les fractures du radius distal

Abstract

BackgroundDistal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. Patients and methodsWe reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. ResultsTwo main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI: 1.4 to 2.9). DiscussionGlobal prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. Level of evidenceIV (observational/descriptive); cross-sectional study.