Does pisiform subluxation affect the postoperative outcomes in a cohort of patients with distal radius fractures?

Yoichi Sugiyama,Kazuo Kaneko,Hiroyuki Obata,Mayuko Kinoshita,Nana Nagura,Kenji Goto,Kiyohito Naito,Yoshiyuki Iwase

doi:10.1016/j.amsu.2018.09.028

Yoichi Sugiyama, Kazuo Kaneko + Show 6 more

Open Access

https://doi.org/10.1016/j.amsu.2018.09.028

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Abstract

BackgroundIn this study, we retrospectively surveyed the presence or absence of pisiform subluxation in surgically treated distal radius fractures (DRF) cases. In addition, we investigated whether or not the postoperative short-term treatment outcome differs due to the presence of pisiform subluxation.Materials and methodsThe subjects were 134 DRF patients treated with volar locking plate fixation (53 males and 81 females, mean age: 64 years old). The pisotriquetral joint was observed on a preoperative CT to investigate the presence or absence of pisiform subluxation according to the criteria reported by Vasilas. 134 patients divided into subluxation group and non-subluxation group, and the clinical outcomes were compared between these groups.ResultsPisiform subluxation was noted in 23.1% (31 patients, 15 males and 16 females, mean age 61 years). No significant difference was noted in patient background in both groups. The postoperative pronation angle in the non-subluxation group was significantly greater than that in the subluxation group, but there was no significant difference in any other parameter (the range of motion of the wrist, grip strengths, VAS, Q-DASH scores, and Mayo score) between these 2 groups. However it concomitantly occurred in 23.1% of DRF cases in our series, there was no significant difference in the postoperative treatment outcome between these 2 groups.ConclusionsTherapeutic intervention of pisiform subluxation is unnecessary during treatment of DRF, since pisiform subluxation does not affect the postoperative clinical outcomes of distal radius fractures.

Highlights

Various traumas concomitantly occur around the carpal bones with distal radius fractures (DRF) [1,2,3], but some traumas may be overlooked on examination by plain radiography alone [2]
Pisiform subluxation was noted in 23.1% (31 patients (15 males and 16 females), mean age: 61 years old), and the fracture type based on the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification [9] was A2 in 10 patients, A3 in 1, B2 in 1, B3 in 2, C1 in 10, C2 in 1, and C3 in 6
Pisiform subluxation was absent in 76.9% (103 patients (38 males and 65 females), mean age: 64 years old), and the AO classification fracture type was A2 in 29 patients, A3 in 2, B2 in 1, B3 in 3, C1 in 44, C2 in 8, and C3 in 16

Summary

Introduction

Various traumas concomitantly occur around the carpal bones with distal radius fractures (DRF) [1,2,3], but some traumas may be overlooked on examination by plain radiography alone [2]. We retrospectively surveyed the presence or absence of pisiform subluxation in surgically treated distal radius fractures (DRF) cases. The postoperative pronation angle in the non-subluxation group was significantly greater than that in the subluxation group, but there was no significant difference in any other parameter (the range of motion of the wrist, grip strengths, VAS, Q-DASH scores, and Mayo score) between these 2 groups. It concomitantly occurred in 23.1% of DRF cases in our series, there was no significant difference in the postoperative treatment outcome between these 2 groups. Conclusions: Therapeutic intervention of pisiform subluxation is unnecessary during treatment of DRF, since pisiform subluxation does not affect the postoperative clinical outcomes of distal radius fractures

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