Intra-Articular Fractures of the Distal End of the Radius in Young Adults: Reexamined as Evidence-Based and Outcomes Medicine

Abstract

The article “Intra-Articular Fractures of the Distal End of the Radius in Young Adults,” by Knirk and Jupiter, published in The Journal of Bone and Joint Surgery1 in 1986, in its day, was arguably one of the most important works on the management of intra-articular fractures of the distal end of the radius. Prior to the publication of that study, the critical factors that determined successful long-term management of intra-articular distal radial fractures in young patients had not been determined. The finding with the greatest impact on treatment algorithms was that accurate articular restoration was the most critical factor in preventing long-term arthritis in young patients with intra-articular distal radial fractures. However, twenty-three years of advancements in orthopaedic surgery and technology have exposed the methodological flaws of that study. The radiographic analysis incorrectly interpreted fracture lines, and the study failed to use intraobserver and interobserver validation in its analysis. The study also was conducted before the popularization of computerized tomography and wrist arthroscopy. Despite these shortcomings, an updated critical analysis reveals that its conclusions are still germane in today's treatment of distal radial fractures in young adults. The study by Knirk and Jupiter1 has been cited in 330 research and scholarly articles. Although it is sometimes inaccurately referenced2, it ranks among the most cited manuscripts in the orthopaedic surgery literature. Today, its conclusions not only direct the treatment of distal radial fractures but they also continue to generate hypotheses for outcome studies. Given the impact of the study on the standard of care and orthopaedic research, it is appropriate to critically review its methodology to determine whether the findings remain relevant today. Intra-articular fractures of the distal end of the radius in the young adult are a distinct group of fractures that can lead to accelerated …