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 > 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT

  • Renata E. GologanEmail author
  • M. Koeck
  • A. J. Suda
  • U. Obertacke
Handsurgery
  • 7 Downloads

Abstract

To clarify the role of concomitant carpal lesions in dislocated distal radius fractures (DRF), 104 consecutive patients with DRF underwent a preoperative morphological examination using CT and MRI. The study was performed between 2004 and 2006 with the aim of recording all types of concomitant carpal lesions as well as their consequences after 1 year. Carpal lesions of different types were found in all treated cases of dislocated DRF. A clinical follow-up 1 year (13.9 ± 6.5 months) after surgical treatment showed no correlation between the carpal lesions and the treatment outcome (previously described by Gologan et al. 2011). A second follow-up study ( > 10 years postoperative, range 11.2 ± 0.9 years) was initiated to find suspected later decompensations of the concomitant carpal lesions. A total of 37 of the original 104 patients could potentially be followed up: 22 patients had passed through both follow-ups and 15 could only be contacted with restrictions. 27 patients had died, 24 patients were excluded due to the presence of dementia or explicit rejection, and 16 patients could no longer be found. Using the Castaing score, the first follow-up after 1 year resulted in an average of 4.95 ± 3.1 points (range 0–12; “good result”) and the second follow-up after 10 years in an average of 5.91 ± 2.9 points (range 2–14; “good result”). Again, there were no correlations with the primarily recognized carpal lesions [comparable groups 22 vs 22 (identical patients in both follow-ups); lost to follow-up rate 15.4%]. These results suggest that concomitant carpal lesions are primarily prevalent and detectable in (nearly) all dislocated DRF cases. However, with the usual protection of the wrist and the carpus after surgical treatment of DRF, these lesions often do not decompensate or require treatment, even after 10 years.

Keywords

Distal radius fracture Carpal lesion outcome Long-term outcome distal radius fracture 

Notes

Author contributions

All the authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be submitted.

Compliance with ethical standards

Conflict of interest

All the authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) our work.

References

  1. 1.
    Richards RS et al (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 22(5):772–776CrossRefGoogle Scholar
  2. 2.
    Rose S, Frank J, Marzi I (1999) Diagnostic and therapeutic significance of arthroscopy in distal radius fracture. Zentralbl Chir. 124(11):984–992Google Scholar
  3. 3.
    Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Br 22(5):638–643CrossRefGoogle Scholar
  4. 4.
    Fischer M, Denzler C, Sennwald G (1996) Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases. Swiss Surg 2(6):269–272Google Scholar
  5. 5.
    Desai MJ, Kamal RN, Richard MJ (2015) Management of intercarpal ligament injuries associated with distal radius fractures. Hand Clin 31(3):409–416CrossRefGoogle Scholar
  6. 6.
    Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Jt Surg Am 89(11):2334–2340Google Scholar
  7. 7.
    Gologan R et al (2014) Carpal lesions associated with dislocated fractures of the distal radius. A systematic screening of 104 fractures using preoperative CT and MRI. Unfallchirurg. 117(1):48–53CrossRefGoogle Scholar
  8. 8.
    Mrkonjic A et al (2012) The natural course of traumatic triangular fibrocartilage complex tears in distal radial fractures: a 13–15 year follow-up of arthroscopically diagnosed but untreated injuries. J Hand Surg Am 37(8):1555–1560CrossRefGoogle Scholar
  9. 9.
    Mrkonjic A et al (2015) Arthroscopically diagnosed scapholunate ligament injuries associated with distal radial fractures: a 13- to 15-year follow-up. J Hand Surg Am 40(6):1077–1082CrossRefGoogle Scholar
  10. 10.
    Gologan R et al (2016) 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg 136(3):425–432CrossRefGoogle Scholar
  11. 11.
    Castaing J (1964) Recent fractures of the lower extremity of the radius in adults. Rev Chir Orthop 50:581–696Google Scholar
  12. 12.
    Bolmers A et al (2013) A comparison of the long-term outcome of partial articular (AO Type B) and complete articular (AO Type C) distal radius fractures. J Hand Surg Am 38(4):753–759CrossRefGoogle Scholar
  13. 13.
    Steffen T, Eugster T, Jakob RP (1994) Twelve years follow-up of fractures of the distal radius treated with the AO external fixator. Injury. Suppl 4:SD44–54Google Scholar
  14. 14.
    Gruber G et al (2006) Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period. Arch Orthop Trauma Surg 126(10):680–685CrossRefGoogle Scholar
  15. 15.
    Goehre F et al (2014) Comparison of palmar fixed-angle plate fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients. J Hand Surg Eur 39(3):249–257CrossRefGoogle Scholar
  16. 16.
    Rein S et al (2007) Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg Am 32(7):954–961CrossRefGoogle Scholar
  17. 17.
    Gartland JJ Jr, Werley CW (1951) Evaluation of healed Colles' fractures. J Bone Jt Surg Am 33-A(4):895–907CrossRefGoogle Scholar
  18. 17.
    Barker SL et al (2016) Assessment following distal radius fractures: a comparison of 4 scoring systems, visual numerical scales, and objective measurements. J Hand Surg Am 41(2):219–224.e1CrossRefGoogle Scholar
  19. 19.
    Westphal T (2007) Reliability and responsiveness of the german version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Unfallchirurg 110:548–552CrossRefGoogle Scholar
  20. 20.
    Gruber G et al (2010) Quality of life after volar plate fixation of articular fractures of the distal part of the radius. J Bone Jt Surg Am 92(5):1170–1178CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Renata E. Gologan
    • 1
    Email author
  • M. Koeck
    • 2
  • A. J. Suda
    • 2
  • U. Obertacke
    • 2
  1. 1.Klinik für Orthopädie Und Unfallchirurgie, Diakonissenkrankenhaus MannheimMedizinische Fakultät Mannheim der Universität HeidelbergMannheimGermany
  2. 2.Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin MannheimMedizinische Fakultät Mannheim der Ruprecht-Karls-Universität HeidelbergMannheimGermany

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