Plastic Surgery Research Council
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Presenter: Ronit Wollstein
Co-Authors: Shakir S; Gilula L; Naran S
University of Pittsburgh

BACKGROUND: Distal radius fractures (DRFs) are often treated surgically to prevent malunion. However, despite anatomic reduction, some patients continue to experience wrist symptoms and functional limitation. This may be secondary to subtle associated ligamentous injuries that remain untreated. The purpose of this study was to identify radiocarpal ligamentous changes by comparing the position of the scaphoid within the radioscaphoid joint in normal radiographs to its position following open reduction internal fixation (ORIF) of DRFs.

METHODS: Measurements were performed on posteroanterior (PA) radiographs of DRFs post ORIF. Parameters were measured in the coronal plane perpendicular to the long axis of the radius; a method validated in a previous study on normal radiographs. Distance between the ulnar border of the radial styloid and the radial border of the scaphoid was measured at a level midway between the tip of the styloid and the scaphoid base (D). To account for scaphoid shape and flexion/extension/rotation, scaphoid width was measured at the same level (W). The measurements D/W were expressed as a ratio, which was found to be the most reliable for evaluating scaphoid shift. The measured values were compared to our previously established normal data using the student t-test, with p<0.05 considered significant.

RESULTS: Fifty radiographs were available for measurement. 52% of the patients were female. Average age at injury was 47.9417.94 years. Measurements for our fracture group and control group averaged 3.021.38mm and 2.050.12mm for D, and 10.481.66mm and 5.851.23mm for W, and 0.300.016 and 0.350.014 for D/W, respectively. The difference between these groups was significant (p=0.0001).

CONCLUSION: Despite accurate surgical reduction of DRFs, there persists abnormal positioning of the scaphoid in the radioscaphoid joint. We believe this reflects ligamentous injury and may explain suboptimal results as well as development of wrist osteoarthritis. Addressing radiocarpal ligamentous instability at the time of radius reduction may prevent the development of these adverse clinical symptoms.

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