medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2022, Number 4

<< Back Next >>

Acta Ortop Mex 2022; 36 (4)

Reliability of radiographic parameters to determine the surgical success in distal radius fractures

García-González N, Berúmen-Nafarrate E, Ávila-Carrasco L, Martínez-Fierro M, Monárrez-Espino J

Language: Spanish
References: 16
Page: 216-222
PDF size: 208.28 Kb.


ABSTRACT

Introduction: distal radius fractures are the most common in upper extremities. Therefore, it is important to standardize radiographic measures for their surgical approach. This study assessed the intra/interobserver reproducibility of radiographic parameters associated with surgical success of distal radius fractures. Material and methods: retrospective cross-sectional design of secondary data extracted from clinical records. Posteroanterior and lateral X-rays of 112 distal radius fractures were assessed by two trauma specialists standardized in the measurements required to compute five parameters indicative of postoperative success: radial height, radial inclination, volar tilt, ulnar variance, and articular stepoff. The reproducibility of distances and angles was evaluated using the Bland-Altman method, calculating the mean of the difference between measurements, the range at ± 2 SD, and the proportion of measurements outside ± 2 SD. Postoperative success was also compared between patients with and without obesity according to the mean of the two measures made by each evaluator. Results: evaluator 1 had the largest intra-observer difference in radial height (0.16 mm) and the largest proportion outside ± 2 SD in ulnar variance (8.1%); evaluator 2 had the largest difference in volar tilt (1.92o) and the highest proportion in radial inclination (10.7%). The largest inter-observer difference was for ulnar variance (1.02 mm) and the largest proportion outside ± 2 SD. for radial height (5.4%). Radial tilt had the largest difference (1.41o) with 4.5% of measurements outside ± 2 SD. Ulnar variance and volar tilt had the largest difference in postoperative success between evaluators, especially in patients with obesity. Conclusion: improving the radiographic quality and standardizing the measurements results in more reproducible indicators.


REFERENCES

  1. Inclan P M, Dy CJ. How to treat distal radius fractures. Hand Clin. 2021; 37(2): 205-14. doi: 10.1016/j.hcl.2021.02.003.

  2. Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am. 2018; 49(2): 211-22. doi: 10.1016/j.ocl.2017.12.001.

  3. Acosta-Olivo C, Gonzalez-Saldivar JC, Villarreal-Villarreal G, Torres-Botello A, Gomez-Garcia E, Tamez-Mata Y, et al. Correlation between obesity and severity of distal radius fractures. Orthop Traumatol Surg Res. 2017; 103(2): 199-202. doi: 10.1016/j.otsr.2016.12.007.

  4. Ebinger T, Koehler DM, Dolan LA, McDonald K, Shah AS. Obesity increases complexity of distal radius fracture in fall from standing height. J Orthop Trauma. 2016; 30(8): 450-5. doi: 10.1097/bot.0000000000000546.

  5. Goodloe JB, Traven SA, Herzog LN, Richardson CM, Daley DN, Slone HS. Elevated BMI is associated with intra-articular comminution, prolonged operative time, and postoperative complications in distal radius fractures. Injury. 2020; 51(11): 2612-16. doi: 10.1016/j.injury.2020.08.006.

  6. García-Cepeda I, Aguado-Maestro I, De Blas-Sanz I, Quintanilla-García A, García-Alonso M. Radiological results of surgical management of fracture of the distal radius treated with volar locking plates. Injury. 2020; 51: S42-7. doi: 10.1016/j.injury.2020.02.106.

  7. Neder Filho AT, Mazzer N, Bataglion LR, Pires RE, Macedo AP, Shimano AC. Distal radius fracture fixation using volar plate: a comparative study evaluating the biomechanical behavior of uni and bicortical distal screws. Injury. 2021; 52: S38-43. doi: 10.1016/j.injury.2021.02.031.

  8. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005; 21(3): 279-88. doi: 10.1016/j.hcl.2005.02.008.

  9. O'Malley MP, Rodner C, Ritting A, Cote MP, Leger R, Stock H, Wolf JM. Radiographic interpretation of distal radius fractures: visual estimations versus digital measuring techniques. Hand (N Y). 2014; 9(4): 488-93. doi: 10.1007/s11552-014-9666-2.

  10. Perugia D, Guzzini M, Civitenga C, Guidi M, Dominedò C, Fontana D, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury. 2014; 45: S21-6. doi: 10.1016/j.injury.2014.10.018.

  11. Porrino JA, Maloney E, Scherer K, Mulcahy H, Ha AS, Allan C. Fracture of the distal radius: epidemiology and premanagement radiographic characterization. AJR Am J Roentgenol. 2014; 203(3): 551-9. doi: 10.2214/ajr.13.12140.

  12. Lirola-Palmero S, Salvà-Coll G, Terrades-Cladera FJ. Análisis de la varianza cubital como factor de riesgo para el desarrollo de pseudoartrosis de escafoides carpiano. Revista Española de Cirugía Ortopédica y Traumatología. 2015; 59(3): 150-6. doi: 10.1016/j.recot.2014.08.002.

  13. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurements for healed distal radius fractures. J Hand Surg Am. 1996; 21(1): 31-9. doi: 10.1016/s0363-5023(96)80151-1.

  14. Stirling E, Jeffery J, Johnson N, Dias J. Are radiographic measurements of the displacement of a distal radial fracture reliable and reproducible? Bone Joint J. 2016; 98-B(8): 1069-73. doi: 10.1302/0301-620x.98b8.37469.

  15. Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statistician. 1983; 32: 307-7. doi: 10.2307/2987937.

  16. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999; 8: 135-60. doi: 10.1191/096228099673819272.



EVIDENCE LEVEL

III




2020     |     www.medigraphic.com