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Marginal secondary displacement in fractures of the distal radius at follow-up - an important predictor for late displacement and malunion
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.ORCID-id: 0000-0002-8727-9555
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.ORCID-id: 0000-0002-5469-2730
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
2023 (Engelska)Ingår i: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, Vol. 48, nr 6, s. 524-531Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Treatment recommendations in fractures of the distal radius are often based on the degree of displacement and functional demands. The fracture may be within an acceptable radiological range, but a marginal deterioration in alignment then occurs between the initial visit and follow-up. This may pose a risk for late displacement that may require further treatment. We secondarily analysed prospectively collected data and included 165 patients. We found that marginal secondary displacement (odds ratio (OR) 9.7), anterior comminution (OR 8.8), loss of anterior apposition (OR 6.8) and dorsal comminution (OR 2.6) were predictors of late displacement. Marginal secondary displacement is an important predictor of late displacement and malunion in fractures of the distal radius. Clinicians should not unequivocally accept general guidelines on alignment but also assess a deterioration in fracture alignment on radiographic follow-up and be aware of the potential need for surgery to avoid malunion in cases that show early secondary displacement, even when radiographic measures are within acceptable limits.Level of evidence: III.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2023. Vol. 48, nr 6, s. 524-531
Nyckelord [en]
Distal radius fracture, instability, late displacement, malunion, marginal secondary displacement
Nationell ämneskategori
Ortopedi
Identifikatorer
URN: urn:nbn:se:umu:diva-202710DOI: 10.1177/17531934221146063ISI: 000911377300001PubMedID: 36624929Scopus ID: 2-s2.0-85146164839OAI: oai:DiVA.org:umu-202710DiVA, id: diva2:1726427
Tillgänglig från: 2023-01-13 Skapad: 2023-01-13 Senast uppdaterad: 2024-04-03Bibliografiskt granskad
Ingår i avhandling
1. Fractures of the distal radius: radiological measurements and clinical outcome
Öppna denna publikation i ny flik eller fönster >>Fractures of the distal radius: radiological measurements and clinical outcome
2024 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Distala radiusfrakturer : radiologiska mätningar och kliniskt utfall
Abstract [en]

The most common fracture is the distal radius fracture (DRF). Wrist function is of importance for the ability to perform activities of daily living, work-related tasks and leisure activities. Treatment generally focuses on restoring anatomical alignment and providing adequate rehabilitation.

To improve our knowledge of DRFs, this thesis explores factors affecting clinical and radiological outcomes in the short- and long-term after a DRF.

Paper I analysed the magnitude of radiographic malalignment leading to deterioration in clinical outcomes. Some 366 patients with prospective data were analysed 1 year after fracture. A nonlinear association between radiographic and clinical outcome was found for dorsal tilt. Larger malalignment resulted in increasingly worse outcomes, starting from about 5 degrees of dorsal tilt and progressing with increasing malalignment.

In Paper II, a novel predictor of instability was assessed, namely marginal secondary displacement. The study included 165 patients with prospective data treated non-operatively with complete radiological follow-up and acceptable alignment 10-14 days after injury. Marginal secondary displacement was an important predictor of late displacement with malunion in DRFs. Clinicians should not unequivocally accept general guidelines for alignment. They should also assess the deterioration in fracture alignment at radiographic follow-up and be aware of the potential need for surgery to avoid malunion, even if radiographic measures are within acceptable limits.

Paper III investigated the long-term effects of DRFs in a large prospective study 11 to 13 years post-injury and found that clinical outcomes improve with time. A decade after the fracture, patient-reported function, health-related quality of life, grip strength and range of motion were restored at the group level. Neither osteoarthritis nor pseudoarthrosis of the ulnar styloid affected the outcomes. Dorsal tilt, radial inclination and ulnar variance did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process lasting years. A decade after injury, recovery was achieved regardless of radiological outcomes.

Paper IV evaluated the potential consequences of the fast-tracks introduced in the Swedish National Guidelines in a retrospective study. Some 1,609 patients with DRFs 4-7 years before the introduction of the national guidelines were studied. The patients' treatment was compared to how they would have been treated had the guidelines been followed. The results suggest that the fast-track treatment pathway will probably i) identify unstable fractures, ii) lead to more patients being treated with early primary surgery and iii) result in delayed primary surgery being avoided in most cases.

To conclude, clinical outcomes are affected by the degree of radiological alignment 1 year after a DRF. However, patients continue to recover over a long period. After a decade, normal function is restored at the group level, irrespective of the radiological outcome. Clinical outcomes at 1 year can most likely be ameliorated by identifying unstable fractures and following protocols promoting early surgery for these fractures.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2024. s. 112
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2279
Nyckelord
Radius, distal radius fracture, fracture, orthopedics, radiology, outcome, clinical outcome, Radius, distal radius fraktur, fraktur, ortopedi, radiologi, utfall, kliniskt utfall
Nationell ämneskategori
Ortopedi Kirurgi
Forskningsämne
ortopedi
Identifikatorer
urn:nbn:se:umu:diva-222962 (URN)978-91-8070-249-2 (ISBN)978-91-8070-250-8 (ISBN)
Disputation
2024-05-08, Aulan, Sundsvalls sjukhus, Sundsvall, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2024-04-17 Skapad: 2024-04-03 Senast uppdaterad: 2024-04-09Bibliografiskt granskad

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