title: Cortical comminution in distal radial fractures can predict the radiological outcome: a cohort multicentre study.
abstract: This paper investigates whether cortical comminution and intra-articular involvement can predict displacement in distal radius fractures by using a classification that includes volar comminution as a separate parameter. A prospective multicentre study involving non-operative treatment of distal radius fractures in 387 patients aged between 15 and 74 years (398 fractures) was conducted. The presence of cortical comminution and intra-articular involvement according to the Buttazzoni classification is described. Minimally displaced fractures were treated with immobilisation in a cast while displaced fractures underwent closed reduction with subsequent immobilisation. Radiographs were obtained after reduction, at 10 to 14 days and after union. The outcome measure was re-displacement or union. In fractures with volar comminution (Buttazzoni type 4), 96% (53 of 55) displaced. In intra-articular fractures without volar comminution (Buttazzoni 3), 72% (84 of 117) displaced. In extra-articular fractures with isolated dorsal comminution (Buttazzoni 2), 73% (106 of 145) displaced while in non-comminuted fractures (Buttazzoni 1), 16 % (13 of 81 ) displaced. A total of 32% (53 of 165) of initially minimally displaced fractures later displaced. All of the initially displaced volarly comminuted fractures re-displaced. Displacement occurred in 31% (63 of 205) of fractures that were still in good alignment after 10 to 14 days. Regression analysis showed that volar and dorsal comminution predicted later displacement, while intra-articular involvement did not predict displacement. Volar comminution was the strongest predictor of displacement.
authors.affiliation: Umeå University, Department of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901 87 Umeå, Sweden.
authors.forename: M Å
authors.initials: MÅ
authors.lastname: Wadsten
authors.affiliation: Umeå University, Department of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901 87 Umeå, Sweden.
authors.forename: A S
authors.initials: AS
authors.lastname: Sayed-Noor
authors.affiliation: Sundsvall Hospital, Department of Research and development, Västernorrland County, 851 86 Sundsvall, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Englund
authors.affiliation: Umeå University, Department of Surgical and Perioperative Sciences (Orthopedics-Östersund), 901 87 Umeå, Sweden.
authors.forename: G G
authors.initials: GG
authors.lastname: Buttazzoni
authors.affiliation: Umeå University, Department of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901 87 Umeå, Sweden.
authors.forename: G O
authors.initials: GO
authors.lastname: Sjödén
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D005260:Female; D018460:Fractures, Comminuted / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012307:Risk Factors; D055815:Young Adult
keywords: Comminution; Distal radius fracture; Outcome; Radiology