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Scientific Articles   |    
Comparison of Intra-Articular Simple Compression and Extra-Articular Distal Radial Fractures
J. Sebastiaan Souer, MD, PhD; David Ring, MD, PhD; Jesse Jupiter, MD; Stefan Matschke, MD; Laurent Audigé, PhD; Marta Marent-Huber
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org
Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann Strasse 13, D-67071 Ludwigshafen, Germany
AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Dübendorf, Switzerland
LCP Distal Radius Study Group: Dr. Beate Hanson, AO-CID, Dübendorf, Switzerland; Dr. D. Rikli, Kantonsspital Luzern, Luzern, Switzerland; Prof. H.R. Siebert, Dakonie-Krankenhaus, Schwäbisch Hall, Germany; Dr. D.A. Campbell, St. James’ University Hospital, Leeds, Great Britain; Dr. Lam-Chuan Teoh, Singapore General Hospital, Singapore; Dr. F. Torretta, Istituto Ortopedico Gaetano Pini, Milano, Italy; Dr. G. Lauri, Centro Traumatologico Ortopedico, Firenze, Italy; Dr. W. Hintriger, Krankenanstaltverbund Korneuburg-Stockerau, Stockerau, Austria; Dr. H. Drobetz, Unfallabteilung Krankenhaus Neunkirchen, Neunkirchen, Austria; Dr. M. Plecko, Abteillung Unfallchirurgie, Unfallkrankhaus, Graz, Austria; Prof. A. Wentzensen, BG Unfallklinik, Ludwigshaven, Germany; Prof. D. Höntzsch, BG Unfallklinik, Tübingen, Germany; Prof. R.H. Neugebauer, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany; Prof. N.P. Haas, Charité, Berlin, Germany; Prof. K.E. Rehm, Chirurgisiche Universitätsklinik, Köln, Germany; Prof. K.H. Winker, HELIOS Klinikum Unfallchirugie, Erfurt, Germany; Prof. W. Ertel, Universitätsklinik Benjamin Franklin, Berlin, Germany; and Dr. Chr. Sommer, Rätisches Kantons- und Regionalspital, Chur, Switzerland; Prof. M. Wagner; Wilhelminenspital, Wien, Austria; Prof. S.P. Chow; Queen Mary Hospital, Hong Kong.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 16;93(22):2093-2099. doi: 10.2106/JBJS.J.01069
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Abstract

Background: 

The impact of a single well-reduced or stable intra-articular fracture oriented in the sagittal plane on the outcome of internal fixation of a distal radial fracture is uncertain. We tested the hypothesis that wrist motion and function scores would not differ between patients with an extra-articular fracture and those with a single sagittal intra-articular fracture following open fracture reduction and internal fixation with use of a volar locking plate.

Methods: 

Thirty-seven patients with a single sagittal intra-articular fracture of the distal aspect of the radius and seventy-four age and sex-matched patients with an extra-articular distal radial fracture were retrospectively analyzed with use of data gathered in a cohort study of plate and screw fixation of distal radial fractures. A volar locking plate was used in all patients. The two cohorts were analyzed for differences in motion, grip strength, pain, and Gartland and Werley, DASH (Disabilities of the Arm, Shoulder and Hand), and SF-36 (Short Form-36) scores six, twelve, and twenty-four months after surgery. Differences between the cohorts and differences within each cohort over time were determined with use of regression analysis and the likelihood ratio test.

Results: 

Patients with a single sagittal intra-articular fracture and those an extra-articular fracture did not differ significantly with respect to motion, grip strength, Gartland and Werley score, or DASH score at any time point. However, there was a trend toward less pronation (95% compared with 98% of that in the contralateral arm) and less grip strength (76% compared with 81% of that in the contralateral arm) at six months and toward a smaller flexion-extension arc (118° compared with 128°) at one year after surgery in patients with a single sagittal intra-articular fracture.

Conclusions: 

Open reduction and volar locking plate and screw fixation of extra-articular fractures and of simple intra-articular fractures of the distal aspect of the radius are associated with comparable impairment and disability within two years of surgery.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    References

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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