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Intra-Articular Fractures of the Distal End of the Radius in Young Adults: Reexamined as Evidence-Based and Outcomes Medicine
Brian M. Haus, MD1; Jesse B. Jupiter, MD1
1 Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street – White 535, Boston, MA 02114. E-mail address for B.M. Haus: brihaus@gmail.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Dec 01;91(12):2984-2991. doi: 10.2106/JBJS.I.00269
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The article "Intra-Articular Fractures of the Distal End of the Radius in Young Adults," by Knirk and Jupiter, published in The Journal of Bone and Joint Surgery1 in 1986, in its day, was arguably one of the most important works on the management of intra-articular fractures of the distal end of the radius. Prior to the publication of that study, the critical factors that determined successful long-term management of intra-articular distal radial fractures in young patients had not been determined. The finding with the greatest impact on treatment algorithms was that accurate articular restoration was the most critical factor in preventing long-term arthritis in young patients with intra-articular distal radial fractures. However, twenty-three years of advancements in orthopaedic surgery and technology have exposed the methodological flaws of that study. The radiographic analysis incorrectly interpreted fracture lines, and the study failed to use intraobserver and interobserver validation in its analysis. The study also was conducted before the popularization of computerized tomography and wrist arthroscopy. Despite these shortcomings, an updated critical analysis reveals that its conclusions are still germane in today's treatment of distal radial fractures in young adults.
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