gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

The effect of articular tilt on carpal alignment in acute distal radius fractures

Meeting Abstract

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  • presenting/speaker Rachel Dias - Kings College, London, United Kingdom
  • Nick Johnson - University Hospitals of Leicester, Leicester, United Kingdom
  • Joseph Dias - University Hospitals of Leicester, Leicester, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1661

doi: 10.3205/19ifssh1358, urn:nbn:de:0183-19ifssh13583

Published: February 6, 2020

© 2020 Dias et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Carpal malalignment is thought to be an important influence on functional outcome following distal radius fracture. The aim of this study was to investigate the relationship between tilt of the articular surface of the radius and measures of carpal malalignment in patients with an acute distal radius fracture.

Methods: Radiographs of 249 consecutive distal radius fractures were prospectively analysed. Distal radius articular tilt, scapholunate angle, radiolunate angle, capitolunate angle and capitate shift were measured. Patient demographics, wrist position, radiograph quality and fracture type were recorded. 184 patients underwent manipulation under anaesthetic and all measurements were repeated after manipulation. One independent observer carried out all measurements which were then checked by the senior author. Linear regression modelling was used to investigate the relationship between tilt and the carpal parameters. Models were tested using forward selection to identify if other parameters affected the association.

Results and Conclusions: A significant, linear relationship was seen between scapholunate angle (p<0.005, R2=0.20), radiolunate angle (p<0.005, R2=0.35), capitolunate angle (p<0.005, R2=0.33), capitate shift (p<0.005, R2=0.82) and tilt. This relationship was consistent irrespective of whether the fracture was displaced volarly or dorsally. A similar, proportionate change in alignment was seen with reduction of the fracture. Initial malalignment increases with age. Capitate shift occurs independently of wrist position.

Carpal malalignment frequently occurs following distal radius fracture. Reduction of the fracture will reliably reduce the malalignment. Capitate shift appears to be the most useful measurement of carpal malalignment as it is not affected by the position of the wrist when the radiograph is taken. We would recommend capitate shift is routinely measured by clinicians on initial radiographs, following manipulation and during long term follow up.