Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, 634-8522, Japan.
Department of Hand Surgery, Nara Medical University, Kashihara, Nara, 634-8522, Japan.
J Orthop Sci. 2022 Mar;27(2):384-388. doi: 10.1016/j.jos.2020.12.029. Epub 2021 Mar 9.
Reduction using ligamentotaxis may not be effective enough to treat impacted intraarticular fragments of distal radius fractures. Articular incongruence resulting from the loss of reduction is a risk factor for postoperative osteoarthritis and worse clinical outcome. This study aimed to analyze the radiographic characterization of the impacted intraarticular fragments of distal radius fractures using two/three-dimensional computed tomography (CT). Further, we assessed the reliability and diagnostic accuracy in detecting the fragments using plain radiographs.
We analyzed 167 three-dimensional CT images of the intraarticular distal radius fractures and selected 12 fractures with impacted intraarticular fragments. We recorded the location, size, and displacement of the fragment using CT images. In addition, six examiners evaluated 25 fractures including those 12 fractures having the fragments using plain radiographs for detecting the fragments and their displacements. Further, we evaluated the reliability and diagnostic accuracy of the plain radiographs in the detection of the fragment.
Fifteen impacted intraarticular fragments were found in 12 wrists. The displacement of the scaphoid facet fragment was significantly larger than that of the lunate facet fragment in CT measurement (7.0 mm and 3.6 mm). Inter and intraobserver reliability of the diagnosis for the fragment in plain radiographs were poor and fair (κ: 0.14 and κ:0.27). Diagnostic accuracy in detecting the fragment in plain radiographs generated mean sensitivity: 0.4, mean specificity: 0.73, and mean accuracy: 0.58. The mean sensitivity in detecting a lunate facet fragment was lower than that of a scaphoid facet fragment in plain radiographs (0.24 and 0.44).
Impacted intraarticular fragments were found in 7% of intraarticular distal radius fractures. We observed low reliability and sensitivity in detecting the fragment using plain radiographs. Preoperative recognition of the fragments using plain radiograph were difficult, even though the magnitude of step-off of the scaphoid facet fragment was large.
使用韧带整复术可能不足以有效治疗桡骨远端关节内粉碎性骨折。由于复位丢失而导致的关节不平整是术后发生骨关节炎和临床预后较差的一个危险因素。本研究旨在通过二维/三维计算机断层扫描（CT）分析桡骨远端关节内粉碎性骨折的关节内碎片的影像学特征。此外，我们评估了使用普通 X 线片检测这些碎片的可靠性和诊断准确性。
我们分析了 167 例三维 CT 图像的关节内桡骨远端骨折，并选择了 12 例存在关节内粉碎性骨折的病例。我们使用 CT 图像记录了骨折块的位置、大小和移位。此外，有 6 名检查者使用普通 X 线片评估了包括这 12 例存在骨折块的 25 例骨折，以检测骨折块及其移位。此外，我们评估了普通 X 线片检测骨折块的可靠性和诊断准确性。
在 12 个腕关节中发现了 15 个关节内粉碎性骨折块。在 CT 测量中，舟状骨关节面骨折块的移位明显大于月状骨关节面骨折块（7.0mm 和 3.6mm）。普通 X 线片诊断骨折块的组内和组间可靠性均较差和一般（κ：0.14 和 κ：0.27）。普通 X 线片检测骨折块的诊断准确性为平均敏感性：0.4，平均特异性：0.73，平均准确性：0.58。普通 X 线片检测月状骨关节面骨折块的敏感性低于检测舟状骨关节面骨折块（0.24 和 0.44）。
关节内桡骨远端骨折中发现有 7%存在关节内粉碎性骨折块。我们观察到使用普通 X 线片检测骨折块的可靠性和敏感性较低。尽管舟状骨关节面骨折块的台阶高度较大，但术前使用普通 X 线片很难识别骨折块。
