Jung Hyoung-Seok, Lee Jeuk, Kang Kyu-Tae, Lee Jae-Sung
Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):2861-2866. doi: 10.1007/s00068-024-02559-y. Epub 2024 May 31.
To identify the incidence of dorsal comminution using computed tomography (CT) images and identify predictors of this phenomenon in older adults with low-energy distal radius fractures (DRFs).
A total of 150 patients aged > 50 years with fall-induced dorsally angulated DRFs were enrolled in this study. Patients were divided into two groups based on the presence of dorsal comminution, defined as a metaphyseal void of greater than one-third of the maximum posterior to anterior depth of the bone on at least three cuts in the sagittal plane on post-reduction CT images. Data on participants' basic demographics, including age, sex, body mass index (BMI), and AO classification of DRFs, were collected. Bone mineral density (BMD) was assessed using T-scores of the femoral neck, and cortical thickness of the distal radius was determined from plain post-reduction radiographs. Radiological parameters and combined ulnar fractures were measured on plain pre-reduction radiographs.
Among study participants, 91 (61%) had dorsal comminution, whereas 59 (39%) had no dorsal comminution on CT images. Both patient groups were compared based on presence of dorsal comminution, and showed no significant differences in age, sex, BMI, BMD, or cortical thickness on radiographs. However, all radiological parameters were better in the no dorsal comminution group than in the dorsal comminution group, and the proportion of patients with combined ulnar fractures was higher in the dorsal comminution group. In the multivariate analysis, the presence of combined ulnar fractures was the only significant predictor of dorsal comminution (p = 0.029, odds ratio = 2.267, 95% confidence interval: 1.085-4.736).
The incidence of dorsal comminution is relatively high in patients with low-energy DRFs aged > 50 years. In particular, the presence of combined ulnar fractures is closely associated with dorsal comminution of DRFs. Thus, surgeons should exercise caution when evaluating this phenomenon.
利用计算机断层扫描（CT）图像确定老年低能量桡骨远端骨折（DRF）患者中背侧粉碎的发生率，并确定这一现象的预测因素。
本研究共纳入150例年龄大于50岁、因跌倒导致背侧成角的DRF患者。根据是否存在背侧粉碎将患者分为两组，背侧粉碎定义为复位后CT图像矢状面至少三个层面上干骺端空洞大于骨前后最大深度的三分之一。收集参与者的基本人口统计学数据，包括年龄、性别、体重指数（BMI）和DRF的AO分类。使用股骨颈T值评估骨密度（BMD），并根据复位后的X线平片确定桡骨远端的皮质厚度。在复位前的X线平片上测量放射学参数和合并尺骨骨折情况。
在研究参与者中，91例（61%）在CT图像上存在背侧粉碎，而59例（39%）不存在背侧粉碎。根据背侧粉碎的存在情况对两组患者进行比较，结果显示两组患者在年龄、性别、BMI、BMD或X线平片上的皮质厚度方面无显著差异。然而，无背侧粉碎组的所有放射学参数均优于背侧粉碎组，且背侧粉碎组合并尺骨骨折的患者比例更高。在多变量分析中，合并尺骨骨折是背侧粉碎的唯一显著预测因素（p = 0.029，比值比 = 2.267，95%置信区间：1.085 - 4.736）。
年龄大于50岁的低能量DRF患者中背侧粉碎的发生率相对较高。特别是，合并尺骨骨折与DRF的背侧粉碎密切相关。因此，外科医生在评估这一现象时应谨慎。
