Ulmer Clinton J, Verlinsky Luke, Emukah Chimobi C, Ogburn Mallory J, Ubanwa Bryan, Sager Brian W
The University of Texas Health Science Center at San Antonio, USA.
Hand (N Y). 2025 Jun 12:15589447251346859. doi: 10.1177/15589447251346859.
Distal radius fractures represent a significant cause of morbidity and loss of independence, particularly in older patients. There is no good consensus on which fractures managed nonoperatively will be unstable in a cast or splint other than Lafontaine criteria, the only relevant clinical study to date. Second metacarpal cortical percentage (2MCP) has been shown to be a reliable predictor of osteoporosis and poor bone quality. This study investigates the utility of 2MCP as an independent predictor of fracture displacement in nonoperative fracture management.
A retrospective cohort of distal radius fractures treated conservatively over 7 years (2013-2020) was investigated. Injury, postreduction, and 4-week follow-up radiographs were reviewed for 2MCP, volar tilt, ulnar variance, and other demographic factors. Multivariate regression analysis was used to predict fracture displacement.
Only 2MCP and initial fracture displacement were associated with displacement at 4 weeks ( = .008, = .008). Other than initial fracture displacement, Lafontaine criteria were not associated with radiographic outcomes. A 2MCP threshold of 53.5% optimized sensitivity (67.5%) and specificity (70.2%) in predicting 10° of fracture displacement ( = .003). A 2MCP threshold of 49.5% was 86.7% sensitive and 74.7% specific at detecting dorsal malunion ( = .032).
Second metacarpal cortical percentage is a useful clinical tool in predicting distal radius fracture instability. Clinicians can use 2MCP both in guiding decision-making when selecting patients who may benefit from operative management and as a screening tool for osteoporosis and initiation of antiresorptive therapy.
桡骨远端骨折是导致发病和失去独立生活能力的重要原因，在老年患者中尤为如此。除了拉方丹标准（迄今为止唯一相关的临床研究）外，对于哪些非手术治疗的骨折在石膏或夹板固定下会不稳定，尚无良好的共识。第二掌骨皮质百分比（2MCP）已被证明是骨质疏松症和骨质量差的可靠预测指标。本研究探讨2MCP作为非手术骨折治疗中骨折移位独立预测指标的效用。
对7年（2013 - 2020年）期间保守治疗的桡骨远端骨折回顾性队列进行研究。对损伤、复位后及4周随访的X线片进行评估，记录2MCP、掌倾角、尺骨变异及其他人口统计学因素。采用多变量回归分析预测骨折移位。
只有2MCP和初始骨折移位与4周时的移位相关（P = 0.008，P = 0.008）。除初始骨折移位外，拉方丹标准与影像学结果无关。2MCP阈值为53.5%时，预测骨折移位10°的敏感性（67.5%）和特异性（70.2%）最佳（P = 0.003）。2MCP阈值为49.5%时，检测背侧畸形愈合的敏感性为86.7%，特异性为74.7%（P = 0.032）。
第二掌骨皮质百分比是预测桡骨远端骨折不稳定性的有用临床工具。临床医生可在选择可能从手术治疗中获益的患者时，将2MCP用于指导决策，也可作为骨质疏松症筛查工具及启动抗吸收治疗的依据。
