Kim Sujin, Lee Guen Young, Lee Jae-Sung, Jung Hyoung Seok, Chung Bo Mi
Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-Gu, Seoul, 156-755, Republic of Korea.
Department of Radiology, Chung-Ang University Gwangmyeong Hospital, 110, Deokan‑ro, Gwangmyeong‑si, Gyeonggi‑do, Republic of Korea.
BMC Musculoskelet Disord. 2025 Aug 7;26(1):757. doi: 10.1186/s12891-025-08990-5.
Delayed extensor pollicis longus (EPL) rupture is a known complication of distal radius fractures (DRF). Identifying predictive imaging findings could aid in early risk stratification. This study aims to evaluate the association between floating fat signs in patients with DRF and delayed EPL rupture.
In this retrospective study, we included 352 consecutive patients with DRF from a single institution. Of these patients, 12 experienced an EPL rupture, while 340 had no tendon-associated complications. We evaluated the preoperative CT scans of patients with DRF. For the second and third extensor compartments, we visually graded the floating fat sign on a semi-quantitative Likert scale (0-2). We assessed the presence of bone fragments, Lister's tubercle fracture type, fracture gap, intra-articular fracture, and articular step-off in intra-articular fractures.
The sum of floating fat sign scores in the second and third compartments was significantly correlated with the rate of EPL rupture in all patients (p < 0.001), as well as in the subgroup analysis of conservative treatment and volar plating groups (p = 0.009 and 0.001, respectively). Univariate analysis showed significant differences between the EPL rupture and non-rupture groups regarding the treatment choice (p = 0.001) and the sum of the floating fat sign scores (p < 0.001). Conservative treatment and sum of floating fat sign scores of 3 and 4 were independent predictive indicators of EPL rupture (p = 0.001, Odds ratio [OR] = 0.04; p = 0.006, OR = 38.22; and p = 0.022, OR = 25.54, respectively).
The floating fat sign in DRF is associated with EPL rupture and could help predict delayed EPL rupture.
拇长伸肌（EPL）延迟性断裂是桡骨远端骨折（DRF）的一种已知并发症。识别具有预测性的影像学表现有助于早期风险分层。本研究旨在评估DRF患者的脂肪漂浮征与EPL延迟性断裂之间的关联。
在这项回顾性研究中，我们纳入了来自单一机构的352例连续性DRF患者。其中，12例发生了EPL断裂，而340例没有肌腱相关并发症。我们评估了DRF患者的术前CT扫描。对于第二和第三伸肌间隔，我们采用半定量李克特量表（0-2）对脂肪漂浮征进行视觉分级。我们评估了骨碎片的存在、Lister结节骨折类型、骨折间隙、关节内骨折以及关节内骨折的关节台阶。
第二和第三间隔的脂肪漂浮征评分总和与所有患者的EPL断裂发生率显著相关（p < 0.001），在保守治疗组和掌侧钢板固定组的亚组分析中也是如此（分别为p = 0.009和0.001）。单因素分析显示，EPL断裂组和未断裂组在治疗选择（p = 0.001）和脂肪漂浮征评分总和（p < 0.001）方面存在显著差异。保守治疗以及脂肪漂浮征评分总和为3和4是EPL断裂的独立预测指标（分别为p = 0.001，比值比[OR]=0.04；p = 0.006，OR = 38.22；p = 0.022，OR = 25.54）。
DRF中的脂肪漂浮征与EPL断裂相关，有助于预测EPL延迟性断裂。
