Skip to main content
SpringerLink
Log in

1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

An Erratum to this article was published on 17 February 2016

Abstract

Introduction

Ligamentous lesions are concomitant to dislocated distal radius fractures in a high percentage. The purpose of this study was to evaluate the relevance of intracarpal lesions.

Methods

Seventy eight of an original cohort of 104 distal radius fractures (74 %) were studied over a follow-up period of one year after surgery with complete data (X-rays, CT, MRI, follow-up X-rays and questionnaire).

Results

Most of our radius fractures (AO 23 type: A 39, B 9, C 30) present additional lesions: 97 %. One-year evaluation showed an average Castaing score of 4.5 ± 2.5 points, means a “good” result of a scale of 0–27. Fifty five of seventy eight had an “excellent” or “good” result (<6 points). No patient had more than 12 points (“fair”).

Conclusions

The dislocated distal radial fracture implies severe and complex injury to the whole wrist, mostly concerning intracarpal concomitant lesions (MRI). Surgical therapy of dislocated radius fractures followed by 6 weeks relief through thermoplastic splint seems to be sufficient to achieve good 1-year results. MRI-detectable carpal lesions at the time of the radial fracture are common, but only a few of them seem to decompensate later, give symptoms and became of therapeutic relevance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chen NC, Jupiter JB (2007) Management of distal radial fractures. J Bone Joint Surg Am 89:2051–2062

    Article  PubMed  Google Scholar 

  2. Poigenfürst L (1980) Brüche am distalen Unterarmende. Einteilung der Bruchformen und Indikation. H Unfallheilkunde 148:53–59

    Google Scholar 

  3. Fernandez DL, Jupiter JB (2002) Fractures of the distal radius—a practical approach to management. In: Fractures of the distal radius 2. Aufl. Springer, New York

  4. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21:316–322

    Article  PubMed  Google Scholar 

  5. Campbell DA (2000) Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate. J Hand Surg (Br) 25:528–534

    Article  CAS  Google Scholar 

  6. Fischer M, Denzler C, Sennwald G (1996) Carpal ligament lesions associated with fresh distal radius fractures: arthroscopic study of 54 cases. Swiss Surg 2:269–272

    CAS  PubMed  Google Scholar 

  7. Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg [Br] 22:638–643

    Article  CAS  Google Scholar 

  8. Herbert TJ, Faithfull RG, McCann DJ, Ireland J (1990) Bilateral arthrography of the wrist

  9. Pilný J, Kubes J, Hoza P et al (2007) Scapholunate instability of the wrist following distal radius fracture. Acta Chir Orthop Traumatol Cech 74(1):55–58

    PubMed  Google Scholar 

  10. Gologan R, Ginter VM, Ising N, Kilian AK, Obertacke U, Schreiner U (2014) Unfallchirurg 117(1):48–53. doi:10.1007/s00113-012-2264-2.German

    Article  CAS  PubMed  Google Scholar 

  11. Laulan J, Bismuth JP (1999) Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year. A prospective study of 95 cases. Acta Orthop Belg 65:418–423

    CAS  PubMed  Google Scholar 

  12. Tang JB, Shi D, Gu YQ, Zhang QG (1996) Can cast immobilization successfully treat scapho—lunate dissociation associated with distal radius fractures? J Hand Surg (Am) 21:583–590

    Article  CAS  Google Scholar 

  13. Ehalt W (1935) Die Bruchformen am unteren Ende der Speiche und Elle. Arch OrthopUnf Chir Z5:397–465

    Google Scholar 

  14. Bacorn RW, Kurtzke JF (1953) Colles’ fracture: a study of two thousand cases from the New York State workmen’s compensation board. JBJS 35-A:643–658

    CAS  Google Scholar 

  15. Pechlaner S, Gabl M, Lutz M, Krappinger D, Leixnering M, Krulis B, Ulmer H, Rudisch A (2007) Distal radius fractures-aetiology, treatment and outcome. Handchir Mikrochir Plast Chir 39:19–28

    Article  CAS  PubMed  Google Scholar 

  16. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. S2e Leitlinie: Distale Radiusfraktur vom 10.02.2015. http://www.awmf.org/uploads/tx_szleitlinien/012-015l_S2e_Distale_Radiusfraktur_2015-02.pdf

  17. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  PubMed  Google Scholar 

  18. Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg (Am) 22:792–800

    Article  CAS  Google Scholar 

  19. Rose S, Frank J, Marzi I (1999) Diagnostic and therapeutic significance of arthroscopy in distal radius fracture. Zentralbl Chir 124:984–992

    CAS  PubMed  Google Scholar 

  20. Rappold G, Leixnering M, Pezzei C (2001) Carpal injuries associated with distal radius fractures. Diagnosis and therapy. Handchir Mikrochir Plast Chir 33:221–228

    Article  CAS  PubMed  Google Scholar 

  21. Kordasiewicz B, Pomianowski S, Orlowski J, Rapala K (2006) Interosseous ligaments and TFCC lesions in intraarticular distal radius fractures—radiographic versus arthroscopic evaluation. Ortop Traumatol Rehabil 8:263–267

    PubMed  Google Scholar 

  22. Castaing J (1964) Les fractures récentes de l'extrémité inférieure du radius chez l'adulte. Rev Chir Orthop Reparatrice Appar Mot 50:581–696

    CAS  PubMed  Google Scholar 

  23. Gartland John J, Werley Charles W (1951) Evaluation of healed Colles fracture. JBJS 33-A(4):895–907

    Google Scholar 

  24. Changulani M, Okonkwo U, Keswani T, Kalairajah Y (2008) Outcome evaluation measures for wrist and hand: which one to choose? Int Orthop 32(1):1–6 (Epub 2007 May 30. Review)

    Article  PubMed Central  PubMed  Google Scholar 

  25. Seifert J, Müller C, Schauwecker HH (1998) Studying minimally invasive osteosynthesis methods for distal radius fractures. Intra-focal vs. conventional wire osteosynthesis. Unfallchirurgie 24(1):18–24

    CAS  PubMed  Google Scholar 

  26. Gruber G, Zacherl M, Giessauf C, Glehr M, Fuerst F, Liebmann W, Gruber K, Bernhardt GA (2010) Quality of life after volar plate fixation of articular fractures of the distal part of the radius. J Bone Joint Surg Am 92(5):1170–1178

    Article  PubMed  Google Scholar 

  27. Figl M, Weninger P, Liska M, Hofbauer M, Leixnering M (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129(5):661–669

    Article  PubMed  Google Scholar 

  28. Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS (2009) Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 91(8):1837–1846

    Article  PubMed  Google Scholar 

  29. MacKay BJ, Montero N, Paksima N, Egol KA (2013) Outcomes following operative treatment of open fractures of the distal radius: a case control study. Iowa Orthop J 33:12–18

    PubMed Central  PubMed  Google Scholar 

  30. Gliatis JD, Plessas SJ, Davis TR (2000) Outcome of distal radial fractures in young adults. J Hand Surg (Br) 25:535–543

    Article  CAS  Google Scholar 

  31. Schädel-Hopfner M, Bohringer G, Junge A, Celik I, Gotzen L (2001) Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius. Handchir Mikrochir Plast Chir 33:229–233

    Article  PubMed  Google Scholar 

  32. Schädel-Hopfner M, Iwinska-Zelder J, Bohringer G, Braus T, Klose KJ, Gotzen L (2001) MRI or arthroscopy in the diagnosis of scapholunate ligament tears in fractures of the distal radius? Handchir Mikrochir Plast Chir 33:234–238

    Article  PubMed  Google Scholar 

  33. Spies CK, Prommersberger KJ, Langer M, Müller LP, Hahn P, Unglaub F (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg 118(8):701–717

    Article  CAS  PubMed  Google Scholar 

  34. Spies CK, Müller LP, Oppermann J, Hahn P, Unglaub F (2014) Instability of the distal radioulnar joint—an overview of clinical and radiological procedures regarding their efficacies. Handchir Mikrochir Plast Chir 46(3):137–150

    Article  CAS  PubMed  Google Scholar 

  35. Hohendorff B, Eck M, Mühldorfer M, Fodor S, Schmitt R, Prommersberger KJ (2009) Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures. Handchir Mikrochir Plast Chir 41(5):295–299

    Article  CAS  PubMed  Google Scholar 

  36. Jakob M, Rikli DA, Regazzoni P (2000) Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br 82(3):340–344

    Article  CAS  PubMed  Google Scholar 

  37. Forward DP, Lindau TR, Melsom DS (2007) Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89(11):2334–2340

    Article  PubMed  Google Scholar 

  38. Frank J, Pralle H, Lehnert M, Marzi I (2010) Begleitverletzungen distaler Radiusfrakturen. Unfallchirurg 113(10):796, 797–803

Download references

Author information

Authors and Affiliations

  1. Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Renata Gologan, V. M. Ginter, U. Obertacke & U. Schreiner

  2. Alameda County Medical Center, Oakland, CA, USA

    A. Haeffner

Authors
  1. Renata Gologan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. M. Ginter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Haeffner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Obertacke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Schreiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renata Gologan.

Ethics declarations

Ethics Committee of the Ruprecht-Karls-University Heidelberg, Medical Faculty Mannheim on 11/26/2004, reference number 225/04.

Conflict of interest

Renata Emiliana Gologan, Vera Maria Ginter, Astrid Haeffner, Udo Obertacke, Ute Schreiner declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gologan, R., Ginter, V.M., Haeffner, A. et al. 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg 136, 425–432 (2016). https://doi.org/10.1007/s00402-015-2357-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-015-2357-9

Keywords

Search

Navigation