Knirk and Jupiter set out to identify which factors decide the outcome of intra‑articular distal radius fractures in young adults, with particular attention to residual radiocarpal incongruity.
Retrospective review of 43 fractures in 40 young adults (mean age 27.6), mostly treated closed, followed a mean 6.7 years.
Methods
Design
Retrospective cohort
Data source
Massachusetts General Hospital, Boston
Patients
43 fractures in 40 young adults
Mean age 27.6
Exposure
Cast alone (21)
Pins and plaster cast (17)
External fixation (2)
Open reduction and internal fixation (3)
Follow-up
Mean 6.7 years
Outcomes
Radiographic post‑traumatic arthritis
Functional rating (excellent to poor)
Key Findings
Arthritis developed in 91% of wrists that healed with any articular step‑off (22 of 24), vs 11% of wrists that healed congruous (2 of 19).
Radiographic post‑traumatic arthritis was present in 65% of the fractures (28 of 43) at a mean 6.7 years.
Functional results across all 43 fractures were rated 26% excellent, 35% good, 33% fair and 6% poor.
Closed means reduced the die‑punch fragment anatomically in 49% of the 37 fractures that had one, and 75% of joints still incongruous at late follow‑up (18 of 24) had a die‑punch fragment.
Initial dorsal angulation, radial length (r = 0.15) and maintenance of the extra‑articular reduction (r = -0.27) showed no effect on radiocarpal arthritis, and extra‑articular alignment mattered only with severe radial shortening.
Wrists with an ulnar styloid non‑union had worse results.
Board pearl
Every wrist that healed with a radiocarpal step‑off of 2 mm or more developed arthritis (8 of 8).
Authors' conclusion
Accurate articular restoration was the most critical factor in achieving a successful result.
Knirk and Jupiter set out to identify which factors decide the outcome of intra‑articular distal radius fractures in young adults, with particular attention to residual radiocarpal incongruity.
Retrospective review of 43 fractures in 40 young adults (mean age 27.6), mostly treated closed, followed a mean 6.7 years.
Methods
Design
Retrospective cohort
Data source
Massachusetts General Hospital, Boston
Patients
43 fractures in 40 young adults
Mean age 27.6
Exposure
Cast alone (21)
Pins and plaster cast (17)
External fixation (2)
Open reduction and internal fixation (3)
Follow-up
Mean 6.7 years
Outcomes
Radiographic post‑traumatic arthritis
Functional rating (excellent to poor)
Key Findings
Arthritis developed in 91% of wrists that healed with any articular step‑off (22 of 24), vs 11% of wrists that healed congruous (2 of 19).
Radiographic post‑traumatic arthritis was present in 65% of the fractures (28 of 43) at a mean 6.7 years.
Functional results across all 43 fractures were rated 26% excellent, 35% good, 33% fair and 6% poor.
Closed means reduced the die‑punch fragment anatomically in 49% of the 37 fractures that had one, and 75% of joints still incongruous at late follow‑up (18 of 24) had a die‑punch fragment.
Initial dorsal angulation, radial length (r = 0.15) and maintenance of the extra‑articular reduction (r = -0.27) showed no effect on radiocarpal arthritis, and extra‑articular alignment mattered only with severe radial shortening.
Wrists with an ulnar styloid non‑union had worse results.
Board pearl
Every wrist that healed with a radiocarpal step‑off of 2 mm or more developed arthritis (8 of 8).
Authors' conclusion
Accurate articular restoration was the most critical factor in achieving a successful result.