Retrospective cohort of 43 patients with ASIF C2/C3 displaced intra-articular distal radius fractures treated with ORIF. Asks which fracture characteristics and postoperative radiographic parameters best predict functional outcome at mean 38-month follow-up. Introduces an injury score system based on fragment displacement and carpal injury to stratify prognosis.
When you see a complex intra-articular distal radius fracture, the question is not whether you corrected the tilt — it is whether you closed the gap.
This paper established that residual total incongruity greater than 1 mm (step-off + gap combined) is the threshold driving poor outcomes, with an R² of 0.7. Palmar tilt and radial tilt, the parameters historically used to judge reduction quality, did not predict function at all.
In practice: count the fragments on the CT before you operate. More than four fragments means a guarded prognosis. Counsel the patient and plan for bone grafting to support the reduction. Do not hesitate to add external fixation for metaphyseal comminution; it does not worsen results.
The Frykman classification, still widely referenced, failed to predict outcomes here (p > .08) because it ignores articular displacement. Use ASIF/AO C2-C3 designation or fragment count to stratify prognosis and set expectations.
Retrospective cohort of 43 patients with ASIF C2/C3 displaced intra-articular distal radius fractures treated with ORIF. Asks which fracture characteristics and postoperative radiographic parameters best predict functional outcome at mean 38-month follow-up. Introduces an injury score system based on fragment displacement and carpal injury to stratify prognosis.
When you see a complex intra-articular distal radius fracture, the question is not whether you corrected the tilt — it is whether you closed the gap.
This paper established that residual total incongruity greater than 1 mm (step-off + gap combined) is the threshold driving poor outcomes, with an R² of 0.7. Palmar tilt and radial tilt, the parameters historically used to judge reduction quality, did not predict function at all.
In practice: count the fragments on the CT before you operate. More than four fragments means a guarded prognosis. Counsel the patient and plan for bone grafting to support the reduction. Do not hesitate to add external fixation for metaphyseal comminution; it does not worsen results.
The Frykman classification, still widely referenced, failed to predict outcomes here (p > .08) because it ignores articular displacement. Use ASIF/AO C2-C3 designation or fragment count to stratify prognosis and set expectations.