Can we restore anatomy after surgical treatment of distal radius fractures? A radiological study

Abstract

Purpose: This study aimed to assess radiological outcomes of surgical treatment of distal radius fractures to verify whether surgery associates with restoration of radioulnar anatomy. In addition, this study aimed to identify variables associated with increased chance of anatomical restoration. Methods: We included all closed distal radius fractures surgically treated with percutaneous wires or with volar locking plate between January 2005 and November 2019. For each case, radial height, radial inclination, ulnar variance, and volar tilt were measured in preoperative, postoperative, and follow-up radiographs. Fractures were classified using the Frykman classification. We built Cox regression models to identify preoperative variables associated with normalization of each radiographic parameter assessed in the postoperative and in the follow-up radiograph. Results: We studied a total of 249 cases, 199 of whom treated with volar locking plate fixation and 50 treated with percutaneous Kirschner wire fixation. Overall, there was a trend for improvement of each radiological parameter. However, only 4 individuals achieved a normal anatomy in all assessed parameters. The use of volar plate was associated with significant improvements on restoring normal volar tilt. No other variables were identified as significantly associated with radiological improvement. Conclusions: Volar locking plate fixation associated with higher probability of restoring normal volar tilt, although no restoration of all radiological parameters has been reached in most cases. Level of Evidence: Level III, retrospective cohort study.