Distinct patterns of fracture propagation in distal radial fractures and the relationship to the ulnar head

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL Clinical Biomechanics Pub Date : 2024-05-01 DOI:10.1016/j.clinbiomech.2024.106260

G.E. Giddins, S. Sassi

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Abstract

Background

The aim was to assess the direction of distal radius fractures and their relationship to the ulnar head.

Methods

We reviewed the 160 wrist radiographs. The fracture line was measured on the postero-anterior and lateral radiographs relative to the long axis of the forearm and the relationship to the ulnar head.

Findings

PA radiographs: the fracture line ran distal ulnar to proximal radial (ulnar to radial) in 11%, transverse in 74% and distal radial to proximal ulnar (radial to ulnar) in 16%. Lateral radiographs: the fracture line ran distal volar to proximal dorsal in 88%, transverse in two 1% and dorsal to volar in 11%. Radial shift (7.5%) only occurred with ulnar to radial or transverse fractures.

The ulnar to radial fracture line started at the proximal end of the ulnar head/distal radio-ulnar joint in 88%. The radial to ulnar fracture line started ended a mean of 2.5 mm proximal to the distal radio-ulnar joint (p < 0.01). The transverse fracture line started at the base of the distal radio-ulnar joint in 53% and proximally in 47%.

Interpretation

There are two distinct coronal patterns: radial to ulnar ending c. 2 mm proximal to the distal radio-ulnar joint; ulnar to radial starting at the proximal distal radio-ulnar joint. There may be third pattern - transverse fractures; these may be variants of the above. Sagittally the main direction is volar to dorsal but 11% are obverse.

This is the first description of distinct fracture patterns in extra-articular distal radius fractures. In addition the fracture patterns appear to correlate with different directions of force transmission which fit with our understanding of falling and the relatively uncontrolled impact of the wrist/hand with the ground.

These patterns of fracture propagation help understand how the biomechanics of wrist fractures and may enable prediction of collapse.

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桡骨远端骨折的不同骨折扩展模式及其与尺骨头的关系

背景旨在评估桡骨远端骨折的方向及其与尺骨头的关系。结果桡骨远端骨折线从尺骨远端到桡骨近端（尺骨到桡骨）的占11%，横向的占74%，从桡骨远端到尺骨近端（桡骨到尺骨）的占16%。侧位X光片：88%的患者骨折线从远端外侧延伸至近端背侧，2 1%为横向，11%为背侧至外侧。桡骨移位（7.5%）仅发生在尺骨至桡骨或横向骨折中。88%的患者的尺骨至桡骨骨折线始于尺骨头/远端无线电尺关节的近端。桡骨至尺骨骨折线开始于远端尺桡关节近端平均2.5毫米处（p <0.01）。有两种截然不同的冠状模式：桡骨至尺骨骨折线在距远端无线电-尺关节近端约 2 毫米处终止；尺骨至桡骨骨折线在距远端无线电-尺关节近端处开始。可能还有第三种模式--横向骨折；这可能是上述模式的变体。这是对桡骨远端关节外骨折不同骨折模式的首次描述。此外，骨折模式似乎与不同的力传导方向相关，这符合我们对高空坠落以及腕部/手部相对不受控制地撞击地面的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.