Intra-Articular Distal Radius Fractures - Key Radiological Determinants Having Bearing on Final Outcome

Intra articular distal radius fractures are now recognized as complex injuries with high percentage of long term complications. We present this study emphasizing on importance of radiological parameters which have bearing on the final outcome and overall functional result in patients with intra articular distal radius fractures, imperative of treatment method employed.

This is a retrospective study comprising of forty-four patients (38 males and 6 females) between the age group 18–65 years. The initial radiographs were assessed to determine fracture pattern and intra articular congruity. All fractures were classified according to "Universal Classification System" and study group of type IV fracture (i.e. intra articular fracture) of this classification system was included in this study. There were 12 patients with type IVA, 24 with type IVB, seven with type IVC and one with type IVD. Post treatment radiological evaluation was based on following parameters; radial shortening, radial displacement, radial angulation, volar tilt and intra-articular step-off. Evaluation of final results was done based on modified Gartland and Werley scoring system which includes both functional and radiological parameters. Average follow up was 20 months (18–24 months).

Result was evaluated based on modified Gartland and Werley's scoring system taking into account subjective based on pain, diability and range of motion, objective and radiological criteria. 10 patients (23%) had excellent result, 24 patients (55%) had good result, nine patients (20%) had fair results and one patient (2%) had poor result.

Intra-articular step off is the single most important radiological parameter which alone have direct bearing on final outcome in patients with these intra-articular distal end radius fractures managed either conservatively or operatively.