No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

Distal radius fractures and distal ulna fractures among adults in a southern China county during the 11-year-period 2010 to 2020

Most distal radius fractures are associated with distal ulnar fractures. However, there is still a lack of consensus on the incidence of different types of distal ulnar fractures among adults in China. Therefore, we analyzed the incidence of distal radial fractures with and without associated distal ulnar fractures among adults in a southern China county from 2010 to 2020. Registry data of 2333 patients (2351 sides) with a distal radius fracture from 2010 to 2020 underwent evaluation, encompassing parameters such as age, sex, distal radius fracture classification, fracture side, and distal ulnar fracture classification. Distal radial fractures were classified according to the AO/OTA classification. Distal ulnar fractures were examined using the Q-modifier classification. 1719 females (73.68%) and 614 males (26.32%) were included in the study. Compared to men, the incidence of distal radial fractures accompanying distal ulnar fractures in women was approximately 2.8 times higher. Additionally, 49.81% of distal radius fractures were associated with fractures of the distal ulna, while 46.44% were associated with fractures of the ulnar styloid. The most common fracture type was that of the ulnar styloid Q1 (93.73%). The mean age of female patients was 61.71 ± 12.13, while male patients had an average age of 50.63 ± 14.86. The Q1 type was the most common type of distal ulnar fracture. We also found that more females (age range: 50 years or older) had type C distal radius fractures compared to males. However, type B fractures were observed more frequently in males than in females (range: 18-49 years). Osteoporosis was believed to be the main cause of fractures in women aged >50 years old. Moreover, the peak incidence of radius fractures in males was lower than in females in different age groups.

The Choice of Osteosynthesis for Distal Radius Fractures: A Matter of Taste, Fracture Instability, or Patient-Related Factors? A Retrospective Study of Functional Outcome in 346 Distal Radius Fractures Operated With Percutaneous Wires or Volar Plate Fixation

BACKGROUND

Surgery with volar locking plate (VLP) for distal radius fractures (DRFs) has become dominant over percutaneous Kirschner wire (K-wire) (PKW) fixation. Not many studies have proved advantages of the VLP and the increasing dominance of the VLP is thus not derived from evidence of superiority but influenced by other factors.

METHODS

By retrospectively classifying 346 DRFs treated with either PKW or VLP fixation, according to the Buttazzoni classification system, we aimed to investigate the determining factors for choice of surgical method, and by review of the patients' medical records, the functional outcome, duration, and frequentness of the rehabilitation period were correlated to Buttazzoni type and surgical method.

RESULTS

The odds ratio of having volar plate fixation was negatively correlated to age and positively correlated to a higher Buttazzoni type. We found no clinically significant differences in the functional outcome for different Buttazzoni type of fractures within the VLP and PKW groups, respectively, nor between the 2 methods of surgery for any Buttazzoni type of fracture.

CONCLUSION

Younger patients and fractures with higher grade of instability were more likely to be treated with VLP than PKW; however, neither fracture instability nor surgical method had any impact on functional outcome.

Illicit drug abuse and complexity of tibial shaft fracture based on AO/OTA classification: Is there any connection?

Purpose

Illicit drug abuse is a global epidemic afflicting millions worldwide. Several studies have investigated the contribution of this dependence as a risk factor for fracture, but its impacts on fracture severity have been rarely studied. The present study primarily aims to determine the relationship between illicit drug abuse and the severity of tibial shaft fractures.

Methods

This retrospective study consecutively included patients aged ≥18 years with tibial shaft fracture who attended Sina Tertiary Hospital, Tehran, Iran, between 2016 and 2021. The fracture patterns were assessed according to the Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association classification. Participants were divided into three individual specialists into groups: simple (A), wedge (B) and multifragmentary (C) fractures. The association of illicit drug abuse and other recorded variables, including age, sex, body mass index (BMI), comorbidities, physical activity, smoking habits and mechanism of injury, was also examined and assessed in multivariate logistic regression.

Results

Of 219 patients, 26 were drug abusers, and 193 had no history of use. A total of 20 out of 26 drug abusers experienced a complex fracture, yielding a rate of 76.9%, while this rate for nonusers was 50.3% (97 out of 193), indicating a statistically significant difference between the two subgroups (p = 0.011). The smoking history also influenced the fracture pattern (p = 0.027) based on univariate analysis; however, using adjusted multivariate analysis yielded only illicit drug abuse (odds ratio = 3.495; confidence interval = 1.144-10.680) as a risk factor for more complex fractures.

Conclusion

The evidence from this study suggests that complexity and fracture patterns can depend on illicit drug abuse history.

Level of Evidence

Level III.

Variations in Strain Distribution at Distal Radius under Different Loading Conditions

Distal radial fractures exhibit various fracture patterns. By assuming that the strain distribution at the distal radius affects the diversification of the fracture pattern, a parameter study using the finite element model of a wrist developed from computed tomography (CT) images was performed under different loading conditions. The finite element model of the wrist consisted of the radius, ulna, scaphoid, lunate, triquetrum, and major carpal ligaments. The material properties of the bone models were assigned on the basis of the Hounsfield Unit (HU) values of the CT images. An impact load was applied to the scaphoid, lunate, and triquetrum to simulate boundary conditions during fall accidents. This study considered nine different loading conditions that combine three different loading directions and three different load distribution ratios. According to the analysis results, the strain distribution at the distal radius changed with respect to the change in the loading condition. High strain concentration occurred in regions where distal radius fractures are commonly developed. The direction and distribution of the load acting on the radius were considered to be factors that may cause variations in the fracture pattern of distal radius fractures.