Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;142(6):1075-1082.
doi: 10.1007/s00402-021-03801-7. Epub 2021 Feb 8.

Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study

Laura A Hruby  1 , Thomas Haider  1   2 , Roberta Laggner  1 , Claudia Gahleitner  1 , Jochen Erhart  2 , Walter Stoik  1 , Stefan Hajdu  1 , Gerhild Thalhammer  3
Affiliations

Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study

Laura A Hruby et al. Arch Orthop Trauma Surg. 2022 Jun.

Abstract

Introduction: Distal radius fractures account for one-fifth of all fractures in the emergency department. Their classification based on standard radiographs is common practice although low inter-observer reliabilities and superiority of computer tomography (CT) scanning in evaluation of joint congruency have been reported.

Materials and methods: We retrospectively analyzed 96 displaced distal radius fractures scheduled for open reduction and internal fixation using standard radiographic assessment. The radiographs were classified with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA), Fernandez and Frykman classifications by three observers and inter-rater reliabilities were calculated. Additional CT scanning was performed in all cases and the following parameters were assessed: radiocarpal joint involvement, fracture extent into the radial sigmoid notch, i.e. the distal radio-ulnar joint, comminution of the metaphysis, and concomitant ulnar styloid fracture. The CT scans were used as a reference standard to determine sensitivity and accuracy of standard radiographic assessment in evaluation of distal radius fractures.

Results: The inter-rater agreement for the AO classification was 35.4%, 68.8% for the Fernandez and 38.5% for the Frykman classification. Fracture extension into the radiocarpal joint was present in 81 cases (84.4%). Sigmoid notch involvement was found in 81 fractures (84.4%). Involvement of both joints was present in 72 cases (75%). The sensitivity of standard radiographs regarding radiocarpal joint involvement was 93.8%. Considering involvement of the distal radio-ulnar joint the false-negative rate using standard radiographs was 61.7% and the test's accuracy for sigmoid notch involvement was 45.8%.

Conclusion: This study demonstrates that involvement of the sigmoid notch is frequently missed in standard radiographs. The presented data support the frequent use of CT imaging to allow the holistic illustration of a fracture's complexion and to ensure optimal pre-operative planning.

Keywords: Distal radioulnar joint; Distal radius fracture; Fracture classification system; Interobserver reliability.

PubMed Disclaimer

Conflict of interest statement

The authors declare they have no financial interests.

Figures

Fig. 1
Fig. 1
Distal radius fracture in a 63-year-old female patient. Considering the posteroanterior (a) and lateral (b) projections of plain film radiography, this fracture was classified as an extraarticular A2 fracture according to the AO/OTA classification. In the coronal (c) and axial (d) CT reconstructions, however, radiocarpal joint involvement was clearly identified
Fig. 2
Fig. 2
Distal radius fracture in a 61-year-old female patient. Using standard posteroanterior (a) and lateral (b) radiographs, this fracture was classified as a type IV fracture according to the Frykman classification. The coronal (c) and axial (d) CT reconstructions, however, clearly show fracture extension into the sigmoid notch
See this image and copyright information in PMC

References

    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. doi: 10.1016/j.injury.2006.04.130. - DOI - PubMed
    1. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, Keller RB. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996;7(6):612–618. doi: 10.1097/00001648-199611000-00008. - DOI - PubMed
    1. Walenkamp MM, Vos LM, Strackee SD, Goslings JC, Schep NW. The unstable distal radius fracture-how do we define it? A Systematic Review J Wrist Surg. 2015;4(4):307–316. doi: 10.1055/s-0035-1556860. - DOI - PMC - PubMed
    1. Tanabe K, Nakajima T, Sogo E, Denno K, Horiki M, Nakagawa R. Intra-articular fractures of the distal radius evaluated by computed tomography. J Hand Surg Am. 2011;36(11):1798–1803. doi: 10.1016/j.jhsa.2011.08.021. - DOI - PubMed
    1. Lindau T, Aspenberg P. The radioulnar joint in distal radial fractures. Acta Orthop Scand. 2002;73(5):579–588. doi: 10.1080/000164702321022884. - DOI - PubMed

LinkOut - more resources