A new distal radius fracture classification depending on the specific fragments through machine learning clustering method

Abstract

Purposes: The objective of this study was to investigate intra-articular distal radius fractures, aiming to provide a comprehensive analysis of fracture patterns and discuss the corresponding treatment strategies for each pattern.

Methods: 294 cases of intra-articular distal radius fractures lines were collected and clustered thorough K-means and hierarchical clustering algorithm. The demographic data of patients and the clinical treatment outcomes were recorded. For functional evaluation, quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS) pain score, range of motion (ROM) of the wrist joint and the percentage of the grip strength relative to the healthy wrist at 12 months follow-up were evaluated and recorded; For radiographic parameters of volar tilt (VT), radial inclination (RI), and ulnar variance (UV) were obtained; The occurrence of complications was carefully assessed and documented.

Results: Totally 294 patients were included and divided into the volar side affected group and the dorsal side affected groups. And each group was further categorized into three types: type I, with two parts fractures with either one volar/dorsal side intact; type II, with three parts fractures with volar/dorsal side simply affected; and type III, with four parts fractures with volar/dorsal side communited affected. The volar plate fixation was performed as the standard treatment, while the combined plate fixation was used for comminuted dorsal bone defects of the metaphysis and impaction. There were no differences in the postoperative radiograph parameters, functional outcomes and incidences of complications for each type of volar side group and dorsal side group except that the 3.2 type DRFs showed less range of flexion (75.56±7.48)° and extension (61.65±9.9)° than other dorsal types.

Conclusions: A new intra-articular distal radius fractures classification was proposed based on the affection condition of volar or dorsal side. The volar plate fixation is an effective treatment for the intra-articular distal radius fractures, while combined plate fixation can be considered as an alternative treatment for dorsal side comminuted fractures.

Level of evidence: III a.

Keywords: Articular; Classification; Combined fixation; Distal radius fractures; Machine learning; Plate fixation; Specific fragment.

Fig. 1

The flowchart of machine learning procedure on the DRFs

Fig. 2

The definition of the fragment in distal radius fractures: 1.the volar rim fragment, 2. the intermediate fragment, 3. the radial styloid fragment, 4. the dorsal wall fragment, 5. the dorsal ulnar corner(DUC) fragment; 4 + 5: the dorsal rim fragment

Fig. 3

The intra-articular DRFs were grouped into 2 groups depending on side affected and 3 types depending on the side affected degree. Each group was further categorized into three types: type I, with two parts fractures with either one volar/dorsal side intact; type II, with three parts fractures with volar/dorsal side simply affected; and type III, with four parts fractures with volar/dorsal side communited affected

Fig. 4

For type 1.1 DRFs, the fracture line traversed from the the sigmoid notch to the volar side articular surface. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered by and covered on the intra-articular surface; c) the model for type 1.1 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images

Fig. 5

For type 1.2 DRFs, the coronal fracture line is closed to the dorsal side and forms the dorsal fragment. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered and covered on the intra-articular surface; c) the model for type 1.2 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images

Fig. 6

For type 2.1 DRFs, the fracture lines originated from the sigmoid notch and extended to the dorsal and volar side of the articular surface forming a distinctive “├” shape. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered and covered on the intra-articular surface; c) the model for type 2.1 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images

Fig. 7

For type 2.2 DRFs, the fracture lines traversed coronally through the articular surface and extended to the volar side like “┴” shape. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered and covered on the intra-articular surface; c) the model for type 2.2 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images

Fig. 8

For type 2.3 DRFs, the fracture lines traversed along the dorsal side and radial styloid forming like “Y” shape. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered and covered on the intra-articular surface; c) the model for type 2.3 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images

Fig. 9

For type 3.1 DRFs, the fracture lines derived from the sigmoid notch, dorsal side, radial side and volar side, and crossed along the interfossal ridge forming like “×” shape. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered and covered on the intra-articular surface; c) the model for type 3.1 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images

Fig. 10

For type 3.2 DRFs, the fracture lines derived from the sigmoid notch, dorsal side, radial side and volar side, and crossed along the interfossal ridge forming like “+” shape. The morphological characteristics and the clinical treatment were shown as follows: a)-b) the fracture lines clustered and covered on the intra-articular surface; c) the model for type 3.2 DRFs; d) the CT scan for the fracture lines at the articular surface; e)-f) postoperative posteroanterior and lateral X-ray images