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. 2025 Feb 15;26(1):156.
doi: 10.1186/s12891-025-08367-8.

A novel approach for three-dimensional evaluation of reduction morphology in distal radius fracture

Yuichi Yoshii  1 , Yusuke Eda  2 , Reo Asai  3 , Akira Ikumi  3 , Yasukazu Totoki  3 , Sho Kohyama  4 , Takeshi Ogawa  5
Affiliations

A novel approach for three-dimensional evaluation of reduction morphology in distal radius fracture

Yuichi Yoshii et al. BMC Musculoskelet Disord. .

Abstract

Background: Distal radius fractures are among the most common fractures, traditionally evaluated using two-dimensional (2D) parameters. These methods are unreliable in significantly displaced fractures, with discrepancies among evaluators. Recent advancements in imaging have introduced three-dimensional (3D) models, but standard parameters for 3D reduction morphology are not well established. This study aimed to develop a novel method for evaluating 3D reduction morphology based on the normal vector of a plane defined by anatomical reference points, comparing the reduction shape to the mirror image of the unaffected contralateral side.

Methods: This retrospective case-control study included 27 patients (mean age 67.6 years) who underwent osteosynthesis with a volar locking plate for distal radius fractures. Preoperative and postoperative computed tomography (CT) scans of the affected and unaffected wrists were analyzed using 3D image analysis software. The 3D coordinates of three reference points; (1) radial styloid process, (2) sigmoid notch volar edge, and (3) sigmoid notch dorsal edge, were used to evaluate the reduction shape and compare it to the unaffected side mirror image. Correlations between vector angles in the coronal, sagittal, and axial planes and clinical outcomes, such as % total active motion (%TAM) and Mayo wrist scores, were analyzed.

Results: The distances between the unaffected mirror image and postoperative image for the three reference points were 2.1 mm, 2.1 mm, and 2.7 mm, with barycenter differences of 1.7 mm. The postoperative plane areas consisted from three reference points were significantly larger in the postoperative image compared to the unaffected mirror image (203.4 mm² vs. 192.4 mm², P < 0.01). Correlation coefficients for vector angles in the yz-plane between unaffected mirror image and postoperative image were moderate (0.58, P < 0.05). Mild correlations were found between postoperative vector angles in the xy and xz planes and %TAM.

Conclusions: This novel 3D evaluation method provides a more comprehensive assessment of fracture reduction, particularly in the axial plane. While it demonstrates good reproducibility in coronal alignment, further refinement is needed for sagittal and axial alignments. This method could enhance surgical precision and improve clinical outcomes in distal radius fracture management.

Clinical trial number: Not applicable.

Keywords: Distal radius fracture; Normal vector; Osteosynthesis; Reduction; Three-dimensional.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Tokyo Medical University (protocol code T2022-0041 and date of approval, Dec 14th, 2022). Consent for publication: Written consent for publication was obtained from all study participants. Consent to participate: Written informed consent for participation in this study was obtained from all participants. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Representative images for each reference point and normal vector
Fig. 2
Fig. 2
Angles of vectors in the xy, yz, and xz-planes. (a) Angle of vector in yz-plane. (b) Angle of vector in xy-plane. (c) Angle of vector in xz-plane
Fig. 3
Fig. 3
Results of the distance and area. (a) Results of distances between unaffected mirror image and postoperative image. (b) Results of areas connecting three reference points. (c) *P < 0.01
Fig. 4
Fig. 4
Correlations of the quaternion components. (a) Correlations for the quaternion component of x. (b) Correlations for the quaternion component of z. (c) Correlations for the quaternion component of θ
Fig. 5
Fig. 5
Correlations of unit vector angles of the xy, yz, and xz planes. (a) Correlations for xy plane. (b) Correlations for yz plane. (c) Correlations for xz plane
Fig. 6
Fig. 6
Correlations between the vector angles of the xy and yz planes and 3D-PT and 3D-RI. (a) Correlation between the vector angle of xy plane and 3D-PT. (b) Correlation between the vector angle of yz plane and 3D-RI
Fig. 7
Fig. 7
Correlations between the vector angles of the planes and Mayo Wrist Score. (a) Correlations between the vector angles of the xy plane and Mayo Wrist Score. (b) Correlations between the vector angles of the yz plane and Mayo Wrist Score. (c) Correlations between the vector angles of the xz plane and Mayo Wrist Score
Fig. 8
Fig. 8
Correlations between the vector angles of the planes and %TAM. (a) Correlations between the vector angles of the xy plane and %TAM. (b) Correlations between the vector angles of the yz plane and %TAM. (c) Correlations between the vector angles of the xz plane and %TAM
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