Short summary

A wrist fracture is one of the most common injuries seen in emergency rooms worldwide, accounting for approximately 15% of all fractures in the adult population. The right treatment at the right time is of utmost importance ensuring the best possible outcome. Treatment is commonly based on radiographic measurements. The objectives of this study are to estimate accuracy and reliability of the radiographic measurements upon which treatment is based with the long term goal to improve outcome for patients with wrist fractures by ensuring that characterization of fracture and decision to treat is based on evidence based measurements.

Rationale

What we don´t know about wrist fractures: Correlation of radiographs and RadioStereometric Analysis

Background

A wrist fracture is one of the most common injuries seen in emergency rooms worldwide, accounting for approximately 15% of all fractures in the adult population. A wrist fracture is of significant socioeconomic concern, particularly due to the high incidence and the possible long-term disability caused by post-traumatic osteoarthrosis. Osteoarthrosis is a well-known condition following a wrist fracture, and some studies find incidences as high as 65% approximately 7 years after initial fracture. Treatment of a wrist fracture is mainly decided based on radiographic characterization of the fracture. Measurements of tilt of the distal radius, radial shortening, and articular step-off of the distal radius, are often used to decide between operative and non-operative treatment.

Prior to using radiographic measurements in the treatment decision, an assessment of measurement accuracy is essential. To summarize existing evidence on accuracy of the radiographic measurements, we made a systematic literature review, and were only able to include 5 studies that assessed measurement accuracy by comparing radiographic measurements to gold standard, defined as measurements taken directly on the bone.

To the best of our knowledge, this was the first systematic review on accuracy of the radiographic measurements of tilt, shortening, inclination and articular step-off of the radius and ulnar variance. Five studies addressed this, all indicating a lack of radiographic stringency and perhaps, therefore, differing results. We were not able to draw any conclusions on accuracy, and must conclude that there appears to be a lack of evidence on accuracy of abovementioned measurements.

In summary, there is, at this time, not consensus on the threshold values used to decide between operative and non-operative treatment of a wrist fracture. A set of non-standardized acquired radiographs from which non-evidence based radiographic measurement are taken, are commonly applied in the treatment decision. Furthermore, the radiographic procedure, i.e. positioning of the arm, may alter apparent values of the measurements. Unsurprisingly, the predictive value of radiographic measurements in regards to outcome is contradictory within the literature. Further investigation is warranted on this matter, particularly given the prevalence of wrist fractures and the predisposition to long-term complications and post-traumatic osteoarthrosis.

This is a diagnostic accuracy study using donor arms with artificially created compressed and dislocated intra-articular distal radius fractures mimicking findings in the acute setting.

The purposes of this study are:

1. To estimate correlation of forearm positioning on the radiographic measurements of radial tilt, inclination and shortening

2. To estimate reliability and accuracy of articular step-of measured on radiographs using RSA as gold standard

Description of the cohort

21 donor arms with artificially created compressed and dislocated intra-articular distal radius fractures mimicking findings in the acute setting

Data and biological material

Radiographic measurements and RSA data

Collaborating researchers and departments

Research and Innovation Unit of Radiology, University of Southern Denmark

Department of Radiology, Odense University Hospital

• Professor (assoc.) Ole Graumann, MD, PhD

Department of Radiology, Odense University Hospital

• Trine Torfing, MD 

University College Lillebelt

• Senior Lecturer Helle Precht, PhD 

Research and Innovation Unit of Radiology, University of Southern Denmark

Department of Radiology, Odense University Hospital

• Clinical instructor Benjamin S. B. Rasmussen, MD. Ph.D.

Department of Orthopedic Surgery

• Hans Tromborg. MD. Ph.D. Lektor