Distal radius fractures and radiographic assessment: a systematic review of measurement accuracy

Abstract

Background Distal radius fracture characterization and treatment are mainly based on radiographic measurements but with contradictory findings on the correlation of those measurements to clinical outcome. Before applying radiographic measurement to the treatment decision and before correlating the measurements to clinical outcome, an accuracy of measurements must be established. Purpose To summarize existing evidence on accuracy of the radiographic measurements of: (i) dorsal/volar tilt of the distal radius; (ii) radial shortening; (iii) ulnar variance; (iv) radial inclination; and (v) articular step-off of the distal radius. We conducted a systematic critical review of the literature. Material and Methods MEDLINE, EMBASE, and the Cochrane Library database were searched. The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were followed. Quality of included studies was assessed using a tailored version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results A total of 5908 publications were screened and five studies met the inclusion criteria. Four studies assessed accuracy of articular step-off but with contradictory outcomes. Radiographic measurements of step-off were accurate in two studies and inaccurate in one study. In the last step-off study, some of their measurements varied significantly but accuracy was not reported. The radiographic measurements of ulnar variance were significantly underestimated when compared to the true variance. We were not able to include studies that assessed accuracy of radial shortening, radial inclination, or dorsal/volar tilt against a reference standard. Conclusion Currently, evidence is not available to support accuracy of the radiographic measurements commonly used to characterize distal radius fractures.

Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians’ radiograph interpretation

“…A thorough review on the radiographic parameters of distal radius fractures showed marked variability in the actual description of performing the measurements (Lalone et al., 2015). In a recent review on the evidence regarding the accuracy of the parameters, five of 5908 publications were found to be eligible (Jensen et al., 2019). The study concluded that there is no evidence available to support the accuracy of the radiographic measurements.…”

Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials

“…However, there is lack of evidence supporting the correlation between clinical outcomes of the fracture and degree of radiographic deformity. 40 In a recent randomized study, Plant et al reported radiographic parameters as poor predictors of satisfactory functional outcomes and raised concerns about the use of radiological parameters to determine management. 41…”

“…However, there is lack of evidence supporting the correlation between clinical outcomes of the fracture and degree of radiographic deformity. 40 In a recent randomized study, Plant et al reported radiographic parameters as poor predictors of satisfactory functional outcomes and raised concerns about the use of radiological parameters to determine management. 41 Initial postoperative superiority of VLP fixation in terms of DASH, grip strength, and ROM outcomes could be explained by immediate commencement of early rehabilitation protocol after surgery, anatomical restoration of joint, the surface and superior biochemical properties of volar plates that are capable of sustaining physiological loads of early active wrist motion.…”

Efficacy of electroacupuncture in assisting postoperative healing of distal radius fractures: study protocol for a randomized controlled trial

“…In order to promote blood circulation and eliminate inflammatory edema, we choose the density wave with a frequency of 2/100 HZ. Previous guidelines developed by ASSH and several studies have shown that ulnar variability is an accurate radiological predictor of functional outcome [ 48 , 49 ]. We will calculate the changes in ulnar positive variance before and after treatment in both groups of patients.…”