Radiographic prediction of Colles fracture displacement after splint fixation-a prospective study of 97 patients

Abstract

Objective: The study aimed to prospectively analyze the relevant radiographic data before and after the reduction of Colles fractures with splint fixation, to analyze the related influencing factors of fracture redisplacement from the perspective of imaging indicators, and to predict the key factors through artificial machine learning. The predictive value of the screened key factors may provide a reference for the prognosis judgment of the subsequent clinical application of splint in the treatment of Colles fractures. Methods: The study included 97 adult Colles fracture patients from January 2018 to October 2021 in the outpatient and emergency department of the Affiliated Hospital of Nanjing University of Chinese Medicine. The basic data of the patients, as well as standard frontal and lateral radiographs of the wrist before reduction, immediately after reduction, and 4 weeks after reduction and fixation were recorded. Data were collected from Radiograph. Grouping and statistics were performed according to whether fracture displacement occurred at the end of the 4-week follow-up after reduction and fixation. Two statistical methods were used for analysis to explore the risk factors for displacement, and the risk factors were were listed independently and analyzed and predicted by random forest method. Results: 31 patients were judged to be displaced at the end of follow-up, and an additional 66 patients were judged to be in good fracture position. The statistical analysis results showed that the risk factors for displacement after Colles fracture with splints predicted by both methods were the absence of anatomic alignment of the volar cortex, dorsally comminution, and anterior radial displacement before reduction. The above three factors were listed independently and analyzed and predicted by random forest method. The results showed that the AUC area predicted by these three indicators was 0.823, which has an ideal prediction accuracy. Conclusion: Malalignment of the volar cortex, dorsal comminution, and radial displacement before reduction are independent risk factors for fracture redisplacement after conservative splinting of Colles fractures. Predicting fracture redisplacement based on the above conditions has reliable accuracy. For patients with the above conditions, the choice of splinting therapy should be cautious and should be fully communicated with the patient in order to achieve a better clinical prognosis. Level of evidence:Level Ⅳ; Case series