[An analytical classification of fractures of the distal radius: The "M.E.U." classification]. / Classification analytique des fractures de l'extrémité distale du radius : la classification << M.E.U. >>

INTRODUCTION: Fractures of the distal radius are often complex injuries involving to a varying degree the radial metaphysis (M), radial epiphysis (E) and distal ulna (U). The association of these three parameters varies in a given injury and each fracture is a specific lesion which often defies inclusion in a well-defined group. An analytical classification is proposed. MATERIALS AND METHODS: The classification system analysed the three components of the fracture, assigning to each an index of gravity increasing from 0 to 4 and taking into account the main prognostic factor. Interobserver and intraobserver evaluation was carried out. The system was a posteriori applied to a prospective series of 166 distal radius fractures. RESULTS: Mean interobserver reliability was 0.78 and mean intraobserver reproducibility 0.81. M and E were closely correlated with treatment, M with algodystrophy, E with pain and U with mobility and patient satisfaction at one year. CONCLUSIONS: Inter- and intraobserver reproducibilities were good and the results validated our gravity indexes. This classification, describing all possible combinations of the three components of the fracture, is useful for both prognosis and treatment.

Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year. A prospective study of 95 cases.

Intracarpal ligamentous lesions associated with fractures of the distal radius (FDR) are frequent. The prevalence of these lesions has been assessed either by arthrography or by arthroscopy, but their outcome remains unknown. We carried out a radiographic study to assess the incidence of intracarpal ligamentous lesions with scapholunate (SL) and/or lunotriquetral (LT) dissociation and their outcome at one year. These lesions were termed "dissociative ligamentous lesions" (DLL). This prospective series consisted of 102 consecutive FDR's. The initial x-rays, immediate postoperative x-rays and x-rays at 1 year were studied. We studied the relationships of the bones of the first carpal row, abnormal joint space widening, Gilula's lines and the values of the intracarpal angles. The evolution of the carpal height ratio between day 0 and one year was studied. Complete xrays were available for 95 patients. There were 9 epiphyseal, 45 metaphyseal and 41 mixed fractures. DLL's were diagnosed in the early stages in 40 patients. There were 29 isolated SL lesions, 2 isolated LT lesions and 9 cases of associated SL and LT lesions. At 1 year, the diagnosis was confirmed in all these cases but a further case of SL dissociation was diagnosed. At 1 year, 61% of DLL's showed significant loss of carpal height and were considered as progressive. There was an association between the type of fracture and the presence or absence of DLL (p = 0.02). This study, based on radiographic analysis alone, showed 43% DLL's. The majority could be identified immediately. These findings are similar to those in recent arthrographic or arthroscopic studies, but the interest of plain radiographic study is to diagnose only those lesions having a definite effect on the carpus ("static instability"). At 1 year, 61% of lesions diagnosed have significantly affected carpal height.