ABSTRACT
The purpose of this study was to evaluate the role of the metaphyseal cancellous bone defect size in secondary dislocation of Colles' fracture. Thirty-five patients with a dislocated Colles' fracture were examined by computed tomography (CT) for metaphyseal bone defects. The size of the defect was assessed and related to the surface area of the cross-section of the distal radius at the site of the defect. The relative size of the defect correlated with the severity of dorsal angulation of the fracture but not with the shortening of the radius seen after cast immobilization. We concluded that secondary displacement of the distal radius is partly mediated through the metaphyseal cancellous bone defect, and to prevent malunion in dorsal angulation, operative treatment or possibly filling of the defect should be considered even as early as during primary reduction if a large defect is suspected.
Subject(s)
Colles' Fracture/complications , Epiphyses/diagnostic imaging , Joint Dislocations/etiology , Wrist Joint/diagnostic imaging , Adult , Aged , Casts, Surgical , Colles' Fracture/diagnostic imaging , Colles' Fracture/therapy , Female , Follow-Up Studies , Fracture Fixation/instrumentation , Fracture Fixation/methods , Fracture Healing/physiology , Humans , Injury Severity Score , Joint Dislocations/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray Computed , Wrist Joint/physiopathologyABSTRACT
Interobserver reliability of the AO system of classification of fractures of the distal radius was assessed using plain radiographs and CT. Five observers classified 30 Colles'-type fractures using only plain radiographs; two months later they were reclassified using CT in addition. Interobserver reliability was poor in both series when detailed classification was used. By reducing the categories to five, interobserver reliability was slightly improved, but was still poor. When only two AO types were used, the reliability was moderate using plain radiographs and good to excellent with the addition of CT. The use of CT as well as plain radiographs brings interobserver reliability to a good level in assessment of the presence or absence of articular involvement, but is otherwise of minor value in improving the interobserver reliability of the AO system of classification of fractures of the distal radius.
