Distal radius fractures and accuracy of measurements – does positioning influence clinician decision-making?
Janni Jensen, Radiographer, PhD student
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 because of the high incidence and the possible long-term disability caused by post-traumatic osteoarthrosis. Treatment of a wrist fracture is mainly decided based on radiographic characterization of the fracture. Measurements of tilt of the distal radius, radial inclination (RI), and ulnar variance (UV), are often used to decide between operative and non-operative treatment.
Study A - Systematic review (doi: 10.1177/0284185119834687)
Prior to using radiographs 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. 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.
Study B – laboratory study
This is a diagnostic accuracy study using donor-arms in which radiostereometric analyses (RSA) Tantalum beads are injected and artificially created wrist fractures are made. The overall purpose of this study is, in a laboratory setting, to assess:
- Accuracy of the radiographic measured values of UV, RI and tilt and,
- the influence of forearm supination/pronation on reproducibility of the radiographic measured values of UV, RI and tilt
RSA is a validated and highly precise research tool originally developed to measure micromotion of joint implant in relation to bone. In this study RSA is used to give a precise measure of supination and pronation of the forearm between alternating exams. RSA is also used for highly accurate values of UV, RI and tilt in the fractured arms.
Expected clinical impact
The goal in the long run is to improve outcome for patients with wrist fractures by ensuring that characterization of fracture and decision to treat is based on evidence based measurements. Hypothesizing that long-term complication such as post-traumatic osteoarthrosis can be minimized.
Ole Graumann, Associate Professor, MD, PhD
Benjamin S Rasmussen, MD, PhD, Post Doc
Hans Bønnelykke Tromborg, MD, PhD
Helle Precht, Radiographer, PhD, Post Doc