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Association Between Radiological and Patient-Reported Outcomes


Key Points

  • Restoration of the main radiographic distal radial parameters has long been a focus of treatment in closed versus open management of distal radial fractures (DRFs).

  • Commonly used radiographic predictors for assessing adequate anatomic restoration include radial inclination, sagittal tilt (dorsal and volar), radial shortening, as well as intraarticular incongruity.

  • In review of the literature, radial height and articular incongruity have the most significant effect on patient-reported outcome measures (PROMs).

  • In particular, radial height loss of greater than 5–6 mm and articular incongruity > 2 mm is predictive of worse PROMs.

  • Radial inclination and sagittal tilt, while important to restore do not impact PROMs as significantly.

Panel 1: Case Scenario

A 63-year-old active female physiotherapist falls from standing and presents to the emergency department with a moderately displaced extra-articular distal radius fracture. On postreduction radiographs, the dorsal tilt is neutral, radial inclination is 15 degrees and the distal radius is 5 mmshortened ( Fig. 1 ). She strongly requests “anatomic reduction” and fixation as she fears the slightest malunion may jeopardize her function. Opting for shared decision-making, the main question arises: What radiographic parameters are most predictive of patient-reported outcomes?

Fig. 1, Postreduction radiographs.

Importance of the Problem

Distal radius fractures (DRFs) are one of the more common musculoskeletal injuries that present to the emergency department or urgent care. Deciding how to manage a DRF therefore has implications with respect to patient function. Displaced, comminuted intraarticular DRFs are challenging injuries to treat with closed management, prone to collapse or re-displacement, and are often indicated for open reduction and internal fixation.

One of the first attempts to evaluate the functional outcomes of dorsally displaced DRFs was by Gartland and Werley in 1951. They concluded that the degree of comminution was directly proportional to the development of posttraumatic arthritis. However, despite incomplete reduction, satisfactory functional results were obtained in 68.3% of the series over 1 year of follow-up.

Since this study, predicting the successful return to function and elimination of pain has been studied in the literature by several papers. Commonly used radiographic predictors for assessing adequate anatomic restoration radial inclination, sagittal tilt (dorsal and volar), radial shortening, as well as intraarticular incongruity.

Main Question

To what extent do radiographic parameters of radial inclination, radial height, dorsal tilt, and articular incongruity predict patient-reported outcome measures (PROMs)?

Current Opinion

Despite the fact that radiographic parameters influence treatment paradigms to a large extent and are widely used as core evaluation tool, there remains lacking consensus on which radiographic parameters have the greatest impact on PROMs.

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