Fixation of dorsal rim fragments in distal radial intra-articular fractures: Is it necessary

doi:10.21203/rs.3.rs-3343842/v1

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Fixation of dorsal rim fragments in distal radial intra-articular fractures: Is it necessary

https://doi.org/10.21203/rs.3.rs-3343842/v1

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Background

To retrospectively analyze the effects of open reduction and internal fixation (ORIF) of AO type C intra-articular fractures on the recovery of wrist function in distal radial fractures with or without dorsal rim fragments and with or without dorsal rim fragment fixation.

Methods

A total of 98 patients with type C distal radius fractures treated with ORIF using the volar approach were enrolled. They were divided into three groups based on the existence and fixation of dorsal rim fragments: no dorsal rim fragment, fixed dorsal rim fragment, and unfixed dorsal rim fragment. Patients were followed-up with radiographs, range of motion (ROM), disabilities of arm, shoulder, and hand (DASH) scores, and Gartland–Werley (G–W) scores.

Results

The radiographs showed significant improvement at each follow-up time point compared to the preoperative status in all groups. There were no significant differences in the G–W and DASH scores among the three groups, except for the DASH score 3 months after surgery. No significant differences in wrist ROM, functional assessment scores, volar tilt angle, or radial length were observed between the fixed and nonfixed groups.

Conclusion

ORIF with locking plates is an effective approach for restoring the wrist anatomy in AO type C distal radius fractures. Significant differences were observed in radial inclination, radial styloid height, and postoperative wrist flexion ROM between the three groups 12 months after surgery, whereas no significant differences were found in volar tilt angle, other wrist ROMs, G–W, or DASH scores. Therefore, fixing dorsal rim fragments in distal radial intra-articular fractures is unnecessary.

Distal radius fracture

Dorsal rim fracture

Functional recovery

Disabilities of Arm

Shoulder and Hand score

Gartland-Werley score

Distal radial fractures (DRFs) are among the most common injuries, particularly in elderly individuals, and may lead to impaired wrist function with residual malunion ^[1]. With the aging population, the incidence of this fracture has been growing for decades. Meanwhile, the principles and methods of treatment, including conservative plaster splints, buttress plates, and minimally invasive locking plate systems, have evolved in recent years owing to developments in biomechanics, biology, and materials science ^[2–8]. Understanding the three-column theory and the characteristics of the articular surface in combined fractures provides useful references for internal fixation of distal radius fractures ^[9–11]. Many authors have realized that anatomical reduction of the articular surface and fragment stability are key points for achieving excellent outcomes ^[12–16].

It has been reported that volar plating for the treatment of comminuted intra-articular fractures of the distal radius with dorsal rim fragments is effective through the volar approach ^[17–19]. However, type C comminuted fractures with dorsal rim fragments pose challenges for surgeons because of thin dorsal fragments, difficulty in fixation, uncertain fixation effects, and tendon irritation complications caused by the dorsal cortex penetration of screws ^[20–23]. In recent years, studies have revealed no significant differences in functional recovery of the wrist between fixed and unfixed dorsal rim fragments ^[24–28]. Dorsal rim fractures are common distal radial fractures and are difficult to fix in some cases. It is of great significance to elucidate the influence of fixed versus unfixed dorsal rim fragments on functional recovery of the wrist.

A total of 98 patients with AO type C DRFs treated with open reduction and internal fixation (ORIF) at our hospital between May 2016 and May 2019 were enrolled in this study. The average age was 62.3 years old and the average follow-up period was 20.5 months. All patients sustained closed AO type C intra-articular comminuted fractures and underwent ORIF using a volar locking plating system (Synthes). Based on the presence and fixation of dorsal rim fragments, patients were divided into three groups: no dorsal rim fragment group (29 cases), fixed dorsal rim fragment group (31 cases), and unfixed dorsal rim fragment group (38 cases). All surgeries, follow-ups, and measurements were performed by the same trauma medical team at our hospital. Informed consent was obtained from each patient before enrollment and the study was approved by the ethics committee of our hospital.

The exclusion criteria were patients with multiple systemic fractures and ipsilateral limb fractures affecting treatment and assessment; patients with severe comorbidities of the heart, brain, and other vital organs influencing surgery and rehabilitation; patients with malignancies and connective tissue diseases affecting bone and joint functional recovery; and patients with distal radius fractures accompanied by distal and proximal radioulnar joint dislocation.

Wrist function was evaluated using the range of motion (ROM), grip strength, disabilities of arm, shoulder, and hand (DASH) score, and Gartland–Werley (G–W) score. Grip strength was quantified using a Jamar dynamometer with the elbow flexed at 90° and forearm in neutral rotation and expressed as a percentage of the corresponding value of the uninjured wrist. The ROM, including wrist flexion/extension and forearm supination/pronation, was measured using a goniometer. The DASH scores range from 0 to 100, with higher scores indicating more severe disability. The G–W scores range from 0 to 24, with higher scores indicating poorer wrist function.

Radiographic measurements were performed by the same two surgeons preoperatively and at 3, 6, and 12 months postoperatively, including volar tilt angle, ulnar inclination angle in anteroposterior and lateral views, articular surface length of the distal radius, and radial styloid height. Anteroposterior and lateral radiographs and computed tomography (CT) images were measured using a millimeter ruler. The dimensions of the dorsal rim fragments were quantified from the sagittal view of the CT images.

Continuous data are presented as the mean ± standard deviation (SD). An independent sample t test was used to evaluate differences between groups. Categorical data are presented as frequencies and percentages. A paired chi-squared test was used to analyze the differences between the groups. Statistical significance was set at P < 0.05. All statistical analyses were performed using SPSS version 22.0.

3.1 Radiographic measurements at different follow-up time points

There were statistically significant differences in the articular surface length of the radius and radial styloid height in the no dorsal rim fracture group based on the rank-sum test (P = 0.00 < 0.01). No significant differences were observed in volar tilt angle, ulnar inclination angle, or wrist deviation angle (P = 0.235–0.538). In the fixed dorsal rim fracture group, no significant differences were found in the volar tilt angle (P = 0.221) or radial styloid height (P = 0.935). Significant differences were observed in the ulnar inclination angle (P = 0.025) and radial articular surface length (P = 0.00 < 0.01). In the unfixed dorsal rim fracture group, there were no significant differences in volar tilt angle (P = 0.873) or ulnar inclination angle (P = 0.095), whereas significant differences were noted in radial articular surface length (P = 0.00 < 0.01) and radial styloid height (P = 0.027).

Based on the Kruskal–Wallis H test, significant differences were observed in radial inclination and radial styloid height among the three groups at each follow-up time point (P = 0.00–0.041), but no significant differences were observed in the volar tilt angle (P = 0.939–0.337).

Significant differences were found in ulnar length, styloid height (P = 0.01–0.001), ulnar inclination angle, wrist flexion ROM (P = 0.001–0.019), and DASH score 3 months after surgery (P = 0.011) between the fixed and unfixed groups. No significant differences were observed in the other parameters.

The preoperative displacement of dorsal rim fragments was 1.78 ± 0.29 mm for the fixed group and 1.91 ± 0.26 mm in the unfixed group. The postoperative displacement was 0.27 ± 0.11 mm and 0.85 ± 0.15 mm for the fixed and unfixed groups, respectively. The width of dorsal rim fragments was 3.25 ± 0.25 mm for the fixed group and 3.25 ± 0.21 mm in the unfixed group. The independent sample rank sum test showed significant differences between the preoperative and postoperative values in both groups (P = 0.001). No significant intergroup differences were observed (P = 0.854–0.611). At the 3-month follow-up, X-ray examination demonstrated fracture healing of the dorsal rim with the disappearance of fragment gaps. Details are presented in Table 1.

3.2 Comparison of ROM at different follow-up time points

The wrist flexion/extension and rotation ROMs improved gradually at 3, 6, and 12 months after surgery in all 3 groups, and the differences were statistically significant (P = 0.00 < 0.01). Significant differences existed in wrist flexion and rotation ROM 3 months after surgery among the groups (P = 0.002–0.022), whereas no significant differences were observed at other time points. The ROM stabilized 12 months after the surgery and no longer improved. Details are presented in Table 1.

3.3 Comparison of G–W and DASH scores at different follow-up points

The G–W and DASH scores of the patients in each group improved progressively after surgery, and the differences were statistically significant (P = 0.001). No significant differences were observed in the G-W and DASH scores among the three groups at each follow-up, except for the DASH score at 3 months after surgery (P = 0.021). Details are presented in Table 2.

3.4 Typical case image

Details are presented in Fig. 1 and Fig. 2.

Anatomical reduction and stabilization of the articular surface are critical for satisfactory outcomes in distal radius fractures ^{[2, 29–34]}. Volar plating fixation for the treatment of distal radius-comminuted fractures, including dorsally comminuted fractures, through the volar approach has shown excellent efficacy. Dorsal rim fractures are common in distal radial fractures. Thin dorsal fragments, difficulty in fixation, potential screw penetration of the dorsal cortex, and subsequent tendon irritation make the treatment of dorsal rim fractures challenging ^[16–18]. In recent years, studies have revealed no significant differences in wrist functional recovery between fixed and unfixed dorsal rim fragments ^[35–37]. In our study, dorsal rim fractures were frequently encountered during surgery for distal radial fractures and fixation was difficult in some cases. It is of clinical value to investigate the impact of fixed versus unfixed dorsal rim fragments on wrist function ^[24].

In this study, the results of the three groups demonstrated that ORIF with volar locking plates was an effective approach for restoring the anatomical structure of the wrist, leading to good functional outcomes. The radiographic parameters at follow-up visits after surgery were significantly improved compared with the preoperative status. Based on the independent sample rank sum test, no significant differences were found in the volar tilt angle, ulnar inclination angle, or radial styloid height in the group without dorsal fragments at different time points after surgery. In the fixed dorsal rim fragment group, there were no significant differences in the volar tilt angle and radial styloid height. In the unfixed group, no significant differences were observed in volar tilt or ulnar inclination angles. These findings indicate that locking plate fixation provides sufficient stability for distal radius fractures, which is consistent with the findings of previous studies ^{[38, 39]}. The ROM, G–W, and DASH scores improved progressively after surgery in all the groups, and the differences were statistically significant ^[40–43].

Radiographic measurements showed a slight shortening trend in radial articular length in all groups, which may be attributable to the age and systemic osteoporosis of the enrolled patients ^[44]. Meanwhile, distal volar screw fixation was distant from the articular cartilage, which may have led to a gradual loss of articular height due to local osteoporosis.

Our results confirmed that based on the Kruskal–Wallis H test for comparisons among groups, no significant differences were observed in volar tilt angle and articular length, while significant differences existed in other parameters at follow-up examinations, indicating that the postoperative volar tilt angle was not affected by the existence and fixation of dorsal rim fragments. The outcomes showed significant differences in ROM during the first three months after surgery. No significant differences were found in the G–W and DASH scores among all groups three months after surgery, except for the DASH score. Significant differences were observed in the final results, whereas no significant differences were observed in other parameters. Paired analysis revealed significant differences in ROM between the fixed and unfixed groups at each follow-up, suggesting that dorsal rim fragments may only influence postoperative ROM instead of functional assessment scores.

Compared to the no dorsal rim fracture group, no significant differences were noted in volar tilt angle, ROM, or functional scores between the fixed and unfixed groups at each time point, which is consistent with the results of previous studies ^[24]. Further statistical analysis showed that, based on the independent sample rank sum test, the preoperative displacement of dorsal rim fragments was 1.78 ± 0.29 mm in the fixed group and 1.91 ± 0.26 mm in the unfixed group (P = 0.854). The width of dorsal rim fragments was 3.25 ± 0.25 mm in the fixed group and 3.25 ± 0.21 mm in the unfixed group and no significant intergroup differences were found (P = 0.611). Significant differences were observed between the fixed (0.27 ± 0.11 mm) and unfixed (0.85 ± 0.15 mm) groups postoperatively (P = 0.001). However, fracture healing with the disappearance of articular gaps was observed at the 3-month follow-up. Significant differences were found in ulnar length, radial styloid height, ulnar inclination angle, wrist flexion ROM, and DASH score three months after surgery between the two groups, while no significant differences were found in other parameters.

Our study had several limitations. First, the retrospective nature of this study could have introduced confounding biases. In addition, the relatively small sample size of our study warrants caution when interpreting the results, and larger datasets are needed to draw reliable conclusions. Moreover, a longer follow-up period is necessary to accurately assess the incidence of long-term complications.

In conclusion, this study demonstrated that ORIF with volar locking plates is effective in the treatment of distal radius-comminuted fractures, leading to satisfactory functional outcomes. Dorsal rim fractures are common type C fractures characterized by thin fragments and fixation difficulties. However, our study confirmed that the existence and fixation of dorsal rim fragments only influenced ulnar inclination, radial styloid height, and postoperative wrist flexion ROM but did not affect postoperative volar tilt angle or wrist function. The limitations of this study include its small sample size and potential errors in radiographic measurements, which should be addressed in future studies. A larger sample size and control group setting could further improve the evidence level of this study.

ORIF, open reduction and internal fixation; ROM, range of motion; DASH, disabilities of arm, shoulder and hand; G–W, Gartland–Werley; DRFs, Distal radial fractures

Acknowledgements

Not applicable.

Funding

No funding was received.

Availability of data and materials

Please contact the author for data requests.

Author Contributions

All authors contributed to the data analysis, drafting or revising the article, agreeing to the journal to which the article will be submitted, gave final approval of the version to be published, and agreed to be accountable for all aspects of this work.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The study was approved by the ethics committee of the Beijing Friendship Hospital. This study was conducted in accordance with the latest guidelines of the Declaration of Helsinki. Each participant was assured of anonymity, which was maintained using subject-specific numeric codes on all records, including registration cards.

Shigi A, Oka K, Kuriyama K, Tanaka H, Yoshikawa H, Murase T. (2020) Three-dimensional analysis of displacement characteristics of dorsally angulated intra-articular distal radial fractures. J Hand Surg Eur Vol,45:339-347. doi: 10.1177/1753193419885265
Dario P, Matteo G, Carolina C, Marco G, Cristina D, Daniele F, Andrea F. (2014) Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury,45 Suppl 6:S21-S26. doi: 10.1016/j.injury.2014.10.018
Carter PR, Frederick HA, Laseter GF. (1998) Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg Am,23:300-307. doi: 10.1016/S0363-5023(98)80131-7
McCall TA, Conrad B, Badman B, Wright T. (2007) Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study. J Hand Surg Am,32:806-812. doi: 10.1016/j.jhsa.2007.04.016
Sammer DM, Fuller DS, Kim HM, Chung KC. (2008) A comparative study of fragment-specific versus volar plate fixation of distal radius fractures. Plast Reconstr Surg,122:1441-1450. doi: 10.1097/PRS.0b013e3181891677
Passiatore M, De Vitis R, Perna A, D'Orio M, Cilli V, Taccardo G. (2020) Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc system and K-wire pinning. Eur J Orthop Surg Traumatol,30:1243-1250. doi: 10.1007/s00590-020-02698-z
Maccagnano G, Noia G, Vicenti G, Baglioni M, Masciale MR, Cassano GD, Vitiello R, et al. (2021) Volar locking plate versus external fixation in distal radius fractures: A meta-analysis. Orthop Rev (Pavia),13:9147. doi: 10.4081/or.2021.9147
Disseldorp DJ, Hannemann PF, Poeze M, Brink PR. (2016) Dorsal or Volar Plate Fixation of the Distal Radius: Does the Complication Rate Help Us to Choose? J Wrist Surg,5:202-210. doi: 10.1055/s-0036-1571842
Harness NG, Ring D, Zurakowski D, Harris GJ, Jupiter JB. (2006) The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am,88:1315-1323. doi: 10.2106/JBJS.E.00686
Jakob M, Rikli DA, Regazzoni P. (2000) Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br,82:340-344. doi: 10.1302/0301-620x.82b3.10099
Katz MA, Beredjiklian PK, Bozentka DJ, Steinberg DR. (2001) Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment? J Hand Surg Am,26:415-421. doi: 10.1053/jhsu.2001.22930a
McQueen M, Caspers J. (1988) Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br,70:649-651. doi: 10.1302/0301-620X.70B4.3403617
Rikli DA, Regazzoni P. (1996) Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br,78:588-592. doi:
McQueen MM, Hajducka C, Court-Brown CM. (1996) Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br,78:404-409.
Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC. (2005) A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am,30:1185-1199. doi: 10.1016/j.jhsa.2005.08.009
Jung HS, Cho HC, Lee JS. (2021) Combined Approach for Intra-articular Distal Radius Fracture: A Case Series and Literature Review. Clin Orthop Surg,13:529-538. doi: 10.4055/cios20291
Musgrave DS, Idler RS. (2005) Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am,30:743-749. doi: 10.1016/j.jhsa.2005.03.006
Orbay JL, Fernandez DL. (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am,27:205-215. doi: 10.1053/jhsu.2002.32081
Ruch DS, Tocci FL, Grier AJ, Miles JJ, Patel PS, Mithani SK, Richard MJ. (2020) Integrated Compression Screw Stabilization of the Dorsal Lunate Facet in Intra-Articular Distal Radius Fractures. J Hand Surg Am,45:361. doi: 10.1016/j.jhsa.2019.09.001
Toros T, Sugun TS, Ozaksar K. (2013) Complications of distal radius locking plates. Injury,44:336-339. doi: 10.1016/j.injury.2013.01.008
Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. (2008) Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am,33:691-700. doi: 10.1016/j.jhsa.2008.01.024
Rozental TD, Beredjiklian PK, Bozentka DJ. (2003) Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am,85:1956-1960. doi: 10.2106/00004623-200310000-00014
Miyashima Y, Kaneshiro Y, Yano K, Teraura H, Sakanaka H, Uemura T. (2019) Size and stabilization of the dorsoulnar fragment in AO C3-type distal radius fractures. Injury,50:2004-2008. doi: 10.1016/j.injury.2019.08.003
Kim JK, Cho SW. (2012) The effects of a displaced dorsal rim fracture on outcomes after volar plate fixation of a distal radius fracture. Injury,43:143-146. doi: 10.1016/j.injury.2011.03.049
Kambouroglou GK, Axelrod TS. (1998) Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg Am,23:737-741. doi: 10.1016/S0363-5023(98)80063-4
Lozano-Calderon SA, Doornberg J, Ring D. (2006) Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation. J Bone Joint Surg Am,88:1486-1493. doi: 10.2106/JBJS.E.00930
Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR. (2013) External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury,44:409-416. doi: 10.1016/j.injury.2012.12.003
Lee JI, Cho JH, Lee SJ. (2015) The effects of the Frag-Loc((R)) compression screw on distal radius fracture with a displaced dorsoulnar fragment. Arch Orthop Trauma Surg,135:1315-1321. doi: 10.1007/s00402-015-2290-y
Medoff RJ. (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin,21:279-288. doi: 10.1016/j.hcl.2005.02.008
Mann FA, Wilson AJ, Gilula LA. (1992) Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology,184:15-24. doi: 10.1148/radiology.184.1.1609073
Batra S, Gupta A. (2002) The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury,33:499-502. doi: 10.1016/s0020-1383(01)00174-7
Rubinovich RM, Rennie WR. (1983) Colles' fracture: end results in relation to radiologic parameters. Can J Surg,26:361-363.
Jenkins NH, Mintowt-Czyz WJ. (1988) Mal-union and dysfunction in Colles' fracture. J Hand Surg Br,13:291-293. doi: 10.1016/0266-7681_88_90090-3
Orbay JL, Touhami A. (2006) Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res,445:58-67. doi: 10.1097/01.blo.0000205891.96575.0f
Failla JM, Koniuch MP, Moed BR. (1993) Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases. J Hand Surg Am,18:648-651. doi: 10.1016/0363-5023(93)90310-Y
Khamaisy S, Weil YA, Safran O, Liebergall M, Mosheiff R, Khoury A. (2011) Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates. Injury,42:393-396. doi: 10.1016/j.injury.2010.10.011
Chirpaz-Cerbat JM, Ruatti S, Houillon C, Ionescu S. (2011) Dorsally displaced distal radius fractures treated by fixed-angle volar plating: Grip and pronosupination strength recovery. A prospective study. Orthop Traumatol Surg Res,97:465-470. doi: 10.1016/j.otsr.2011.01.016
Matschke S, Wentzensen A, Ring D, Marent-Huber M, Audige L, Jupiter JB. (2011) Comparison of angle stable plate fixation approaches for distal radius fractures. Injury,42:385-392. doi: 10.1016/j.injury.2010.10.010
Gui XY, Cheng ZH, Shi HF, Chen YX, Xiong J, Wang JF, Qiu XS, et al. (2021) Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution. J Orthop Surg Res,16:530. doi: 10.1186/s13018-021-02641-w
Phadnis J, Trompeter A, Gallagher K, Bradshaw L, Elliott DS, Newman KJ. (2012) Mid-term functional outcome after the internal fixation of distal radius fractures. J Orthop Surg Res,7:4. doi: 10.1186/1749-799X-7-4
Rausch S, Klos K, Stephan H, Hoffmeier K, Gras F, Windolf M, Gueorguiev B, et al. (2011) Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model--a biomechanical study. Injury,42:1248-1252. doi: 10.1016/j.injury.2010.12.005
Cheng HS, Hung LK, Ho PC, Wong J. (2008) An analysis of causes and treatment outcome of chronic wrist pain after distal radial fractures. Hand Surg,13:1-10. doi: 10.1142/S0218810408003748
Knight D, Hajducka C, Will E, McQueen M. (2010) Locked volar plating for unstable distal radial fractures: clinical and radiological outcomes. Injury,41:184-189. doi: 10.1016/j.injury.2009.08.024
Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. (2004) Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am,86:1900-1908. doi: 10.2106/00004623-200409000-00007

Table 1 Image measurement index and range of motion (ROM) at different follow-up times in the different groups

group			Image index				ROM
group		1 week	3 months	6 months	12 months		3 months	6 months	12 months
non dorsal rim fracture group n=29	radial articular surface length（cm）	0.14±0.27	0.09±0.29	0.018±0.30	0.003±0.295#	wrist flexion（°）	52.86±15.13	57.10±14.39	56.82±13.26
	radial styloid process height（cm）	1.16±0.21	1.17±0.22	1.15±0.23	1.18±0.21	wrist extention（°）	56.27±10.82	59.17±11.13	59.86±11.35
	radial declination（°）	22.44±3.77	22.77±4.20	22.65±4.28	23.08±4.41	pronation（°）	79.03±10.97	82.96±9.35	84.86±7.32
	Volar tilt（°）	9.16±3.99	9.38±3.84	9.38±5.32	8.41±4.73	supination（°）	86.68±4.60	90.34±3.75	90.82±3.80
dorsal rim fracture fixed group n=31	radial articular surface length（cm）	0.15±0.19	0.07±0.12	0.06±0.12	0.04±0.15	wrist flexion（°）	49.58±8.40	53.00±9.06	54.29±9.21
	radial styloid process height（cm）	1.00±0.23	1.01±0.23	1.04±0.19	1.01±0.19	wrist extention（°）	50.80±7.63	54.77±10.19	56.61±9.27
	radial declination（°）	19.07±4.64	19.93±4.39	20.45±4.00	18.88±3.29	pronation（°）	75.12±9.36	78.96±9.01	80.41±8.08
	Volar tilt（°）	9.71±4.17	9.51±4.56	8.91±3.75	8.72±3.59	supination（°）	87.00±5.07	91.16±3.79	91.87±3.49
dorsal rim fracture unfixed group n=38	radial articular surface length（cm）	0.02±0.15	-0.01±0.19	-0.01±0.17	-0.02±0.19	wrist flexion（°）	42.60±6.89	48.57±5.68	49.78±5.59
	radial styloid process height（cm）	1.21±0.27	1.15±0.18	1.16±0.21	1.15±0.24	wrist extention（°）	51.47±9.81	57.47±10.01	60.05±9.02
	radial declination（°）	22.41±4.45	22.76±3.71	22.84±3.57	22.47±4.09	pronation（°）	73.23±10.06	78.31±12.60	79.86±12.15
	Volar tilt（°）	9.18±5.21	7.82±4.50	8.12±5.08	8.20±4.47	supination（°）	85.10±9.18	88.81±8.70	90.39±9.36

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Fixation of dorsal rim fragments in distal radial intra-articular fractures: Is it necessary

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Abstract

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Introduction

Materials and Methods

Results

3.1 Radiographic measurements at different follow-up time points

3.2 Comparison of ROM at different follow-up time points

3.3 Comparison of G–W and DASH scores at different follow-up points

3.4 Typical case image

Discussion

Conclusion

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