Radiological Assessment of Carpal BonesInstability in Conservatively ManagedDistal Radius Fractures
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Abstract
Background: Fractures of the distal radius are the most common type of fracture, which affects ~15–18% of all
skeletal fractures and are frequently associated with soft-tissue injuries that can alter carpal alignment. Progressive
carpal malalignment may influence fracture stability and overall radiological outcome. The objective of the study was
to determine carpal bone instability following non-operative management with the help of radiological parameters
and to assess the final outcome of distal radius fractures that were managed conservatively for a minimum of
6 weeks. Objectives: The purpose of this study was to determine the incidence and pattern of carpal instability in
distal radius fractures, which were managed with non-operative methods, and to evaluate the relationship between
initial fracture characteristics and subsequent radiological alignment. Materials and Methods: A prospective
study involving 104 patients with fractures of the distal radius treated by non-operative methods (closed reduction
and casting) was conducted. Cases were selected based on the inclusion and exclusion criteria. X-rays were
obtained pre-reduction, immediately post-reduction, and at the 6-week follow-up. Radial height, dorsal tilt, effective
radiolunate flexion (ERLF), scapholunate angle (SLA), and radiolunate angle (RLA) were recorded. Based on
ERLF, malalignment was categorized as midcarpal (ERLF <25°) or radiocarpal (ERLF >25°). Results: Midcarpal
malalignment was observed in 84.6% (88/104), whereas 15.4% (16/104) demonstrated radiocarpal malalignment.
Although immediate post-reduction films showed significant improvement (P < 0.05), loss of reduction was more
prominent in the radiocarpal group. ERLF remained significantly elevated in the radiocarpal pattern at all-time
points. SLA and RLA changes over time were also more unstable in this group. Conclusion: Two reproducible
patterns of carpal bone malalignment accompany fractures of the distal radius. Malalignment of the radiocarpal
joint is more resistant to correction and more frequently associated with instability during immobilization. ERLF
was a sensitive parameter for classifying malalignment and predicting radiological outcomes.
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