Comparison of AO type-B and type-C volar shearing fractures of the distal part of the radius

Souer, J. Sebastiaan, Ring, David, Jupiter, Jesse B., Matschke, Stefan, Audige, Laurent, Marent-Huber, Marta, Hanson, Beate, Rikli, D., Siebert, H.R., Campbell, D.A., Teoh, L.-C., Torretta, F., Lauri, G., Hintringer, W., Drobetz, H., Plecko, M., Wentzensen, A., Höntzsch, D., Neugebauer, R.H., Haas, N.P., Rehm, K.E., Winker, K.H., Ertel, W., Sommer, Chr., Wagner, M., and Chow, S.P. (2009) Comparison of AO type-B and type-C volar shearing fractures of the distal part of the radius. Journal of Bone and Joint Surgery, 91 (11). pp. 2605-2611.

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Abstract

Background: Fractures of the volar articular margin of the distal part of the radius with volar radiocarpal subluxation (volar shearing, or Barton, fractures) can be accompanied by a fracture of the dorsal metaphyseal cortex. We tested the null hypothesis that there is no difference in wrist function or health status after open reduction and plate-and-screw fixation between volar shearing fractures with a dorsal cortical fracture (complete articular, AO Type C) and those without a dorsal cortical fracture (partial articular, AO Type B).

Methods: In a multicenter cohort study, fifty-seven patients with a volar marginal shearing fracture of the distal part of the radius and volar radiocarpal subluxation were followed for at least one year following plate-and-screw fixation. Thirty-seven patients who also had a dorsal metaphyseal cortical fracture (Type-C fracture) were compared with twenty patients who had a partial articular (Type-B) fracture. The two cohorts were analyzed for differences in wrist and forearm motion, grip strength, pain, and the Gartland and Werley, Disabilities of the Arm, Shoulder and Hand (DASH), and Short Form-36 (SF-36) scores at six, twelve, and twenty-four months postoperatively. Differences in mean values and their change over time were determined.

Results: There were no significant differences between patients with a Type-B fracture and those with a Type-C fracture with respect to motion, grip strength, or the Gartland and Werley or DASH score at any time point. At six months after the surgery, the patients with a Type-B volar shearing fracture reported a mean score for pain in motion of 0.5 point on a 10-point visual analogue scale compared with 2.2 points for patients with a Type-C fracture (difference in means, 1.7 points [95% confidence interval, 0.7 to 2.6 points]; p < 0.001), but no significant difference was seen at twelve or twenty-four months.

Conclusions: Volar shearing fractures are usually complete articular, Type-C injuries. Patients with a Type-C volar shearing fracture experience more pain during early recovery, but ultimately their outcome is comparable with that for patients with a Type-B (partial articular) volar shearing fracture.

Item ID: 30051
Item Type: Article (Research - C1)
ISSN: 1535-1386
Funders: AO Clinical Investigation and Documentation, Small Bone Innovations, Smith and Nephew Richards, Wright Medical, Tornier, Acumed, Joint Active Systems, Biomet, Stryker, DePuy, Hand Innovations, Skeletal Dynamics, Illuminos, Mimedex
Date Deposited: 05 Nov 2013 01:06
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110314 Orthopaedics @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1106 Human Movement and Sports Science > 110601 Biomechanics @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920116 Skeletal System and Disorders (incl. Arthritis) @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 50%
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