Distal Radial fracture Case presentation Emil Dionysian, MD Kaiser Permanente, Orange County, CA
Operative Decision point
The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review
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Table 3
Level of evidence for the most commonly used definitions
Page 8 of 18
Level of
Year Definition evidence .
Secondary NA Displaced fracture following adequate reduction Expert opinion displacement (V)
Lafontaine 1989 At least three of the following criteria: Ill
• Dorsal angulation > 20° • Dorsal comminution • Intra-articular radiocarpal fracture • Associated u In ar fracture • Age > 60 years
Volarly displaced NA • Smith fracture Expert opinion • Reversed Barton fracture (V)
Irreducible NA • frreducible fracture Expert opinion (V)
AO type C2 1990 • Complete articular fractures Expert opinion • Simple articular fracture (V)
• Multifragmentary metaphyseal component
Poigenflirst 1980 • Radioulnar separation Expert opinion • The presence of dorsal comminution (V)
• Associated ulna fracture resulting in ulnar disinsertion
Cooney 1979 One or more of the following: Expert opinion • Radial shortening of IO mm (V) • Dorsal angulation > 20° • Marked comminution combined with intra-articular
fragments
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Abbreviation: NA, not applicable.
'The levels of evidence for definition of unstable distal radius fracture based in original study on the Oxford Centre for Evidence-based Medicine Levels of Evidence (March 2009),i
Only Lafontaine's definition originated from a clinical study, describing a retrospective cohort of 167 cases.s- Lafontaine et al performed a univariate analysis for each risk factor and found a significant influence of each factor on the radiological outcome. They concluded that only patients with three or fewer instability factors had a satisfactory radiological outcome. Accordingly, Lafontaine considered a distal radius fracture unstable if three or more of the following factors were present: dorsal angulation exceeding 20°; dorsal comminution; intra-articular radiocarpal fracture; associated ulnar fracture; and
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4626227/ 2/6/2021
Journal of wrist surgery 2015 Nov. 4(4)307-316“The Unstable Distal radius Fracture- How do we define it”systematic review of 479 studiesWalenkamp et al.Amsterdam, The Netherlands
Lafontaine Criteria for “unstable fx “:3 out of 5Dorsal angulation > 20 deg.Dorsal ComminutionIntra-articular radio-carpal fxAssociated ulnar fxAge > 60
• Case #2• 53 y/o female executive• fell off her bicycle 4 days prior• closed injury, no neurovascular injury
Case #3
• 53 y/o right hand dominant female• fell in campground with left distal intra-
articular distal radius fracture• healthy except for extreme obese• BMI 62 • Lives alone, recently divorced