Journal List > Arch Hand Microsurg > v.23(3) > 1106619

Kim, Jung, Park, Lee, Choi, and Lee: Does the Morphological Type of the Lunate Affect Surgical Outcomes in Patients with Distal Radius Fractures?

초록

Purpose:

We sought to compare the surgical results of distal radius fractures treated with volar locking plate (VLP) between two types of lunate. The hypothesis was that wrists with type II lunate might have worse surgical outcomes of distal radius fracture.

Methods:

Seventy patients with surgically treated distal radius fracture were included in this study. Morphology of the lunate was analyzed with computed tomography scans and simple radiographs. Patients with type I lunate were defined as having no articulation with the hamate. Patients with type II lunate were defined as having accessory articulation with the hamate. Surgical outcomes were assessed. Range-of-motion (ROM) and grip strength were measured at the final follow-up. All subjects were divided into two groups based on the lunate type and compared. Multiple logistic regression analysis was performed to find predictors for worse surgical outcome.

Results:

Mean age of the subjects was 53.66 years (17 to 74 years). Mean follow-up was 14.54 months (12 to 52 months). The mean flexion of the wrist joint was significantly lower in the group with type II lunate. The multiple logistic regression analysis demonstrated that the predictors for worse flexion of the wrist joint were patients with type II lunate, and insufficient restoration of normal volar tilt angle at final follow-up.

Conclusion:

Type II lunate wrist joints had significantly lower ROM, compared with type I lunate wrist joints after surgical treatment of distal radius fracture using VLP.

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Table1.
Baseline data of the subjects
Variable Value 95% CI of proportion
Patient no. 70  
Age (yr) 53.66±12.72 (17-74)  
Sex (men:women) 19:51  
Follow-up duration (mo) 14.54±7.72 (12-52)  
Fracture type (AO/OTA)    
 A:B:C 26:12:32  
Lunate morphology (evaluated with CT)    
 Type I 38 (54.3) 42.9-65.7
 Type II 29 (41.4) 30.0-52.9
 Vague type 3 (4.3) 0-10.0

Values are presented as number, mean±SD (range), or n (%).

CI: confidence interval, CT: computed tomography.

Table2.
Inter-observer measurement reliability
Variable Value
Lunate type measured with CT  
 Observer I (type I:type II:vague) 38:29:3
 Observer II (type I:type II:vague) 37:31:2
 Cohen's kappa 0.946
Lunate type measured with simple X-ray  
 Observer I (type I:type II:vague) 37:25:8
 Observer II (type I:type II:vague) 33:26:11
 Cohen's kappa 0.738

CT: computed tomography.

Table3.
Comparison results between two groups*
Variable Group I (Lunate type I) Group II (Lunate type II) p-value
No. 38 29 -
Age (yr) 51.8±13.30 56.0±11.72 0.183
Sex (men:women) 11:27 8:21 0.903
Fracture type (AO/OTA)      
 A:B:C 11:7:20 13:4:12 0.238
Follow-up (mo) 14.71±8.50 14.31±6.69 0.835
Within normal range:Abnormal      
 Radial inclination at final 34:4 26:3 0.981
 Radial height at final 33:5 25:4 0.940
 Ulnar variance at final 31:7 24:5 0.901
 Volar tilt at final 30:8 21:8 0.534
DASH 17.58±20.44 (0-91) 18.27±21.45 (0-82) 0.815
MMWS 76.61±16.94 (20-100) 76.38±17.47 (15-100) 0.944
Flexion 96.4±10.67 (50.0-112.5) 86.7±15.63 (53.3-100.0) 0.002
Extension 94.8±12.0 (35.3-118.2) 88.9±12.70 (60.0-110.0) 0.028
Radial deviation 92.7±23.2 (33.3-121.3) 88.2±16.83 (50.0-100.0) 0.457
Ulnar deviation 98.0±18.76 (50.0-150.0) 88.7±19.18 (33.3-116.7) 0.063
Supination 96.9±8.56 (60.0-100.0) 96.6±9.66 (58.8-100.0) 0.993
Pronation 97.1±11.09 (33.3-100.0) 98.3±2.61 (93.8-100.0) 0.248
Grip strength 79.1±21.86 (26.8-123.8) 79.8±18.61 (28.6-100.0) 0.652

Values are presented as number, mean± SD, or mean±SD (range).

DASH: disabilities of the arm, shoulder, and hand, MMWS: modified Mayo wrist score.

Cases with vague type lunate were excluded in analysis.

Table4.
Odds ratio of the several variables predicting worse flexion of wrist joint controlled with other confounders
Variable Odds ratio (95% CI) p-value
Lunate type II 6.156 (1.558-24.313) 0.010
Age 0.978 (0.925-1.034) 0.434
Fracture type (AO/OTA)    
 A (reference value) - -
 B 3.634 (0.457-28.876) 0.222
 C 2.330 (0.523-10.387) 0.267
Follow-up 0.886 (0.886-0.750) 0.434
Abnormal radial inclination at final 3.332 (0.376-29.539) 0.280
Abnormal radial height at final 1.079 (0.121-9.599) 0.946
Abnormal ulnar variance at final 2.575 (0.434-15.273) 0.298
Abnormal volar tilt at final 5.494 (1.216-24.820) 0.027

CI: confidence interval.

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