RESEARCH ARTICLE


Evaluation of an Image-Based Tool to Examine the Effect of Fracture Alignment and Joint Congruency on Outcomes after Wrist Fracture



Emily A Lalone 1, 2, Ruby Grewal 1, 3, Graham W King 1, 3, Joy C MacDermid*, 1, 2, 3
1 Roth McFarlane Hand and Upper Limb Centre, St Joseph’s Healthcare London, Ontario, Canada
2 School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
3 The University of Western Ontario, London, Ontario, Canada


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© Lalone et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Health Care London, 268 Grosvenor Street, London, ON, N6A 4L6, Canada; Tel: 519-646-6000, Ext. 64636; Fax: 519-646-6049; E-mail: jmacderm@uwo.ca


Abstract

Some mal-alignment of the wrist occurs in up to 71% of patients following a distal radius fracture. A multiple case study was used to provide proof of principle of an image-based technique to investigate the evolution and impact of post-traumatic joint changes at the distal radioulnar joint. Participants who had a unilateral distal radius fracture who previously participated in a prospective study were recruited from a single tertiary hand center. Long term follow-up measures of pain, disability, range of motion and radiographic alignment were obtained and compared to joint congruency measures. The inter-bone distance, a measure of joint congruency was quantified from reconstructed CT bone models of the distal radius and ulna and the clinical outcome was quantified using the patient rated wrist evaluation. In all four cases, acceptable post-reduction alignment and minimal pain/disability at 1-year suggested good clinical outcomes. However, 10 years following injury, 3 out of 4 patients had radiographic signs of degenerative changes occurring in their injured wrist (distal radioulnar joint/radio-carpal joint). Proximity maps displaying inter-bone distances showed asymmetrical congruency between wrists in these three patients. The 10-year PRWE (patient rated wrist evaluation) varied from 4 to 60, with 3 reporting minimal pain/disability and one experiencing high pain/disability. These illustrative cases demonstrate long-term joint damage post-fracture is common and occurs despite positive short-term clinical outcomes. Imaging and functional outcomes are not necessarily correlated. A novel congruency measure provides an indicator of the overall impact of joint mal-alignment that can be used to determine predictors of post-traumatic arthritis and is viable for clinical or large cohort studies.

Keywords: Degenerative disease, distal radius fracture, in vivo, joint alignment, outcome measure, x-ray computed tomography.