Podium (General) 01

Quantifying metaphyseal comminution objectively in distal radius fracture: An omen that portends the quality of clinico radiological outcome

Prof. Raghavendra Shankar Kulkarni
Consultant SSPM Medical College and Lifetime Hospital, Padave, Sindhudurg Oros, India

Introduction: The metaphyseal comminution was quantified objectively by metaphyseal collapse ratio, a very specific mensurable parameter. Its reliability is correlated between clinical and radiological parameter to evaluate the outcome in distal radius fractures.


Material & Methods: Clinical and radiographic data of 492 distal radius fractures in elderly patients was analysed. Conservatively treated groups consisted 92 (18.7%) with below elbow cast and 102(20.7%) with above elbow cast. Patients treated by surgical intervention comprised pins & plaster 98 (19.9%), external fixator 111 (22.6%) & volar plate in 89 (18.1%).


Results: The overall metaphyseal collapse ratio was 50.4 ± 15.8% (range 12.7 to 81.5%). The interclass correlation coefficient for inter observer reliability was 0.715 with a p value of < 0.001 and intra observer reliability was 0.764 with a p value of < 0.001. Among the radiographic factors examined, radial shortening, volar tilt and radial inclination were found to be significantly correlated with metaphyseal collapse ratio (r = 0.392 p < 0.001, r = -0.524, p< 0.001, and r = -0.428, p = 0.002) respectively. 82(35.19%) patients with dorsal comminution, 46(52.87%) with volar comminution and 44(25.58%) with both dorsal and volar comminution group were satisfied with range of motion of wrist and strength in injured hand and 151(64.8%), 41(47.12%), 128(74.41%) respectively were not.


Conclusion: The metaphyseal collapse ratio is an important radiological index which provides objective, reliable and reproducible system for describing metaphyseal comminution. More the metaphyseal collapse ratio longer is the prediction of displacement of fragments and ultimately functional radiological outcome.