1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development. (4th May 2021)

• Record Type: Journal Article
• Authors: Esworthy, G; Johnson, N; Dias, J; Divall, P
• Is Part Of: British journal of surgery. Volume 108(2021)Supplement 2
• Publication Date: 2021-05-04
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab134.344
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method: A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results: Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions: Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.