Dorsal Tilt of the Distal Radius Fracture Changes With Forearm Rotation When Measured on Radiographs

Janni Jensen; Hans B. Tromborg; Benjamin Rasmussen; Oke Gerke; Trine Torfing; Helle Precht; Ole Graumann

doi:10.1016/j.jhsg.2021.05.006

Dorsal Tilt of the Distal Radius Fracture Changes With Forearm Rotation When Measured on Radiographs

Janni Jensen
, Hans B. Tromborg
, Benjamin Rasmussen
, Oke Gerke
, Trine Torfing
, Helle Precht
, Ole Graumann

University of Southern Denmark

Research output: Contribution to journal › Journal article › Research › peer-review

Abstract

Purpose: This study examined the impact of pronation and supination on the reliability of the radiographically measured values of dorsal tilt, radial inclination (RI), and ulnar variance (UV) in cadaveric forearms with artificially created distal radius fractures. Methods: We prepared 21 human cadaveric forearms (11 right and 10 left) for radiostereometric analysis (RSA) by insertion of tantalum markers. Distal radius fractures were created midway between the marker segments. Radiographs and RSA images were taken at different degrees of supination and pronation. The precise degree of forearm rotation was calculated using RSA software. Two observers (H.B.T. and T.T.) independently measured tilt, RI, and UV on all radiographs in a blinded and randomized fashion. Univariate linear regression analyses were used to determine the relationship between forearm rotation and the measured radiographic values. Results: The radiographically measured value of tilt was significantly impacted by forearm rotation. Supinating or pronating the forearm by 10° decreased and increased, respectively, the radiographic value of dorsal tilt by approximately 3°. Conclusions: This study showed that the positioning of the fractured forearm during the radiographic procedure significantly impacted subsequent radiographic measurements of tilt. Dorsal tilt measurements increased (ie, fracture displacement measured more dorsal) with pronation and decreased (ie, fracture displacement measured more toward neutral, with less dorsal tilt) with supination of the forearm. However, measurements of RI (p = 0.12 and p = 0.55 for observer 1 and 2) and UV (p = 0.34 and p = 0.17, observer 1 and 2) were not significantly impacted by rotation. Clinical relevance: Treatment of a distal radius fracture is, at least to some extent, based on radiographic quantification of fracture deformity. Therefore, unreliable measurements may adversely influence clinical decision making

Original language	English
Journal	Journal of Hand Surgery (European Volume)
Volume	3
Issue number	4
Pages (from-to)	182-189
ISSN	1753-1934
DOIs	https://doi.org/10.1016/j.jhsg.2021.05.006
Publication status	Published - Jul 2021

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10.1016/j.jhsg.2021.05.006Licence: CC BY-NC-ND

Distal radius fractures and accuracy of measurements - Does positioning influence clinician decision making?
Jensen, J. (Principle researcher), Graumann, O. (Co-researcher), Tromborg, H. (Co-researcher), Rasmussen, B. (Principle researcher) & Precht, H. (Co-researcher)
01/01/19 → 01/01/24
Project: Development project/ Innovation

Cite this

@article{04c764bdf21a4821a5c0fcdfd989895f,

title = "Dorsal Tilt of the Distal Radius Fracture Changes With Forearm Rotation When Measured on Radiographs",

abstract = "Purpose: This study examined the impact of pronation and supination on the reliability of the radiographically measured values of dorsal tilt, radial inclination (RI), and ulnar variance (UV) in cadaveric forearms with artificially created distal radius fractures. Methods: We prepared 21 human cadaveric forearms (11 right and 10 left) for radiostereometric analysis (RSA) by insertion of tantalum markers. Distal radius fractures were created midway between the marker segments. Radiographs and RSA images were taken at different degrees of supination and pronation. The precise degree of forearm rotation was calculated using RSA software. Two observers (H.B.T. and T.T.) independently measured tilt, RI, and UV on all radiographs in a blinded and randomized fashion. Univariate linear regression analyses were used to determine the relationship between forearm rotation and the measured radiographic values. Results: The radiographically measured value of tilt was significantly impacted by forearm rotation. Supinating or pronating the forearm by 10° decreased and increased, respectively, the radiographic value of dorsal tilt by approximately 3°. Conclusions: This study showed that the positioning of the fractured forearm during the radiographic procedure significantly impacted subsequent radiographic measurements of tilt. Dorsal tilt measurements increased (ie, fracture displacement measured more dorsal) with pronation and decreased (ie, fracture displacement measured more toward neutral, with less dorsal tilt) with supination of the forearm. However, measurements of RI (p = 0.12 and p = 0.55 for observer 1 and 2) and UV (p = 0.34 and p = 0.17, observer 1 and 2) were not significantly impacted by rotation. Clinical relevance: Treatment of a distal radius fracture is, at least to some extent, based on radiographic quantification of fracture deformity. Therefore, unreliable measurements may adversely influence clinical decision making",

author = "Janni Jensen and Tromborg, \{Hans B.\} and Benjamin Rasmussen and Oke Gerke and Trine Torfing and Helle Precht and Ole Graumann",

note = "Funding Information: This work (PhD study) was funded by RadiografR{\aa}det; the Torben og Alice Frimodts fund; the Grosser Foghts fund and Grosser A. V. Lykfeldt og hustrus Legat; the University of Southern Denmark; and the Department of Radiology, Odense University Hospital. None of the funding bodies had any influence on conduct of the research and/or interpretation of the results.",

year = "2021",

month = jul,

doi = "10.1016/j.jhsg.2021.05.006",

language = "English",

volume = "3",

pages = "182--189",

journal = "Journal of Hand Surgery (European Volume)",

issn = "1753-1934",

publisher = "SAGE Publications",

number = "4",

}

TY - JOUR

T1 - Dorsal Tilt of the Distal Radius Fracture Changes With Forearm Rotation When Measured on Radiographs

AU - Jensen, Janni

AU - Tromborg, Hans B.

AU - Rasmussen, Benjamin

AU - Gerke, Oke

AU - Torfing, Trine

AU - Precht, Helle

AU - Graumann, Ole

N1 - Funding Information: This work (PhD study) was funded by RadiografRådet; the Torben og Alice Frimodts fund; the Grosser Foghts fund and Grosser A. V. Lykfeldt og hustrus Legat; the University of Southern Denmark; and the Department of Radiology, Odense University Hospital. None of the funding bodies had any influence on conduct of the research and/or interpretation of the results.

PY - 2021/7

Y1 - 2021/7

N2 - Purpose: This study examined the impact of pronation and supination on the reliability of the radiographically measured values of dorsal tilt, radial inclination (RI), and ulnar variance (UV) in cadaveric forearms with artificially created distal radius fractures. Methods: We prepared 21 human cadaveric forearms (11 right and 10 left) for radiostereometric analysis (RSA) by insertion of tantalum markers. Distal radius fractures were created midway between the marker segments. Radiographs and RSA images were taken at different degrees of supination and pronation. The precise degree of forearm rotation was calculated using RSA software. Two observers (H.B.T. and T.T.) independently measured tilt, RI, and UV on all radiographs in a blinded and randomized fashion. Univariate linear regression analyses were used to determine the relationship between forearm rotation and the measured radiographic values. Results: The radiographically measured value of tilt was significantly impacted by forearm rotation. Supinating or pronating the forearm by 10° decreased and increased, respectively, the radiographic value of dorsal tilt by approximately 3°. Conclusions: This study showed that the positioning of the fractured forearm during the radiographic procedure significantly impacted subsequent radiographic measurements of tilt. Dorsal tilt measurements increased (ie, fracture displacement measured more dorsal) with pronation and decreased (ie, fracture displacement measured more toward neutral, with less dorsal tilt) with supination of the forearm. However, measurements of RI (p = 0.12 and p = 0.55 for observer 1 and 2) and UV (p = 0.34 and p = 0.17, observer 1 and 2) were not significantly impacted by rotation. Clinical relevance: Treatment of a distal radius fracture is, at least to some extent, based on radiographic quantification of fracture deformity. Therefore, unreliable measurements may adversely influence clinical decision making

AB - Purpose: This study examined the impact of pronation and supination on the reliability of the radiographically measured values of dorsal tilt, radial inclination (RI), and ulnar variance (UV) in cadaveric forearms with artificially created distal radius fractures. Methods: We prepared 21 human cadaveric forearms (11 right and 10 left) for radiostereometric analysis (RSA) by insertion of tantalum markers. Distal radius fractures were created midway between the marker segments. Radiographs and RSA images were taken at different degrees of supination and pronation. The precise degree of forearm rotation was calculated using RSA software. Two observers (H.B.T. and T.T.) independently measured tilt, RI, and UV on all radiographs in a blinded and randomized fashion. Univariate linear regression analyses were used to determine the relationship between forearm rotation and the measured radiographic values. Results: The radiographically measured value of tilt was significantly impacted by forearm rotation. Supinating or pronating the forearm by 10° decreased and increased, respectively, the radiographic value of dorsal tilt by approximately 3°. Conclusions: This study showed that the positioning of the fractured forearm during the radiographic procedure significantly impacted subsequent radiographic measurements of tilt. Dorsal tilt measurements increased (ie, fracture displacement measured more dorsal) with pronation and decreased (ie, fracture displacement measured more toward neutral, with less dorsal tilt) with supination of the forearm. However, measurements of RI (p = 0.12 and p = 0.55 for observer 1 and 2) and UV (p = 0.34 and p = 0.17, observer 1 and 2) were not significantly impacted by rotation. Clinical relevance: Treatment of a distal radius fracture is, at least to some extent, based on radiographic quantification of fracture deformity. Therefore, unreliable measurements may adversely influence clinical decision making

U2 - 10.1016/j.jhsg.2021.05.006

DO - 10.1016/j.jhsg.2021.05.006

M3 - Journal article

SN - 1753-1934

VL - 3

SP - 182

EP - 189

JO - Journal of Hand Surgery (European Volume)

JF - Journal of Hand Surgery (European Volume)

IS - 4

ER -

Dorsal Tilt of the Distal Radius Fracture Changes With Forearm Rotation When Measured on Radiographs

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Distal radius fractures and accuracy of measurements - Does positioning influence clinician decision making?

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