Impact of teardrop angle correction on functional outcomes in die punch fractures of the distal radius: retrospective study

Authors

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242999

Keywords:

Radius fractures, Wrist injuries, Fracture fixation, Internal, Treatment outcome, Retrospective studies

Abstract

Background: Anatomic reduction of die punch fractures of the distal radius is crucial to optimize functional outcomes. The teardrop angle, formed by the volar cortex and articular surface, reflects distal radius alignment and articular congruity. This study evaluated the relationship between teardrop angle correction and clinical/functional results following surgical fixation of these injuries.

Methods: This retrospective study included patients undergoing open reduction and internal fixation for die punch distal radius fractures between 2015-2020. Patients were divided into two groups based on teardrop angle correction: group 1 (≤10°) and group 2 (>10°). Disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist evaluation (PRWE) scores, range of motion, and grip strength were assessed at final follow-up (minimum 12 months). Multivariate analysis identified predictors of functional outcomes.

Results: 60 patients were included (32 in group 1, 28 in group 2). Groups were similar in baseline demographics and injury characteristics. Group 2 (>10° correction) had significantly better outcomes including lower DASH scores (14.5 versus 24.6, p=0.003), lower PRWE scores (21.6 versus 36.8, p=0.002), greater grip strength (84.6% versus 71.2%, p=0.005), increased flexion (62.5° versus 52.7°, p=0.004), and extension range of motion (55.8° versus 43.5°, p<0.001). On multivariate analysis, greater teardrop angle correction was an independent predictor of improved DASH and PRWE scores.

Conclusions: Obtaining >10° of teardrop angle correction during surgical fixation of die punch distal radius fractures correlated with superior functional outcome scores, grip strength, and mobility compared to ≤10° of correction. These findings emphasize the importance of restoring distal radius anatomy and articular congruity in this injury pattern. Precise intraoperative correction of the teardrop angle deformity should be a key goal.

References

Freeland AE, Luber KT. Biomechanics and biology of distal radius fractures. Hand Clin. 2005;21(3):335-50.

Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014;3(4):325-32.

Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647-59.

Catalano LW, Cole RJ, Gelberman RH, Evanoff BA, Gilula LA, Borrelli J. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am. 1997;79(9):1290-302.

Teunis T, Meijer S, Jupiter J; DRF-VALCP study group; Rikli D. The correlation between the teardrop angle and anterior lunate facet displacement in plating distal radial fractures. J Hand Surg Eur Vol. 2019;44(5):462-7.

Fujitani R, Omokawa S, Iida A, Santo S, Tanaka Y. Reliability and clinical importance of teardrop angle measurement in intra-articular distal radius fracture. J Hand Surg. 2012;37(3):454-9.

Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am. 2004;29(6):1121-7.

Knirk JL, Jupiter LB. Intra-articular fractures of the distal end of radius in young adults. J Bone Joint Surg. 1986;68A:647-59.

Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg. 1994;19A:325-40.

Forward DP, Davis TRC, Sithole JS. Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis? J Bone Joint Surg. 2008;90B:629-37.

Shaw JA, Bruno A, Paul EM. Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation. J Hand Surg [Am]. 1990;15:712-20.

Ruch DS, Lumsden BC, Papadonikolakis A. Distal radius fractures: a comparison of tension band wiring versus ulnar outrigger external fixation for the management of distal radioulnar instability. J Hand Surg [Am]. 2005;30:969-77.

Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures: perilunate fracture-dislocations of the wrist. Clin Orthop. 1987;214:136-47.

Chung KC, Watt AJ, Kotsis SV. Treatment of unstable distal radial fractures with the volar locking plate system. J Bone Joint Surg [Am]. 2006;88-A:2687-94.

Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop. 2003;27:1-6.

Murakami K, Abe Y, Takahashi K. Surgical treatment of unstable distal radius fractures with volar locking plates. J Orthop Sci. 2007;12:134-40.

Grewal R, MacDermid JC. The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. J Hand Surg Am. 2007;32(7):962-70.

Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg Br. 2009;91-B(1):102-7.

Synn AJ, Makhni EC, Makhni MC, Rozental TD, Day CS. Distal radius fractures in older patients: is anatomic reduction necessary? Clin Orthop Relat Res. 2009;467(6):1612-20.

Downloads

Published

2024-10-09

Issue

Section

Original Research Articles