Fractures of the distal radius Factors related to radiographic evaluation, conservative treatment and fracture healing

Christersson, A. 2017. Fractures of the distal radius. Factors related to radiographic evaluation, conservative treatment and fracture healing. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1290. 124 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-9796-5. Distal radius fractures (DRFs) are one of the most common injuries encountered in orthopaedic practise. Such fractures are most often treated conservatively, but surgical treatment has become increasingly common. This trend is not entirely scientifically based The aims of this thesis were threefold: to increase measurement precision in dorsal angulation (DA) on radiographs and computer tomographies (CTs); to assess the results after shortened plaster cast fixation time in reduced DRFs; and to evaluate the feasibility and safety of applying Augment® (rhPDGF-BB/β-TCP) in DRFs. In Paper I and Appendix 1 and 2, a semi-automatic CT-based three-dimensional method was developed to measure change in DA over time in DRFs. This approach proved to be a better (more sensitive) method than radiography in determining changes in DA in fractures of the distal radius. In Paper II, a CT model was used to simulate lateral radiographic views of different radial directions in relation to the X-ray. Using an alternative reference point on the distal radius, precision and accuracy in measuring DA was increased. Paper III and IV are based on a prospective and randomised clinical study (the GitRa trial) that compares clinical and radiographic outcomes after plaster cast removal at 10 days versus 1 month in 109 reduced DRFs. Three patients in the early mobilised group were excluded because of fracture dislocation (n=2) or a feeling of fracture instability (n=1). For the remaining patients in the early mobilised group (51/54) a limited but temporary gain in range of motion, but a slight increase in radiographic displacement were observed. Our results suggest that plaster cast removal at 10 days after reduction of DRFs is not feasible. Paper V is based on a prospective, randomised clinical study (the GEM trial) in which 40 externally fixated DRFs were randomised to rhPDGF-BB/β-TCP into the fracture gap or to the control group. Augment® proved to be convenient and safe during follow-up (24 weeks). However, because of the nature of the study design, the effect on fracture healing could not be determined. A decrease in pin infections was seen in the Augment® group, a finding we could not explain. Albert Christersson, Department of Surgical Sciences, Orthopaedics, Akademiska sjukhuset, Uppsala University, SE-75185 Uppsala, Sweden. © Albert Christersson 2017 ISSN 1651-6206 ISBN 978-91-554-9796-5 urn:nbn:se:uu:diva-312931 (http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-312931) To my heroes and idols: Christina Malin, Johanna and Oskar This thesis is based on the following papers I Christersson. A., Nysjö. J., Berglund L., Malmberg. F., Sintorn IM., Nyström I, Larsson. S. (2015) Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures. Skeletal Radiology, 2016 Jun; 45(6):763-9 II Christersson. A., Larsson. S. Increased precision in the measurement of dorsal angulation in distal radius fractures using the dorsal-ulnar corner as the reference point versus Lister ́s tubercle. Manuscript. III Christersson. A., Larsson. S., Östlund. B., Sandén. B. (2016) Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomised study. Journal of Orthopaedic Surgery and Research, 2016 Nov 21;11(1):145 IV Christersson. A., Larsson. S., Sandén. B. (2016) Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomised study. Submitted. V Christersson. A., Sandén. B., Larsson. S. (2015) Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures. Journal of Orthopaedic Surgery and Research, 2015 Mar 21; 10:37 Reprints were made with permission from the publisher