Four-Corner Concept: CT-Based Assessment of Fracture Patterns in Distal Radius

Abstract

Operative treatment using plate fixation is an important adjunct in the treatment of distal radius fractures, although the evidence for its superiority over other modalities remains limited. We propose a new concept for fractures of the distal radius, based on the three-column model of the distal radius, and on the expanding knowledge about the different fracture patterns obtained by evaluation of the distal radius by computed tomographic (CT) scan. All fracture types can be characterized by subdividing the wrist joint into four corners, each with its own characteristics in terms of mobility, stability, and transfer of forces in the intact distal radius. Recognition of the specific fracture types based on this four-corner concept enables a tailored approach to treatment.

Keywords

distal radius fractures - intra-articular fractures

• References

• 1 Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996; 78 (4) 588-592
• 2 Melone Jr CP. Articular fractures of the distal radius. Orthop Clin North Am 1984; 15 (2) 217-236
• 3 Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB ; AOCID Prospective ORIF Distal Radius Study Group. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am 2009; 91 (4) 830-838
• 4 Reichl M, Piatek S, Adolf D, Winckler S, Westphal T. [Unrepaired fracture of the styloid process of the ulna: not a bad treatment result at distal radius fracture]. Unfallchirurg 2011; 114 (12) 1099-1104
• 5 Rikli DA, Honigmann P, Babst R, Cristalli A, Morlock MM, Mittlmeier T. Intra-articular pressure measurement in the radioulnocarpal joint using a novel sensor: in vitro and in vivo results. J Hand Surg Am 2007; 32 (1) 67-75
• 6 Andermahr J, Lozano-Calderon S, Trafton T, Crisco JJ, Ring D. The volar extension of the lunate facet of the distal radius: a quantitative anatomic study. J Hand Surg Am 2006; 31 (6) 892-895
• 7 Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am 2004; 86-A (9) 1900-1908
• 8 Forward DP, Davis TR, Sithole JS. Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis?. J Bone Joint Surg Br 2008; 90 (5) 629-637
• 9 Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury 2010; 41 (10) 986-995
• 10 Bain GI, Alexander JJ, Eng K, Durrant A, Zumstein MA. Ligament origins are preserved in distal radial intraarticular two-part fractures: a computed tomography-based study. J Wrist Surg 2013; 2 (3) 255-262
• 11 Ng CY, McQueen MM. What are the radiological predictors of functional outcome following fractures of the distal radius?. J Bone Joint Surg Br 2011; 93 (2) 145-150
• 12 Harness NG, Ring D, Zurakowski D, Harris GJ, Jupiter JB. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am 2006; 88 (6) 1315-1323