OTA 2008 Posters
Scientific Poster #116 Upper Extremity OTA-2008
Comparison of AO Type B and Type C Volar Shearing Fractures of the Distal Radius
J. Sebastiaan, Souer, MD (a-AO Foundation; b-Stichting Micheal van Vloten Fonds,
Rotterdam Netherlands; Stichting Annafonds, Leiden, Netherlands);
David C. Ring, MD, PhD (a,e-Acumed, LLC, Biomet; a-Joint Active Systems, a,b-Small Bone
Innovations; a,b,e- Smith + Nephew, Wright Medical Technology, Inc.; c-Hand Innovations;
d-Illuminos, Inc., Mimedex, Inc.; e-Tornier); Stefan Matschke (n);
Laurent J. Audige, MD (e-AO Foundation); Marta Marent (e-AO Foundation);
Jesse B. Jupiter, MD (a-Aircast (DJ), Biomet, Hand Innovations, Linvatec; Mitek, SBI, Synthes,
Wright Medical Technology, Inc., Zimmer; e-Amgen Co, Wyeth); AO-CID Study Group
Massachusetts General Hospital, Boston, Massachusetts, USA
Background: Fractures of the volar articular margin of the distal radius with volar radiocarpal subluxation (volar shearing fractures) can be accompanied by fracture of the dorsal metaphyseal cortex. We hypothesized that there is no significant difference in wrist function or health status after open reduction and plate and screw fixation between volar shearing fractures with a dorsal cortical break (AO/OTA type C fracture) and isolated volar shearing fractures (type B).
Methods: In a prospective cohort study of plate and screw fixation of the distal radius, 58 patients with a volar marginal shearing fracture of the distal radius and volar radiocarpal subluxation (eponymically known as volar Barton’s fracture) were followed for at least 1 year. 38t patients who also had a dorsal metaphyseal cortical fracture (type C fracture) were compared with 20 patients with true (type B) fractures. An expert panel of experienced orthopaedic hand surgeons and trainees reviewed all of the cases and agreed that they were appropriately considered as volar Barton’s fractures. Statistical significance was adjusted for multiple testing using a Bonferroni correction.
Results: There was a significant difference in wrist motion between patients with type C fractures and patients with type B fractures at 6 months only for radial deviation (P = 0.06), grip strength (P = 0.03), pain in motion (P = 0.01), and Gartland and Werley score (P = 0.08) There were no differences found between the two cohorts at 1 and 2 years. There were no significant differences in Disabilities of the Arm, Shoulder and Hand or Short Form-36 scores at any time point.
Conclusions: Volar shearing fractures are usually complete articular, type C fractures. Type C volar shearing fractures take longer to recover, but ultimately do as well as true type B volar shearing fractures.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.