Sat., 10/18/08 Upper Extremity, Paper #72, 4:34 pm OTA-2008
The Association between Osteopenia and Severity of Distal Radial Fractures
Robert A. E. Clayton, MB, ChB1 (n); Mark S. Gaston1 (n);
Stuart H. Ralston, MD2 (n); Charles M. Court-Brown, MD1 (n);
Margaret M. McQueen, MD1 (n);
1Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom;
2Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom
Introduction: The role of osteoporosis and osteopenia in the etiology of fractures of the distal radius is well established but no previous studies have investigated the link between osteoporosis and the severity of distal radius fractures. The aim of this study is to investigate the association between the degree of osteoporosis with the severity of distal radius fracture.
Methods: 138 consecutive low-energy distal radius fractures underwent dual energy x-ray absorptiometry (DEXA) scanning. The resultant T-score represents the number of standard deviations the measured bone density is away from the mean value in healthy controls. Plain radiographs of the fractured distal radius were assessed for angulation, metaphyseal and articular comminution, carpal malalignment, ulnar variance, AO group and subgroup, early and late displacement, and malunion. Severity of fractures was quantified using previously published algorithms for probability of malunion, early and late displacement. These severity scores were correlated with the DEXA T-scores using the Spearman rank-order correlation test and the Pearson product moment correlation.
Results: There was a statistically significant linear correlation between increasing T-score and increasing likelihood of malunion, early instability, and late carpal malalignment (P = 0.0024). Patients with T-scores below –3 had a 69.9% likelihood of malunion compared with 46.8% when the T-score was greater than –1.
Conclusion: This is the first study to show a definite correlation between the degree of osteopenia and the severity of distal radius fractures. This may have implications in determining thresholds for pharmacologic treatment of osteopenia.
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.