Meulen, T.D. van der (2018) CT en Q3DCT analyse van intra-articulaire Radiografische parameters voorspellen functie op lange termijn. thesis, Medicine.
Full text available on request.Abstract
Background Intra-articular incongruence of distal radial fractures could lead to radiographic radiocarpal osteoarthritis. The correlation between de degree of the intra-articular dislocation of the fracture fragments and wrist function in long term is limited. Previous studies often used measurements obtained from radiographs, which showed to have a very low intra-rater reliability. The aim of this study is to identify the dislocation based on the more reliable measurements of CT-scans and quantitative 3D models (Q3DCT) from conservatively treated patients with intra-articular distal radius fractures. Subsequently we will analyze the influence this ‘measured dislocation’ on patient reported functional outcome measures after long term follow-up. Method Retrospectively we reviewed over 1000 CT-scans of the wrist, which were made between 2008 and 2015. In total there were 117 patients with conservatively treated intra-articular distal radius fractures with also a high-quality CT-scan available. All patients received the validated questionnaires DASH and PRWE (Scale 0 to 100, 0 means no dysfunction and 100 means high dysfunction of the wrist). The Response rate was 38% (n=40). Degree of dislocation (namely the gap and step-off, respectively defined as the distance between fracture fragments parallel and perpendicular to the articular surface) was measured on CT-scans and 3D models (Q3DCT). With a multivariate regression analysis, we investigated the relation between the degree of dislocation and the functional outcome in the long term. Results 40 patients were included (mean age of 54 years old) with AO type B- (20%) and type Cfractures (80%). Mean follow-up was 6,7 year (range 3 to 10 years). Mean gap was 2,3 mm (range 0 – 4,5) and step-off was 0,6 mm (range 0 – 5,5). At follow-up the mean DASH score was 7,1 (range 0 – 68,3) and the mean PRWE score was 8,4 (range 0 – 41). A multivariate regression analysis showed that an increase of one millimeter step-off results in an increase of the DASH score with 5,15 (p<0,01) (Confidence interval 1,7 – 8,6) and an increase of the PRWE score with 6,73 (p<0,01) (Confidence interval 3,6 – 9,8). An increase of the gap wasn’t correlated with decreased DASH and PRWE scores (p=0,3 and p=0,18). When there is presence of an ulna fracture the PRWE will be 7,73 higher (p=0,02) (Confidence interval 1,1 – 14,4). Conclusion In the current Dutch guideline articular incongruence >2mm is one of the most important factors to consider operative treatment. This study shows that a gap >2mm (range 0 – 4,5 mm) can lead to acceptable wrist function in the long term. A step-off >2mm results in a clinically relevant decrease in wrist function in the long term. A greater degree of dislocation could probably be accepted for conservative treatment before considering operative treatment than current guidelines suggests.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and IJpma, dr. F.F.A and traumachirurg and Afdelingen Traumachirurgie and 3D lab & Mond- Kaak- en Aangezichtschirurgie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2274 |
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