Correlation of the radial inclination angle in the distal part of the radius with the volar cortical angle and age-related changes of these angles

Hüsniye Tuğba YAZIBAŞI; Hıdır PEKMEZ; İsmail AĞIR; Fatih ÜÇKARDEŞ; Büşra ZENCİRCİ; Merve AYDIN

doi:10.2298/VSP220727011Y

Hüsniye Tuğba YAZIBAŞI Adiyaman University, Faculty of Medicine Institute of Graduate Science, Department of Anatomy, Adiyaman, Turkey
Hıdır PEKMEZ Malatya Turgut Özal University, Faculty of Medicine, Department of Anatomy, Malatya, Turkey
İsmail AĞIR Adiyaman University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adiyaman, Turkey
Fatih ÜÇKARDEŞ Adiyaman University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Adiyaman, Turkey
Büşra ZENCİRCİ Adiyaman University, Faculty of Medicine, Department of Anatomy, Adiyaman, Turkey
Merve AYDIN Malatya Turgut Özal University, Faculty of Medicine, Department of Anatomy, Malatya, Turkey

DOI: https://doi.org/10.2298/VSP220727011Y

Keywords: age factors, bone plates, radiography, radius fractures, weights and measures

Abstract

Background/Aim. The radial inclination (RI) and volar cortical (VC) angle values used in the treatment of radial distal end fractures may vary depending on factors such as the age and gender of the patient. That raises the question of the compatibility of the standard anatomical plates, which are frequently used in the surgical treatment of these fractures. The aim of the study was to evaluate the VC and RI angles depending on the age and gender of subjects and determine the correlation between these two angles. Methods. A total of 121 individuals (59 females and 62 males) aged 10–65 years were included in the study. The individuals were divided into two groups: a group of 60 adolescents (31 females, 29 males) 10–20 years old and a group of 61 adults (28 females, 33 males) aged 20–65 years. The subjects were also evaluated between themselves, independently, within each age group. Radiographic images were evaluated by using the 3.0.1.55 version of the KarPacsViewer application. Measurement points were determined, and angles between these points were measured. Statistical analyses were made using the SPSS 15.0 program. Results. When the correlation for 121 individuals was assessed independently of their gender, no statistically significant relationship was found between the RI angle and age (p = 0.616; r = -0.046). A statistically negative (or opposite) relationship was found between the VC angle and age (p < 0.001; r = -0.396). When women and men were compared in terms of the RI and VC angles, no statistically significant difference was found (p = 0.958, p = 0.165, respectively). The VC angle decreased as the age increased in females (p = 0.004; r = -0.365), while both the RI and VC angles decreased with increasing age in males (p = 0.032, r = -0.273; p < 0.0001, r = -0.445, respectively). Conclusion. Our findings regarding the RI and VC angles offer an advantage in terms of determining which plate designs are most appropriate for planning surgical procedures and treatment processes.

References

1. Rainbow MJ, Wolff AL, Crisco JJ, Wolfe SW. Functional kinematics of the wrist. J Hand Surg Eur Vol 2016; 41(1): 7–21.

2. Rosenauer R, Pezzei C, Quadlbauer S, Keuchel T, Jurkowitsch J, Hausner T, et al. Complications after operatively treated distal radius fractures. Arch Orthop Trauma Surg 2020; 140(5): 665–73.

3. Mader K, Pennig D. The treatment of severely comminuted intra-articular fractures of the distal radius. Strategies Trauma Limb Reconstr 2006; 1(1): 2–17.

4. Handoll HH, Huntley JS, Madhok R. External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev 2007; (3): CD006194.

5. Balik MS, Gurbuz H. Results of external fixator treatment in distal radius intra-articular fractures. Hand Microsurg 2019; 8(2): 80–90.

6. Acosta-Olivo C. Distal radius fractures: still a common problem. Medicina Universitaria 2017; 19(76): 140–2.

7. Vatansever A, Pişkin A, Kayalar M, Bal E, Ada S. The effect of dorsal cortical comminution on radiographic results of unstable distal radius fractures treated with closed reduction and K-wire fixation. Acta Orthop Traumatol Turc 2007; 41(3): 202–6. (Turkish)

8. Duymus TM, Mutlu S, Komur B, Mutlu H, Yucel B, Parmaksizoglu AS. Measurement of malrotation on direct radiography in pediatric distal radius fractures: prospective observational study. Medicine (Baltimore) 2016; 95(18): e3569.

9. Oc Y, Kilinc BE, Gulcu A, Varol A, Ertugrul R, Kara A. Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation. J Orthop Surg Res 2018; 13(1): 70.

10. Stirling E, Jeffery J, Johnson N, Dias J. Are radiographic measurements of the displacement of a distal radial fracture reliable and reproducible? Bone Joint J 2016; 98-B(8): 1069–73.

11. Fox S, Johnston G, Stewart S. Improved precision of radiographic measurements for distal radius fractures after a technique-teaching tutorial. Can J Surg 2020; 63(3): E261–71.

12. Kilic A, Ozkaya U, Kabukcuoglu Y, Sokucu S, Basilgan S. The results of non-surgical treatment for unstable distal radius fractures in elderly patients. Acta Orthop Traumatol Turc 2009; 43(3): 229–34.

13. Ağir I, Aytekin MN, Küçükdurmaz F, Başci O, Tetik C. Distal radius measurements and efficacy of fixed-angle locking volar plates. Turk J Med Sci 2014; 44(1): 36–41.

14. Gandhi RA, Hesketh PJ, Bannister ER, Sebro R, Mehta S. Age-related variations in volar cortical angle of the distal radius. HAND (N Y) 2020; 15(4): 573–7.

15. Imatani J, Akita K. Volar distal radius anatomy applied to the treatment of distal radius fracture. J Wrist Surg 2017; 6(3): 174–7.

16. Jose A, Suranigi SM, Deniese PN, Babu AT, Rengasamy K, Najimudeen S. Unstable distal radius fractures treated by volar locking anatomical plates. J Clin Diagn Res 2017; 11(1): RC04–8.

17. Brennan SA, Kiernan C, Beecher S, O’Reilly RT, Devitt BM, Kearns SR, et al. Volar plate versus k-wire fixation of distal radius fractures. Injury 2016; 47(2): 372–6.

18. Namazi H, Khaje R. Normal age-related alterations on distal radius radiography. Arch Bone Jt Surg 2015; 3(4): 250–3.

19. Ballal A, Sadasivan AK, Hegde A, Shetty A. Open reduction and volar plate fixation of dorsally displaced distal radius fractures: a prospective study of functional and radiological outcomes. J Clin Diagn Res 2016; 10(12): RC01–4.

20. Baek GH, Lee HJ, Gong HS, Rhee SH, Kim J, Kim KW, et al. Long-term outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up. Clin Orthop Surg 2011; 3(4): 295–301.

21. Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med 2018; 18(3): 91–3.

22. 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): 629–37.

23. Wilcke MK, Abbaszadegan H, Adolphson PY. Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year: A randomized study of 63 patients with a dorsally displaced fracture of the distal radius. Acta Orthop 2011; 82(1): 76–81.

24. Roh YH, Lee BK, Baek JR, Noh JH, Gong HS, Baek GH. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg Am 2015; 40(1): 34–41.

25. Solarino G, Vicenti G, Abate A, Carrozzo M, Picca G, Colella A, et al. Volar locking plate vs epibloc system for distal radius fractures in the elderly. Injury 2016; 47(Suppl 4): S84–90.

26. Kwon BC, Lee JK, Lee SY, Hwang JY, Seo JH. Morphometric variations in the volar aspect of the distal radius. Clin Orthop Surg 2018; 10(4): 462–7.

27. Kwak DS, Lee JY, Im JH, Song HJ, Park D. Do volar locking plates fit the volar cortex of the distal radius? J Hand Surg Eur Vol 2017; 42(3): 266–70.

28. Evans S, Ramasamy A, Deshmukh S. Distal volar radial plates: how anatomical are they? Orthop Traumatol Surg Res 2014; 100(3): 293–5.