Imaging anatomy study of dorsal ulnar fragment in comminuted intra-articular fractures of the distal radius based on CT three-dimensional reconstruction and precise measurement
Wang Junke, Zhang Chengnan, Ning Rende
Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei 230000, China
Abstract：Objective This study aimed to investigate the imaging anatomic morphological characteristics and clinical significance of dorsal ulnar fragment (DUF) in comminuted intra-articular fractures of distal radius on the basis of CT three-dimensional (3D) reconstruction and accurate measurement. Methods This cross-sectional investigation was conducted from January 2018 to October 2023, at the Third Affiliated Hospital of Anhui Medical University. It involved 150 patients with comminuted distal radius fractures accompanied by DUF, including 54 males and 96 females aged 38-81 (54±14) years. The patients were categorized in accordance with fracture classification as follows: 43 patients with AO23/C1 type, 69 patients with C2 type, and 38 patients with C3 type. All patients underwent preoperative high-resolution wrist CT scans with a slice thickness of 0.625 mm. By using Mimics software, a 3D model of the distal radius fracture and a standardized measurement coordinate system were established on the basis of the original CT scan data. The 3D model of DUF was isolated, and its dimensions, including the maximum length, width, and height of DUF and the sagittal plane fracture line angle (θ), were measured on the X, Y, and Z axes of the standardized measurement coordinate system, respectively. The ratio of DUF, which was the maximum length/width to the maximum length/width of the distal radius cross-section (i.e., the articular surface, FLr, FWr, %) was calculated as a corrected value for DUF dimensions after eliminating the influence of body type differences. Comparative analysis were conducted among different genders and fracture types on the basis of these parameters. Results The DUF length was (14.1±3.5) mm, the DUF width was (12.0±2.1) mm, the DUF height was (15.7±1.0) mm, the θ was 15.6°±1.8°, the FLr was 33.4% ± 4.4%, and the FWr was 27.0% ± 3.1%. The length of DUF in male patients [(15.3±3.1) mm] exceeded that in female patients [(13.4±3.5) mm], with statistically significant differences (t=-3.27, P=0.001). However, the FLr values for males (33.5%±4.8%) and females (33.3%±4.1%) showed no statistically significant difference (t=-0.27, P=0.791). There were no significant differences in the width and height of DUF, θ, and FWr between the males and the females (all P values > 0.05). The DUF length and FLr in patients with AO23/C1 type ([17.2±3.0] mm, 36.0%±4.4%) were notably greater than those in patients with C2 type ([11.2±2.1] mm, 31.3%±4.6%) and C3 type ([13.9±2.7] mm, 32.8%±3.4%), with statistically significant differences (all P values <0.05). There was no significant difference in width, height of DUF ,θ, and FWr in AO23/C1 type, AO23/C2 type and AO23/C3 type (all P values >0.05). Conclusion Within various comminuted distal radius fractures, DUF exhibited an unstable pattern characterized by a relatively perpendicular fracture angle on the dorsal aspect. After eliminating the body size differences between male and female patients, the morphological differences in DUF between different genders are not prominent. Notably, the length of DUF and its proportion in the distal radius cross-section were significantly larger in C1 fractures than those in C2 and C3 fractures. The above research findings indicate the significance of DUF in surgical reduction and underscore the necessity of individualized treatment based on precise preoperative 3D DUF.
王钧可, 张成楠, 宁仁德. 基于CT三维重建测量的桡骨远端粉碎性关节内骨折尺背侧骨折块的影像解剖学研究[J]. 中华解剖与临床杂志, 2024, 29(4): 232-238.
Wang Junke, Zhang Chengnan, Ning Rende. Imaging anatomy study of dorsal ulnar fragment in comminuted intra-articular fractures of the distal radius based on CT three-dimensional reconstruction and precise measurement. Chinese Journal of Anatomy and Clinics, 2024, 29(4): 232-238.
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