[Analysis of risk factors of postoperative bone fragment displacement in patients with distal radius fractures involving the dorsal side of the radius].

OBJECTIVE: To analyze the factors influencing dorsal intra-articular bone fragment displacement after palmar internal fixation in patients with distal radius intra-articular fractures involving the dorsal radius, providing a theoretical basis for clinical treatment.

METHODS: A retrospective analysis was conducted on the clinical data of 64 patients with intra-articular distal radius fractures who underwent volar internal fixation between February 2022 and June 2024, including 22 males and 42 females, with an age range of 35 to 79 years and a mean age of (61.71±10.25) years. Data including patients' age, gender, AO fracture classification, preoperative CT imaging parameters, postoperative rehabilitation status and follow-up outcomes were collected. Univariate and multivariate Logistic regression analyses were used to identify the influencing factors of postoperative dorsal intra-articular bone fragment displacement, and receiver operating characteristic (ROC) curve was adopted to evaluate the efficacy of the prediction model.

RESULTS: Among 64 patients who underwent surgery for distal radius fractures, fragment displacement occurred in 18 cases, with an incidence rate of 28.13% (18/64). Univariate Logistic regression analysis demonstrated that there were statistically significant differences between the displacement group and the non-displacement group regarding osteoporosis, preoperative total fragment displacement distance, transverse width, transverse-to-longitudinal ratio, and volume (P<0.05). The results of multivariate analyses showed that preoperative total distance of fracture block displacement [OR=1.864, 95%CI(1.030, 3.372), P=0.040], osteoporosis [OR=7.767, 95%CI(1.333, 45.108), P=0.022], transverse-to-longitudinal ratio [OR=0.393, 95%CI(0.227, 0.681), P=0.001], transverse width [OR=0.624, 95%CI(0.391, 0.996), P=0.048], and volume [OR=0.980, 95%CI(0.963, 0.998), P=0.026] were the independent influences on postoperative dorsal intra-articular fracture block displacement (P<0.05). The results of ROC curve analyses showed that the area under the curve(AUC) of osteoporosis, preoperative fracture block displacement distance, transverse width, transverse to longitudinal ratio, volume were lower than the AUC of joint prediction, respectively.

CONCLUSION: Postoperative fracture block displacement in patients with intra-articular fractures of the distal radius involving the dorsal radius is influenced by a number of factors, among which the presence of osteoporosis in the patient, total preoperative fracture block displacement distance, transverse-to-longitudinal ratio, transverse width, and volume are important independent influencing factors. Clinicians should take these factors into account to thoroughly assess the stability of the patient's fracture block and select the most appropriate internal fixation method to reduce the risk of postoperative block displacement.