CLASSIFICATION AND MANAGEMENT OF INTRA-ARTICULAR FRACTURES OF THE DISTAL RADIUS BY PREOPERATIVE CT SCANNING

Abstract

Background: A classification of intra-articular fractures of the distal radius is described on the basis of observations of consistent patterns of fracture fragmentation and displacement. The Melone intra-articular classification system categorizes articular fractures into 4 types, with the medial complex assuming a pivotal position as the cornerstone of both the radiocarpal and distal radio-ulnar joints. The purpose of this study was to classify AO type-C3 fractures according to the Melone classification system using preoperative CT scan data.

Methods: We retrospectively reviewed the clinical records of all patients who underwent open reduction and internal fixation (ORIF), according to the AO type-C3 classification. Between September, 2006, and May, 2009, 36 patients and a total of 38 fractures were identified. These intra-articular fractures were also classified according to the Melone classification system using preoperative CT scan data. We also investigated a bone fracture type and surgicalprocedures.

Results: Nine fractures were divided into Melone type-1, 17 into type-2 (anterior displacement), 6 into type-2 (posterior displacement), 2 into type-3, and 4 into type-4. Thirty fractures were treated using plate fixation, and 8 fractures were treated using nail fixation. Melone type-1 fractures were usually treated with nail fixation, whereas type-2, -3, and -4 fractures were usually treated using plate fixation.

Conclusions: Classification according to the Melone classification system using preoperative CT scan data enables the identification and elucidation of displacement in the major fracture components and enables the establishment of rational guidelines for the management of ORIF.