From the Guidelines
Grading a radius fracture involves assessing several key factors, including fracture pattern, displacement, angulation, and shortening, with the AO/OTA classification system commonly used to categorize fractures into types A, B, and C, as recommended by the American Academy of Orthopaedic Surgeons (1). To determine the severity of a radius fracture, evaluate the following factors:
- Fracture pattern (transverse, oblique, comminuted, or spiral)
- Displacement (measured in millimeters)
- Angulation (in degrees)
- Shortening The AO/OTA classification system is a widely accepted method for categorizing radius fractures, with types A (extra-articular), B (partial articular), and C (complete articular) indicating increasing complexity (1). For distal radius fractures specifically, assess:
- Dorsal angulation (normal is 11-12° volar tilt)
- Radial inclination (normal is 22-23°)
- Radial height (normal is 11-12mm) Additionally, evaluate for associated ulnar styloid fractures, DRUJ instability, and carpal injuries, as recommended by the American Academy of Orthopaedic Surgeons (1, 1). Radiographic assessment should include standard posteroanterior and lateral views, with CT scans recommended for complex intra-articular fractures, as suggested by the American Academy of Orthopaedic Surgeons (1, 1). This comprehensive evaluation helps determine whether conservative management with casting or surgical intervention is appropriate, with more displaced, unstable, or intra-articular fractures typically requiring surgical fixation to restore anatomy and optimize functional outcomes, as recommended by the American Academy of Orthopaedic Surgeons (1, 1).
From the Research
Classification Systems for Radial Fractures
The criteria for grading a radial fracture involve various classification systems, including:
- Frykman classification 2, 3
- AO/ASIF classification 2, 3
- Jupiter-Fernandez classification 3
- Melone classification 2, 4
- Universal Classification system 4
- Fernandez classification 4
Reliability of Classification Systems
Studies have evaluated the reliability of these classification systems, with results showing:
- Inter-observer agreement for AO/OTA, Frykman, and Jupiter-Fernandez classifications was slight to fair 3
- Intra-observer agreement showed similar results, with the Universal classification system having the highest kappa coefficient 4
- Simplifying the AO/OTA classification system improved inter- and intra-observer agreement 3
Factors Affecting Outcome
Understanding the classifications of distal radius fractures is important in identifying the key aspects that affect their outcome, including: