Association of secondary displacement of distal radius fractures with cortical bone quality at the distal radius

A. M. Daniels*, H. M. J. Janzing, C. E. Wyers, B. van Rietbergen, L. Vranken, R. Y. Van der Velde, P. . P. M. M. Geusens, S. Kaarsemaker, M. Poeze, J. P. Van den Bergh

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction The aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters. Materials and methods Dorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up. Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients. Outcome Characteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27-212.86), p = 0.008], total [OR 0.16 (95% CI 0.04-0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05-0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02-0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures. Conclusions In conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.

Original languageEnglish
Pages (from-to)1909-1918
Number of pages10
JournalArchives of Orthopaedic and Trauma Surgery
Issue number11
Early online date31 Oct 2020
Publication statusPublished - Nov 2021


  • Distal radius fracture (DRF)
  • Fracture displacement
  • High-resolution peripheral quantitative CT (HR-pQCT)
  • Bone microarchitecture and strength
  • Primary reduction
  • AO

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