Download PDF
J Hand Microsurg 2016; 08(01): 027-033
DOI: 10.1055/s-0036-1581125
Original Article
Society of Indian Hand & Microsurgeons

Melone's Concept Revisited: 3D Quantification of Fragment Displacement

Teun Teunis
1   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Niels H. Bosma
1   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Bart Lubberts
1   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Dirk P. Ter Meulen
1   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
David Ring
2   Dell Medical School, The University of Austin at Texas, Texas, United States
› Author Affiliations
Further Information

Publication History

18 May 2015

09 March 2016

Publication Date:
27 April 2016 (online)

    Permissions and Reprints

Abstract

We applied quantitative 3D computed tomography to 50 complete articular AO type C fractures of the distal radius and tested the null hypothesis that fracture fragments can be divided according to Melone's concept (radial styloid and volar and dorsal lunate facet fragments) and that each fragment has similar (1) displacement and (2) articular surface area. Thirty-eight fractures fit the Melone distribution of fragments. Radial styloid fragments were most displaced, and volar lunate fragments were least displaced. Volar lunate fragments had the largest articular surface area. While these findings confirm Melone's concepts, the finding that volar lunate fragments are relatively large and dorsal lunate fragments relatively small suggests that alignment of the volar lunate fragment with the radial styloid may be the key element of treatment and the dorsal lunate fragment may not routinely benefit from specific reduction and fixation.

Keywords

computed tomography - distal radius - fractures - morphology - quantitative

Note

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


Supplementary Material

 

  • References

  • 1 McQueen MM, Jupiter JB. Musculoskeletal Trauma Series: Radius and Ulna. Oxford: Butterworth-Heinemann; 1999
    Google Scholar
  • 2 Müller ME. The Comprehensive Classification of Fractures of Long Bones. New York, NY: Springer-Verlag; 1990
    CrossrefGoogle Scholar
  • 3 Browner BD. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, PA: Saunders; 1992
    Google Scholar
  • 4 Cooney WP. Fractures of the distal radius. A modern treatment-based classification. Orthop Clin North Am 1993; 24 (2) 211-216
    PubMedGoogle Scholar
  • 5 Fernández DL. Fractures of the distal radius: operative treatment. Instr Course Lect 1993; 42: 73-88
    PubMedGoogle Scholar
  • 6 Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin 2005; 21 (3) 279-288
    CrossrefPubMedGoogle Scholar
  • 7 Melone Jr CP. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am 1993; 24 (2) 239-253
    PubMedGoogle Scholar
  • 8 Guitton TG, van der Werf HJ, Ring D. Quantitative measurements of the volume and surface area of the radial head. J Hand Surg Am 2010; 35 (3) 457-463
    CrossrefPubMedGoogle Scholar
  • 9 Guitton TG, van der Werf HJ, Ring D. Quantitative three-dimensional computed tomography measurement of radial head fractures. J Shoulder Elbow Surg 2010; 19 (7) 973-977
    CrossrefPubMedGoogle Scholar
  • 10 Teunis T, Bosma NH, Lubberts B, Ter Meulen DP, Ring D. MM Q3DCT radius. Available at: http://youtu.be/M0niRAoZ2xw . Accessed March 25, 2014
    PubMedGoogle Scholar
  • 11 McCallister WV, Smith JM, Knight J, Trumble TE. A cadaver model to evaluate the accuracy and reproducibility of plain radiograph step and gap measurements for intra-articular fracture of the distal radius. J Hand Surg Am 2004; 29 (5) 841-847
    CrossrefPubMedGoogle Scholar
  • 12 Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin 1997; 13 (1) 63-82
    PubMedGoogle Scholar
  • 13 Zumstein MA, Hasan AP, McGuire DT, Eng K, Bain GI. Distal radius attachments of the radiocarpal ligaments: an anatomical study. J Wrist Surg 2013; 2 (4) 346-350
    PubMedGoogle Scholar
  • 14 Melone Jr CP. Open treatment for displaced articular fractures of the distal radius. Clin Orthop Relat Res 1986; (202) 103-111
    PubMedGoogle Scholar
  • 15 Mandziak DG, Watts AC, Bain GI. Ligament contribution to patterns of articular fractures of the distal radius. J Hand Surg Am 2011; 36 (10) 1621-1625
    CrossrefPubMedGoogle Scholar
  • 16 Rikli DA, Honigmann P, Babst R, Cristalli A, Morlock MM, Mittlmeier T. Intra-articular pressure measurement in the radioulnocarpal joint using a novel sensor: in vitro and in vivo results. J Hand Surg Am 2007; 32 (1) 67-75
    CrossrefPubMedGoogle Scholar
  • 17 Catalano III LW, Cole RJ, Gelberman RH, Evanoff BA, Gilula LA, Borrelli Jr J. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am 1997; 79 (9) 1290-1302
    CrossrefPubMedGoogle Scholar
  • 18 Fritscher K, Karasev P, Pieper S, Kikinis R . (2014) Documentation/4.3/Extensions/VirtualFractureReconstruction. 3D Slicer. Available at: https://www.slicer.org/slicerWiki/index.php/Documentation/4.3/Extensions/VirtualFractureReconstruction . Accessed March 25, 2014
    PubMed