Computed tomography–based predictors of ulnar-sided complications after distal radius fracture fixation - 13/03/26

Doi : 10.1016/j.otsr.2026.104652

Matthieu Vermeuil ^a,^b, Marie Le Baron ^a,^b, Xavier Flecher ^a,^b, Jean-Noël Argenson ^b,^c, Damien Lami ^b,^c, Jean-Baptiste de Villeneuve Bargemon ^b,^d,^e,⁎

^a Orthopaedic and Traumatology Department, Nord Hospital (University), 265 Chemin Bourrely, Marseille, France

^b Institute of Movement and Locomotor System (IML), Sainte-Marguerite Hospital (University), 270 Boulevard Sainte Marguerite, Marseille, France

^c Orthopaedic and Traumatology Department, Sainte-Marguerite Hospital (University), 270 Boulevard Sainte Marguerite, Marseille, France

^d Hand Surgery and Limb Reconstructive Surgery Department, La Timone Adult Hospital, Aix Marseille University, 264 Rue Saint Pierre, 13005 Marseille, France

^e Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, 99 Avenue Saint Roch, 83100 Toulon, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 13 March 2026

Abstract

Purpose

Ulnar-sided complications after distal radius fracture fixation remain frequent and poorly understood. This study aimed to identify CT-based risk factors for poor ulnar-sided outcomes (PUO).

Hypothesis

Sigmoid notch involvement and inadequate reduction are associated with PUO, whereas ulnar styloid fractures and native DRUJ anatomy are not.

Methods

A retrospective single-center study included 75 wrists treated with volar plating, with systematic pre- and postoperative CT scans. PUO at 6 months was defined by limited pronosupination, ulnar-sided pain, or DRUJ instability. CT analysis assessed sigmoid notch involvement, DRUJ congruence, fracture pattern, anatomical variants, and reduction quality.

Results

PUO occurred in 32/75 wrists (42.6%). Sigmoid notch involvement (p = 0.01), postoperative reduction defect (p = 0.01), and DRUJ incongruity (preoperative p = 0.01; postoperative p = 0.04) were significantly associated with PUO. Ulnar styloid fractures and DRUJ anatomical variants were not. Multifragmentary sigmoid notch fractures, particularly involving the volar rim, were associated with higher PUO risk (p = 0.04).

Conclusion

Poor ulnar-sided outcomes after distal radius fracture fixation are primarily related to sigmoid notch involvement and reduction quality. Systematic CT assessment may help identify high-risk patterns and optimize surgical planning.