Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures

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1 Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures Poster No.: C-0669 Congress: ECR 2014 Type: Scientific Exhibit Authors: J. Tonak, I. Wobbe, R. L. Duschka, J. Haegele, J. Barkhausen, J. P. Goltz; Lübeck/DE Keywords: DOI: Musculoskeletal bone, Musculoskeletal system, Conventional radiography, CT, Diagnostic procedure, Trauma /ecr2014/C-0669 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Aims and objectives Distal radius fracture may be difficult to detect. Indirect fracture signs can help to disclose osseous injury. Amongst others Fallahi et al. (1) described the pronator quadratus fat pad sign (FPS) as an adjuvant marker for distal radius fractures. The purpose of our study was to evaluate the accuracy and reliability of FPS to predict distal radius fracture severity. We analysed the thickness of FPS using X-ray (CR) and in addition compared the findings with computed tomography images (CT) (Fig. 1). Methods and materials Retrospectively we identified 89 consecutive patients (41 female, mean age 49 +/-18 years) who had CR and CT within 24h following distal forearm trauma. Thickness of pronator quadratus fat pad complex (PQC) was measured using lateral views (CR) (Fig. 2) and sagittal reconstructions (CT) (Fig. 3). Analog to Fallahi et al. we defined a positive FPS as a PQC >8.0mm (female) or >9.0mm (male). Frykman classification was utilized to assess the severity of fractures. Eight clusters are discriminated (2): Type I Extra-articular distal radial fracture without a fracture of the ulnar styloid. Type II Extra-articular distal radial fracture with a fracture of the ulnar styloid. Type III Radiocarpal joint fracture without a fracture of the ulnar styloid. Type IV Radiocarpal joint fracture with a fracture of the ulnar styloid. Type V Radioulnar joint fracture without a fracture of the ulnar styloid. Type VI Radioulnar joint fracture with a fracture of the ulnar styloid. Type VII Radiocarpal and radioulnar joint fracture without a fracture of the ulnar styloid. Type VIII Radiocarpal and radioulnar joint fracture with a fracture of the ulnar styloid. Statistical analysis was performed using a specialized computer algorithm (IBM SPSS Statistics 21.Ink). Statistical significance was set at a P value of less than 0.05, high significance less than 0,01. Pearson's test was used to determine the correlations. Page 2 of 9

3 Results 44/89 patients (49%) had a fracture (Frykman I n=3, II n=0, III n=10, IV n=5, V n=2, VI n=2, VII n=9, VIII n=13). Mean thickness of the PQC was 7.5 ± 2.8mm (CR), respectively 9.4 ± 3.0mm (CT), resulting in a high significant correlation (p=0,01) coefficient of A positive FPS at CR was present in 21/44 patients (48%) with fracture and in 2/45 patients (4%) without fracture (table 1) resulting in a high specificity of 96% and a low sensitivity of 48% for the detection of distal radius fractures (table 2). In addition we found a highly significant correlation (p=0.01) between a positive FPS using either CR (0.494) or CT (0.461) in detecting distal radius fractures. There was no significant correlation between thickness of the PQC and severity of fractures. Conclusion The PQC thickness can reliably be measured on lateral X-ray views and sagittal CT reconstructions. A positive FPS shows high specificity but low sensitivity for the detection of a distal radius fractures. The PQC thickness is unreliable for predicting the severity of distal radius fractures. Personal information References (1) Skeletal Radiol Feb; 42(2): doi: /s Epub 2012 Jun 9. Explorative study of the sensitivity and specificity of the pronator quadratus fat pad sign as a predictor of subtle wrist fractures. Fallahi F, Jafari H, Jefferson G, Jennings P, Read R. (2) Acta Orthop Scand. 1967: Suppl 108: Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function.a clinical and experimental study. Page 3 of 9

4 Frykman G. Images for this section: Fig. 1: Analyse the thickness of FPS using computed tomography images Page 4 of 9

5 Page 5 of 9

6 Fig. 2: Thickness of PQC was measured using lateral views (CR) Page 6 of 9

7 Page 7 of 9

8 Fig. 3: Thickness of PQC was measured using sagittal reconstructions (CT) Table 1: Frequency of positive and negative FPS in each subgroup and in total Table 2: Sensitivity and specificity of a positive FPS in predicting distal radius fractures Page 8 of 9

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