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Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement

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Abstract

Purpose

Rami comminution has been found to be predictive of lateral compression type 1 (LC1) injury instability on examination under anesthesia (EUA) and lateral stress radiographs (LSR). The purpose of this study was to evaluate how rami comminution and subsequent operative vs. nonoperative management impact the late displacement of these injuries.

Methods

Retrospective review of a prospectively collected LC1 database was performed to identify all patients with minimally displaced LC1 injuries (< 1 cm) and follow-up radiographs over a four-year period (n = 125). Groups were separated based on the presence of rami comminution and subsequent management, including rami comminution/operative (n = 49), rami comminution/nonoperative (n = 54), and no comminution/nonoperative (control group, n = 22). The primary outcome was late fracture displacement, analyzed as both a continuous variable and as late displacement ≥ 5 mm.

Results

As a continuous variable, late fracture displacement was lower in the comminuted rami/operative group as compared to the comminuted rami/nonoperative group (PD: −3.0 mm, CI: −4.8 to −1.6 mm, p = 0.0002) and statistically non-different from control. Late displacement ≥ 5 mm was significantly more prevalent in the comminuted rami/nonoperative group than in the comminuted rami/operative and no comminution/nonoperative groups (control)(PD: −33.9%, CI: −49.0% to −16.1%, p = 0.0002 and PD: −30.0%, CI: −48.2% to −6.5%, p = 0.02, respectively).

Conclusion

Late fracture displacement was greatest in the group with rami comminution/nonoperative management. Rami comminution, which has been previously associated with dynamic displacement on EUA and LSR, is also associated with a higher incidence of late displacement when managed nonoperatively.

Level of evidence

Level III, prognostic retrospective cohort study.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA

    Nicholas J. Tucker, Austin Heare, Stephen C. Stacey, Cyril Mauffrey & Joshua A. Parry

  2. Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA

    Nicholas J. Tucker, Austin Heare, Stephen C. Stacey, Cyril Mauffrey & Joshua A. Parry

  3. Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Bryan L. Scott

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Correspondence to Joshua A. Parry.

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Tucker, N.J., Scott, B.L., Heare, A. et al. Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03646-3

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