Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis

Pain Sensitization and Association With Baseline Factors in Elderly Patients With Distal Radius Fracture: A Cross-Sectional Study

BACKGROUND

The aim of this study was to describe the presence of pain sensitization (PS) and its association with baseline factors after cast removal in patients older than 60 years with distal radius fracture (DRF) treated conservatively.

METHODS

This cross-sectional study included 220 patients older than 60 years with extra-articular DRF who completed the Pain Sensitivity Questionnaire (PSQ). Patients with PSQ score > 7 points were considered positive for PS. In addition, sociodemographic, anthropometrics, clinical, radiological, lifestyle behaviors, pain-related psychological factors, and functional outcomes were analyzed as baseline predictors, all measured were performed 2 weeks after cast removal.

RESULTS

A total of 159 patients (72.3%) showed PS. The results showed an association between higher values of PSQ-total with the affected dominant hand (β = 1.1; P = 0.04), high energy of injury (β = 3.5; P < .001), extra-articular comminuted metaphyseal DRFs (β = 1.8; P < .001), lower values of Rapid Assessment of Physical Activity questionnaire (β = 3.1; P < .001), higher values of Pittsburgh Sleep Quality Index (β = 2.5; P < .001), higher values of Tampa Scale of Kinesiophobia (β = 1.9; P < .001), higher values of Pain Catastrophizing Scale (β = 1.8; P < .001), higher values of Disabilities of the Arm, Shoulder and Hand questionnaire (β = 1.6; P < .001), lower values of grip strength (β = 1.4; P < .001) and higher values of Visual analog scale (β = 4.2; P < .001).

CONCLUSIONS

A high percentage of patients older than 60 years with extra-articular DRFs present PS at 2 weeks after cast removal. Our results may help physicians and physiotherapists identify risk and/or prognostic baseline factors for the occurrence of PS after DRF, and the need for a therapeutic approach that incorporates the clinical management of this condition in these patients.

Non-surgical vs. surgical treatment of distal radius fractures: a meta-analysis of randomized controlled trials

PURPOSE

To compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture.

METHODS

We performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS).

RESULTS

There were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD - 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed.

CONCLUSIONS

The results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture.

Volar fixed plating of distal radius fractures: optimizing plate position for enhanced clinical outcomes

BACKGROUND

The precise influence of plate position on clinical outcomes in the context of volar fixed-angle plating for distal radius fractures is not fully understood. This article aims to investigate the influence of plate position on clinical results, and functional outcomes in patients treated with volar fixed plating for distal radius fractures.

METHODS

A total of 58 patients with 64 distal radius fractures were included in the study. Patient demographics, fracture characteristics, surgical details, and radiographic data were collected. Post-operative AP and Lat views of all patients taken on the first day after surgery were evaluated. Volar Tilt, Radial Inclination and Radial Height measurements were used as reduction criteria. In the follow-up, the patients were called for their last control, flexion and extension angles of the wrist and Mayo Wrist Scores, the distance of the plate to the joint line and the angle between the plate and the radial shaft were measured and recorded.

RESULTS

A total of 64 distal radius fractures, with a mean age of 46.9 years, and the mean follow-up period 24.9 months were included in this study. There was a significant relationship between the Radial Inclination and Plate-Shaft Angle variables and the Mayo Wrist Score at a 99% confidence interval. Additionally, a relationship was observed between the Radial Height variable and the Mayo Score at a 90% confidence interval. A significant positive association was observed between radial inclination and achieving a Good-to-Excellent Mayo score (OR = 1.28, 95% CI [1.08-1.51], p = 0.004). Plate distance to joint line demonstrated a marginally significant positive association with a Good-to-Excellent Mayo score (OR = 1.31, 95% CI [0.97-1.77], p = 0.077). Univariate analysis revealed a significant negative association between plate-shaft angle and achieving a Good-to-Excellent Mayo score (OR = 0.71, 95% CI [0.52-0.99], p = 0.045). This negative association remained statistically significant in the multivariate analysis (p = 0.016).

CONCLUSION

Radial inclination, plate distance to joint line, and angle between plate and radius shaft were identified as significant factors associated with improved Mayo Wrist Scores.

Distal radial fractures: a nationwide register study on corrective osteotomies after malunion

The aim of the present study was to explore the incidence of corrective osteotomies after conservatively treated distal radial fracture and the risk for late correction depending on the patient's age. Based on data from the Finnish National Care Register of Health Care, Specialist Care, on all corrective osteotomies carried out in Finland during 2015-2019 in adults aged ≥20 years, we calculated the mean annual incidence rates per 100,000 person-years, standardized with the European Standard Population 2013. Using multivariable logistic regression, we calculated the risk of corrective osteotomies in various age groups. In total, 41,418 distal radial fractures were identified. Of those, 10,577 received surgical treatment in the acute phase. The incidence rate of primary operations for distal radial fractures was 47.9 per 100, 000 person-years. A total of 321 conservatively treated fractures needed corrective osteoteomy, with a surprisingly low mean annual incidence rate of 1.5 per 100,000 person-years. The risk for this was highest in patients in their fourth or fifth decade.Level of evidence: III.

Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study

We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.Level of evidence: II.

The ageless approach: Nonoperative mastery competes head-on with surgery for elderly distal radius fractures

The aim of the current study is to compare the clinical outcomes of cast immobilization (CI) versus surgical treatment after 1 year for distal radius fractures (DRFs) in the elderly population. The cohort included patients aged 70-89 who suffered an acute, closed, and displaced DRF and who were treated conservatively or surgically at our clinic between August 2018 and January 2022. Those who had pathological fractures, open fractures, concomitant ulna fractures (except ulna styloid fractures), were not between the ages of 70 and 89, or refused to participate were excluded from the study. The study gathered data on patient demographics, initial radiological measurements, clinical measurements after 1 year, treatment models employed, and rates of complications. Of the total number of patients (276), CI was used on 77.2% (213), whereas the other 25 had volar-locked plates (VLP), 25 received external fixators with percutaneous pinning (EFPP), and 13 had isolated percutaneous pinning (IPP). 19 of 276 individuals had complications, with Complex Regional Pain Syndrome and Carpal Tunnel Syndrome being the most often documented. EFPP resulted in significantly higher Disability of the Arm, Shoulder, and Hand (DASH) score values than VLP and IPP at the 1st postoperative year (p < 0.05). No statistically significant difference was found between the DASH score and ROM values at the 1st postoperative year for patients who received CI versus those who underwent surgery (p > 0.05). In the first postoperative year, CI still retains its validity and performs similarly to surgery for DRFs in older individuals. VLPP and IPP methods outperformed EFPP surgeries.

Managing patient expectations about recovery after a distal radius fracture based on patient reported outcomes

INTRODUCTION

PROMs are increasingly used by clinicians to evaluate recovery after distal radius fractures, but can also be used as benchmark data to help patients managing their expectations about recovery after DRF.

PURPOSE OF THE STUDY

The study aimed to determine the general course of patient-reported functional recovery and complaints during 1 year after a DRF, depending on fracture type and age. The study aimed to determine the general course of patient-reported functional recovery and complaints during one year after a DRF, depending on fracture type and age.

METHODS

Retrospectively analyzed PROMs of 326 patients with DRF from a prospective cohort at baseline and at 6, 12, 26 and 52 weeks included PRWHE questionnaire for measuring functional outcome, VAS for pain during movement, and items of the DASH for measuring complaints (tingling, weakness, stiffness) and limitations in work and daily activities. The effect of age and fracture type on outcomes were assessed using repeated measures analysis.

RESULTS

PRWHE scores after one year were on average 5.4 points higher compared to the patients' pre-fracture scores. Patients with type B DRF had significantly better function and less pain than those with types A or C at every time point. After six months, more than 80% of the patients reported mild or no pain. Tingling, weakness or stiffness were reported by 55-60% of the overall cohort after six weeks, while 10-15% had persisting complaints at one year. Older patients reported worse function and more pain, complaints and limitations.

CONCLUSIONS

Functional recovery after a DRF is predictable in time with functional outcome scores after one-year follow-up that are similar to pre-fracture values. Some outcomes after DRF differ between age and fracture type groups.

The hematoma block is not enough as method of anesthesia in reduction of displaced distal radius fractures

BACKGROUND

Two out of three wrist fractures seen in the emergency are displaced but most can be treated conservatively after closed reduction. Patient-reported pain during closed reduction of distal radius fractures varies widely and the best method to decrease the perceived pain has not been well established. The purpose of this study was to assess the pain during closed reduction of distal radius fractures after using the hematoma block as method of anaesthesia.

PATIENTS AND METHODS

Cross-sectional clinical study including all patients who presented an acute fracture of the distal radius requiring closed reduction and immobilization during a six-month period in two University Hospitals. Demographic data, fracture classification, perceived pain using a visual analog scale at different times of reduction and complications were registered.

RESULTS

Ninety-four consecutive patients were included. Mean age was 61 years. Mean pain score at initial assessment was 6 points. After the hematoma block, the perceived pain during the reduction manoeuvre improved to 5.1 points at the wrist, but increased to 7.3 points at the fingers. Pain decreased to 4.9 points during cast placement and reached 1.4 point after sling placement. The reported pain was higher in women at all times. There were no significant differences according to the according to the type of fracture. No neurological or skin complications were observed.

CONCLUSIONS

The hematoma block is only a mild effective method to reduce the wrist pain during closed reduction of distal radius fractures. This technique decreases slightly the perceived pain in the wrist and does not reduce the pain in the fingers. Other reduction methods or other analgesic techniques may be more effective options.

LEVEL OF EVIDENCE

Therapeutic study. Cross-sectional study - Level IV.

[Translated article] The haematoma block is not enough as method of anaesthesia in reduction of displaced distal radius fractures

BACKGROUND

Two out of three wrist fractures seen in an emergency department are displaced but most can be treated conservatively after closed reduction. Patient-reported pain during closed reduction of distal radius fractures varies widely and the best method to decrease the perceived pain has not been well established. The purpose of this study was to assess pain during closed reduction of distal radius fractures after using haematoma block as method of anaesthesia.

PATIENTS AND METHODS

Cross-sectional clinical study including all patients who presented an acute fracture of the distal radius requiring closed reduction and immobilisation during a six-month period in two University Hospitals. Demographic data, fracture classification, perceived pain using a visual analogue scale at different times of reduction and complications were registered.

RESULTS

Ninety-four consecutive patients were included. Mean age was 61 years. Mean pain score at initial assessment was 6 points. After the haematoma block, the perceived pain during the reduction manoeuvre improved to 5.1 points at the wrist, but increased to 7.3 points at the fingers. Pain decreased to 4.9 points during cast placement and reached 1.4 point after sling placement. The reported pain was higher in women at all times. There were no significant differences according to the according to the type of fracture. No neurological or skin complications were observed.

CONCLUSIONS

Haematoma block is only a mildly effective method to reduce wrist pain during closed reduction of distal radius fractures. This technique slightly decreases the perceived pain in the wrist and does not reduce the pain in the fingers. Other reduction methods or other analgesic techniques may be more effective options.

LEVEL OF EVIDENCE

Therapeutic study. Cross-sectional study - Level IV.

Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study

PURPOSE

This study aimed to analyze baseline predictors of functional outcomes six weeks and at one year follow-up in patients older than 60 years with complex regional pain syndrome type 1 (CRPS I) after distal radius fracture (DRF).

METHODS

A total of 120 patients with CRPS I after DRF were prospectively recruited. Presumptive relevant factors were collected and analyzed as potential baseline predictors. Additionally, functional outcomes were assessed at the beginning of physiotherapy treatment, at six weeks after finishing physiotherapy treatment, and at one year follow-up. Patient-Rated Wrist Evaluation; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; Jamar dynamometer; and visual analog scale (VAS) were assessed.

RESULTS

All participants completed the study. At 6 weeks, the main results showed an association of lower values of grip strength with female sex (p = 0.010), intra-articular DRFs (p = 0.030), longer immobilization time (p = 0.040), lower levels of physical activity (p < 0.001), higher levels of kinesiophobia (p = 0.010), and anxiety (p = 0.020). At 1-year follow-up, the results showed an association of lower values of DASH with higher BMI (p < 0.001) and longer immobilization time (p < 0.001); and higher values of VAS showed an association with older age (p = 0.010), higher BMI (p = 0.010), and lower levels of physical activity (p = 0.040).

CONCLUSION

At six weeks, factors such as BMI, immobilization time, physical activity, and kinesiophobia are associated with lower functional outcomes. Additionally, at one year follow-up, BMI, immobilization time, and physical activity continue to be associated with lower functional outcomes in patients with CRPS I after DRF treated conservatively.

Association Between Radiographic and Clinical Outcomes Following Distal Radial Fractures: A Prospective Cohort Study with 1-Year Follow-up in 366 Patients

BACKGROUND

Several studies of distal radial fractures have investigated final displacement and its association with clinical outcomes. There is still no consensus on the importance of radiographic outcomes, and published studies have not used the same criteria for acceptable alignment. Previous reports have involved the use of linear or dichotomized analyses.

METHODS

The present study included 438 patients who were managed with either reduction and cast immobilization or surgery for the treatment of distal radial fractures. Radiographic outcomes were determined on the basis of radiographs that were made 3 months after the injury. Clinical outcome was determined on the basis of the QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) score, range of motion, and grip strength at 1 year after the injury. Nonlinear relations were analyzed with cubic splines.

RESULTS

Three hundred and sixty-six patients (84%) had both radiographic and clinical follow-up. Seventy patients were lost to follow-up. The mean age was 57 years (range, 18 to 75 years), and 79% of the patients were female. Dorsal tilt was the radiographic parameter that was most strongly associated with the QuickDASH score, grip strength, and range of motion. We found nonlinear relations. Clinical outcomes were found to worsen with increasing dorsal tilt, with the cutoff value being approximately 5°.

CONCLUSIONS

We found that clinical outcomes following distal radial fractures have a nonlinear relationship with dorsal tilt, with worse outcomes being associated with increasing dorsal tilt. The decline in clinical outcome starts at 5°, but there is unlikely to be a noticeable difference in capability as measured with the QuickDASH until 20° of dorsal tilt (based on the minimum clinically important difference) in a population up to 75 years old.

LEVEL OF EVIDENCE

Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Questions, answers and challenges: Summarising the guidance for distal radius fractures

This article summarises the current recommendations from the American Academy of Orthopaedic Surgeons (AAOS), the British Orthopaedic Association (BOA), the British Society for Surgery of the Hand (BSSH) and the National Institute of Health and Care Excellence (NICE) for the management of distal radius fractures (DRF). We performed an audit of DRF management at our local emergency hospital. Results and conclusion: Despite DRF representing a large portion of our workload, there remains a paucity of evidence to base recommendations on. Recommendations can be conflicting, and some seem aspirational rather than achievable. Our local audit highlights the challenges of putting guidelines into practice. Treatment plans should incorporate best practice guidance but ultimately be individualised to each patient.

Association of Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults: A Network Meta-analysis

Importance

Randomized clinical trials (RCTs) and meta-analyses have reported inconsistent conclusions regarding optimal distal radius fracture (DRF) treatment in older adults and are limited due to the inclusion of cohort studies with small sample sizes. A network meta-analysis (NMA) addresses these limitations by only synthesizing direct and indirect evidence from RCTs and may clarify optimal DRF treatment in older adults.

Objective

To examine DRF treatment results in optimal short-term and intermediate-term patient-reported outcomes.

Data Sources

Searches of MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes in older adults between January 1, 2000, and January 1, 2022.

Study Selection

Randomized clinical trials including patients with a mean age of 50 years or older that compared the following DRF treatments were eligible for inclusion: casting, open reduction and internal fixation with volar lock plating (ORIF), external fixation, percutaneous pinning, and nail fixation.

Data Extraction and Synthesis

Two reviewers independently completed all data extraction. An NMA aggregated all direct and indirect evidence among DRF treatments. Treatments were ranked by surface under the cumulative ranking curve score. Data are reported as standard mean differences (SMDs) and 95% CIs.

Main Outcomes and Measures

The primary outcome was short-term (≤3 months) and intermediate-term (>3 months to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1-year complication rates.

Results

In this NMA, 23 RCTs consisting of 3054 participants (2495 women [81.7%]) with a mean (SD) age of 66 (7.8) years were included. At 3 months, DASH scores were significantly lower for nail fixation (SMD, -18.28; 95% CI, -29.93 to -6.63) and ORIF (SMD, -9.28; 95% CI, -13.90 to -4.66) compared with casting. The PRWE scores were also significantly lower for ORIF (SMD, -9.55; 95% CI, -15.31 to -3.79) at 3 months. In the intermediate term, ORIF was associated with lowered DASH (SMD, -3.35; 95% CI, -5.90 to -0.80) and PRWE (SMD, -2.90; 95% CI, -4.86 to -0.94) scores. One-year complication rates were comparable among all treatments.

Conclusions and Relevance

The findings of this NMA suggest that ORIF may be associated with clinically significant improvements in short-term recovery compared with casting for multiple patient-reported outcomes measures with no increase in 1-year complication rates. Shared decision-making with patients may be useful to identify patient preferences regarding recovery to determine optimal treatment.

Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF).

METHODS

We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs.

RESULTS

Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at -4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications.

CONCLUSIONS

Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.

Marginal secondary displacement in fractures of the distal radius at follow-up - an important predictor for late displacement and malunion

Treatment recommendations in fractures of the distal radius are often based on the degree of displacement and functional demands. The fracture may be within an acceptable radiological range, but a marginal deterioration in alignment then occurs between the initial visit and follow-up. This may pose a risk for late displacement that may require further treatment. We secondarily analysed prospectively collected data and included 165 patients. We found that marginal secondary displacement (odds ratio (OR) 9.7), anterior comminution (OR 8.8), loss of anterior apposition (OR 6.8) and dorsal comminution (OR 2.6) were predictors of late displacement. Marginal secondary displacement is an important predictor of late displacement and malunion in fractures of the distal radius. Clinicians should not unequivocally accept general guidelines on alignment but also assess a deterioration in fracture alignment on radiographic follow-up and be aware of the potential need for surgery to avoid malunion in cases that show early secondary displacement, even when radiographic measures are within acceptable limits.Level of evidence: III.

Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

BACKGROUND

Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia.

METHODS

Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union.

RESULTS

There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries.

CONCLUSIONS

Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review

BACKGROUND

The inclusion of patient-reported outcome measures (PROMs) serves to better quantify aspects of patient outcomes missed with objective measures, including radiographic indices and physical examination findings. We hypothesize that PROMs are inconsistently and heterogeneously captured in the treatment of distal radius fractures.

METHODS

We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of all level I and II randomized controlled trials (RCTs) of distal radius fracture treatment of any modality for those older than 50 years of age from January 2008 to January 2018. A total of 23 studies were included in the final analysis. The metrics used by each study to assess outcomes were collected, compared, and described.

RESULTS

Physical examination findings and radiographic measures were reported in 70% and 74% of studies, respectively. Patient-reported outcomes measures were used to assess outcomes in 74% of studies. Only the Disabilities of the Arm, Shoulder, and Hand was used in greater than half of the studies (57%). Pain scores were assessed in 39% of studies and complications in only 26%.

CONCLUSIONS

There is substantial heterogeneity and lack of standardization in the collection of both objective outcome measures and PROMs in level I and II RCTs for the treatment of distal radius fractures. The ability to compare between studies or aggregate data among studies is therefore limited. Radiographic and physical examination findings remain frequently reported despite known limitations of these metrics. The routine collection of PROMs after the treatment of distal radius fractures can ensure care is directed toward improving what is most important to patients.

Use of Plain Radiography of Uninjured Wrists as Patient-Specific Markers of Successful Reduction of Unilateral Distal Radius Fractures

BACKGROUND

The standard of care of distal radius fractures requiring operative intervention involves restoration of anatomical alignment radiologically by comparing preoperative films and intraoperative fluoroscopy with established values based on population norms. The objective of this study is to evaluate the use of plain radiographs obtained from the uninjured wrist of patients who present with unilateral displaced distal radius fractures as a measure of successful achievement of anatomical realignment.

METHODS

A retrospective review was performed on 133 consecutive patients who presented from August 2020 to August 2021 with a diagnosis of unilateral distal radius fracture as confirmed on 3-view plain radiography. Patients who had bilateral radiographs and underwent open reduction and internal fixation were included. The primary outcome measure was comparison of radial inclination, radial height, tilt, and ulnar variance measured by 3 observers on preoperative, 1-week postoperative, and uninjured contralateral wrist films.

RESULTS

Twenty-one patients were included for analysis. Comparison of postoperative radiologic parameters with the contralateral uninjured extremity revealed a mean radial inclination difference of 3.8°, radial height difference of 2.0 mm, volar tilt difference of 6.3°, and ulnar variance difference of 0.9 mm. The average postreduction radial height was found to deviate from contralateral radial height significantly more than from the historic radial height parameter (2.0 vs 0.6 mm, P < .001).

CONCLUSION

Attempts at achieving distal radius fracture reduction to within historical normal limits may result in an increased deviation from patient-specific anatomical parameters, especially with respect to radial height.

Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis

BACKGROUND

The aim of this study was to determine whether surgical treatment is more effective than conservative treatment in terms of functional outcomes in elderly patients with distal radius fractures (DRFs).

METHODS

An electronic search of the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases was performed, from inception until July 2021. The eligibility criteria for selecting studies were randomized clinical trials that compared surgical versus conservative treatment in subjects older than 60 years with DRFs. Two authors independently performed the search, data extraction, and assessed risk of bias (RoB) using the Cochrane RoB tool.

RESULTS

Twelve trials met the eligibility criteria, and nine studies were included in the quantitative synthesis. For volar plate versus cast immobilization at 1-year follow-up, the mean difference (MD) for PRWE was -5.36 points (p=0.02), for DASH was -4.03 points (p=0.02), for grip strength was 8.32% (p=0.0004), for wrist flexion was 4.35 degrees (p=0.10), for wrist extension was -1.52 degrees (p=0.008), for pronation was 2.7 degrees (p=0.009), for supination was 4.88 degrees (p=0.002), and for EQ-VAS was 2.73 points (p=0.0007), with differences in favor of volar plate. For K-wire versus cast immobilization at 12 months, there were no statistically significant differences in wrist range of motion (p>0.05).

CONCLUSIONS

There was low to high evidence according to GRADE ratings, with a statistically significant difference in functional outcomes in favor of volar plate versus conservative treatment at 1-year follow-up. However, these differences are not minimally clinically important, suggesting that both types of management are equally effective in patients older than 60 years with DRFs.

LEVEL OF EVIDENCE

I; Therapeutic (Systematic review and meta-analysis of randomized clinical trials).

Implicit and Explicit Factors That Influence Surgeons' Decision-Making for Distal Radius Fractures in Older Patients

PURPOSE

The purpose of this study was to evaluate factors that influence surgeons' decision-making in the treatment of distal radius fractures in older patients.

METHODS

Fourteen clinical vignettes of a 72-year-old patient with a distal radius fracture were sent to 185 orthopedic hand and/or trauma surgeons. The surgeons were surveyed regarding the demographic/practice details, treatment decision (surgical or nonsurgical), and factors that influenced management, including the Charlson Comorbidity Index, functional status, radiographic appearance, and handedness. Multivariable regression analyses were used to assess the effect of both surgeon-described (explicit) and given clinical (implicit) factors on the treatment decision and to evaluate for discrepancies.

RESULTS

Sixty-six surgeons completed the survey, and 7 surgeons completed 10-13 vignettes. Surgeons made the explicit determination to pursue nonsurgical treatment based on the presence of comorbidities (odds ratio [OR], 0.02 for surgery; 95% confidence interval [CI], 0.01-0.05), but the observation of the underlying clinical data suggested that the recommendation for surgical treatment was instead based on a higher functional status (OR, 3.54/increase in functional status; 95% CI, 2.52-4.98). Those employed by hospitals/health systems were significantly less likely to recommend surgery than those in private practice (OR, 0.42; 95% CI, 0.23-0.79) CONCLUSIONS: This study demonstrates that the presence of comorbidities, functional status, and practice setting has a significant impact on a surgeon's decision to treat distal radius fractures in older patients. The discrepancy between the surgeon-described factors and underlying clinical data demonstrates cognitive bias.

CLINICAL RELEVANCE

Surgeons should be aware of cognitive biases in clinical reasoning and should work through consequential patient decisions using an analytical framework that attempts to reconcile all available clinical data.

Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

BACKGROUND

Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making.

METHODS

We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications.

RESULTS

There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union.

CONCLUSION

We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury.

LEVEL OF EVIDENCE

III (Retrospective matched cohort study).

Computed Tomography and Pathobiomechanical-Based Treatment of Volar Distal Radius Fractures

Today, there are various classifications for distal radius fractures (DRF). However, they are primarily based on plain radiographs and do not provide sufficient information on the best treatment option. There are newer classifications that simultaneously consider the pathobiomechanical basis of the fracture mechanism and analysis of computed tomography images. Main determinants of which type of DRFs occurs are the strength/direction of the applied forces on the carpus and radius, and the position of the wrist relative to the radius during the fall. Reconstruction of the mechanism of injury provides information about which anatomic structures are involved, such as torn ligaments, bone fragments, and the dislocated osteoligamentous units. This article attempts to combine and modify current pathobiomechanically oriented classifications with an improved understanding of the "key fragments" to subsequently offer a treatment approach to stabilize these critical fragments through specific types of internal fixation.

The predictive value of disability at 2 weeks after plating of distal radial fractures: a prospective study of 101 patients

Assuming that some patients may benefit from early supervised rehabilitation after distal radial fractures, we investigated to what extent self-reported measures of disability, pain and performance of daily activities 2 weeks after anterior locking plating of distal radial fractures could predict long-lasting disability. We included 101 patients in a prediction study and recorded the scores of the Disability of the Arm, Shoulder and Hand questionnaire, visual analogue scales for pain and the Canadian Occupational Performance Measure. We found that the Disability of the Arm, Shoulder and Hand scores with a cut-off score of 50 were the best at predicting disability at 6 months in patients who did not receive early supervised therapy. The positive predictive value was 65% and the negative predictive value was 71%. We conclude that these scores could be used as a single measure to predict patient disability, although the predictive value was rather weak.Level of evidence: II.

Weight-Bearing Restrictions With Distal Radius Wrist-Spanning Dorsal Bridge Plates

PURPOSE

The fixation of comminuted distal radius fractures using wrist-spanning dorsal bridge plates has been shown to have good postoperative results. We hypothesized that using a stiffer bridge plate construct results in less fracture deformation with loads required for immediate crutch weight bearing.

METHODS

We created a comminuted, extra-articular fracture in 7 cadaveric radii, which were fixed using dorsal bridge plates. The specimens were positioned to simulate crutch/walker weight bearing and axially loaded to failure. The axial load and mode of failure were measured using 2- and 5-mm osteotomy deformations as cutoffs. Bearing 50% and 22% of the body weight was representative of the force transmitted through crutch and walker weight bearing, respectively.

RESULTS

The load to failure at 2-mm deformation was greater than 22% body weight for 2 of 7 specimens and greater than 50% for 1 of 7 specimens. The load to failure at 5-mm deformation was greater than 22% body weight for 6 of 7 specimens and greater than 50% for 4 of 7 specimens. The mean load to failure at 2-mm gap deformation was significantly lower than 50% body weight (110.4 N vs 339.2 N). The mean load to failure at 5-mm deformation was significantly greater than 22% body weight (351.8 N vs 149.2 N). All constructs ultimately failed through plate bending.

CONCLUSIONS

All constructs failed by plate bending at forces not significantly greater than the 50% body weight force required for full crutch weight bearing. The bridge plates supported forces significantly greater than the 22% body weight required for walker weight bearing 6 of 7 times when 5 mm of deformation was used as the failure cutoff.

CLINICAL RELEVANCE

Elderly, walker-dependent patients may be able to use their walker as tolerated immediately after dorsal bridge plate fixation for extra-articular fractures. However, patients should not be allowed to bear full weight using crutches immediately after bridge plating.

Does circumferential casting prevent fracture redisplacement in reduced distal radius fractures? A retrospective multicentre study

Background

This study evaluates whether a circumferential cast compared to a plaster splint leads to less fracture redisplacement in reduced extra-articular distal radius fractures (DRFs).

Methods

This retrospective multicentre study was performed in four hospitals (two teaching hospitals and two academic hospitals). Adult patients with a displaced extra-articular DRF, treated with closed reduction, were included. Patients were included from a 5-year period (January 2012–January 2017). According to the hospital protocol, fractures were immobilized with a below elbow circumferential cast (CC) or a plaster splint (PS). The primary outcome concerned the difference in the occurrence of fracture redisplacement at one-week follow-up.

Results

A total of 500 patients were included in this study (PS n = 184, CC n = 316). At one-week follow-up, fracture redisplacement occurred in 52 patients (17%) treated with a CC compared to 53 patients (29%) treated with a PS. This difference was statistically significant (p = 0.001).

Conclusion

This study suggests that treatment of reduced DRFs with a circumferential cast might cause less fracture redisplacement at 1-week follow-up compared to treatment with a plaster splint.

Level of Evidence Level III, Retrospective study.

A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients following Distal Radius Fractures Treated with 4- and 6-Week Cast Immobilization

BACKGROUND

There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization.

METHODS

This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: (1) muscle strength, (2) range of motion.

RESULTS

The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs.

CONCLUSION

Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation

Purpose

Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF.

Methods

Adult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score.

Results

Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern.

Conclusions

At mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation.

Type of study/level of evidence

Prognostic IV.

Population-based Analysis for Risk of Suicide Death in Elderly Patients after Osteoporotic Fracture: a Nested Case-Control Study

BACKGROUND

The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture.

METHODS

We used the National Health Insurance Service-Senior cohort of South Korea. Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death.

RESULTS

Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57-4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04-2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74-2.77; P = 0.282).

CONCLUSION

There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

Patient-Perceived Outcomes After Nonoperative Treatment of Distal Radius Fracture in Older Adults

Malunion after distal radius fracture is common in older patients; however, whether patient-perceived outcomes are influenced by radiologic outcome is controversial. This study evaluated patient-perceived outcomes according to radiologic parameters in older patients who underwent nonoperative treatment. The records of 167 patients older than 55 years who had a distal radius fracture were reviewed. All fractures were treated nonoperatively, and average length of follow-up was 7 years. Outcomes were evaluated using numeric rating scales for pain and satisfaction, as well as Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Radiographs were evaluated for dorsal tilt, radial inclination, and ulnar variance. Fifty-one patients (30%) developed malunion. The pain numeric rating scale score was 0.8 for patients with malunion and 0.4 for patients with acceptable alignment; this difference was not statistically significant. The QuickDASH score was higher for patients with malunion (14.9 vs 11.1 for patients with acceptable alignment); however, this difference was not clinically meaningful. Satisfaction scores were lower for patients with malunion than for patients with acceptable alignment (80.8 vs 92.3). Patients with malunion stated they would choose surgery rather than a cast (13.3% vs 7.2%) if they developed another fracture; this difference was not statistically significant. The subanalysis according to radiologic parameters showed dorsal tilt and ulnar variance affected patient satisfaction but not other outcomes. This study indicated nonoperative treatment in older adults obtained acceptable patient-perceived outcomes despite residual deformity. However, patients whose radiologic parameter exceeded the tolerable range were less satisfied. [Orthopedics. 2021;44(2):e190-e196.].

Dorsally displaced distal radius fractures: introduction of Pacetti's line as radiological measurement to predict dorsal fracture displacement

BACKGROUND AND AIM OF THE WORK

In the best of our knowledge there is not yet in the literature a measurement able to assess post reduction stability of distal radius fractures.

AIM

to study the relationship between our newly introduced Pacetti's line, anatomical reduction of DRFs and post-reduction stability of fractures.

METHODS

Patients/Participants: 230 patients (122men, 108women) who sustained a dorsally displaced distal radius fracture. Close reduction procedures attempted; below elbow cast applied.

FOLLOW-UP

Pacetti's line used on true AP and lateral view xrays after reduction and casting (T0) and at 7-14 days (T1-T2).

MAIN OUTCOME MEASUREMENTS

Assessment and prediction of early displacement of DRFs.

RESULTS

The Pacetti's line intersected the lunate bone in 162 cases (70.4%) after anatomical reduction, of which 20.4% (N=33) lost anatomical reduction. Cramer's V test: significant relationship between transition of Pacetti's line through the semilunar bone and stability of anatomical reduction at T0 follow-up (p<0.001, Cramer's value=0.83). The Pacetti's line intersected the lunate bone in 119 cases (51.7%) at 7-14 days follow-up. None of patients lost anatomical reduction. Cramer's V test: significant relationship between transition of Pacetti's line through the semilunar bone and stability anatomical reduction at T1 and T2 follow-up (p<0.001, Cramer's value=0.73).

CONCLUSIONS

We strongly recommend the use of the Pacetti's line as it seems to provide reliable prediction of further fracture displacement and consequently of definitive management. The Pacetti's line seems to represent a very useful tool providing simple, feasible, efficient and reliable information on DRFs characteristics and natural course.

Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year

INTRODUCTION

Distal radius fractures (DRF) are the most common fractures of the upper extremities and incidence is expected to continue rising as life expectancy increases. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF. Main aim of this study was to investigate correlation between radiological and clinical outcome in patients stabilized by palmar locking plate with a minimum follow-up of one year.

METHODS

A total of 524 patients with DRF, stabilized using palmar angular stable locking plate fixation were included in the study. Of these, 117 patients had to be excluded and another 177 were not accessible. The study group thus compromised 230 patients who returned for the follow-up investigation and were followed-up clinically and radiologically with a mean follow-up interval of 20 months. Outcome was evaluated using pain, range of motion (ROM) and grip strength parameters. In addition, self-assessment by patients was registered on the QuickDASH, PRWE and Mayo Score. The immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off.

RESULTS

Bivariant correlation analysis showed a significant correlation between ulnar variance and QuickDASH (r = 0.18, p = 0.01), grip strength (r = - 0.18, p = 0.04) and Mayo Score (r = - 0.23, p = 0.001). No significant differences could be found between an unacceptable (> 2 mm) and acceptable (< 2 mm) ulnar variance in respect of pain, ROM, grip strength and patient-reported outcome measurements. Age, gender, additional fracture to the ulnar styloid, or type of postoperative immobilization showed no significant or clinical important impact on the final patient-reported outcome. No significant differences in incidence of complications, ROM or loss of reduction could be found in any patients over or under 65 years of age.

CONCLUSIONS

Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment and results in a good clinical and radiological outcome with low complication rate. Ulnar variance showed a significant correlation to grip strength, QuickDASH and Mayo Score, but an unacceptable ulnar variance (> 2 mm) was not associated with a worse clinical important outcome. Age (< 65/> 65 years), gender and type of immobilization had no impact on the complication rate or in the final functional or radiological outcome.

Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

A wide range of different classifications exist for distal radius fractures (DRF). Most of them are based on plane X-rays and do not give us any information on how to treat these fractures. A biomechanical understanding of the mechanical forces underlying each fracture type is important to treat each injury specifically and ensure the optimal choice for stabilization. The main cause of DRFs are forces acting on the carpus and the radius as well as the position of the wrist in relation to the radius. Reconstructing the mechanism of the injury gives insight into which structures are involved, such as ruptured ligaments, bone fragments as well as the dislocated osteoligamentous units. This article attempts to define certain key fragments, which seem crucial to reduce and stabilize each type of DRF. Once the definition is established, an ideal implant can be selected to sufficiently maintain reduction of these key fragments. Additionally, the perfect approach is selected. By applying the following principles, the surgeon may be assisted in choosing the ideal form of treatment approach and implant selection.

Volar Plate Fixation Versus Plaster Immobilization in Acceptably Reduced Extra-Articular Distal Radial Fractures: A Multicenter Randomized Controlled Trial

BACKGROUND

There is no consensus as to whether displaced extra-articular distal radial fractures should be treated operatively or nonoperatively. We compared the outcomes of open reduction and volar plate fixation with closed reduction and plaster immobilization in adults with an acceptably reduced extra-articular distal radial fracture.

METHODS

In this multicenter randomized controlled trial, patients 18 to 75 years old with an acceptably reduced extra-articular distal radial fracture were randomly assigned to open reduction and volar plate fixation or plaster immobilization. The primary outcome was function as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire after 12 months. Follow-up was conducted at 1, 3, and 6 weeks and at 3, 6, and 12 months. Analyses were performed according to the intention-to-treat principle.

RESULTS

Ninety-two patients were randomized, 48 to open reduction and volar plate fixation and 44 to plaster immobilization; 1 patient in each group was excluded for withdrawing informed consent. At all follow-up time points, operatively treated patients had significantly better functional outcomes, as indicated by significantly lower DASH scores, than patients treated nonoperatively (all p values < 0.05). Twelve nonoperatively managed patients (28%) had fracture redisplacement within 6 weeks and underwent subsequent open reduction and internal fixation, and 6 patients (14%) had a symptomatic malunion treated with corrective osteotomy.

CONCLUSIONS

Patients with an acceptably reduced extra-articular distal radial fracture treated with open reduction and volar plate fixation have better functional outcomes after 12 months compared with nonoperatively managed patients. Additionally, 42% of nonoperatively managed patients had a subsequent surgical procedure. Open reduction and volar plate fixation should be considered for patients who experience this common injury.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.