Long-term outcome of nonsurgically treated distal radius fractures

Abstract

Purpose: To study the long-term outcome after nonsurgically treated distal radius fractures including recovery of grip strength, mobility, and radiographic parameters.

Methods: Eighty-seven patients, mean age 55 (range 19-78) years, treated with closed reduction and casts, were evaluated radiographically and clinically during the first 6 months and finally after 9-13 years. Fifty patients had extra-articular fractures (AO Class A), 4 had simple intra-articular fractures (AO Class B) and 33 had complete intra-articular fractures (AO Class C).

Results: Fifty-two of 66 patients with unilateral fractures were, after 9-13 years, rated as excellent/good according to the Green and O'Brien score as modified by Cooney et al (GOBC score). Fracture class according to AO did not correlate to outcome. Considerable fracture displacements remained: dorsal angulation (mean 13 degrees in <60 y, 18 degrees in >/=60 y), greater radial shortening than initially (mean 2 mm in <60 y, 3 mm in >/=60 y). Five patients had remaining joint step-off (1-2 mm) after reduction, but only one developed mild osteoarthritis. Patients with an unsatisfactory outcome had sustained more displaced fractures that also healed with greater displacement. The remaining subjective complaints were pain or reduced function during heavier tasks. Outcome was not correlated to age. Wrist mobility returned notably faster than grip strength. Patients over 60 years of age recovered slower in both mobility and strength. Closed reduction and plaster improved dorsal angulation but not radial shortening.

Conclusions: Our data indicate that a number of patients with nonsurgically treated distal radius fractures still experience some hand/wrist impairment a decade after the trauma. The severity of fracture displacement seems to influence the clinical outcome in contrast to patients' age. Recovery of grip strength is slower than that of range of motion. Elderly patients recover more slowly than young patients. Dorsal angulation was improved but remained considerable (13 degrees -18 degrees ), while final radial shortening (2-3 mm) increased from the injury status.