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. 2009 Jun;467(6):1612-20.
doi: 10.1007/s11999-008-0660-2. Epub 2008 Dec 12.

Distal radius fractures in older patients: is anatomic reduction necessary?

Andrew J Synn  1 , Eric C Makhni, Melvin C Makhni, Tamara D Rozental, Charles S Day
Affiliations

Distal radius fractures in older patients: is anatomic reduction necessary?

Andrew J Synn et al. Clin Orthop Relat Res. 2009 Jun.

Abstract

The relationship between radiographic and functional outcomes in older patients with distal radius fractures is controversial. We explored this relationship by assessing the influence of radiographic displacement and fracture comminution on the functional outcomes of these fractures. We also asked whether operative intervention and demographic factors (age, gender, duration of followup) influenced outcome. We examined 53 patients older than 55 years with distal radius fractures with various functional assessments: range of motion (ROM) and strength measurements, three subjective surveys (Disabilities of the Arm, Shoulder, and Hand; Patient-rated Wrist Evaluation; Modernized Activity Subjective Survey of 2007), a Gartland and Werley score, and an objective, standardized hand performance test (Jebsen-Taylor). We measured angulation, articular gap/stepoff, and radial shortening on final radiographs and fracture comminution of preoperative radiographs. We observed no effect of radiographic displacement on subjective or objective outcome assessments, including standardized hand performance timed testing. Surgically treated fractures were less likely to display residual dorsal angulation and radial shortening, but surgical intervention did not independently predict functional outcome. Fracture comminution, patient gender, and months of followup similarly had no effect on outcome. We found no relationship between anatomic reduction as evidenced by radiographic outcomes and subjective or objective functional outcomes in this older patient cohort.

Level of evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
The different assessments of functional outcome used in this study are shown. These tools can be classified into three general categories: objective, subjective, and observed function assessments.
Fig. 2
Fig. 2
We assessed the radiographic outcome of 53 patients with distal radius fractures. Twenty-six (49%) of the patients in this cohort showed evidence of radiographic displacement in at least one of four general displacement categories: tilt, radial shortening, and articular gap/stepoff. Thirteen (25%) of the fractures showed displacement of two or more parameters.
See this image and copyright information in PMC

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