Purpose
To determine the magnitude, direction, temporal patterns, and frequency of reduction
loss following nonsurgical, closed treatment of distal radius fractures in women 50
years and older and correlate these observations with bone mineral density and age.
Methods
We reviewed registry data on 1,148 patients 50 years and older with distal radius
fractures managed by closed reduction and cast immobilization. Radial inclination
(RI), ulnar variance (UV), and radial tilt (RT) were measured immediately and at 1,
2, 3, 6, 9, and 12 weeks after reduction. Magnitude, direction, frequency, and patterns
of change were compared at each time point and correlated with bone mineral density
T-scores and age using paired t tests in a mixed effects model.
Results
Over 12 weeks, RI decreased by 3° ± 5°, the majority occurring in the first 2 weeks
and significantly correlated with bone mineral density T-score and age. Unexpectedly,
RI increased over time in 5% of patients. Ulnar variance increased by 2.3 ± 1.7 mm,
the majority occurring in the first 3 weeks and correlated with age. Radial tilt changed
by 7° ± 11° in those displacing dorsally and 8° ± 12° in those displacing volarly at 12 weeks, with the majority occurring in the
first 3 weeks and significantly correlating with age. Ulnar variance and RT continued
to change by small increments between weeks 3 and 6. Nearly 90% of our cohort experienced
measurable loss of reduction and 50% changed at least 5° RI, 11° RT, and 2 mm UV.
Conclusions
Most distal radius fracture managed with closed reduction and casting have some loss
of reduction, the majority occurring in the first 3 weeks and correlated with increased
age and osteoporosis. This guides clinicians in informing patients about expected
reduction loss, frequency of clinical and radiographic follow-up, and timing of discussions
regarding the need for surgery.
Type of study/Level of evidence
Prognostic II.
Key words
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Article info
Publication history
Published online: March 26, 2022
Accepted:
January 6,
2022
Received:
December 30,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
