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Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density

  • Trauma Surgery
  • Published:
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Abstract

Introduction

We hypothesized that treating distal radius fractures with cast only or closed reduction and cast is associated with high malunion risk and that the risk is higher in patients with low bone mineral density (BMD).

Materials and methods

We prospectively studied 130 patients aged 40 years or older with distal radius fractures treated with cast only (87 patients) or closed reduction and cast (43 patients). Radiographs were obtained before treatment, after reduction (in the closed reduction group), and at 1 year. We measured calcaneal BMD with DXA scanner and calculated T scores. We calculated radiological changes from baseline (initial radiographs in cast only and post-reduction radiographs in closed reduction patients) to 1 year. We assessed the relationship between BMD status (normal, osteopenia or osteoporosis) and baseline-to-1-year worsening in volar tilt, ulnar variance, and radial inclination with analysis of covariance adjusting for baseline radiological values. We used receiver operating characteristic (ROC) analysis to determine the ability of T scores to distinguish patients with severe malunion (dorsal tilt >25° and/or ulnar variance ≥5 mm) from those with less severe or no malunion.

Results

In both treatment groups, baseline radiological variables had deteriorated at 1 year, more in the closed reduction group. Compared to patients with normal BMD, those with osteoporosis had significantly greater worsening in volar tilt and radial inclination but did not differ in ulnar variance worsening. Severe malunion was found in 34 fractures (26 %, 15 in cast only group); T scores had a modest ability in distinguishing severe malunion (area under ROC curve 0.67, 95 % CI 0.56–0.78, p = 0.003).

Conclusions

Closed reduction and cast is not an effective treatment for distal radius fractures if radiological graphic outcomes are considered. There is a higher risk of malunion involving dorsal and radial tilt in patients with osteoporosis. Calcaneal BMD measurement may have some benefit in predicting the risk of severe malunion.

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Acknowledgments

This research was supported by Skane County Council’s Research and Development Foundation, Hässleholm Hospital and Swedish Society of Medicine.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Hand Surgery, Skåne University Hospital, Jan Waldenströmsgatan 5, 20502, Malmö, Sweden

    Elisabeth Brogren

  2. Clinical Sciences, Lund University, Lund, Sweden

    Elisabeth Brogren & Isam Atroshi

  3. Department of Radiology, Hässleholm Hospital, 29125, Hässleholm, Sweden

    Michael Petranek

  4. Department of Orthopedics, Hässleholm Hospital, 29125, Hässleholm, Sweden

    Isam Atroshi

Authors
  1. Elisabeth Brogren
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  2. Michael Petranek
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  3. Isam Atroshi
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Correspondence to Elisabeth Brogren.

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Brogren, E., Petranek, M. & Atroshi, I. Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density. Arch Orthop Trauma Surg 135, 927–933 (2015). https://doi.org/10.1007/s00402-015-2220-z

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  • DOI: https://doi.org/10.1007/s00402-015-2220-z

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