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Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures

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Abstract

Introduction

The purpose of this study was to identify radiological predictors of early and late instability following conservative treatment of extra-articular distal radius fractures.

Materials and methods

An observational study design was employed using patient records and standardized radiological follow-up examinations as data sources. The database at a single institution was used to identify all patients with extra-articular distal radius fractures over the course of 1 year. A total of 71 patients with extra-articular distal radius fractures (50 dorsally displaced, 21 undisplaced) fulfilled the inclusion criteria. Patients were predominantly female (87%) with a pooled mean age of 64.9 years. All patients with displaced extra-articular distal radius fractures underwent closed reduction with subsequent cast immobilization. Undisplaced fractures were simply treated with cast immobilization. The primary outcomes were early (1 week) and late (6 weeks) instability of the fracture. Instability was defined as: (1) dorsal tilt >15°, (2) volar tilt >20°, (3) ulnar variance >4 mm, (4) radial inclination <10°.

Results

Degree of radial shortening and volar tilt were predictive of early instability (p<0.05), with dorsal comminution also approaching statistical significance (p=0.06). Radial inclination, age, radial shortening, and volar tilt were predictive of late failure (p<0.05). An unexpected result showed that one-third of undisplaced fractures went on to fail, most of which occurred in those patients over the age of 65 years.

Conclusion

An awareness of independent predictors of instability in extra-articular distal radius fractures is helpful in anticipating the final alignment outcome.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada

    James Leone, Mohit Bhandari, Anthony Adili, Scott McKenzie, Jaydeep K. Moro & R. Brett Dunlop

  2. Room 2C12, Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, 1200 Main Street West, Hamilton , Ontario, L8N 3Z5, Canada

    Mohit Bhandari

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  1. James Leone
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  2. Mohit Bhandari
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  3. Anthony Adili
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Correspondence to Mohit Bhandari.

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Leone, J., Bhandari, M., Adili, A. et al. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg 124, 38–41 (2004). https://doi.org/10.1007/s00402-003-0597-6

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  • DOI: https://doi.org/10.1007/s00402-003-0597-6

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