Poor fracture alignment equals poor outcome? Analysis of conservatively managed distal radius fractures

PURPOSE: The NOM (non-operative management) of distal radius fractures (DRF) is influenced by various factors. This study seeks to determine whether poor fracture alignment correlates with poor outcome.

METHODS: Over a period of three years, a study was conducted on conservatively treated DRF involving 127 patients, 104 women (81.9%) and 23 men (18.1%). The average age was 70.6 years (SD ± 19.1; range 21 to 102 years). The patient population is categorized into two groups according to radiological healing outcomes: Group I and Group II. The classification threshold was established as (1) > 10° dorsal/volar tilt of the lateral articular surface angle. (2) Radial tilt of the anteroposterior joint surface angle exceeds 10 degrees. (3) The loss in radial height surpasses 4 mm. Patients were categorized into group II if they met two or more criteria for DRFs, while those with one or fewer criteria were placed in group I.

RESULTS: Group I exhibited superior mobility across all planes, except in radial abduction. There was also a significant improvement in the clinical scores (QuickDASH, PRWE). Patients over 70 years with anatomically healed distal radius fractures (Group I) had superior range of motion in all planes, with the exception of radial abduction. Group II exhibited significantly higher scores (QuickDASH, PRWE).

CONCLUSION: Thus, the ultimate goal-both in younger and older patients-should remain to achieve the best possible anatomical reduction. And especially in geriatric people, anatomical repositioning demonstrates enhanced ROM and significantly improvement in patient's satisfaction and daily functioning.