Elsevier

The Journal of Hand Surgery

Volume 29, Issue 6, November 2004, Pages 1128-1138
The Journal of Hand Surgery

Original articles
Distal radius fractures
Assessment of instability factors in adult distal radius fractures

https://doi.org/10.1016/j.jhsa.2004.06.008Get rights and content

Background

The purpose of this study was to evaluate the radiographic outcome of unstable distal radius fractures treated by closed reduction and sugar tong splinting and to quantitatively evaluate Lafontaines’ criteria of instability.

Methods

Fifty patients with 3 or more instability factors as described by Lafontaine were treated by finger trap traction, closed reduction, and sugar-tong splinting. They were evaluated radiographically for initial angulation, radial inclination, radial length, and palmar tilt at the time of injury, after reduction, and 1 week, 2 weeks, and 4 weeks after reduction. The fracture either maintained an adequate reduction or failed to maintain an adequate reduction and showed secondary displacement based on specific criteria.

Results

At 4 weeks after reduction 46% of these unstable distal radius fractures maintained an adequate reduction. Of the 54% of fractures that failed to maintain an adequate reduction, age was the only statistically significant predictor of secondary displacement. After obtaining an acceptable initial closed reduction, patients 58 years of age were found to be at 50% risk for secondary displacement. The risk for displacement with an unacceptable radiographic result was found to increase with increasing age and decrease with decreasing age.

Conclusion

In the closed management of these potentially unstable distal radius fractures, age was the only statistically significant risk factor in predicting secondary displacement and instability. These data help guide treatment by closed reduction and immobilization with serial x-rays or by surgical stabilization.

Section snippets

Materials and methods

From February 2002 to February 2003 there were 289 fractures of the distal radius that were treated consecutively at our institution. Standard initial treatment consisted of local hematoma block, 10 pounds of finger-trap traction, and manual closed reduction of the fracture. Each patient was placed into a well-molded sugar-tong splint. Postreduction radiographs were performed in the posteroanterior, lateral, and oblique planes. Follow-up radiographs were obtained at 1 week, 2 weeks, and 4 weeks

Results

Based on the radiographic measurements and criteria for an acceptable reduction the number of patients who failed to maintain an adequate reduction at 1 week was 17 (34%), at 2 weeks an additional 7 patients failed (48%), and at 4 weeks an additional 3 patients failed (54%) (Fig. 7). Of the total 27 patients who failed at 4 weeks, 10 patients failed because of excessive dorsal tilt, 7 patients failed because of excessive radial shortening, 5 patients failed because of excessive radial

Discussion

Fractures of the distal radius are common, especially in elderly patients. Initial treatment consists of closed reduction and immobilization. With increasing knowledge and understanding of fracture patterns and the long-term effects of malunion, however, a more aggressive surgical approach has been used for potentially unstable fractures. The definition of instability has been a topic of controversy for decades. The results of this study will aid the clinician in identification and treatment

References (17)

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    Citation Excerpt :

    DRFs in older patients have typically been treated conservatively with closed reduction and cast immobilization [3]. However, this method of treatment may fail to maintain reduction, and re-displacement or malunion rates is reported in over 50% of cases [4], as age is one of the most significant risk factors for loss of reduction and secondary fracture displacement [5,6]. When the initial reduction fails to meet acceptable radiographic parameters, surgical management, such as internal or external fixation, may be used [7].

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