Evaluation of Risk Factors for Loss of Acceptable Alignment for Distal Radius Fractures That Are Nondisplaced or Minimally Displaced on Initial Presentation

Abstract

Purpose: Numerous studies have evaluated risk factors for loss of acceptable radiographic alignment, as described by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines (CPG), following closed reduction of distal radius fractures (DRFs). Less is known about DRFs that are well aligned on initial presentation and do not require closed reduction. We evaluated the rate of and risk factors for displacement of DRFs that are nondisplaced or minimally displaced on initial presentation.

Methods: This retrospective cohort study identified patients with nondisplaced or minimally displaced DRFs seen at a single academic tertiary center between 2015 and 2019. DRFs that required a reduction or initial surgical treatment based on the American Academy of Orthopaedic Surgeons CPG and those with a volar shear pattern were excluded. We recorded standard radiographic measurements on presentation and wrist radiographs after 6 weeks. Univariate and binary multivariable logistic regression analyses evaluated associations between sex, age, the presence of dorsal comminution, intra-articular involvement, associated ulnar fractures, and minimal displacement (vs nondisplacement on initial radiographs) with loss of acceptable alignment.

Results: Of the 110 included patients, 72% were female and the mean age was 52 years (SD, 17 years). Overall, 33 (30%) had displacement beyond the AAOS CPG criteria at 6 weeks. A multivariable analysis demonstrated that the presence of dorsal comminution (odds ratio, 37.8) and age >60 years (odds ratio, 3.6) were significantly associated with loss of acceptable alignment, whereas sex, intra-articular involvement, associated ulnar styloid/neck fractures, and minimal displacement were not associated.

Conclusions: For DRFs that were initially nondisplaced or minimally displaced, the overall rate of unacceptable radiographic displacement at 6 weeks was 30%. Dorsal comminution and age >60 years were both independently associated with displacement, suggesting that patients with these risk factors may warrant closer follow-up than those without risk factors.

Type of study/level of evidence: Diagnostic IV.

Keywords: Distal radius fracture; late displacement; loss of reduction; radiographic alignment; wrist fracture.