title: Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?
abstract: OBJECTIVE
  To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes.
  
  
  METHODS
  Consecutive patients over 50 years of age (n=74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal ( approximately 6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome.
  
  
  RESULTS
  Of the cohort studied (n=74, mean age 68.5 years, primarily white women), 71% had at least one "unacceptable" radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH=24+/-17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes.
  
  
  CONCLUSIONS
  Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the "acceptability" of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.
authors.affiliation: Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Jaremko
authors.forename: R G W
authors.initials: RG
authors.lastname: Lambert
authors.forename: B H
authors.initials: BH
authors.lastname: Rowe
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
authors.forename: S R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D000368:Aged; D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging*; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D014955:Wrist Joint / Q000503:physiopathology