Distal radius fractures in older patients: is anatomic reduction necessary?
The relationship between radiographic and functional outcomes in older patients with distal radius fractures is controversial. We explored this relationship by assessing the influence of radiographic displacement and fracture comminution on the functional outcomes of these fractures. We also asked whether operative intervention and demographic factors (age, gender, duration of followup) influenced outcome. We examined 53 patients older than 55 years with distal radius fractures with various functional assessments: range of motion (ROM) and strength measurements, three subjective surveys (Disabilities of the Arm, Shoulder, and Hand; Patient-rated Wrist Evaluation; Modernized Activity Subjective Survey of 2007), a Gartland and Werley score, and an objective, standardized hand performance test (Jebsen-Taylor). We measured angulation, articular gap/stepoff, and radial shortening on final radiographs and fracture comminution of preoperative radiographs. We observed no effect of radiographic displacement on subjective or objective outcome assessments, including standardized hand performance timed testing. Surgically treated fractures were less likely to display residual dorsal angulation and radial shortening, but surgical intervention did not independently predict functional outcome. Fracture comminution, patient gender, and months of followup similarly had no effect on outcome. We found no relationship between anatomic reduction as evidenced by radiographic outcomes and subjective or objective functional outcomes in this older patient cohort.


METHODS
Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Synn
Andrew J
AJ
Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
Makhni
Eric C
EC
Makhni
Melvin C
MC
Rozental
Tamara D
TD
Day
Charles S
CS
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome