Sequential Radiographic Evaluation during Closed Treatment of Distal Radius Fracture

Objectives:To test the null hypothesis that there is no significant change in radiographic parameters, which determines an acceptable reduction, beyond 3 weeks in distal radius fractures with closed treatment.Design:Retrospective review of a prospectively gathered registry of distal radius fractures.Setting:Academic medical center.Patients:Patients who underwent closed treatment of distal radius fracture.Intervention:Sequential radiographic evaluation.Main Outcome Measurements:Change of radiographic measurement including radial inclination, radial height, ulnar variance, articular tilt, teardrop angle, anteroposterior distance, intra-articular gap, and step-off. We compared postreduction radiographic parameters once within 2 weeks, at the third week, at cessation of immobilization, and analyzed the interobserver reliability test.Results:There was a statistically significant difference between radiographic measurements, which determined an acceptable reduction between radiographs performed within 2 weeks versus the third week. Radial inclination and ulnar variance were statistically different at the third week compared with the time of cessation of immobilization. Seventy-seven percent of patients who had an acceptable reduction after 2 weeks maintained acceptable alignment at cessation of immobilization. Eighty-five percent of patients with acceptable reduction after 3 weeks maintained acceptable alignment at cessation of immobilization. Radial shortening >1.8 mm at the third week predicts an unacceptable radiographic outcome at cessation of immobilization (sensitivity 94.5% and specificity 90%).Conclusion:Radiographic parameters that determine acceptable reduction for closed treatment of distal radius fractures change minimally after 3-week postacceptable closed reduction. Radial shortening at the third week can be used to predict an unacceptable radiographic outcome.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.