gms | German Medical Science

Objectives/Interrogation: Distal radius fracture (DRF) is usually treated with cast immobilization followed in short-interval to observe any reduction loss. However, there is little information whether radiological collapse at 1st follow-up will be associated with further deterioration of radiological results. Purpose of current study is to follow up the radiological results of DRF in two different groups according to radiologic progression at 1st follow-up visit.

Methods: A retrospective study involving non-operative treatment of DRF in 60 patients was conducted. Displaced fractures underwent closed reduction with immobilization. Radiographs were obtained after reduction, at 5~12 days (1st follow-up) and after union. If the radial inclination was decreased more than 5mm, volar tilt was decreased more than 10°, or ulnar variance was increased more than 2mm at the 1st follow-up visit, compared to post-reduction radiograph, we assumed these patients as radiologic collapse (RC) group. We analyzed the amount of change in radiologic parameters and final ratio of unacceptable radiologic results. Displacement involving volar inclination of > 20°, dorsal inclination of > 10°, or positive ulnar variance of > 2mm were considered as radiologically un-acceptable.

Results and Conclusions: At initial presentation, 39-patients (65%) has unacceptable radiologic parameter and this was improved to 30% after reduction. At 1st follow-up, the number of patients with unacceptable reduction was similar compared to immediate post-reduction (28%). However, we could observe the progression of radiologic collapse in 21-patients (35%) and assigned to RC group At 1st follow-up, 33% of of patients had unacceptable radiological outcome in RC group and it was 26% in non-RC group (P=0.6).

At last follow-up, 62% of patients in RC group had resulted in unacceptable radiologic outcome (29%-increase) and in non-RC group, it was 41% (15%-increase). This difference was not statistically significant (P=0.2). Odds ratio for finally unacceptable radiographic results according to the presence of radiologic collapse was 1.7.

Patients, who had radiologic collapse at 1st follow-up, had resulted in higher prevalence of radiologically-unacceptable union, although there was no statistical significance. Data also showed that even if there was no reduction loss at 1st follow-up, substantial number of patients (28%) had continuing collapse of fracture. These knowledge can be used to explain prognosis.