Incidence of displacement after nondisplaced distal radial fractures in adults.
BACKGROUND:
It
is standard practice to closely monitor distal radial fractures treated
nonoperatively to ensure that there is no fracture displacement.
Patients are often asked to initially return weekly for radiographs. To
our knowledge, nondisplaced distal radial fractures in adults have not
been specifically evaluated to determine if this level of vigilance is
required. If this subset of fractures is unlikely to displace, the cost,
radiation exposure, and inconvenience of weekly office visits could be
spared.
METHODS:
Using our billing database, we
identified 642 closed distal radial fractures among the patients who
presented to our institution during the four-year period from the
beginning of 2006 to the end of 2009. Radiographs of the injuries were
reviewed to identify fractures for which radiographic measurements were
within predefined radiographic norms. Only those fractures that were
believed to be nondisplaced by all reviewers were classified as
nondisplaced for the purposes of this study. Radiographic measurements
were made at the time of injury and at the time of fracture union to
evaluate for displacement over time. The total number of clinic visits
and radiographs that were received were calculated from the longitudinal
medical record for each patient.
RESULTS:
Eighty-two
fractures were identified as nondisplaced. None displaced or required
operative intervention. The largest measured difference from injury to
fracture union for radial inclination was 3.6° (average 0.8°); for
radial height, 2.1 mm (average 0.5 mm); and for palmar tilt, 3.1°
(average 1.0°). These numbers are all within the error of measurement.
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