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.
Conclusions: Nondisplaced distal radial fractures in adults appear to be inherently stable, and it may be appropriate to treat this subset of distal radial fractures with cast immobilization (when swelling allows) and a single follow-up visit with radiographs to document union at the time of cast removal.
Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
1Department of Orthopaedic Surgery (K.M.R., P.E.B., B.E.E., and A.L.) and the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (R.H.), Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115.