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A radiographic analysis of closed reduction and casting of distal radial fractures with consideration of candidacy

Trouw, Arie G. MDa,b; Mulchandani, Neil B. MDa,c; Kelly, John J. MSa,d; Eldib, Ahmed M. MDa; Shah, Neil V. MD, MSa; Banning, George K. MD, MPHa; Chatterjee, Dipal MDa; Scollan, Joseph P. BSa; Yang, Andrew MDa; Kapadia, Bhaveen H. MDa; Diebo, Bassel G. MDa; Illical, Emmanuel M. MD, FRCSCa; Urban, William P. MDa

doi: 10.1097/BCO.0000000000000779
Special Focus: Resident Research Award
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Background: Distal radial fractures (DRF) are treated by internal fixation or closed reduction and casting (CRC). Over the years, various DRF classification systems and radiographic thresholds have been developed to guide management for orthopaedic surgeons, yet no gold standard has been established. This study sought to identify patients who presented with DRF and received treatment with CRC and determine if the process of selecting CRC-managed patients had improved by analyzing radiographic maintenance of reduction through final bone union.

Methods: Retrospective review of a single-site database from 2012-2015 identified CRC-managed DRF with pre-CRC, post-CRC, and final-union radiographs. Outcomes compared included radial height (RH), radial inclination (RI), volar tilt (VT), teardrop angle (TDA), and ulnar variance (UV).

Results: Post-CRC RH increased (7.5 to 10.4 mm, P<0.01) and regressed by 1.3 mm by union. RI increased (14.4 to 19.4 degrees, P<0.01) and returned to 17.3 degrees by union. Mean VT changed from −9.9 to 7.9 degrees (P<0.01) and to 1.1 degrees by union (P<0.05). TDA increased by union (34.1 to 44.5 degrees, P<0.01). UV changed from 1.2 to −0.2 mm (P<0.02) to 1.2 mm by union (P<0.01). At presentation the following parameters had differences when considering established favorable and unfavorable values at final-union: RH (9.58 vs. 5.26 mm), RI (16.9 vs. 8.1 degrees), and UV (0.4 vs. 3.9 mm) (all P<0.0005).

Conclusions: Current literature demonstrated substantial variation in DRF management and expectations after CRC. This study revealed that RH greater than 9.5 mm and UV less than 3.8 mm at presentation were associated with successful reductions without functional deficit.

aDepartment of Orthopaedic Surgery, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY

bDepartment of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT

cDepartment of Orthopaedic Surgery, Northwell-Lenox Hill Hospital, New York, NY

dSchool of Medicine, SUNY Upstate Medical University, Syracuse, NY

Financial Disclosure: Dr. Illical discloses a financial relationship outside this work with Biocomposite and Skeletal Dynamics. The authors report no conflicts of interest.

Correspondence to Neil V. Shah, MD, MS, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203S Tel: (718)-221-5270; fax: (718)-270-8769; e-mail: neilvshahmd@gmail.com.

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