Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

Jaremko, J.L.; Lambert, R.G.W.; Rowe, B.H.; Johnson, J.A.; Majumdar, S.R.

doi:10.1016/j.crad.2006.08.013

« Previous Next »Clinical Radiology
Volume 62, Issue 1 , Pages 65-72, January 2007

Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

J.L. Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
R.G.W. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
B.H. Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
J.A. Johnson
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
S.R. Majumdar
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Guarantor and correspondent: S.R. Majumdar, Division of General Internal Medicine, Department of Medicine, 2E3.07 Walter MacKenzie Health Sciences Centre, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7. Tel.: +1 780 407 1399; fax: +1 780 407 2680.

Received 7 June 2006; received in revised form 8 August 2006; accepted 15 August 2006.

Aim

To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes.

Materials and methods

Consecutive patients over 50 years of age (n=74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal (∼6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome.

Results

Of the cohort studied (n=74, mean age 68.5 years, primarily white women), 71% had at least one “unacceptable” radiographic deformity by traditional criteria. Acceptable reduction varied from 60–99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH=24±17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes.

Conclusion

Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the "acceptability" of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.