Factors Associated with Re-Displacement after Nonsurgical Treatment of Distal Radius Fractures in Adults: A Retrospective Study

Hong-zhou Zhao, Jian-ge Chen, Hai-ning Zhang, Jia-hui Xing, Ming-jun Liu, Wei-min Wang

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Orthopaedic Surgery ›› 2024, Vol. 16 ›› Issue (1) : 234-244. DOI: 10.1111/os.13950
TRADITIONAL CHINESE MEDICINE IN ORTHOPAEDICS

Factors Associated with Re-Displacement after Nonsurgical Treatment of Distal Radius Fractures in Adults: A Retrospective Study

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Abstract

Objective:: Closed reduction combined with external fixation is a frequently utilized approach for treating distal radial fractures in adults. Nonetheless, the potential for re-displacement following external fixation remains. Analyzing the factors influencing re-displacement after nonsurgical treatment of distal radial fractures in adults is vital for preventing re-displacement and making prognostic assessments.

Methods:: A retrospective analysis was performed on 884 patients who underwent nonsurgical treatment for distal radius fractures in the reduction room of the Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine at Tianjin Hospital, Tianjin, China, between July 2019 and December 2022. Patients were categorized into two groups, namely displaced and nondisplaced, based on radiographic outcomes. Factors affecting fracture re-displacement were examined, including sex, age, side, AO/OTA type, external fixation, and radiographic outcomes at pre-reduction and immediate reduction. Logistic regression analysis was employed to identify the risk factors for fracture re-displacement, and ROC curves were constructed.

Results:: Among the 884 patients, 563 (63.69%) experienced re-displacement after fracture reduction. There were no statistically significant differences (p > 0.05) between the two groups in terms of gender, external fixation method, and palmar tilt angle at pre-reduction and immediate reduction, while significant differences (p < 0.05) were observed in age, side, AO/OTA type, and radial inclination, radial length, and radiographic outcomes of ulnar variance at pre-reduction and immediate reduction. Multifactorial logistic regression analysis revealed that age (odds ratio [OR] = 1.027, p < 0.001), AO/OTA type (OR = 2.327, p = 0.005), ulnar variance at pre-reduction (OR = 1.142, p = 0.048), and ulnar variance at immediate reduction (OR = 1.685, p < 0.001) were significant factors (p < 0.05) associated with re-displacement following nonoperative treatment of adult distal radius fractures. For patients aged ≥60 years, the amount of missing radiographic outcomes was positively correlated with age. The receiver operating characteristic curve demonstrated that age ≥65.5 years, ulnar variance >3.26 mm at pre-reduction, and ulnar variance >2.055 mm at immediate reduction were high-risk factors for fracture re-displacement.

Conclusions:: Nonsurgical treatment of distal radius fractures exhibits a higher rate of re-displacement. Age, AO/OTA type, pre-reduction, and immediate reduction ulnar variance are key factors predicting fracture re-displacement.

Keywords

Distal Radius Fractures / Non-Surgical Treatment / Re-Displacement / Risk Factors

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Hong-zhou Zhao, Jian-ge Chen, Hai-ning Zhang, Jia-hui Xing, Ming-jun Liu, Wei-min Wang. Factors Associated with Re-Displacement after Nonsurgical Treatment of Distal Radius Fractures in Adults: A Retrospective Study. Orthopaedic Surgery, 2024, 16(1): 234‒244 https://doi.org/10.1111/os.13950

References

[1]
Saving J, Severin Wahlgren S, Olsson K, Enocson A, Ponzer S, Sköldenberg O, et al. Nonoperative treatment compared with volar locking plate fixation for dorsally displaced distal radial fractures in the elderly: a randomized controlled trial. J Bone Joint Surg Am. 2019;101(11):961–969.
[2]
Walenkamp MM, Aydin S, Mulders MA, et al. Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg Eur. 2016;41(5):501–515.
[3]
Leone J, Bhandari M, Adili A, McKenzie S, Moro JK, Dunlop RB. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg. 2004;124(1):38–41.
[4]
Bhattacharyya R, Morgan BS, Mukherjee P, Royston S. Distal radial fractures: the significance of the number of instability markers in management and outcome. Iowa Orthop J. 2014;34:118–122.
[5]
Liu K, Ye YL, Hu JW, et al. Analysis of the causes of Re-displacement in 92 cases of distal radius fractures after closed reduction. Chin J Tradit Chin Orthop Traumatol. 2020;28(10):61–64.
[6]
Wadsten MÅ, Sayed-Noor AS, Englund E, Buttazzoni GG, Sjödén GO. Cortical comminution in distal radial fractures can predict the radiological outcome: a cohort multicentre study. Bone Joint J. 2014;96(7):978–983.
[7]
Hua Z, Wang JW, Yin H, et al. Related factors of radius shortening after nonsurgical treatment of distal radius fractures in adults. Chin J Orthop Surg. 2018;26(16):1446–1451.
[8]
Souza KE, Kellam PJ, Stephens AR, Kazmers NH. Evaluation of risk factors for loss of acceptable alignment for distal radius fractures that are nondisplaced or minimally displaced on initial presentation. J Hand Surg Am. 2022;47(1):54–61.
[9]
Johnson NA, Dias J. The current evidence-based management of distal radial fractures: UK perspectives. J Hand Surg Eur. 2019;44(5):450–455.
[10]
Traumatic Orthopedics Group, Society of Orthopedics, Chinese Medical Association, Group of External Fixation and Limb Reconstruction, Society of Orthopedics, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of adult distal radius fracture (2023). Chin J Orthop Trauma. 2023;25(1):6–13.
[11]
Schmidt V, Mellstrand-Navarro C, Mukka S, Wadsten M. Marginal secondary displacement in fractures of the distal radius at follow-up—an important predictor for late displacement and malunion. J Hand Surg Eur. 2023;48:524–531.
[12]
Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurements for healed distal radius fractures. J Hand Surg Am. 1996;21(1):31–39.
[13]
Zhang XH, Xiao ZQ, Wang AM, Zhang HL, Li HJ, Huang SQ. Comparison study of small splint fixation and plaster slab fixation for the treatment of distal radius fractures. Zhongguo Gu Shang. 2010;23(8):578–580.
[14]
Sammer DM, Fuller DS, Kim HM, Chung KC. A comparative study of fragment-specific versus volar plate fixation of distal radius fractures. Plast Reconstr Surg. 2008;122(5):1441–1450.
[15]
Rollo G, Luceri F, Pasquino A, Pichierri P, Tomarchio A, Bisaccia M, et al. Bone grafiting combined with Sauvé-Kapandji procedures for the treatment of aseptic distal radius non-union. J Biol Regul Homeost Agents. 2020 Jul-Aug; 34(Suppl 3):213–218.
[16]
Pace V, Sessa P, Guzzini M, et al. Clinical, functional and radiological outcomes of the use of fixed angle volar locking plates in corrective distal radius osteotomy for fracture malunion. Acta Biomed. 2021;92(3):e2021180.
[17]
Jenkins NH. The unstable Colles' fracture. J Hand Surg Br. 1989;14(2):149–154.
[18]
Bronstein A, Heaton D, Tencer AF, Trumble T. Distal radius malunion and forearm rotation: a cadaveric study. J Wrist Surg. 2014;3(1):7–11.
[19]
Tahririan MA, Javdan M, Nouraei MH, Dehghani M. Evaluation of instability factors in distal radius fractures. J Res Med Sci. 2013;18(10):892–896.
[20]
Jung HW, Hong H, Jung HJ, Kim JS, Park HY, Bae KH, et al. Redisplacement of distal radius fracture after initial closed reduction: analysis of prognostic factors. Clin Orthop Surg. 2015;7(3):377–382.
[21]
Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am. 2008;33(8):1301–1308.
[22]
Shin YH, Gong HS, Gang DH, Shin HS, Kim J, Baek GH. Evaluation of trabecular bone score in patients with a distal radius fracture. Osteoporos Int. 2016;27(12):3559–3565.
[23]
Ghodasra JH, Yousaf IS, Sanghavi KK, et al. Assessing the relationship between bone density and loss of reduction in nonsurgical distal radius fracture treatment. J Hand Surg Am. 2021;46(5):377–385.e2.
[24]
Zengin EC, Ozcan C, Aslan C, Bulut T, Sener M. Cast immobilization versus volar locking plate fixation of AO/OTA type C distal radial fractures in patients aged 60 years and older. Acta Orthop Traumatol Turc. 2019;53(1):15–18.
[25]
Hassellund SS, Williksen JH, Laane MM, Pripp A, Rosales CP, Karlsen Ø, et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Joint J. 2021;103(2):247–255.
[26]
Oldrini LM, Feltri P, Albanese J, Lucchina S, Filardo G, Candrian C. Volar locking plate vs cast immobilization for distal radius fractures: a systematic review and meta-analysis. EFORT Open Rev. 2022;7(9):644–652.
[27]
Ochen Y, Peek J, van der Velde D, Beeres FJP, van Heijl M, Groenwold RHH, et al. Operative vs nonoperative treatment of distal radius fractures in adults: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(4):e203497.
[28]
Koval K, Haidukewych GJ, Service B, et al. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014 Sep; 22(9):566–575.
[29]
Ju JH, Jin GZ, Li GX, Hu HY, Hou RX. Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015;400(7):767–779.
[30]
He B, Tian X, Ji G, Han A. Comparison of outcomes between nonsurgical and surgical treatment of distal radius fracture: a systematic review update and meta-analysis. Arch Orthop Trauma Surg. 2020;140(8):1143–1153.
[31]
Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am. 2004;29:1128–1138.

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