The distal radius fracture - an overview of the treatment situation

Introduction: The distal radius fracture is the most common fracture in humans, there are many different treatment options available, reaching from a conservative approach in a cast to open reduction and internal fixation. All different treatment options aim for a fully functional, pain-free wrist with full grip strength and full range of motion. Although this type of fracture is so common, usually treatment decisions are rather based on experts’ opinions than on consistent studies. Aim of the study: This study wants to give an overview about current treatment options of the distal radius fracture, trying to evaluate the treatment success comparing loss of reduction in cast treatment with that of an operative approach with open reduction and internal fixation. Methods: In this retrospective study we examined the palmar tilt of the distal radius in standard wrist X-rays (lateral view) of 240 adult patients before treatment (T1), after reduction/surgery (T2), two weeks after treatment (T3), four-six weeks after treatment (T4) and after at least six months (T5). In addition patients’ folders were reviewed to identify the cause of trauma and complications following the fracture. Results: 72 % of our patients were female, 28 % were male. 40 % had a category A fracture (AO classification system), 48% a C fracture. 61% were older than 55 years of age, 39 % were 55 years of age or younger. Loss of reduction (change of at least 4°) occurred in 41,25 %. There was no significant difference between loss of reduction and AO category, furthermore did our study not show a significant difference between the younger group (age≤55) and the older group (age>55), which is not in agreement with other studies. Loss of reduction occurred significantly more often in cast treatment compared with internal fixation (55 % versus 33 %). Comparing open reduction and internal fixation (ORIF) with 4 and more than 4 locking screws loss of reduction did not differ significantly between the two groups. Conclusion: The results indicate that a surgical approach might be superior to conservative treatment. Due to many confounders and the retrospective character of this study results have to be interpreted cautiously. Although the treatment outcome of distal radius fractures generally is good there should be further randomized, controlled studies evaluating treatment options and ultimately leading to a widely acknowledged treatment algorithm.2022-04-1