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Lee, Lee, Kim, Back, Song, Park, Chung, and Han: The Factors Predicting Secondary Displacement after Closed Reduction of Unstable Distal Radius Fracture
Original Article

J Korean Soc Surg Hand 2017;22(1):13-19.

Published online: 10 March 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.1.13

The Factors Predicting Secondary Displacement after Closed Reduction of Unstable Distal Radius Fracture

Jung Suk Lee1, Jae Hoon Lee1, Young Joon Kim2, Jong Hun Back3, Wook Jae Song3, Jin Sung Park4, Duke Whan Chung3, Chung Soo Han3

1Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea

2Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Busan, Korea

3Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Seoul, Korea

4Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea

Correspondence to: Jae Hoon Lee Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea TEL: +82-2-440-6153 FAX: +82-2-440-7497 E-mail: ljhos69@naver.com

Received 12 November 20162 February 2017       Accepted 12 February 2017

Copyright © 2017 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

It has been studied prognostic factors about secondary displacement after conservative treatment of the distal radius fracture, but each study showed different results. Authors retrospectively evaluated factors known to be involved secondary displacement of the distal radius fracture to determine its significance.

Methods:

One hundred eighteen cases of the radiographically unstable distal radius fractures that closed reduction was adequately performed were retrospectively studied and the radiographic images were taken at 1, 2, 3, 4, 6 weeks after closed reduction. During follow-up, dorsal tilt more than 15°, volar tilt more than 20°, ulnar positive variance more than 4 mm, radial length less than 6 mm, radial inclination less than 10° were thought of the loss of reduction.

Results:

In 41 cases (34.7%), the loss of reduction occurred. Sex, intra-articular fracture, dorsal and volar comminution, concomitant ulnar fracture and involvement of the distal radio-ulnar joint were statistically not significant. Analysis results of the binomial logistic regression model were as follows: age (p=0.003), radial shortening (p=0.010) and ulnar positive variance (p=0.010) were statistically significant as the predictive prognostic factors. Analysis results of the multinomial logistic regression model showed age (p=0.006) as an only statistically significant factor.

Conclusion:

As the predictive prognostic factors for development of secondary displacement after conservative treatment of the unstable distal radius fracture, age was determined as most significant factor. Also radial shortening and ulnar positive variance were thought of the predictive factors for secondary displacement.

Keywords: Radius, Radius fractures, Conservative treatment, Closed fracture reduction, Colles’ fracture

References

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Table 1.
Demographic data
Variable Value
No. of distal radius fractures 118
Secondary displacement 41
  Male 8
  Female 33
Gender
  Male 18
  Female 99
Age (yr) 62.5 (21–89)
Initial radial inclination (°) 18.0 (4–32.8)
Initial radial length (mm) 7.1 (–3.3 to 14)
Initial positive ulnar variance (mm) 2.94 (–5 to 11)
Initial dorsal angulation (°) 11.8 (–21 to 47.7)
Initial intra-articular fracture (%) 33
Initial articular displacement (mm) 0.15 (0–2)
Initial dorsal comminution (%) 73
Initial volar comminution (%) 19
Initial associated ulnar fracture (%) 60
Initial associated distal radio-ulnar joint 56
involvement (%)
Mean Lafontaine criteria4 2.5 (1–5)

Values are presented as number or mean (range).

Table 2.
Displacement based on age and time from reduction
Age (yr) 1 Week 2 Weeks 3 Weeks 4 Weeks 6 Weeks
21–30 - 1 - - -
31–40 - - - - -
41–50 - - - 2 -
51–60 1 5 - 2 -
61–70 4 2 4 5 1
71–80 - 6 - - 1
81–89 2 - 1 2 2
Table 3.
Chi-square test
Risk factor Odds ratio p-value
Sex 1,584 0.600
Initial intra-articular fracture 188.57 0.314
Initial dorsal comminution 1,062.31 0.662
Initial volar comminution 62.9 0.339
Initial ulnar fracture 548.43 0.694
Initial distal radio-ulnar joint involvement 444.16 0.332
Table 4.
Logistic regression analysis (univariable)
Risk factor Crude odds ratio 95% Confidence interval p-value
Age 1.060 1.020–1.101 0.003
Initial radial inclination 0.958 0.900–1.021 0.185
Initial radial length 0.851 0.753–0.962 0.010
Initial positive ulnar variance 1.284 1.063–1.552 0.010
Initial dorsal angulation 0.996 0.970–1.023 0.785
Initial articular displacement 1.466 0.593–3.626 0.408
Mean Lafontaine criteria4 1.262 0.876–1.819 0.211
Table 5.
Logistic regression analysis (multivariable)
Risk factor Crude odds ratio 95% Confidence interval p-value
Sex 1.773 0.449–7.002 0.414
Age 1.061 1.017–1.107 0.006
Initial radial inclination 1.019 0.925–1.123 0.701
Initial radial length 0.831 0.678–1.019 0.076
Initial positive ulnar variance 1.156 0.929–1.439 0.193
Initial dorsal angulation 0.975 0.941–1.009 0.150
Initial articular displacement 1.631 0.553–4.812 0.376
Intra-articular fracture 3.233 0.758–13.783 0.113
Initial dorsal comminution 1.146 0.834–1.671 0.673
Initial volar comminution 0.981 0.305–3.149 0.974
Initial associated ulnar fracture 1.379 0.136–13.978 0.786
Initial associated distal radio-ulnar joint involvement 1.233 0.116–13.113 0.862
Mean Lafontaine criteria4 0.926 0.560–1.528 0.762
Table 6.
Lafontaine criteria
Sensitivity 1-Specificity
0 1.000 1.000
1.5 0.829 0.805
2.5 0.561 0.429
3.5 0.268 0.195
4.5 0.024 0.000
6 0.000 0.000
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