Prognosis
Non-displaced or minimally displaced fractures
Non-displaced or minimally displaced fractures are associated with good outcomes. Following immobilisation for 3 to 4 weeks and occupational therapy, recovery of motion and strength occurs within 8 to 12 weeks although a complete recovery may take several months.
Displaced fractures
In the short term, open reduction and internal plate fixation lead to better outcomes than non-operative treatment.
One network meta-analysis of randomised trials found that open reduction and internal fixation with a plate offers the best results for adult patients with a distal radius fracture.[78] The study reported that plate fixation was ranked highest for improving functional outcomes at 6 and 12 months, and demonstrated a statistically significant difference compared with plastering at 12 months (OR = 4.27; 95% CrI, 1.07 to 15.12). Plate fixation was also ranked highest for reduction in fracture healing complications, with significantly more favourable results relative to the four other interventions included in the study: OR = 0.25 (95% CrI, 0.07 to 0.86) versus external fixation; OR = 0.09 (95% CrI, 0.02 to 0.36) versus K-wire; OR = 0.01 (95% CrI, 0.00 to 0.03) versus plaster casting; and OR = 0.00 (95% CrI, 0.00 to 0.35) versus intramedullary nailing.
A further randomised controlled trial reported that patients with an acceptably reduced extra-articular distal radius fracture treated with open reduction and volar plate fixation have better functional outcomes after 12 months compared with non-operatively managed patients. Additionally, 42% of non-operatively managed patients had a subsequent surgical procedure.[71]
The decision about whether a surgical intervention is warranted should be discussed between the patient and surgeon.
Concomitant distal radius and scaphoid fractures
Concomitant carpal bone, ligament injuries, or triangular fibrocartilage complex (TFCC) lesions may adversely impact outcome in patients with fractures of the distal radius.[2][79][80] Fracture patterns in which the fracture line of the distal radius exits on the scapholunate crest of the articular surface are particularly prone to injuries of the scapholunate interosseous ligament.
Evidence suggests that distal radius fracture without concomitant ligament injury is rare. Arthroscopic studies report the incidence of concomitant scapholunate ligament (SL) and TFCC injury as 78% and 54% respectively in patients with distal radius fracture.[81][82][83]
Two prospective 13- to 15-year follow-up studies of patients with untreated complete (grade 3) or partial (grade 1 or 2) SL, and TFCC tears associated with displaced distal radius fracture, found no major differences in the subjective, objective, or radiographical outcomes for patients with SL injuries. However, none of the patients had a grade 4 tear, and only one patient with a TFCC tear required an operation for painful instability since the fracture.[81][82] The TFCC tear study concluded that there was insufficient evidence that TFCC tear at the time of distal radius fracture would influence the subjective long-term outcome.[82]
Outcome measures
It has been traditionally suggested that the outcome of these fractures is uniformly satisfactory. However, it is recognised that satisfactory outcomes, while common, are not always the norm. Furthermore, the definition of a satisfactory outcome can vary depending upon a number of factors, including patient age, occupation and functional demands, type and energy of injury, dominant or non-dominant limb affected, presence of any associated injury, duration of follow-up, and the assessment tools utilised to define outcome.
Increasingly, there is a shift from physician-rated criteria to patient-rated outcomes. These include patient-rated wrist evaluations and outcome tools such as the disabilities of the arm, shoulder, and hand.[84][85]
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