Criteria

Risk factors for fracture instability and loss of fracture position[21][42]

Well-known predictors for fracture instability include:

  • Age >60 years

  • Substantial initial deformity (>20° dorsal tilt of the articular surface on the lateral radiograph or >5 mm shortening by ulnar variance on the posteroanterior radiograph)

  • Dorsal comminution

  • Fracture of the ulna

  • Displaced articular fracture.

However, one systematic review reported a significant increase in the risk of secondary displacement following reduction in fractures with dorsal comminution, in women and in patients (men and women) ages >60 years.[43] The review concluded that an associated ulna fracture or intra-articular involvement did not result in an increased risk of secondary displacement. 

Radiographic features of distal radial fractures that suggest the need for surgical treatment[13][32][34][35]

These include:

  • Initial loss of radial length in excess of 15 mm

  • Angulation apex-volar of >20°

  • Postreduction radial shortening of >3 mm

  • Dorsal tilt of >10°

  • Intra-articular step-off of >2 mm.

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