O2116 PROGRESSIVE DEFORMITY AFTER THE TREATMENT OF DISTAL RADIAL FRACTURES WITH TRADITIONAL METHODS

Abstract

Aims: The purpose the study was to evaluate the radiographic progression of distal radial fractures treated with casting with or without percutaneous wires over a one-year period. Methods: One hundred consecutive patients with unilateral Collesñ fractures were enrolled (78 females, 22 males; mean age 72). These were treated with either a below elbow cast with or without manipulation, or by percutaneous wire þxation and a cast after adequate reduction. Two independent observers evaluated all the patients with serial X-rays at 1, 2, 6 weeks and 1 year. Radial length, shift and inclination and volar tilt were compared to the position immediately after injury. Results: Sixty seven patients showed loss of position beyond that seen at 6 weeks after injury. Only 15% of the 21 patients who did not require a manipulative reduction showed any progression of deformity. Only 19% of the 79 patients that had manipulation (± wire þxation) maintained this throughout. The rest showed either early (6 weeks) or late loss of position with a signiþcant proportion of these showing more than 2mm loss of radial length. Loss of position was more frequent in fractures that were only manipulated compared those manipulated and wired; the latter also tended to lose position late rather than early. Twelve of the 30 cases with early loss of position were re-manipulated but þnal position was almost uniformly equivalent to slip position. Conclusions: Radiological parameters are of prognostic importance. Our standard protocols do not hold fracture reduction at 1 year, with þnal deformity greater than appreciated. No beneþt of remanipulation was observed. There may be a need to modify traditional treatment to hold fractures for longer and be able to resist deforming forces.