Loss of position after initial manipulation of distal radius fractures in elderly

Abstract

Objective: A retrospective analysis was carried out on the loss of position after initial manipulation of distal radius fractures in elderly patients. Materials and Methods: Forty patients, all above 60 years, were included in the study. Three measurements were taken on the X-rays of the injured wrist at three different occasions. Radial length and radial inclination were measured on the anteroposterior, and volar tilt was measured on the lateral X-ray. X-rays were measured at the time of injury, soon after manipulation and at first follow-up at about a week. The criteria used to label loss of position were loss of 10° in volar tilt, loss of 5° in radial inclination, and loss of 2 mm in radial length. Results: The total number of patients who lost position after manipulation was 17 (42.5%). All the three measurements were lost in 4 (10%) patients, volar tilt was lost in 17 (42.5%) cases, radial length was lost in 15 (37.5%) cases, and radial inclination was lost in 7 (17.5%) cases. Patients who were given a complete cast within 24 h lost position in seven (23.3%) cases. The ten patients whose cast was completed later than 24 h but within a week had all lost their positions. Conclusion: We concluded that elderly patients should be manipulated and not left alone as most of the time adequate reduction can be achieved. The reason for the loss of reduction is more likely related to the use of dorsal slab, and therefore, complete cast or Charnley method of radial slab should always be used.