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Purpose <p>Nonoperative treatment of distal radial fractures is recommended for intra-articular gaps or step-offs under 2&#xa0;mm; a threshold based on 40-year-old radiographic data, which is still referred to despite the transition toward Computer Tomography (CT)-imaging for assessing displacement. Controversy about treatment exists when displacement slightly exceeds 2&#xa0;mm. We assessed the association between CT-based gaps and step-offs and patient-reported outcomes after nonoperative treatment, and established CT-based thresholds for fracture displacement.</p> Methods <p>A multicenter retrospective cohort study was performed in 176 nonoperatively treated patients with intra-articular distal radial fractures. They completed Disability of Arm, Shoulder, and Hand (DASH) questionnaire after a mean follow-up of 10 ± 4years. The association between CT-based gap and step-off and DASH was analyzed with multivariate regression analysis, where ‘β’ represents the regression coefficient indicating the estimated change in DASH score per millimeter increase in gap or step-off. Groups with increasing displacement were created (1.Gap and step-off &lt; 2&#xa0;mm, 2.Gap = 2–4&#xa0;mm and step-off &lt; 2&#xa0;mm, 3.Gap &lt; 2&#xa0;mm, step-off = 2–4&#xa0;mm, 4.Gap and step-off = 2–4&#xa0;mm and 5.Gap or step-off &gt; 4&#xa0;mm), and DASH-scores were compared using Mann-Whitney-U tests.</p> Results <p>There was no association between DASH and gap (β = 0.66 <i>p</i> = 0.414) or step-off (β = 1.73; <i>p</i> = 0.061). The difference in DASH-score between groups 1 (gap and step-off &lt; 2&#xa0;mm) and group 2 (gap = 2–4&#xa0;mm and step-off &lt; 2&#xa0;mm) was not clinically relevant (4 ± 7 vs. 7 ± 11; <i>p</i> = 0.010). Groups 3,4,5, with step-offs &gt; 2&#xa0;mm were too small for comparisons, as larger step-offs were rarely accepted clinically.</p> Conclusion <p>We found no association between the CT-based gaps and step-offs and DASH in patients with nonoperatively treated distal radial fractures with intra-articular displacement around and even slightly above 2&#xa0;mm. Gaps up to 4&#xa0;mm and step-offs up to 2&#xa0;mm are associated with good patient-reported outcomes.</p> Level of evidence <p>Level III, prognostic study.</p>

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Long-term patient-reported outcomes after nonoperative treatment of distal radial fractures: what CT-based gaps and step-offs can be accepted?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月9日

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  • Lisanne J.M. Roelofs,
  • Tim D. Van der Meulen,
  • Kaj ten Duis,
  • Sven H. van Helden,
  • Arvid V.E. Munzebrock,
  • Eelke Bosma,
  • Job N. Doornberg,
  • Joep Kraeima,
  • Jesse B. Jupiter,
  • Jean-Paul P.M. De Vries,
  • Nick Assink,
  • Frank F.A. IJpma

摘要

Purpose

Nonoperative treatment of distal radial fractures is recommended for intra-articular gaps or step-offs under 2 mm; a threshold based on 40-year-old radiographic data, which is still referred to despite the transition toward Computer Tomography (CT)-imaging for assessing displacement. Controversy about treatment exists when displacement slightly exceeds 2 mm. We assessed the association between CT-based gaps and step-offs and patient-reported outcomes after nonoperative treatment, and established CT-based thresholds for fracture displacement.

Methods

A multicenter retrospective cohort study was performed in 176 nonoperatively treated patients with intra-articular distal radial fractures. They completed Disability of Arm, Shoulder, and Hand (DASH) questionnaire after a mean follow-up of 10 ± 4years. The association between CT-based gap and step-off and DASH was analyzed with multivariate regression analysis, where ‘β’ represents the regression coefficient indicating the estimated change in DASH score per millimeter increase in gap or step-off. Groups with increasing displacement were created (1.Gap and step-off < 2 mm, 2.Gap = 2–4 mm and step-off < 2 mm, 3.Gap < 2 mm, step-off = 2–4 mm, 4.Gap and step-off = 2–4 mm and 5.Gap or step-off > 4 mm), and DASH-scores were compared using Mann-Whitney-U tests.

Results

There was no association between DASH and gap (β = 0.66 p = 0.414) or step-off (β = 1.73; p = 0.061). The difference in DASH-score between groups 1 (gap and step-off < 2 mm) and group 2 (gap = 2–4 mm and step-off < 2 mm) was not clinically relevant (4 ± 7 vs. 7 ± 11; p = 0.010). Groups 3,4,5, with step-offs > 2 mm were too small for comparisons, as larger step-offs were rarely accepted clinically.

Conclusion

We found no association between the CT-based gaps and step-offs and DASH in patients with nonoperatively treated distal radial fractures with intra-articular displacement around and even slightly above 2 mm. Gaps up to 4 mm and step-offs up to 2 mm are associated with good patient-reported outcomes.

Level of evidence

Level III, prognostic study.