ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025
Long-term patient-reported outcomes after nonoperative treatment of distal radial fractures: what CT-based gaps and step-offs can be accepted?
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeNonoperative 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.
methodsA 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.
resultsThere 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.
conclusionWe 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.
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