• Eric C Makhni, Timothy J Ewald, Sean Kelly, and Charles S Day.
• Department of Orthopedic Surgery and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
• J Hand Surg Am. 2008 Oct 1; 33 (8): 1301-8.

PurposeOur study assessed the radiographic outcomes of nonsurgically treated distal radius fractures of patients who were 18 to 44 years old (group 1), 45 to 64 years old (group 2), and 65 years old or older (group 3).MethodsAll distal radius fractures seen in our emergency department from April 2002 to September 2004 that had nonsurgical management (either casting alone or closed reduction with immobilization) were considered for this study (n = 124; 50 casted, 74 closed reduced). Patients were further classified by age. Change in fracture alignment was assessed at the time of fracture union (approximately 8 weeks) and included measurements of angulation, articular gap/step-off, and radial shortening.ResultsWhen the fractures (n = 124) were evaluated at union, there was an overall secondary displacement rate of 64% (n = 79), with 42% in the group whose fractures were immobilized in a cast and 78% in the group whose fractures were treated by closed reduction and cast. There was an increase in displacement rate that was associated with increasing patient age. Among fractures that were only casted, there was no such age-matched increase in rates of secondary displacement. However, when considering those fractures that were subject to closed reduction (n = 74), rates of secondary displacement significantly increased with age (58% in group 1, 81% in group 2, and 89% in group 3; p = .03).ConclusionsOur study found that secondary displacement of distal radius fractures increased with increasing patient age, primarily among fractures subject to closed reduction. Older patients with these fractures require closer management after initial reduction, therefore allowing for better monitoring of expected subsequent fracture collapse. Further, given these high rates of secondary displacement after nonoperative treatment (58% to 89%), it is also important to consider that surgical treatment of these fractures may be necessary.

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