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The Use of a Predictive Model in the Assessment of Distal Radial Fractures – Are We Being Too Conservative?
Reema Chawla, MBChB, BSc; Jamie Mckenzie; Dimpu Bhagawati
Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, United Kingdom

Introduction: A number of methods of treating unstable distal radius fractures have been described; however, there is no accepted method for identifying these fractures in time to initiate appropriate treatment. A predictive model has been developed (Wristcalc, Edinburgh Orthopaedics) which prospectively identifies the radiographic outcome of wrist fractures using pre-defined prognostic factors; including age, fracture comminution and ulnar variance. Our aim was to assess the value of this tool by comparing the actual clinical outcome of distal radius fractures with the predictions made by this tool.

Methods: 80 patients with an extra-articular distal radius fracture were identified using a single institutions database. The probability of radiological malunion was calculated using the Wristcalc tool and this was compared to actual clinical outcome by using an observational study design; using patient records and standardized radiological follow-up examination.

Results: Patients managed operatively (Group A; n=40), had a 60.1%, mean probability of malunion, whilst patients managed conservatively (Group B; n=40) had a 61.3% mean predicted malunion (p>0.05). Mean number of pre-operative radiographs were 2.9(Group A) and 3.8(Group B) (p=0.005). This bears significance when mean ages of the groups were compared 57.8(Group A) and 76 (Group B) (p<0.001). Despite predicting a similar probability of malunion, the decision to operate on wrist was a clinical one, made at an earlier stage and was heavily influenced by external factors, such as age, comorbidities and level of function.

Conclusion: This tool may be a useful adjunct to predict the probability of malunion and therefore can be used to inform the surgeon’s decision to operate. It’s use early in the patients treatment may reduce number of pre-operative radiographs prior to making the decision to operate. Additionally, it may be used as a good primary learning tool to junior surgeons.

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