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Can We Identify a Threshold for Acceptable Radiographic Parameters of Distal Radius Fractures in Patients Over 65 Years Old?
Caitlin J Symonette, MD; MSc; Joy MacDermid, BScPT, MSc; PhD; Ruby Grewal, MD; MSc; FRCSC
University of Western Ontario; Roth MacFarlane Hand and Upper Limb Centre, London, ON, Canada

Introduction: Distal radius fractures are common in older adults. Evidence supports that in patients over 65 years old, malalignment on imaging does not necessarily translate into poor outcomes. Older patients, as a group, appear to tolerate a greater degree of anatomic deformity than their younger counterparts. The purpose of this study was to identify the acceptable threshold for radiographic parameters following distal radius fractures (DRF) in patients over 65 years old according to a patient-rated pain and disability outcome measure.

Methods: A prospective cohort of 190 older adults (? 65 years old) with DRF were recruited from a tertiary care referral center. The influence of specific radiographic parameters (ulnar variance (UV), radial inclination (RI), and volar/dorsal tilt) on 1 year Patient-Rated Wrist Evaluation (PRWE) scores was investigated. The odds ratio (OR) of a poor PRWE outcome at various alignment thresholds was calculated with 95% confidence intervals.

Results: The majority of the cohort (n=158, 83%) had a good PRWE outcome (14.4 +/-19.5, mean +/- SD) despite malalignment on radiographs. Average radiographic parameters for our cohort were an UV of 1.9mm +/- 1.9mm (+/-SD), RI of 18.7 +/- 5.9 (+/-SD) and dorsal tilt of 4.5 +/- 11.9 (+/-SD). The OR of a poor PRWE outcome was not significant for UV. The OR of a poor outcome was significant for RI ? 20 (OR 3.6, 95% CI 1.5-8.7) and dorsal tilt ? 15 (OR 5.3, 95% CI 1.0-27.8).

Conclusion: Our study provides new discrete thresholds for acceptable radiographic parameters following DRF in a cohort ?65 years old according to a validated patient-rated outcome measure. This information can be used to counsel older patients on their increased likelihood of a poor outcome with RI ? 20 or a dorsal tilt ? 15.

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