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Advances in Orthopedics
Volume 2014 (2014), Article ID 785473, 6 pages
http://dx.doi.org/10.1155/2014/785473
Research Article

Manipulation of Displaced Distal Radial Fractures in the Superelderly: Prediction of Malunion and the Degree of Radiographic Improvement

Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK

Received 9 July 2014; Revised 16 September 2014; Accepted 18 September 2014; Published 8 October 2014

Academic Editor: Robert F. Ostrum

Copyright © 2014 N. D. Clement et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Superelderly patients (≥80 years old) account for 20% of all distal radial fractures and are at an increased risk of malunion. The primary aim of this study was to identify predictors of malunion and the degree of improvement in the fracture position offered by closed manipulation of displaced distal radial fractures in the superelderly. We retrospectively identified 228 displaced distal radial fractures in superelderly patients from a prospective database of 4024 distal radial fractures. The inclusion criterion was a patient that underwent closed manipulation as their primary intervention. The majority of patients (, 86%) were defined as having a malunion. A premanipulation dorsal angulation of greater than 25 degrees () and an ulnar variance of 6 mm or more () significantly increased the risk of malunion. The premanipulation dorsal angulation was a significant independent predictor of the degree of improvement in the final dorsal angulation () and ulnar variance (). Patients with a high risk of malunion or poor improvement in the fracture position can be identified before manipulation and these patients may benefit from primary surgical intervention.