We reviewed 260 patients who had been treated non-operatively for a dorsally displaced distal radius fracture a mean 6.3 (range 2.5-12.7) years earlier, in an attempt to find the limits of displacement compatible with a good clinical outcome. We excluded patients with previous or later injuries to the same limb. Bivariate analysis revealed a highly statistically significant relationship between radiographic displacement at review and clinical outcome scores. Correlation coefficients varied between 0.14 and 0.30. However, multiple linear regression analysis using most factors commonly thought to be of importance in determining the clinical outcome as independent variables explained only 23% of the variability of the clinical outcome. Dorsal angulation, ulnar variance, and radial inclination together accounted for only 11% of the variability. We conclude that the final alignment of the distal radius as shown radiologically has only a minor influence on the clinical outcome of Colles' type distal radius fractures.

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Both wrists in 189 patients who had been treated for dorsally displaced distal radius fracture were X-rayed with both right angle and 15° tilted lateral views. Two investigators measured the radial tilt. The mean difference in the angles recorded by the two investigators was 2.5° for the tilted and 3.7° for the right angle projections (p = 4.7 × 10(-8)). The precision of the method was 2.6° for the tilted and 3.5° for right angle projection. The mean angle measured on the tilted views was 3° more dorsal than on the right angle views for wrists with a volar tilt between 10° and 15°, and 0° to 2° for wrists with less volar tilt or dorsal displacement. Lateral projections tilted 15° allow more precise measurements than right angle views. Correction is not necessary when comparing to right angle views, as long as there is displacement in a dorsal direction of the distal fragment.

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Background?An increased scapholunate gap is sometimes seen in patients with a distal radial fracture. The question remains as to whether this represents a scapholunate ligament injury that requires treatment. Questions/purposes?We wished to examine the natural history of an increased scapholunate gap in patients following an extra-articular distal radial fracture. Patients and Methods?We reviewed 260 patients who had sustained a distal radial fracture at a mean of 6.2 (2.7?11.9) years previously and identified 12 extra-articular fractures with an increased gap between the lunate and scaphoid. The mean scapholunate gap was 2.6 (2.1?3.4) mm, and the mean scapholunate angle 62? (39??90?). Controls were found among the remaining patients with extra-articular fractures. Selection criteria were same sex, age at fracture within 5 years, time between injury and review within 2 years, ulnar variance within 2?mm, and dorsal angulation within 5? of index patient. When more than one control fulfilled the criteria for an index patient, their values were averaged. In total there were 54 controls for the 12 index patients. Results?The mean difference between index patients and controls in wrist range of motion was 4%, in grip strength 5%, in visual analog scale (VAS) for pain 1 (on a scale from 1 to 100), in Quick-DASH (Disability of the Arm, Shoulder, and Hand) score 5, and in PRWE score 1. The study was calculated to have the power to detect a difference in Quick-DASH scores and in Patient-Rated Wrist Evaluation (PRWE) scores of 14. Conclusions?We conclude that at a mean follow up of 6.2 years following an extra-articular distal radial fracture, no surgical treatment is usually needed with a scapholunate gap of between 2.1?3.4?mm. Level of Evidence?III, Case control study