[Evaluation of stability of distal radius fracture after conservative treatment]

To evaluate the effect of conservative treatment on stability of different types of distal radius fracture so as to help select the optimal treatment of different distal radius fracture and verify the exact time when the patient need careful.

During the period of one year 103 consecutive patients of distal radius fracture were treated by closed reduction and below-elbow cast immobilization and standard PA in the emergency room and were followed up 1, 2, and 4 weeks after the initial visit until the casts were removed. Lateral radiographic examination was conducted before and after reduction and during the reexamination. All the images were saved in a working server in hospital. The patients were classified according to the Cooney classification system, then the displacement, palmar tilt, radial inclination and radial shortening in every film were measured accurately and involvement of radiocarpal joint surface was noted. Combined with the assessment by the Lindstrom grading system, the radiographic results were divided into 2 groups: accepted and unaccepted. Finally, Pearson Chi-square test, likelihood ratio test, and Kendall correlation analysis were used to testify the radiographic results of different Cooney types.

Fractures of Cooney type 1, 2 and 3 achieved good results after non-operative treatment with the rates of accepted results of 90%, 88.5%, and 88.9% respectively. Only 28.1% of the type 4 fractures reached the accepted criteria. The general rate of accepted results among the 103 fracture patients was 69.9%. The general rate of accepted results of the 103 patients was 69.9%. The rates of accepted results of the Cooney type 1, 2, 3, and 4 fractures were 90.0%, 88.5%, 88.9%, and 28.1% respectively. The radiographic result was significantly correlated with the Cooney classification with a large Kendall coefficient. Displacement after closed reduction was found in 36.5% of the type 2 fractures and 65.6% of the type 4 fractures and a large majority of them displayed instability within a week after the closed reduction and cast immobilization.

A large majority of the distal radius fractures can achieve good results after treatment by closed reduction and cast immobilization, especially those of type 1, 2, and 3, for which conservative treatment should be the first choice. However, type 4 fracture is extremely unstable and a large percentage of it fails to get satisfactory result by non-operative treatment, so operative treatment is better for it. Reexamination 1 - 2 weeks after the manipulation should be emphasized so as to adopt effective treatment in time.