The Predictive Factors of Displacement of Adult Distal End Radius Fracture Treated with Casting

Background: In the conservative management of distal radial fractures (DRFs), the optimal dorsi-volar angulation of the wrist at cast immobilization and proper cast molding to minimize the risk of redisplacement are unclear. This study identified the predictors of fracture redisplacement during cast immobilization for adult DRFs. Methods: We examined for dorsi-volar angulation, gap index, volar tilt (VT), radial inclination (RI), and radial length (RL) in lateral or posteroanterior radiographs of 90 DRFs. We investigated possible predisposition factors for redisplacement including patient age, sex, extra- or intra-articular fracture, metaphyseal comminution, original displacements, dorsi-volar angulation of the wrist at cast immobilization, restoration of the volar cortex at cast immobilization, and gap index of the cast. Results: Neither dorsi-volar angulation nor gap index had significant association with an unacceptable alignment nor decrease of VT, RI, and RL. In multivariate analysis, patient age, original displacement, and intra-articular fracture were the significant predictors of an unacceptable alignment or decrease of VT and RI. Conclusions: Our findings indicate dorsi-volar angulation and cast molding quality have no clinical effect on preventing fracture redisplacement. The predictive factors of the displacement were patient age, original displacement, and intra-articular fracture.