Analysis of Our Open Reduction and Internal Fixation of Distal Radius Fractures in Adults: Are We Over Operating?

Background  Fractures of the distal radius are a common injury. The British Orthopaedic Association (BOA) and The British Society for Surgery of the Hand (BSSH) have released new guidelines outlining the management of these fractures, specifically identifying "thresholds for intervention," based on radiological parameters for management with open reduction and internal fixation (ORIF). Questions/Purposes  Have our distal radius fractures (DRFs), previously managed with ORIF, met the new guidelines' thresholds for intervention, based on radiological parameters? Patients and Methods  A retrospective assessment of DRFs treated with ORIF was performed between January 2017 and August 2018. Patients were categorized into three cohorts based on their age. The five radiological parameters of ulnar variance, dorsal tilt, radial inclination, radial height, and intra-articular step were measured on the initial plain radiograph, "pre-manipulation film," postplaster application radiograph, and "post-manipulation film." These were compared with the "thresholds for intervention" outlined in the BOA/BSSH guidelines. Results  A total of 94 patients underwent an ORIF with a mean age of 56 years (range 17-86 years). As many as 75.74% of patients on the "pre-manipulation film" met the "threshold for intervention" on at least one radiological parameter, while 53.57% of patients on the "post-manipulation" met at least one "threshold for intervention." Dorsal tilt was the parameter that most often met the threshold in both films at 53.37% and 40.11%, respectively. Conclusion  Within our trust, there is a tendency to over manage the distal radius fracture with ORIF, potentially resulting in unnecessary operations. Education surrounding the new guidelines will better serve our decision-making. Level of Evidence  This is a level III study.