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Loss of Reduction Following Nonoperative Management for Distal Radius Fractures: A Prognostic Factor Systematic
Geoffrey W Schemitsch1,2, Navid Ghaderi3, Emma Cooper1
1Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
JBJS Reviews
|June 15, 2026
Summary
Older age and ulnar variance predict loss of reduction in distal radius fractures treated nonoperatively. These findings aid in managing fracture reduction and preventing malunion.
Area of Science:
- Orthopedic surgery
- Traumatology
- Evidence-based medicine
Background:
- Loss of reduction in distal radius fractures can necessitate delayed surgery, malunion, or corrective osteotomy.
- Nonoperative management requires understanding predictors of reduction loss to optimize patient outcomes.
Purpose of the Study:
- To systematically review and synthesize literature on predictors of reduction loss in adult distal radius fractures undergoing nonoperative treatment.
- To identify factors associated with maintaining reduction after initial fracture management.
Main Methods:
- Comprehensive search of MEDLINE, Embase, CINAHL, and Cochrane databases.
- Duplicate screening, data extraction, and risk of bias assessment.
- Random-effects meta-analysis of bivariable and multivariable prognostic factors, with evidence certainty evaluated using GRADE.
Main Results:
- 30 studies (7,495 fractures) were included. Key predictors of reduction loss included dorsal comminution, failure to re-establish volar alignment, prereduction dorsal angulation >20°, and displacement beyond acceptable criteria.
- Multivariable analysis identified age >60 years (aOR 3.80) and prereduction ulnar positive variance (aOR 1.49 per mm) as high-certainty predictors.
- The overall weighted proportion of patients experiencing loss of reduction was 43.4%.
Conclusions:
- Age over 60 and increased prereduction ulnar positive variance are strongly associated with loss of distal radius reduction.
- Further high-quality prognostic studies are needed to refine understanding of predictors for nonoperative distal radius fracture management.
