Efficacy of closed reduction and maintenance of surgical outcome in plaster cast immobilization in different types of distal radius fractures.

BACKGROUND: The aim of this paper is to evaluate the results maintaining after closed reduction of distal radius fracture and to assess difficulties in restoration of the articular surface continuity with reference to the type of fracture according to the AO classification. MATERIAL AND METHODS: 65 patients were included in the study (40 female, 25 male), mean age of 59 years (19-84), diagnosed with the distal radius fracture, treated by closed reduction and a plaster cast immobilization. The mean immobilization period was 40 days (25-50). Secondary dislocations were assessed since closed reduction until follow-up in respective AO groups. Mean follow-up was 624 days ( 374-1210). For the evaluation of secondary dislocations we have applied radiographic parameters defining the distal radius morphology: RIA, RL, UV, RW, PI. In assessment of the articular surface restoration, the articular surface step-off and gap were measured following closed reduction in relevant AO groups. RESULTS: The most significant secondary dislocations occurred in group C3 then A3 and C2. Statistically significant differences in secondary dislocations within respective types of fractures were observed between groups A2 and A3 ( p<0.05). Type C fractures presented statistically significant differences between groups: C1 and C3; C2 and C3 as to chances of restoring the articular surface continuity by closed reduction (p<0.05), whereas no such a difference was observed between group C1 and C2. CONCLUSIONS: The AO classification is a tool which with accuracy characterizes the complex pathomorphology of distal radius fractures and includes essential elements differentiating respective fracture groups. We conclude that in group A3, C2 ,C3 the result of closed reduction is difficult to maintain with a plaster cast immobilization. Additionally, the restoration of articular surface continuity in type C3 fractures can hardly be achieved by closed reduction.