Indications for Fixation (Non-Geriatric Patients)

This guideline is based on 1 high quality study, and 26 moderate quality studies using radiographic parameters of radial shortening >3mm, dorsal tilt >10, or intra-articular displacement or step-off >2mm in adult patients less than 65 years of age diagnosed with a distal radius fracture. The term non-geriatric was used as the spirit of this guideline is to address distal radius fractures in those patients with high functional demand. Age is commonly used as a proxy for functional demand, often using less than 65 years of age to describe those with high functional demand. Although outcomes vary, overall, these studies consistently demonstrated that operative treatment led to improved radiographic outcomes and/or patient reported outcomes in those less than 65 years of age.

Risks and Benefits of Implementation

The results from this CPG align with those of the AAOS Clinical Practice Guideline from 2009, suggesting current practice based on the aforementioned radiographic parameters leads to improved patient outcomes. As such, we anticipate no risks with implementing this guideline. 

Future Research

The effects of using more rigid radiographic criteria (e.g. any fracture displacement not just >2mm) as indications for surgical fixation, and their effect on patient outcomes have not been well studied. The durability of these treatment indications on patient outcomes in the longer term (e.g. 10-20 years) should also be studied.