Manipulation of displaced distal radial fractures in the superelderly: prediction of malunion and the degree of radiographic improvement.

Superelderly patients (≥80 years old) account for 20% of all distal radial fractures and are at an increased risk of malunion. The primary aim of this study was to identify predictors of malunion and the degree of improvement in the fracture position offered by closed manipulation of displaced distal radial fractures in the superelderly. We retrospectively identified 228 displaced distal radial fractures in superelderly patients from a prospective database of 4024 distal radial fractures. The inclusion criterion was a patient that underwent closed manipulation as their primary intervention. The majority of patients (n = 196, 86%) were defined as having a malunion. A premanipulation dorsal angulation of greater than 25 degrees (P = 0.047) and an ulnar variance of 6 mm or more (P = 0.02) significantly increased the risk of malunion. The premanipulation dorsal angulation was a significant independent predictor of the degree of improvement in the final dorsal angulation (P < 0.001) and ulnar variance (P = 0.01). Patients with a high risk of malunion or poor improvement in the fracture position can be identified before manipulation and these patients may benefit from primary surgical intervention.