The incidence of rotational displacement following distal radial fractures in adults: a biomechanical–clinical study

The aims of this study were to establish the radiographic features of distal radial fracture malrotation on bone models and then assess the prevalence of distal radial malalignment in a series of extra-articular fractures in adults. We cut distal radial bone models and simulated pronation and supination malrotation in different positions of dorsal angulation. We also reviewed 160 displaced distal radial fractures in 158 adults assessing any malrotation immediately following fracture and after closed reduction. Malrotation was more obvious on lateral than posteroanterior radiographic images. Following a distal radial fracture, we noted malrotation in 58 (36%); 47 (33%) were either into supination or pronation, six definitely into supination and five clearly in pronation. Eleven were not manipulated. Of the remainder, 44 (of 149) (30%) were malrotated, 35 were into pronation or supination and 10 were into pronation. Malrotation was not associated with an ulnar styloid fracture. Distal radial fracture malrotation appears common but underappreciated. Future studies would be needed to determine if malrotation would affect clinical outcome.<b>Level of evidence:</b> V.