Relationship Between the Predictive Assessment of Radiographic Measurements of the Distal Radius and Functional Outcomes

BACKGROUND: Distal radius fractures are common in adults. Surgical fixation seeks to restore anatomical alignment, but the relationship between radiographic correction and functional recovery remains uncertain. METHODS: A cross-sectional study of 201 patients treated with distal radius plate fixation at Hospital Universitario de la Samaritana E.S.E. (2014-2018) was conducted. Patients with incomplete records, poor-quality radiographs, or reintervention were excluded. Radiographic parameters assessed preoperatively and postoperatively included radial height, radial shift, ulnar variance, and palmar tilt in extraarticular fractures, and teardrop angle, lunate-lunate facet ratio, and capitate-to-axis-of-radius distance (CARD) in intraarticular fractures. Functional outcomes were measured with the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and associations with radiographic indices were analyzed. RESULTS: Among patients, 70.1% had extraarticular and 29.8% intraarticular fractures. In extraarticular cases, the combination of radial shift >3 mm, palmar tilt >8°, and radial height >10 mm predicted favorable outcomes. In intraarticular fractures, postoperative CARD >6.4 mm correlated with significantly better functional results. DISCUSSION: Radiographs remain essential in distal radius fracture management, but their correlation with function is inconsistent. Radial height and palmar tilt were the most relevant predictors for extraarticular fractures, while CARD was the strongest predictor in intraarticular cases. Notably, higher CARD values, even outside standard ranges, were paradoxically associated with better outcomes, likely reflecting biomechanical adaptations or subgroup-specific tolerance to deformity. CONCLUSIONS: Complete radiographic restoration was not consistently associated with function. Instead, specific measures-radial height and palmar tilt in extraarticular fractures, and CARD in intraarticular fractures-emerged as key predictors of favorable recovery.