Predictors of unstable distal radius fractures: a systematic review and meta-analysis

The aim of this study was to perform a systematic review in order to identify predictors of secondary displacement in distal radius fractures. We performed a systematic review and identified all studies that reported secondary displacement following distal radius fractures. Where possible, we pooled the odds ratios of predictors. The initial search yielded 3178 studies of which 27 were included. Multiple studies found that age, shortening, volar comminution, loss of radial inclination, the presence of a volar hook, AO type 3 fractures (A3, B3, C3) and the Older classification were significant predictors of secondary displacement. Pooling revealed a significantly increased risk of secondary displacement in fractures with dorsal comminution, in women and in patients aged >60years. An associated ulna fracture or intra-articular involvement does not result in an increased risk of secondary displacement. The overview provided in this study can help surgeons to inform patients of the chances of success of closed treatment regarding the radiological outcome and facilitate shared decision making. Level of evidence: II