Radiographic Thresholds With Increased Odds of a Poor Outcome Following Distal Radius Fractures in Patients Over 65 Years Old
Bibliographic record
Abstract
PurposeOlder patients (aged older than 65 years) appear to tolerate a great degree of anatomic deformity after DRFs; however, the threshold beyond which the deformity becomes unacceptable is unknown. The purposes of this study were to identify the acceptable threshold for radiographic parameters after DRFs in patients aged over 65 years according to a patient-rated pain and disability outcome measure and to determine whether baseline activity levels influenced these parameters.MethodsA cohort of 190 older adults (aged 65 years and older) with DRF were selected from an existing prospectively collected database. The influence of specific radiographic parameters (ulnar variance, radial inclination [RI], and volar-dorsal tilt) and baseline activity levels on 1-year Patient-Rated Wrist Evaluation (PRWE) scores was investigated. The odds ratio (OR) of a poor outcome according to a 1-year PRWE (cutoff score of ≥25) at various alignment thresholds was calculated with 95% confidence intervals (CIs). Activity level (underactive vs active) was determined using the Rapid Assessment of Physical Activity survey.ResultsRadiographic parameters for the cohort varied widely (mean ulnar variance, 1.9 ± 0.9 mm, range –2.4 to 8.0 mm; mean RI, 18.7°± 5.9°, range, 0.1° to 38°; and mean dorsal tilt, 4.5° ±11.9°, range –24.0° to 33.6°). Most of the cohort (n = 158, 83%) had a good outcome (mean PRWE, 14.4 ± 19.5). The OR of a poor outcome was significant for RI less than 20° (OR = 3.6; 95% CI 1.5–8.7) and dorsal tilt greater than 15° (OR = 5.3; 95% CI, 1.0–27.8). Malalignment on radiographs and a poor outcome according to PRWE were not significantly different in the underactive versus active subpopulations.ConclusionsThis study provides alignment cutoffs that best discriminate adverse pain and disability patient outcomes after DRF in a cohort aged more than 65 years. This information can be used to counsel older patients about their increased likelihood of a poor outcome with RI less than 20˚ or a dorsal tilt greater than 15°. Further research is required to examine outcomes after applying these thresholds in a prospective manner to management decision algorithms for DRF in patients aged over 65 years.Type of study/level of evidencePrognostic II. Older patients (aged older than 65 years) appear to tolerate a great degree of anatomic deformity after DRFs; however, the threshold beyond which the deformity becomes unacceptable is unknown. The purposes of this study were to identify the acceptable threshold for radiographic parameters after DRFs in patients aged over 65 years according to a patient-rated pain and disability outcome measure and to determine whether baseline activity levels influenced these parameters. A cohort of 190 older adults (aged 65 years and older) with DRF were selected from an existing prospectively collected database. The influence of specific radiographic parameters (ulnar variance, radial inclination [RI], and volar-dorsal tilt) and baseline activity levels on 1-year Patient-Rated Wrist Evaluation (PRWE) scores was investigated. The odds ratio (OR) of a poor outcome according to a 1-year PRWE (cutoff score of ≥25) at various alignment thresholds was calculated with 95% confidence intervals (CIs). Activity level (underactive vs active) was determined using the Rapid Assessment of Physical Activity survey. Radiographic parameters for the cohort varied widely (mean ulnar variance, 1.9 ± 0.9 mm, range –2.4 to 8.0 mm; mean RI, 18.7°± 5.9°, range, 0.1° to 38°; and mean dorsal tilt, 4.5° ±11.9°, range –24.0° to 33.6°). Most of the cohort (n = 158, 83%) had a good outcome (mean PRWE, 14.4 ± 19.5). The OR of a poor outcome was significant for RI less than 20° (OR = 3.6; 95% CI 1.5–8.7) and dorsal tilt greater than 15° (OR = 5.3; 95% CI, 1.0–27.8). Malalignment on radiographs and a poor outcome according to PRWE were not significantly different in the underactive versus active subpopulations. This study provides alignment cutoffs that best discriminate adverse pain and disability patient outcomes after DRF in a cohort aged more than 65 years. This information can be used to counsel older patients about their increased likelihood of a poor outcome with RI less than 20˚ or a dorsal tilt greater than 15°. Further research is required to examine outcomes after applying these thresholds in a prospective manner to management decision algorithms for DRF in patients aged over 65 years.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".