Functional outcomes and imaging-related factors in Distal Radius Fractures(DRF) among older adults: A comprehensive review

Title : Functional outcomes and imaging-related factors in Distal Radius Fractures(DRF) among older adults: A comprehensive review

Abstract:

Background: Distal Radius Fractures (DRFs) are common in older adults, often resulting in significant functional impairments and reduced quality of life. Radiographic parameters such as dorsal/volar angulation, radial inclination, radial height, ulnar variance, and articular incongruity are emphasized in treatment planning, yet their relationship with functional recovery remains inconsistent. This systematic review synthesizes evidence from 23 studies to evaluate the associations between imaging-related factors and functional outcomes in elderly DRF patients, aiming to inform strategies that prioritize functionality over strict radiological alignment.

Methods: A review of 23 studies was conducted, analyzing radiographic parameters—dorsal/volar angulation, radial inclination/height, ulnar variance, and articular incongruity—and their relationship with functional recovery. Outcomes were assessed using metrics such as the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, and range of motion. Treatment approaches, including surgical (e.g., volar locking plate fixation) and conservative (e.g., casting) methods, were evaluated for their effectiveness.

Results: Radial inclination/height (14/23 studies), dorsal/volar angulation (10/23), and ulnar variance (10/23) were the most frequently studied radiographic factors. Surgical interventions improved radiological alignment but did not consistently correlate with better functional outcomes. Radial shortening and articular step-off were associated with worse outcomes, while radial inclination and ulnar variance correlated with improved recovery. Grip strength and range of motion emerged as stronger predictors of functional recovery than radiographic alignment, underscoring the importance of patient-centered approaches. Variability in findings highlights the influence of individual factors like age, comorbidities, and activity levels.

Conclusion: Radiological parameters have limited predictive value for functional recovery in elderly DRF patients. Management should prioritize functionality, grip strength, and range of motion over radiographic alignment. Personalized protocols are essential to address the unique needs of older adults and improve long-term outcomes.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Biography:

Joseph Salem Hernández is a fourth-year medical student at the University of Puerto Rico School of Medicine, expected to graduate in May 2026, with a strong academic focus in orthopaedic surgery and musculoskeletal research. He will serve as an Incoming Orthopaedic Surgery Research Fellow at the Ponce Health Sciences University, Department of Orthopaedic Surgery, where he will continue advancing his clinical and academic contributions to the field. Of Puerto Rican and Lebanese descent, Joseph brings a diverse and global perspective to orthopaedic research. His work spans a broad range of topics including clinical and imaging-related outcomes in distal radius fractures, surgical management of lateral epicondylitis, nerve transfer techniques in brachial plexus injuries, and cross-cultural validation of orthopaedic outcome measures such as the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). He has authored and co-authored multiple peer-reviewed publications in journals such as the Journal of Pediatric Orthopaedics, Journal of Hand Surgery Global Online, Heliyon, and Arthroplasty Today, with ongoing work in upper extremity, spine, and arthroplasty research. His research has been presented extensively at national and international conferences, including the AO Orthopaedic Research Summit (Davos), ICEOS (France), and multiple World Orthopaedic Conferences. Joseph is a recipient of the AO Foundation/ON Foundation Education Grant and the Research Travel Award from the Center for Hispanic Excellence. In addition to his research, he serves as Co-President of the Orthopaedic Surgery Interest Group (OSIG) at UPR, where he leads mentorship, education, and professional development initiatives for students pursuing orthopaedics. With a strong foundation in both clinical research and academic leadership, Joseph is committed to advancing evidence-based orthopaedic care and contributing meaningfully to the academic growth of the field.