Priority 10 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: For people over 50, how well does a wrist fracture need to be reduced (put back into its normal position) to ensure a good long-term functional outcome?  (JLA PSP Priority 10)
Overall ranking 10
JLA question ID 0093/10
Explanatory note Ensuring a patient achieves a good level of function after they break their wrist is essential. When a patient breaks their wrist, we try to put it back into the same position as it was before it was broken. This question looks to determine if this is necessary and whether a patient can achieve a good level of function even if their bones to do not line up perfectly?  Can we cause more damage by trying to put the bones back into place?

The British Society of Surgery for the Hand. Best Practice for management of Distal Radius Fractures (DRFs). BSSH, 2018

Mulders MAM; Detering R; Rikli DA; Rosenwasser MP; Goslings JC; Schep NWL; Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis. The Journal of hand surgery; Aug 2018; vol. 43 (no. 8); p. 710-719.e5 

Health Research Classification System category  Injuries and Accidents
Extra information provided by this PSP
Original uncertainty examples Do all fractures need to be reduced before further treatment? ~ Patients often find manipulation procedures traumatic...does this result in long term sequalae? ~ Do distal radius fractures in patients over 80 need manipulation? ~ Does accuracy of reduction matter?
Submitted by 4 x Healthcare Professionals, 2 x Patients
PSP information
PSP unique ID 0093
PSP name Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP. 50  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 3 December 2018