AI Copilot

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Nexus Copilot · v6.4

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For a 34F with FOOSH injury and dorsally angulated distal radius fx (12°), what's the threshold for closed reduction vs ORIF per current AAOS guidance?

Per AAOS Clinical Practice Guideline (2023) for distal radius fractures in adults:

Closed reduction is appropriate when post-reduction radiographs show dorsal tilt ≤10°, radial shortening ≤3mm, and intra-articular step-off ≤2mm.
Surgical fixation (ORIF) should be considered when these thresholds cannot be maintained, or in active patients <65 with displaced fractures.
At 12° dorsal angulation, this case sits at the boundary. Attempt closed reduction with hematoma block; reassess at 1- and 2-week follow-up X-rays.

Sources: AAOS CPG 2023, Cochrane Rev. 2024 (8 RCTs, n=1,294)

Draft an impression and follow-up recommendation.

Impression

Acute transverse distal radius fracture with 12° dorsal angulation, Colles-pattern. Possible non-displaced ulnar styloid hairline fracture (83% conf).

Recommendation

Closed reduction with hematoma block, short-arm cast, orthopedic follow-up in 7-10 days with repeat AP/LAT to assess maintenance of reduction.

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