A 1989 retrospective study of 112 consecutively treated distal radius fractures. It evaluated five radiological and demographic factors as predictors of secondary displacement after closed reduction and cast immobilization. The goal was to identify which fractures would fail conservative management before they actually did.
When a patient comes in with a distal radius fracture, the initial radiograph tells you most of what you need to know about whether casting will hold.
Count the Lafontaine factors at the time of diagnosis: dorsal angulation >20°, dorsal comminution, intra-articular extension, associated ulnar fracture, age >60. Three or more means the fracture is mechanically predisposed to re-displace regardless of how well you reduce it.
For high-score patients, plan closer radiographic follow-up at one and two weeks post-reduction. Have the operative conversation early — waiting for re-displacement to become obvious on X-ray means waiting until the clinical opportunity to intervene has narrowed.
This paper established the conceptual foundation for modern distal radius instability criteria and directly influenced subsequent operative threshold recommendations. The Lafontaine score remains a standard reference in hand surgery literature and is a high-yield board topic.
A 1989 retrospective study of 112 consecutively treated distal radius fractures. It evaluated five radiological and demographic factors as predictors of secondary displacement after closed reduction and cast immobilization. The goal was to identify which fractures would fail conservative management before they actually did.
When a patient comes in with a distal radius fracture, the initial radiograph tells you most of what you need to know about whether casting will hold.
Count the Lafontaine factors at the time of diagnosis: dorsal angulation >20°, dorsal comminution, intra-articular extension, associated ulnar fracture, age >60. Three or more means the fracture is mechanically predisposed to re-displace regardless of how well you reduce it.
For high-score patients, plan closer radiographic follow-up at one and two weeks post-reduction. Have the operative conversation early — waiting for re-displacement to become obvious on X-ray means waiting until the clinical opportunity to intervene has narrowed.
This paper established the conceptual foundation for modern distal radius instability criteria and directly influenced subsequent operative threshold recommendations. The Lafontaine score remains a standard reference in hand surgery literature and is a high-yield board topic.