Lafontaine criteria and instability assessment of distal end radius fracture


  • Nuttapol Khajonvittayakul Tharongchang hospital


Distal end radius fracture, Lafontaine criteria, Instability of distal end radius fracture


          Background: Distal end radius fractures are one of the most common injuries encountered in orthopedic practice. Lafontaine found that presenting 3 or more of dorsal angulation more than 20 degrees, dorsal comminution, intra-articular fracture, associated ulnar fracture and age over 60 years were considered as factors of secondary displacement. But later studies found that Lafontaine criteria did not affect all of these factors.

          Objectives: To determine factors of Lafontaine criteria associated with instability of distal end radius fracture from radiographic imaging in treatment with closed reduction and cast.

          Method: Patients with closed reduction and cast in distal end radius fractures, who had radiograph in onset of injury and more than one times follow-up with complete data records, were identified in Tharongchang Hospital from January 1, 2012 to August 31, 2021. Their radiographs were assessed. Follow up on radiographs after treatment about acceptable alignment, record data and statistical analyze data.

          Results: There were 40 participants with mean age 43.40 years (21 males and 19 females). According to Lafontaine criteria, intraarticular fracture affected to instability of distal end radius fracture, statistically significant (Odd ratio 4.865, P-valve 0.027). Other factors were not statistically significant. In terms of components, radial shortening and change in radial inclination affected to age greater than 60 years, dorsal angulation greater than 20 degrees, dorsal comminution and ulnar fracture. While step-off affected to intra-articular fracture. Loss of palmar tilt and extension more than neutral affected to dorsal angulation greater than 20 degrees and dorsal comminution.

          Conclusion: Important parameter for instability after closed reduction and cast in distal end radius fracture was intra-articular fracture.


Pogue DJ, Viegas SF, Patterson RM, Peterson PD, Jenkins DK, Sweo TD, et al. Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg Am [Internet]. 1990 Sep;15(5):721–7. Available from:

Meena S, Sharma P, Sambharia A, Dawar A. Fractures of distal radius: An overview. J Fam Med Prim Care [Internet]. 2014;3(4):325. Available from:

Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am [Internet]. 2004 Nov;29(6):1128–38. Available from:

Solomon L, Warwick D NS. Apley’s System of Orthopaedics and Fractures. 9th ed. Solomon L, Warwick D NS, editor. Florida: CRC press; 2001. 716–718 p.

Mohammad Ali Tahririan, Mohammad Javdan, Mohammad Hadi Nouraei MD. Evaluation of instability factors in distal radius fractures. J Res Med Sci [Internet]. 2013;18(10):892–6. Available from:

Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury [Internet]. 1989 Jul;20(4):208–10. Available from:

Walenkamp MMJ, Aydin S, Mulders MAM, Goslings JC, Schep NWL. Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg (European Vol [Internet]. 2016 Jun 29;41(5):501–15. Available from:

LaMartina J, Jawa A, Stucken C, Merlin G, Tornetta P. Predicting Alignment After Closed Reduction and Casting of Distal Radius Fractures. J Hand Surg Am [Internet]. 2015 May;40(5):934–9. Available from:

Walenkamp M, Vos L, Strackee S, Goslings J, Schep N. The Unstable Distal Radius Fracture—How Do We Define It? A Systematic Review. J Wrist Surg [Internet]. 2015 Oct 29;04(04):307–16. Available from:

Bernard R. Fundamentals of biostatistics. 5th ed. Duxbery: Thomson learning; 2000. 384–385 p.

Fleiss, J. L., Levin, B., Paik MC. Statistical methods for rates and proportions. 3rd ed. John Wiley&Sons; 2003. 76 p.

Ngamjarus C. C V. n4Studies: Sample size and power calculations for iOS. The Royal Golden Jubilee Ph.D. Program - The Thailand Research Fund&Prince of Songkla University.; 2014.

BINI A, SURACE MF, PILATO G. Complex Articular Fractures of the Distal Radius: The Role of Closed Reduction and External Fixation. J Hand Surg (European Vol [Internet]. 2008 Jun 1;33(3):305–10. Available from:

Kodama N, Takemura Y, Ueba H, Imai S, Matsusue Y. Acceptable parameters for alignment of distal radius fracture with conservative treatment in elderly patients. J Orthop Sci [Internet]. 2014 Mar;19(2):292–7. Available from:

Jung HS, Chun KJ, Kim JY, Lee JS. Necessity of acceptable radiologic alignment by preoperative closed reduction for unstable distal radius fractures treated with volar locking plates. Eur J Trauma Emerg Surg [Internet]. 2021;47(6):1881–7. Available from:

Van den Broeck J, Brestoff JR, editors. Epidemiology: Principles and Practical Guidelines [Internet]. Dordrecht: Springer Netherlands; 2013. Available from:

Mackenney PJ. Prediction of Instability in Distal Radial Fractures. J Bone Jt Surg [Internet]. 2006 Sep 1;88(9):1944. Available from:

Altissimi M, Antenucci R, Fiacca C MG. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986;202–10.

JENKINS N. The unstable colles’ fracture. J Hand Surg J Br Soc Surg Hand [Internet]. 1989 May;14(2):149–54. Available from:



2022-04-25 — Updated on 2022-04-25

How to Cite

Khajonvittayakul, N. (2022). Lafontaine criteria and instability assessment of distal end radius fracture . Region 11 Medical Journal, 36(1). Retrieved from



Original articles