The utility of the cast index in elderly patients remains underexplored. This study investigates the relationship between the cast index and clinical, radiographic, and functional outcomes in patients aged 65 and older with distal radius fractures treated with closed reduction and casting. A retrospective cohort study was conducted involving 66 elderly patients with distal radius fractures treated conservatively. Patients were categorized into two groups (33 patients in each) based on cast index (Group A≤0.8 and Group B>0.8). Demographic data were collected from the patients’ hospital records. Radiographic outcomes (volar tilt, radial inclination, and radial height), clinical metrics (wrist range of motion), and functional scores (MAYO wrist and QuickDASH) were assessed at 12 weeks post-treatment. Patients with a cast index ≤0.8 (Group A) demonstrated significantly better radiographic alignment, including smaller reductions in volar tilt (p=0.001), radial inclination (p=0.002), and radial height (p=0.001). These patients also exhibited greater wrist flexion (p=0.035) and extension (p=0.028), along with superior functional outcomes, as indicated by higher MAYO wrist scores (p=0.001) and lower QuickDASH scores (p=0.002). Subgroup analysis revealed pronounced benefits in simpler fractures (Frykman Types I and II). Group A experienced higher rates of cast-related discomfort, whereas Group B showed increased rates of reduction loss. The cast index is a reliable predictor of outcomes in elderly patients with distal radius fractures treated conservatively. A cast index ≤0.8 correlates with better radiographic, clinical, and functional results, particularly in less complex fractures. These findings support incorporating the cast index into routine assessment to optimize fracture management in this vulnerable population.
Key words: Distal radius fractures, elderly patients, cast index, clinical outcomes, conservative treatment, radiographic alignment
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