Which is more common; right or left distal radial fractures?

Introduction: The aim of this study was to review the published literature to assess whether adult distal radial fractures were more common on the left side than the right, and more common on the non-dominant or dominant side.

Methods: A structured literature review was performed using a predefined search. There were 1726 papers possibly related to dominance and 1571 related to laterality. After screening of the abstracts, 41 papers relating to hand dominance and 144 to laterality were retrieved for full text analysis. Studies reporting adult patients, over 250 fractures and providing data on laterality or hand dominance were included.

Results: There were 10 papers fulfilling the inclusion criteria. Three were from national databases providing 92% of the cases. Overall there were 47,959 distal radial fractures of which 26,534 (55.3%) occurred on the left and 21,425 (44.7%) occurred on the right (p < 0.0001). Of 1738 distal radial fractures where hand dominance was reported, 935 (53.8%) were on the side of the non-dominant hand and 803 (46.2%) on the side of the dominant hand (p < 0.0001).

Conclusion: Distal radial fractures occur significantly more often on the left side and to the non-dominant hand. This is confirmed in the limited data on side of injury in studies of fracture fixation and with the data on implant purchasing patterns for institutions. Why there is this difference is unclear, but may relate to fall mechanics, protective reflexes or subtle differences in bone density. These results may help validate randomization in clinical trials.

Level of evidence: V.