Does position of the wrist during cast immobilisation in patients with distal radius fractures affect outcome?

Abstract Purpose The position of the wrist during cast immobilisation following closed reduction of distal radius fractures is disputed. A systematic review was initiated to assess if there was any relation between wrist position in the cast and outcome in adult patients with non-operatively treated distal radius fractures. Methods A comprehensive search was performed in the bibliographic databases Medline, Embase and Wiley/Cochrane Library from inception up to 27 November 2020. Eligible studies were: randomised controlled trials, prospective and retrospective comparative cohort studies, analysing different positions of the wrist in cast-immobilisation following closed reduction. Primary outcome of the study was functional outcome measured by range of motion. Secondary outcomes were functional outcomes measured by grip strength, patient-reported outcome, radiological outcome and complications such as secondary dislocation and pain. Results The initial search yielded 2733 studies. Five trials, with 519 patients, were included in this systematic review. Range of motion and radiological outcome was significantly better in patients who were immobilised in dorsiflexion compared to palmar flexion or neutral position, although no clinical important difference was found. There were no significant differences in patient-reported outcome, pain, grip strength or complications. Due to heterogeneity of the included studies, data were unsuitable for a meta-analysis. Conclusion This systematic review showed statistically significant better results in favour of cast immobilisation in dorsiflexion, although this small difference does not seem to be relevant in patients daily activities. Systematic review registration number Systematic review registration number: PROSPERO 2018 CRD42018085546.

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The role of concomitant ligament injury in the development of post-traumatic osteoarthritis after distal radius fractures: a protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-039591 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039591

Author(s):

Malou E Slichter ◽

Gerald A Kraan ◽

Wichor M Bramer ◽

Joost W Colaris ◽

Nina M C Mathijssen

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ligament Injury ◽

Original Research ◽

Cochrane Central Register ◽

Radius Fractures ◽

Patient Reported ◽

Post Traumatic

IntroductionTreatment of distal radius fractures (DRFs) aims to restore anatomic position of the fracture fragments and congruity of the articular surface to optimise functional outcomes and prevent osteoarthritis in the long term. While ligament injury of the wrist is often associated with DRFs and sole ligament injuries of the wrist lead to osteoarthritis, it is plausible that concomitant ligament injury in DRFs may aggravate degenerative changes of the wrist. The relationship between concomitant ligament injury and post-traumatic osteoarthritis in patients with DRFs is unclear. This study aims to identify the types of associated ligament injury in patients with a DRF and to elucidate the association of ligament injury on the development of post-traumatic osteoarthritis.Methods and analysisThis protocol is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines. An electronic search in MEDLINE, Embase, Web of Science, Cochrane Central Register of Trials and Google Scholar has been created and performed by a Health Sciences librarian with expertise in systematic review searching. Original research articles in English literature, which report on concomitant ligament injury of the wrist in relation to post-traumatic osteoarthritis, patient-reported outcome measures or clinician-reported outcome measures in patients (aged ≥18 years) with DRFs will be included. Two reviewers will independently screen and appraise articles and perform data extraction. In case of any disagreements, a third reviewer will be consulted. A systematic qualitative synthesis will be performed using text and tables.Ethics and disseminationNo ethical approval is required, since this is a protocol for a systematic review. The systematic review will be submitted for publication in a peer-reviewed scientific journal and for presentation at relevant conferences.PROSPERO registration numberCRD42020165007.

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The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant?

Disability and Rehabilitation ◽

10.1080/09638288.2020.1753247 ◽

2020 ◽

pp. 1-12

Author(s):

Charlotte M. Lameijer ◽

Henk Jan ten Duis ◽

Charlotte M. S. C. Haag ◽

Mostafa El Moumni ◽

Corry K. van der Sluis

Keyword(s):

Distal Radius ◽

Patient Reported Outcome ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Patient Reported ◽

Radiological Measurements

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A COMPARATIVE STU DY BETWEEN “CLOSED REDUCTION, CAST IMMOBILISATION “AND “CLOSED REDUCTION, PERCUTANEOUS K - WIRE FIXATION, CAST IMMOBILISATION” IN DISTAL RADIUS FRACTURES

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2015/1689 ◽

2015 ◽

Vol 4 (67) ◽

pp. 11714-11723

Author(s):

Subramaniam M H ◽

Karthick Anand K ◽

Narayana Reddy M

Keyword(s):

Distal Radius ◽

Closed Reduction ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Cast Immobilisation ◽

Wire Fixation

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Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review

Hand ◽

10.1177/15589447211028919 ◽

2021 ◽

pp. 155894472110289

Author(s):

Nathaniel Fogel ◽

Kevin Mertz ◽

Lauren M. Shapiro ◽

Allison Roe ◽

Sahitya Denduluri ◽

...

Keyword(s):

Systematic Review ◽

Physical Examination ◽

Outcome Measures ◽

Distal Radius ◽

Meta Analysis ◽

Final Analysis ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Patient Reported ◽

Level I

Background The inclusion of patient-reported outcome measures (PROMs) serves to better quantify aspects of patient outcomes missed with objective measures, including radiographic indices and physical examination findings. We hypothesize that PROMs are inconsistently and heterogeneously captured in the treatment of distal radius fractures. Methods We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of all level I and II randomized controlled trials (RCTs) of distal radius fracture treatment of any modality for those older than 50 years of age from January 2008 to January 2018. A total of 23 studies were included in the final analysis. The metrics used by each study to assess outcomes were collected, compared, and described. Results Physical examination findings and radiographic measures were reported in 70% and 74% of studies, respectively. Patient-reported outcomes measures were used to assess outcomes in 74% of studies. Only the Disabilities of the Arm, Shoulder, and Hand was used in greater than half of the studies (57%). Pain scores were assessed in 39% of studies and complications in only 26%. Conclusions There is substantial heterogeneity and lack of standardization in the collection of both objective outcome measures and PROMs in level I and II RCTs for the treatment of distal radius fractures. The ability to compare between studies or aggregate data among studies is therefore limited. Radiographic and physical examination findings remain frequently reported despite known limitations of these metrics. The routine collection of PROMs after the treatment of distal radius fractures can ensure care is directed toward improving what is most important to patients.

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Closed reduction of distal radius fractures: a systematic review and meta-analysis

EFORT Open Reviews ◽

10.1302/2058-5241.3.170063 ◽

2018 ◽

Vol 3 (4) ◽

pp. 114-120 ◽

Cited By ~ 3

Author(s):

Hjalte Søsborg-Würtz ◽

Sükriye Corap Gellert ◽

Julie Ladeby Erichsen ◽

Bjarke Viberg

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Closed Reduction ◽

Meta Analysis ◽

The Elderly ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Optimal Method ◽

Manual Traction

Distal radius fractures (DRF) are a common injury, especially in the elderly. Displaced fractures can be reduced by closed reduction through several techniques, two of which are compared in this systematic review and meta-analysis. Closed reduction by finger-trap traction (FTT) seems to offer better correction of radial shortening. Additionally, there may be less pain and fewer complications associated with this technique. Closed reduction by manual traction seems to offer better correction of the dorsal tilt. Further research is needed to fully determine the optimal method of closed reduction. Cite this article: EFORT Open Rev 2018;3:114-120.DOI: 10.1302/2058-5241.3.170063

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The CAST study protocol: a cluster randomized trial assessing the effect of circumferential casting versus plaster splinting on fracture redisplacement in reduced distal radius fractures in adults

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04238-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Britt Barvelink ◽

◽

Max Reijman ◽

Niels W. L. Schep ◽

Vanessa Brown ◽

...

Keyword(s):

Cost Effectiveness ◽

Distal Radius ◽

Closed Reduction ◽

Patient Reported Outcomes ◽

Distal Radius Fractures ◽

Adult Patients ◽

Primary Study ◽

Radius Fractures ◽

Patient Reported ◽

Cluster Randomized

Abstract Background There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated. Methods/design This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months. Discussion The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery. Trial registration Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311.

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“COMPARATIVE STUDY OF DISTAL END RADIUS FRACTURE TREATED BY PERCUTANEOUS 5 PIN TECHNIQUE V/S CLOSED REDUCTION AND CASTING METHOD”.

10.36106/6900913 ◽

2021 ◽

pp. 29-31

Author(s):

Vibhor Khandal ◽

Ashwani Kumar Mathur ◽

Mohit Kumar ◽

Rajkumar Bairwa

Keyword(s):

Distal Radius ◽

Closed Reduction ◽

Soft Tissues ◽

Hand Function ◽

Early Mobilization ◽

Fracture Site ◽

Distal Radius Fractures ◽

Point System ◽

Casting Method ◽

Radius Fractures

Introduction: Distal end radius fractures crush the mechanical foundation of most useful tool, the hand. No other fracture has a such potential to devastate hand function, and no other metaphysis of bone is embraced by more soft tissues. Closed reduction and percutaneous pinning is one of the standard treatments for management of distal radius fractures, and its modication 'The percutaneous 5 pin technique improves the reliability of xation thus combining the benets of non-invasiveness as in casting and stability achieved is comparable to open reduction and plating. Material and method: This prospective study was done between December 2018 to December 2020 in department of orthopedics, including 60 patients with fracture of distal radius Among them 30 patients subsequently underwent ve pin xation and 30 patients were treated with closed reduction and casting method. Result: Radiological analysis of the data was done using Sarmiento's Modication of Lidstrom Criteria. Activities of daily life (ADL) were examined by using the demerit point system of Gartland and Wereley based on objective and subjective criteria, residual deformity and complications. Radiological parameters were assessed for at the end of 6months. There was signicant difference in all the three parameters i.e, Volar tilt, Radial length, Radial inclination between both groups at the end of 6 months. Closed reduction with ve pinning technique group had shown not only better but also statistically signicant anatomical reduction compared to other groups. Functional outcome was better in patients treated with percutaneous 5 pinning technique. Conclusion: The ve pin technique carries the advantage of early mobilization, DRUJ stability. Radio Ulnar pins and the pins across the fracture site provide enough stability to permit early mobilization leading to less post operative stiffness in joint. Although the study series is small and further research is essential to provide directions for treatment, it is safe to conclude that the ve pin technique is a technically less demanding, lessinvasive and an effective way of treating displaced distal radius fractures without severe articular or metaphyseal comminution

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Optimal screw length in volar locking plate osteosynthesis for distal radius fractures: a systematic review

ANZ Journal of Surgery ◽

10.1111/ans.17390 ◽

2021 ◽

Author(s):

Rajitha Gunaratne ◽

Omid Nazifi ◽

Harry D'Souza ◽

Aaron Tay

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Screw Length ◽

Locking Plate Osteosynthesis

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The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review

Hand ◽

10.1177/1558944717735945 ◽

2017 ◽

Vol 13 (5) ◽

pp. 509-515 ◽

Cited By ~ 4

Author(s):

Jessica L. Truong ◽

Chris Doherty ◽

Nina Suh

Keyword(s):

Systematic Review ◽

Socioeconomic Factors ◽

Clinical Outcomes ◽

Distal Radius ◽

Full Text ◽

Distal Radius Fractures ◽

Quality Analysis ◽

Current Evidence ◽

Radius Fractures ◽

Full Text Screening

Background: Socioeconomic factors are known to affect outcomes for both medical and surgical conditions. The purpose of this systematic review was to assess the current evidence regarding the effect of socioeconomic factors such as income, geographic location, educational level, and occupation on clinical outcomes after distal radius fractures. Methods: A systematic search strategy was performed to identify studies commenting on the effect of socioeconomic factors on clinical outcomes following open or closed distal radius fracture repair. Abstract and full-text screening was performed by 2 independent reviewers, and articles were evaluated by Structured Effectiveness Quality Evaluation Scale (SEQES). Treatment outcomes of interest included, but were not limited to, pain, function, range of motion, and grip strength. Results: There were 1745 studies that met our inclusion and exclusion criteria for abstract screening. Of these, 48 studies met our inclusion criteria for full-text screening and 20 studies met our criteria for quality analysis with the SEQES score. There were 3 studies of high quality, 16 of moderate quality, and 1 of low quality. Meta-analyses were not possible due to the variability in outcomes of interest across papers. Conclusions: Patient factors indicative of socioeconomic status are relevant predictors of functional outcome after distal radius fractures. There is currently limited evidence in this area of research, and further examination should be considered to improve outcomes from a patient and system standpoint.

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