scholarly journals Measuring Outcomes Over Time in Distal Radius Fractures: A Comparison of Generic, Upper Extremity-Specific and Wrist-Specific Outcome Measures

2020 ◽  
Vol 2 (5) ◽  
pp. 272-276
Author(s):  
Amarpal S. Cheema ◽  
Peter J. O’Brien ◽  
Henry M. Broekhuyse ◽  
Kelly A. Lefaivre
Keyword(s):  
Upper Extremity ◽  
Outcome Measures ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Specific Outcome ◽  
Measuring Outcomes ◽  
Over Time

scholarly journals Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

2018 ◽  
Vol 07 (05) ◽  
pp. 409-414
Author(s):  
J. Hill ◽  
Gabriel Bouz ◽  
Ali Azad ◽  
William Pannell ◽  
R. Alluri ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Outcome Measures ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Dash Score ◽  
Radius Fractures ◽  
Volar Plate Fixation

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

2020 ◽  
pp. 175319342094131
Author(s):  
Brent R. DeGeorge ◽  
Holly K. Van Houten ◽  
Raphael Mwangi ◽  
Lindsey R Sangaralingham ◽  
Sanjeev Kakar
Keyword(s):  
Upper Extremity ◽  
Distal Radius ◽  
Complication Rate ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Specific Complication ◽  
Secondary Procedures ◽  
Non Operative Management

To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. Level of evidence: III

scholarly journals 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 ◽  
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.

External Fixation of Distal Radius Fractures

2009 ◽  
Author(s):  
David Slutsky
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Wrist Motion ◽  
Volar Plate Fixation ◽  
Over Time

External fixation has been used for the treatment of distal radius fractures for more than 50 years. Although the fixator configurations have undergone considerable modification over time, the type of fixator itself is not as important as the underlying principles that provide the foundation of external fixation. Although volar plate fixation is currently in vogue, the indications for external fixation remain largely unchanged. New fixator designs have also expanded hrte traditional usage to include nonbridging applications that allow early wrist motion. The following discussion focuses on the myriad uses for external fixation as well as the shortcomings and potential pitfalls.

scholarly journals Objective Outcome Measures Continue to Improve from 6 to 12 Months after Conservatively Treated Distal Radius Fractures in the Elderly—A Prospective Evaluation of 50 Patients

2021 ◽  
Vol 10 (9) ◽  
pp. 1831
Author(s):  
Rikke Thorninger ◽  
Daniel Wæver ◽  
Jonas Pedersen ◽  
Jens Tvedegaard-Christensen ◽  
Michael Tjørnild ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Distal Radius ◽  
Case Series ◽  
The Elderly ◽  
Patient Reported Outcome Measures ◽  
Distal Radius Fractures ◽  
Fracture Dislocation ◽  
Radius Fractures ◽  
Patient Reported ◽  
Prospective Case Series

Distal radius fractures (DRF) in the elderly population above 65 years represent 18% of all fractures and are thereby the second most frequent fracture in the elderly. Fracture dislocation and comminution are often used to determine whether non-operative or operative treatment is indicated. The purpose of this prospective case series of minimally displaced DRF treated with a dorsal cast was to assess the complication rate and patient-reported outcome measures. This single-centre, single-blinded, prospective case series followed 50 conservatively treated DRF patients for one year. Primary outcomes were complications and Quick Disability of Arm Shoulder and Hand (qDASH) score. Secondary outcomes were range of motion (ROM), grip strength and pain, and Patient-Rated Wrist/Hand Evaluation (PRWHE). Results showed only minor complications with a return to prior ROM, qDASH, and pain after 12 months and improvement in outcomes after 6–12 months. In conclusion, the majority of DRF patients who were treated non-operatively with five-week dorsal casting recover fully after minimally displaced DRF. This standard approach is thus considered safe, and the present results provide a reference for other studies.

scholarly journals A comparison of six outcome measures across the recovery period after distal radius fixation—Which to use and when?

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902097186
Author(s):  
Christian Fang ◽  
Evan Fang ◽  
Dennis KH Yee ◽  
Kenny Kwan ◽  
Gladys Leung ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Distal Radius ◽  
Recovery Period ◽  
Criterion Validity ◽  
Distal Radius Fractures ◽  
Multiple Time ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
Floor Effects

Purpose: Many standardized outcome measures exist to measure recovery after surgical fixation of distal radius fractures, however, choosing the optimal instrument is difficult. We evaluated responsiveness, ceiling/floor effects, and criterion validity over multiple time intervals across a 2-year follow-up period for six commonly used instruments. Methods: A total of 259 patients who received open reduction and internal fixation for distal radius fractures between 2012 and 2015 were recruited. Patients were administered the Patient-Rated Wrist Evaluation ( PRWE), Shortened Disabilities of the Arm, Shoulder and Hand questionnaire ( QuickDASH), Green and O’Brien score (Cooney modification) ( CGNO), Gartland and Werley score (Sarmiento modification) ( SGNW), flexion-extension arc ( FEArc), and grip fraction test ( GripFrac) at 1.5, 3, 6, 12, and 24 months postoperatively. Responsiveness was evaluated by calculating standardized response means (SRM) and Cohen’s d effect sizes (ES), and by correlating each instrument’s change scores against those of QuickDASH and PRWE, which were also used as external comparators to assess criterion validity. Ceiling/floor effects were calculated for all measures at each time point. Results: SRM (1.5–24 months) were 1.81, 1.77, 1.43, 1.16, 2.23, 2.45 and ES (1.5–24 months) were 1.81, 1.82, 1.95, 1.31, 1.99 and 2.90 for QuickDASH, PRWE, CGNO, SGNW, FEArc, and GripFrac respectively. Spearman correlation coefficients against QuickDASH at 24 months were: 0.809, 0.248, 0.563, 0.285, and 0.318 for PRWE, CGNO, SGNW, FEArc, and GripFrac respectively. Significant (>15% of patients reaching maximum score) ceiling effects were observed before 6 months for PRWE and SGNW. Conclusions: Our evidence supports the use of QuickDASH, PRWE, FEArc and GripFrac up to 6 months postsurgery, and QuickDASH and PRWE after 6 months. Level of evidence: Level II.

Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures

2021 ◽  
pp. 1-7
Author(s):  
Tim Coughlin ◽  
Alan R. Norrish ◽  
Brigitte E. Scammell ◽  
Paul A. Matthews ◽  
Jessica Nightingale ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Secondary Outcome ◽  
Dash Score ◽  
Radius Fractures ◽  
Face To Face ◽  
Significant Difference ◽  
One Year

Aims Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. Methods Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. Results A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). Conclusion Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy.

scholarly journals Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures: a randomized controlled trial

2019 ◽  
Vol 45 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Caroline A. Selles ◽  
Marjolein A. M. Mulders ◽  
Joost W. Colaris ◽  
Mark van Heijl ◽  
Berry I. Cleffken ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Distal Radius ◽  
Controlled Trial ◽  
Intervention Group ◽  
Primary Outcome Measure ◽  
Distal Radius Fractures ◽  
Secondary Outcome ◽  
Arthroscopic Debridement ◽  
Radius Fractures ◽  
Level Of Evidence

The aim of this study was to determine the difference in functional outcomes after open reduction and internal fixation (ORIF) with and without arthroscopic debridement in adults with displaced intra-articular distal radius fractures. In this multicentre trial, 50 patients were randomized between ORIF with or without arthroscopic debridement. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcome measures were Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, pain scores, range of wrist motion, grip strength, and complications. Median PRWE was worse for the intervention group at 3 months and was equal for both groups at 12 months. The secondary outcome measures did not show consistent patterns of differences at different time-points of follow-up. We conclude that patients treated with additional arthroscopy to remove intra-articular hematoma and debris did not have better outcomes than those treated with ORIF alone. We therefore do not recommend arthroscopy for removal of hematoma and debris when surgically fixing distal radius fractures. Level of evidence: I

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

Hand ◽  
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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