Outcome of Distal Radial Fractures in Young Adults

2000 ◽  
Vol 25 (6) ◽  
pp. 535-543 ◽  
Author(s):  
J. D. GLIATIS ◽  
S. J. PLESSAS ◽  
T. R. C. DAVIS
Keyword(s):  
Young Adults ◽  
Distal Radius ◽  
Articular Surface ◽  
Wrist Pain ◽  
Outcome Questionnaire ◽  
Fracture Union ◽  
Distal Radial Fractures ◽  
Everyday Activities

The outcome of 169 fractures of the distal radius in adults under the age of 50 were assessed at least 18 months after injury (mean follow-up, 4.9 years) using a validated, patient-based outcome questionnaire. The questionnaire responses demonstrated that neither the Frykman nor the Mayo classifications of distal radial fractures predicted outcome. Fracture union with more than 10° of dorsal tilt was associated with increased difficulty with everyday activities and work, while union with a step in the radiocarpal articular surface was associated with loss of wrist mobility and difficulty with fine dextrous tasks. No measure of either intra- or extra-articular malunion influenced the severity or frequency of persistent wrist pain.

scholarly journals A Prospective Study on Treatment of Distal Radial Fractures Using Volar Locking Plate

2020 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Open Reduction ◽  
Locking Plate ◽  
Small Sample ◽  
Care Hospital ◽  
Volar Locking Plate ◽  
Distal Radial Fractures ◽  
Compression Plating

Introduction: Distal radius fractures are one of the most common injuries which come to the orthopaedic surgeons. Displaced extra-or intra-articular fractures require anatomical reduction for a good outcome. Historically, these fractures were treated with manipulation and casting, with or without Kirschner (K) wire fixation. Modern plating techniques have been advocated to restore anatomical alignment and allow early mobilisation. Despite the wide variety of treatment options available there is still debate about the best way to treat these fractures. The aim of this study was to evaluate fifty cases of fracture distal end radius treated by open reduction and internal fixation using locking compression plating (LCP). Methods: The present study was carried out on 50 cases of acute fracture distal radius admitted at a tertiary care hospital treated by open reduction and internal fixation using locking compression plating (LCP) between January 2018 and December 2018. Functional results were rated at the end of the study as excellent, good or poor as criteria laid down by Gartland and Werley’s combined subjective and objective criteria. Results: 50 cases of fracture distal radius were selected for study that fulfill the inclusion criteria, were operated and studied. 10 fractures were fixed using Extra-articular Locking Compression T-Plates, 40 fractures were fixed using Juxtaarticular Locking Compression T-Plates. According to the Gartland and Werley’s rating scale, 20 had excellent results, 23 good results, and 07 fair results during latest follow up. Conclusion: Notwithstanding a very small sample size and a short follow up, Volar locking plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist.

scholarly journals Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Gaetano Caruso ◽  
Francesco Tonon ◽  
Alessandro Gildone ◽  
Mattia Andreotti ◽  
Roberto Altavilla ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Distal Radius ◽  
Randomised Trial ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Radiological Parameters ◽  
Cast Group

Abstract Background Distal radial fractures are common traumatic injuries, but their management remains controversial also in case of conservative treatment regarding the type of immobilisation. Hence, we conducted a two-arm, parallel-group, prospective randomised trial to compare the capacity of long casts (above-elbow) and short casts (below-elbow) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (AO/OTA classification: 2R3A2.2). Methods Seventy-four eligible patients with AO/OTA 2R3A2.2 fractures treated with closed reduction and cast immobilisation were randomised to the long cast group (n°= 37) or to the short cast group (n°= 37). Baseline radiological parameters, radial inclination (RI), radial height (RH), ulnar variance (UV) and palmar tilt (PT) were taken, and compared with clinical (DASH, Mayo Wrist and Mayo Elbow) and radiological scores taken at 7–10 days, 4 weeks and 12 weeks. Furthermore, to evaluate correlations between radiological parameters and functional outcomes, patients were divided into two groups according to whether or not their radiological parameters at Follow-ups 2 and 3 were acceptable, i.e. within the range 11–12 mm for RH, 16°–28° for RI, − 4–+ 2 mm for UV and 0°–22° for PT. Results Patient demographic and baseline radiological parameters were similar between groups. At follow-up, there were no statistically significant differences between the two types of cast in terms of RI, RH, UV or PT, or Mayo wrist or DASH scores. Short cast group patients displayed better Mayo elbow score at follow-up 2 (4 weeks), but this difference was no longer statistically significant at follow-up 3 (12 weeks). No statistically significant differences in clinical outcomes were found between patients who presented acceptable radiographic parameters at follow-up and those who did not. Conclusion As there were no significant differences between short casts and long casts in terms of fracture reduction maintenance or clinical outcomes, short casts are an effective method of post-reduction immobilisation in AO/OTA 2R3A2.2 fracture of the radius. Radiological parameters outside the range conventionally considered acceptable do not preclude a satisfactory clinical outcome. Trial registration ClinicalTrials.gov PRS, NCT04062110. Registred 20 August 2019.

LOCKING PALMAR PLATE FIXATION FOR DORSALLY DISPLACED FRACTURES OF THE DISTAL RADIUS: A PRELIMINARY REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 263-269 ◽  
Author(s):  
Koji Moriya ◽  
Hidehiko Saito ◽  
Yuji Takahashi ◽  
Hiroyuki Ohi
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Functional Results ◽  
Wrist Pain ◽  
Point System ◽  
Articular Fractures ◽  
Palmar Plate ◽  
Ulnar Wrist Pain

We reviewed a series of 62 consecutive patients with dorsally displaced fractures of the distal radius, including 20 extra-articular and 42 intra-articular fractures. All patients were treated with palmar locking plate systems at our institution between 2002 and 2006. After a minimum follow-up time of 12 weeks, the fractures had healed with satisfactory radiographic and functional results. According to the demerit point system of Gartland and Werley, 35 patients were rated excellent, 26 good, and one fair. In the good and fair groups, the demerit points were almost all for ulnar wrist pain. Our results suggest that palmar locking plate systems enable early functional mobilization with good reproducible radiographic and clinical outcomes. Since nine out of 62 patients had residual ulnar wrist pain at the final follow-up evaluation, further investigation of the pathogenesis of ulnar wrist pain is necessary to obtain better functional outcomes.

Natural history and factors associated with ulnar-sided wrist pain in distal radial fractures treated by plate fixation

2016 ◽  
Vol 41 (7) ◽  
pp. 727-731 ◽  
Author(s):  
J. K. Kim ◽  
D. J. Kim ◽  
Y. Yun
Keyword(s):  
Plate Fixation ◽  
Wrist Pain ◽  
Distal Radial Fracture ◽  
Ulnar Styloid ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Ulnar Styloid Fracture ◽  
Evaluation Scores

We documented longitudinal changes in the incidence of ulnar-sided wrist pain after distal radial fractures treated by plate fixation and identified factors associated with ulnar-sided wrist pain. A total of 140 patients were enrolled in this study. Radiographs were taken 3 months after operation, and were used to measure radial inclination, anterior angulation and ulnar variance, and to identify the presence of an ulnar styloid fracture. Clinical assessments at the same time included grip strengths, ranges of wrist motion and the patient-rated wrist evaluation questionnaire. The presence of ulnar-sided wrist pain was noted at each follow-up visit. The incidence of ulnar-sided wrist pain decreased significantly with time after surgery (22 patients at 3 months, 11 patients at 6 months and three patients at 12 months). The mean age, sex, the presence of an ulnar styloid fracture and the classification of the distal radial fracture were not factors that were associated with a higher incidence of ulnar-sided wrist pain, but there was an association between higher patient-rated wrist evaluation scores and the presence of ulnar-sided wrist pain. Level of evidence: Prognosis, Level IV

The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures

2008 ◽  
Vol 33 (3) ◽  
pp. 322-326 ◽  
Author(s):  
H. BOMBACI ◽  
A. POLAT ◽  
G. DENIZ ◽  
O. AKINCI
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Random Order ◽  
Distal Radioulnar Joint ◽  
X Rays ◽  
Distal Radial Fractures ◽  
Ulnar Styloid Fracture ◽  
Significant Difference ◽  
Mri Scans ◽  
Triangular Fibrocartilage

In this prospective study, the plain X-rays and MRI scans of 60 patients with intraarticular distal radius fractures were examined in random order. MRI evaluation revealed that 27 of the 60 patients (45%) had triangular fibrocartilage lesions. No correlation was found between triangular fibrocartilage injury and the Melone classification system, the presence of an ulnar styloid fracture, comminution of the articular surface of the distal radius, >20° dorsal angulation of the distal radius or subluxation/dislocation of the distal radioulnar joint on the plain X-rays. When Frykman Type VI and VIII fractures were compared with all the other Frykman subtypes, a significant difference in the incidence of triangular fibrocartilage complex tears was observed. We conclude that triangular fibrocartilage injury should be considered with all distal radial fractures, especially the Frykman Types VI and VIII.

scholarly journals Early Correction of Distal Radius Partial Articular Malunion Leads to Good Long-term Functional Recovery at Mean Follow-up of 4 Years

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 276-280 ◽  
Author(s):  
T. David Luo ◽  
Fiesky A. Nunez ◽  
Elizabeth A. Newman ◽  
Fiesky A. Nunez
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Articular Surface ◽  
Corrective Osteotomy ◽  
Young Patients ◽  
Posttraumatic Arthritis ◽  
Volar Approach ◽  
Pain Scores

Background: Distal radius articular step-off or deformity may cause posttraumatic arthritis and poor functional outcome. The purpose of this study was to evaluate pain and functional outcomes in patients with malunited partial articular distal radius fractures who underwent corrective osteotomy. We hypothesized that anatomic restoration of distal radius articular surface after a malunited partial articular distal radius fracture results in improvement in pain and functional measures and delays the development of posttraumatic arthritis. Methods: Seven consecutive patients with mean age of 38 years underwent corrective osteotomy via either a standard dorsal approach or combined dorsal and volar approach. Mean time from injury to corrective osteotomy was 10 weeks. Patients were assessed with respect to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), forearm and wrist range of motion, pain, and grip strength. Results: At mean follow-up of 44 months, significant improvements in pain scores (7.1-0.9, P < .001), QuickDASH (38.7-11.6, P < .001), grip strength (21.4-30.0 kg, P = .01) were achieved. All range of motion measurements demonstrated significant improvements except forearm pronation. One patient demonstrated radiographic evidence of osteoarthritis but had no pain at final follow-up. No patients required secondary surgery for removal of symptomatic hardware. Conclusions: Based on these findings, we recommend that early corrective osteotomies should be considered in young patients with intra-articular distal radius malunions before considering salvage procedures such as partial or complete wrist arthrodesis.

scholarly journals Reconstruction of Distal Radius Osteochondral Defects Using Metatarsal Autografts: a Multi-case Series

2019 ◽  
Vol 47 (01) ◽  
pp. 003-009
Author(s):  
Patrick K.Y. Goon ◽  
Shirley D. Stougie ◽  
Kalpesh R. Vaghela ◽  
J. Henk Coert
Keyword(s):  
Distal Radius ◽  
Free Flap ◽  
Articular Surface ◽  
Donor Site ◽  
Case Series ◽  
Donor Site Morbidity ◽  
Difficult Problem ◽  
Prospective Clinical Study ◽  
Level Of Evidence

Objective Delayed reconstruction of the articular surface of the distal radius after trauma is a difficult problem for hand surgeons, and the common solution is usually partial or total wrist fusion, relieving pain but sacrificing motion. A relative novel reconstructive technique addresses the problem with a free microvascular osteochondral flap, using the 3rd metatarsal (3MT) bone. We investigate the possibility of using the same donor as a graft rather than a free flap. Methods This was a prospective clinical study of patients with isolated lunate facet damage following trauma who underwent surgery to remove the damaged articular surface and in whom the defect was reconstructed with an osteochondral graft from the base of the 3MT. All of the patients were followed-up at specific time intervals, with pre- and postoutcome measures taken, including pain, grip strength, range of motion (ROM), and postoperative radiographs and computed tomography (CT) scans to evaluate graft resorption and union. Only patients with isolated distal radius defects were included. Results The average follow-up period was of 51 months (range: 14–73 months). The results of 7 patients included an average improvement of the pain score in the visual analogue scale (VAS) by 3 points, with an average arc of motion of 135°. In all, there was radiographic evidence of full incorporation of the graft, with no resorption. Donor site morbidity was minimal. Conclusions The current gold standard for distal radius articular surface reconstruction remains a free 3MT osteochondral flap. However, our results using the base of the 3MT as a graft shows promise, and if further follow-up confirms comparable results to the free flap technique, this would mean an easier and equally robust reconstruction without complicated microsurgery. Level of Evidence Therapeutic, Level V case series.

Scapho-Lunate Diastasis in Fractures of the Distal Radius

1993 ◽  
Vol 18 (6) ◽  
pp. 725-729 ◽  
Author(s):  
C. MUDGAL ◽  
H. HASTINGS
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
English Literature ◽  
Wrist Pain ◽  
Carpal Instability ◽  
Ligament Injury ◽  
Distal Radial Fractures ◽  
Chronic Wrist Pain

The concurrence of scapho-lunate diastasis and distal radial fractures is now well established. External fixation is considered to be one of the best methods of treating distal radial fractures, but in the presence of ligament injury, distraction fixation may lead to carpal instability and chronic wrist pain. We have reviewed existing English literature and analyzed possible mechanisms of injury, and offer some suggestions towards treatment of this combination of injuries.

Fractures of the Distal End of the Radius in Young Adults: A 30-Year Follow-Up

1993 ◽  
Vol 18 (1) ◽  
pp. 45-49 ◽  
Author(s):  
P. KOPYLOV ◽  
O. JOHNELL ◽  
I. REDLUND-JOHNELL ◽  
U. BENGNER
Keyword(s):  
Young Adults ◽  
Young Adult ◽  
Axial Compression ◽  
Distal Radius ◽  
Leisure Activities ◽  
Degenerative Changes ◽  
Articular Fractures ◽  
Injured Side ◽  
Carpal Joint

76 patients were examined clinically and radiologically 27 to 36 years after a fracture of the distal radius. The average age was 31 years at the time of injury and 63 years at follow-up. In 81% of the patients there was no difference between the fractured and the non-fractured side. No patient had to change his or her occupation or leisure activities because of the fracture. There were more degenerative changes in the fractured wrist than in the non-injured side. A statistically significant correlation was found between axial compression and the presence of degenerative changes in the radio-carpal and distal radio-ulnar joints. Treatment of the fracture of the distal end of the radius in the young adult should aim to conserve the length of the radius. However, after 30 years, complaints are few and correlate with degenerative changes in the radio-carpal joint only. 47 patients with articular fractures of the distal end of the radius were examined in the same way. The average age at the time of injury was 32 years and 58% of the patients were men. In 87% of the patients there was no difference between the fractured and the non-fractured side. However 37% had minor complaints. A higher proportion of patients with articular fractures developed degenerative changes than those with non-articular fractures. The existence of radiographic signs of osteoarthritis is directly related to axial compression and the persistant incongruity, after reposition, in either the radio-carpal or the distal radio-ulnar joints.

Open reduction and plate fixation of dorsally displaced fractures of the distal radius: surgical technique, clinical and radiological outcome

2009 ◽  
Vol 35 (1) ◽  
pp. 56-60 ◽  
Author(s):  
T. E. J. Hems ◽  
B. Rooney
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Articular Surface ◽  
Plate Fixation ◽  
Young Patients ◽  
Extensor Tendon ◽  
Articular Fractures ◽  
Clinical And Radiological Outcome ◽  
Evaluation Measure

Thirty-five unstable dorsally displaced fractures of the distal radius in 34 patients (mean age 39) were studied; 28 fractures were intra-articular. All fractures had open reduction and fixation, through a dorsal approach, with mini-fragment plates placed between the first and second dorsal tendon compartments and deep to the fourth compartment. A congruous reduction of the articular surface was obtained in all cases. Twenty-four patients were available for follow-up (median 38 months). The Modified Mayo wrist score was excellent in 12 cases, good in four, and fair in eight. The median Patient Evaluation Measure score was 23.5. There were no cases of extensor tendon rupture. Radiographic assessment at follow-up showed a mean palmar angle of 6°. There was evidence of osteoarthritis in six patients who had had intra-articular fractures. Open reduction and plating gives satisfactory medium term results for treatment of displaced intra-articular fractures of the distal radius in young patients.

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