Ultrasound Imaging Improves Identification of Prominent Hardware in the Surgical Treatment of Distal Radius Fractures: A Cadaveric and Prospective Clinical Study

Aims The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.

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Radial Overgrowth after Surgical Treatment for Pediatric Distal Radius Fractures

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2016.51.5.365 ◽

2016 ◽

Vol 51 (5) ◽

pp. 365

Author(s):

Min-Wook Kim ◽

Choong-Young Kim ◽

Dae-Hyun Yoon ◽

Dae-Hee Kim ◽

Jung-Ho Lee ◽

...

Keyword(s):

Surgical Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures

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Re: Selles et al. Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures: a randomized controlled trial. J Hand Surg Eur. 2020, 45: 327–32

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420922699 ◽

2020 ◽

Vol 45 (6) ◽

pp. 651-652

Author(s):

David Jann

Keyword(s):

Randomized Controlled Trial ◽

Surgical Treatment ◽

Distal Radius ◽

Controlled Trial ◽

Distal Radius Fractures ◽

Arthroscopic Debridement ◽

Radius Fractures ◽

Randomized Controlled

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Is the Additional Effort for an Intraoperative CT Scan Justified for Distal Radius Fracture Fixations? A Comparative Clinical Feasibility Study

Journal of Clinical Medicine ◽

10.3390/jcm9072254 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2254 ◽

Cited By ~ 1

Author(s):

Sascha Halvachizadeh ◽

Till Berk ◽

Alexander Pieringer ◽

Emanuael Ried ◽

Florian Hess ◽

...

Keyword(s):

Surgical Treatment ◽

Radiation Dose ◽

Ct Scan ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ct Scans ◽

Radius Fractures ◽

Ao Classification ◽

Intraoperative Ct ◽

Duration Of Surgery

Introduction: It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans. Methods: Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT). Exclusion criteria: Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization. Results: A total of 187 patients were included (Group Conv n = 96 (51.3%), Group CT n = 91 (48.7%)). AO Classification: Type A fractures n = 40 (50%) in Group Conv vs. n = 16 (17.6%) in Group CT, p < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), p < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, p < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization. Conclusion: The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.

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Early Outcomes of Scapholunate Injuries With Concomitant Distal Radius Fractures

Hand ◽

10.1177/1558944719890037 ◽

2019 ◽

pp. 155894471989003

Author(s):

Nicholas C. Duethman ◽

William R. Aibinder ◽

Nathaniel L. Robinson ◽

Steven L. Moran ◽

Sanjeev Kakar

Keyword(s):

Surgical Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

Adult Patients ◽

Wrist Arthroscopy ◽

Scapholunate Ligament ◽

Radius Fractures ◽

Treatment Groups ◽

Functional Differences

Background: There is limited literature regarding the treatment of concomitant scapholunate ligament (SL) injuries in acute distal radius fractures (DRFs). We hypothesized that surgical treatment of SL injuries in adult patients with DRFs leads to improved functional outcomes. Methods: A retrospective review was made of 42 adult patients who underwent surgical treatment of a DRF with a SL injury between 2005 and 2013. In all, 39 of the 42 patients sustained an intra-articular DRF (AO B or C). SL injury was diagnosed by SL diastasis > 3 mm on posteroanterior (PA) radiographs, magnetic resonance imaging, or with wrist arthroscopy. Patients were divided into 3 groups: 23 had a SL repair and were treated within 21 days of injury (acute), 8 underwent SL repair greater than 21 days from injury (subacute/chronic), and 11 did not undergo repair (non-operative). Median overall time to clinical follow-up was 5.1 years. Mayo Wrist Scores (MWS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to evaluate functional outcome. Results: Clinical outcomes measured by the MWS at final follow-up (6 months-12 years) showed no significant differences between the 3 groups. Of patients treated acutely, 17.3% had good to excellent MWS. MWS at 1-year follow-up was 68.4, 70, and 64 in the acute, subacute/chronic, and non-operative groups, respectively. DASH scores were 16.7, 14.3, and 11.8 in the acute, subacute/chronic, and nonoperative groups, respectively, at a mean of 7.8 years. Conclusions: At mid-term follow-up, all 3 treatment groups had similar DASH scores to the general population. There were no statistical functional differences between any of the groups based upon MWS or DASH scores.

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