Influence of Cortical Comminution and Intra-articular Involvement in Distal Radius Fractures on Clinical Outcome: A Prospective Multicenter Study

Aim The purpose of this prospective multicenter study was to test the predictive value of cortical comminution and intra-articular involvement on function and quality of life in distal radius fractures (DRFs) using the Buttazzoni's classification system. Patients and Methods We studied 406 patients between skeletal maturity and 74 years of age with DRF. Fractures with acceptable radiographic alignment were immobilized with a cast. Fractures with nonacceptable radiographic alignment underwent closed reduction and 4 to 6 weeks cast immobilization. Radiographs were obtained after reduction and at 10 to 14 days. Redisplaced fractures were offered surgical treatment. One-year follow-up included grip strength, range of motion (ROM), quickDASH, EQ-5D (including visual analog scale [VAS] for health status), and VAS pain. Results We found no statistically significant differences in QuickDASH, EQ-5D questionnaire, EQ-5D health status VAS, and VAS pain among the Buttazzoni classes. However, initial displacement was associated with worse quickDASH score, worse EQ-5D score, reduced grip strength, and reduced ROM. Dorsal comminution was associated with worse quickDASH score, reduced flexion, and reduced pronation–supination ability. Volar comminution predicted loss of extension, while intra-articular involvement was associated with reduced flexion–extension arc and worse EQ-5D score. There was a significant difference in ROM between noncomminuted and comminuted fracture classes. Conclusion Initial fracture position, type of comminution, and intra-articular involvement influenced the clinical outcome in DRF.

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TREATMENT WITH OR WITHOUT INTERNAL FIXATION FOR ULNAR STYLOID BASE FRACTURES ACCOMPANIED BY DISTAL RADIUS FRACTURES FIXED WITH VOLAR LOCKING PLATE

Hand Surgery ◽

10.1142/s0218810412500177 ◽

2012 ◽

Vol 17 (02) ◽

pp. 181-190 ◽

Cited By ~ 9

Author(s):

Yukichi Zenke ◽

Akinori Sakai ◽

Toshihisa Oshige ◽

Shiro Moritani ◽

Toshitaka Nakamura

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Radius Fractures ◽

Ulnar Styloid ◽

Fixation Group ◽

Significant Difference

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

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Mid-Term Functional Outcome after Volar Locking Plate Fixation of Distal Radius Fractures in Elderly Patients

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500273 ◽

2018 ◽

Vol 23 (02) ◽

pp. 238-242 ◽

Cited By ~ 3

Author(s):

Haruhiko Shimura ◽

Akimoto Nimura ◽

Koji Fujita ◽

Takashi Miyamoto

Keyword(s):

Elderly Patients ◽

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Significant Difference

Background: The volar locking plate is frequently used in the fixation of unstable distal radius fractures, but despite this there is a paucity of mid to long term outcome studies. The purpose of this study was to investigate the mid-term functional outcomes of elderly patients treated with a volar locking plate for unstable distal radius fractures. Methods: Thirty-two patients with a mean age of 74.1 (range, 65–85) years were followed for a mean of 39.1 (range, 30–81) months. Patients with follow-up periods of < 24 months were excluded from this study to investigate the mid-term clinical outcomes. The Mayo wrist score (MWS), grip strength and wrist range of motion were retrospectively reviewed at 12 months, 24 months and the latest follow-up (mean 39.1 months). Osteoarthritis status according to the system of Knirk and Jupiter was assessed at 24 months. Results: Significant improvements in MWS and grip strength were observed between 12 and 24 months but not between 24 months and the final follow-up. There was no significant difference in wrist range of motion between 12 and 24 months. The MWS of 14 patients with radiographic signs of osteoarthritis was not significantly different from that of 18 patients without radiographic signs of osteoarthritis. Conclusions: Elderly patients treated with the volar locking plate showed improved MWS and grip strength postoperatively after 12 months. Improvement in grip strength was slower than range of motion.

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Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-013-1767-9 ◽

2013 ◽

Vol 134 (2) ◽

pp. 197-205 ◽

Cited By ~ 44

Author(s):

Jörg Goldhahn ◽

Dorcas Beaton ◽

Amy Ladd ◽

Joy Macdermid ◽

Amy Hoang-Kim

Keyword(s):

Clinical Practice ◽

Clinical Outcome ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Core Set ◽

Standardized Reporting

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Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

Journal of Wrist Surgery ◽

10.1055/s-0038-1667302 ◽

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.

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Clinical Outcomes in Distal Radius Fractures Accompanied by Volar Lunate Facet Fragments: A Comparison between Dorsal and Volar Displaced Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835520500447 ◽

2020 ◽

Vol 25 (04) ◽

pp. 417-422 ◽

Cited By ~ 1

Author(s):

Hiroyuki Obata ◽

Kiyohito Naito ◽

Ayaka Kaneko ◽

Keniji Goto ◽

Yoichi Sugiyama ◽

...

Keyword(s):

Range Of Motion ◽

Distal Radius ◽

Fragment Size ◽

Perioperative Complications ◽

Postoperative Outcome ◽

Distal Radius Fractures ◽

Bone Fragment ◽

Radius Fractures ◽

Mayo Score ◽

Significant Difference

Background: The treatment strategy for distal radius fractures accompanied by volar lunate facet fragment is controversial. In most cases, only the bone fragment size was discussed and a plate for distal placement is selected due to the accompanying volar lunate facet fragment regardless of the direction of bone fragment displacement. In this study, we divided distal radius fractures accompanied by volar lunate facet fragment into dorsal and volar displaced fractures, and treated these surgically based on different treatment strategies. Methods: The subjects were 25 patients with distal radius fractures accompanied by volar lunate facet fragment treated by reduction and fixation using a volar locking plate (VLP) (male: 14, female: 11, mean age: 57.8 years old). A proximal VLP (PVLP) was selected for 13 dorsal displaced fractures and a distal VLP (DVLP) was selected for 12 volar displaced fractures. The range of motion, VAS, Q-DASH, and Mayo score were evaluated at 12 months after surgery, and compared. Results: No significant difference due to the difference in the direction of displacement was noted in the range of motion, VAS, Q-DASH, or Mayo score at 12 months after surgery and there were no perioperative complications. In addition, no re-displacement of volar lunate facet fragment was noted after surgery in any patient and bone fusion was observed. Conclusions: Reduction and fixation with a PVLP are possible even for dorsal displaced distal radius fractures accompanied by volar lunate facet fragment. For the volar displaced distal radius fractures, a favorable postoperative outcome is possible by applying a DVLP to the distal ulnar.

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OUTCOME OF UNSTABLE DISTAL RADIUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION VERSUS EXTERNAL FIXATION

Hand Surgery ◽

10.1142/s0218810412500165 ◽

2012 ◽

Vol 17 (02) ◽

pp. 173-179 ◽

Cited By ~ 4

Author(s):

Emmanuel P. Estrella ◽

Paulo L. Panti

Keyword(s):

Grip Strength ◽

Distal Radius ◽

Clinical Results ◽

Distal Radius Fractures ◽

Wrist Flexion ◽

Radius Fractures ◽

Wrist Extension ◽

Ulnar Deviation ◽

Mayo Wrist Score ◽

Score Range

The objective of this study was to compare the clinical results of unstable distal radius fractures treated with ORIF with plate and screws compared to EF. Patients with unstable distal radius fractures treated with ORIF or EF from January 2005 to December 2010 were reviewed in terms of the Modified Mayo Wrist Score, range of motion, pain, grip strength, and radiologic parameters. Results showed that there was no difference in the Modified Mayo Wrist Score between ORIF (17 patients) and EF (11 patients) (p = 0.07). The ORIF group had better wrist flexion, wrist extension, pronation and supination compared to the EF group (p < 0.05). There were no significant differences in terms of radial and ulnar deviation, grip strength, pain and postoperative radiologic parameters (p < 0.05). Better wrist flexion, wrist extension and forearm rotation can be expected in ORIF compared to EF in the management of unstable distal radius fractures.

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Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: A multicenter study of 73 fractures

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(98)80131-7 ◽

1998 ◽

Vol 23 (2) ◽

pp. 300-307 ◽

Cited By ~ 163

Author(s):

Peter R. Carter ◽

Hugh A. Frederick ◽

Georgiann F. Laseter

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Multicenter Study ◽

Open Reduction ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Low Profile

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Hematoma block for distal radius fractures – prospective, randomized comparison of two different volumes of lidocaine

Journal of International Medical Research ◽

10.1177/0300060518799883 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4535-4538 ◽

Cited By ~ 1

Author(s):

Hagay Orbach ◽

Nimrod Rozen ◽

Barak Rinat ◽

Guy Rubin

Keyword(s):

Distal Radius ◽

Analgesic Efficacy ◽

Fracture Site ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Vas Score ◽

Significant Difference ◽

Group A ◽

Vas Scores ◽

Group B

Objective This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. Methods Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. Results Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. Conclusion VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

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