Preexisting Carpal and Carpometacarpal Osteoarthritis Has No Impact on Function after Distal Radius Fractures

Background Functional outcomes of distal radius fractures vary widely regardless of treatment methods. Purpose This study aims to verify whether preexisting carpal and carpometacarpal (CMC) osteoarthritis (OA) will negatively impact wrist functional outcome in patients with distal radius fractures. Patients and Methods A retrospective case–control study was done using a prospective trauma database. Patients were matched 1:1 in two groups based on the presence of wrist or carpal arthritis (OA). The groups were matched for sex, follow-up, and treatment type. Patients were followed up for a minimum of 1 year and functional outcomes were assessed using validated scores. Results A total of 61 patients were included. Mean age was 63 years (range: 20–85) and average follow-up was 26 months. There were 31 patients in the OA+ group and 30 in the OA− group. Forty-one patients were treated surgically and 20 nonoperatively. None of the patients in the OA− developed OA during follow-up. Both groups were comparable for sex, residual deformity, and follow-up. There was no significant difference for the visual analog scale, Short Form-12, Quick Disability Arm Shoulder Hand, and Patient-rated Wrist Evaluation, or for radiographic outcomes. Conclusion Preexisting OA in the wrist or CMC does not seem to impact outcomes of distal radius fractures, regardless of treatment, age, or sex. Although this is a negative study, the results are important to help counsel patients with distal radius fractures. Further work must be done to identify other potential causes for negative outcomes. Level of Evidence Level III, prognostic study.

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Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation

The Open Orthopaedics Journal ◽

10.2174/1874325001812010033 ◽

2018 ◽

Vol 12 (1) ◽

pp. 33-40 ◽

Cited By ~ 2

Author(s):

Jonathan Lans ◽

Alejandro Lasa ◽

Neal C. Chen ◽

Jesse B. Jupiter

Keyword(s):

Distal Radius ◽

Functional Outcomes ◽

Primary Treatment ◽

Contralateral Side ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Interosseous Ligament ◽

Additional Surgery ◽

Osteoarthritis Of The Wrist

Background:The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable.Objective:The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures.Methods:We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score.Results:There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL.Conclusion:In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.

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Redisplacement of paediatric distal radius fractures: what is the problem?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210111 ◽

2021 ◽

pp. 1-8

Author(s):

Diogo M.C. Constantino ◽

Luis Machado ◽

Marcos Carvalho ◽

João Cabral ◽

Pedro Sá Cardoso ◽

...

Keyword(s):

Risk Factor ◽

Distal Radius ◽

Closed Reduction ◽

Significant Risk ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Cast Immobilization ◽

Significant Difference

Purpose Distal radius fractures represent one of the most common fractures in children. Our purpose is to analyze risk factors for redisplacement in children with distal radius fractures treated by means of closed reduction and plaster cast immobilization. Methods Retrospective study, including children under the age of 17 years, who underwent closed manipulation and cast immobilization for a distal third radius fracture, between 2012 and 2015. Preoperative radiographs were reviewed for initial translation, angulation and shortening, distance of the fracture from the physis, degree of fracture obliquity and the presence of an ulna fracture. Postoperative radiographs were analyzed for translation, angulation and shortening, as well as the quality of closed reduction. Cast index, gap index and three-point index, were measured on the postoperative radiographs. Redisplacement and re-intervention during follow-up were registered. Results A total of 26 patients were included in this study. Comparison between post-reduction and immediate post-cast removal radiographs did not show any statistically significant difference between translation or shortening. Coronal (p = 0.002) and sagittal (p = 0.002) angulation showed a statistically significant difference, but both median values remained below cut-off values for redisplacement. Redisplacement was observed in four patients. Only one patient underwent remanipulation. All four had full remodelling and proper radiological alignment at final follow-up. Quality of reduction was found to be a statistically significant risk factor for redisplacement (p = 0.013). Conclusion Closed reduction and cast immobilization under general anaesthesia yields good results in the treatment of distal forearm fractures in paediatric patients. Quality of reduction was the only risk factor that we found to be predictive of redisplacement. Level of Evidence: Level III – Retrospective comparative study

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Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures

The Bone & Joint Journal ◽

10.1302/0301-620x.103b.bjj-2020-2026.r1 ◽

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.

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Functional Outcomes in Volar-Displaced Distal Radius Fractures Patients with Marginal Rim Fragment Treated by Volar Distal Locking Plates

Journal of Hand and Microsurgery ◽

10.1055/s-0038-1675245 ◽

2018 ◽

Vol 11 (02) ◽

pp. 100-105 ◽

Cited By ~ 4

Author(s):

Kiyohito Naito ◽

Yoichi Sugiyama ◽

Mayuko Kinoshita ◽

Hiroyuki Obata ◽

Kenji Goto ◽

...

Keyword(s):

Distal Radius ◽

Functional Outcomes ◽

Visual Analog Scale Score ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Pronator Quadratus ◽

Ao Classification ◽

The Mean ◽

Pronator Quadratus Muscle

Abstract Background Treatment of volar-displaced distal radius fractures (DRF) accompanied by marginal rim fragment has recently been actively discussed. It is difficult to obtain a sufficient buttress effect on this fragment. Therefore, we actively apply a distal volar locking plate (DVLP) to fractures with this fragment. Here, we report the treatment outcomes and caveats of surgery of fractures with this fragment. Materials and Methods The subjects were 32 patients (male: 11, female: 21, and mean age: 59.4 years) with volar dislocated DRF accompanied by the marginal rim fragment treated using DVLP. The fracture type of AO classification was B3 in 6 patients, C1 in 12, C2 in 6, and C3 in 8. Results The mean duration of follow-up was 13.8 (12–30) months. The plate could be covered with the pronator quadratus muscle in surgery in all patients. On the final follow-up, visual analog scale score was 1.4/10, quick disabilities of the arm, shoulder, and hand score was 9.2/100, and the Mayo wrist score was 93.7/100. No complication was observed in the soft tissue, such as the nerves and flexor tendons. Conclusion The factor determining retention of the reduction position of the marginal rim fragment is a sufficient buttress effect, and DVLP is a useful implant in terms of this point.

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Distal Radius Fractures: Does Obesity Affect Fracture Pattern, Treatment, and Functional Outcomes?

Hand ◽

10.1177/1558944717750915 ◽

2018 ◽

Vol 14 (3) ◽

pp. 398-401 ◽

Cited By ~ 1

Author(s):

Michael D. Montague ◽

Jesse T. Lewis ◽

Obadah Moushmoush ◽

Jaiyoung Ryu

Keyword(s):

Distal Radius ◽

Retrospective Review ◽

Functional Outcomes ◽

Nonoperative Treatment ◽

Fracture Pattern ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Complex Part ◽

Point Increase ◽

Significant Difference

Background: Distal radius fractures (DRFs) are 16% of fractures treated by orthopedic surgeons. Obesity’s influence on DRF complexity has not been studied. This study was undertaken to determine if body mass index (BMI) affects DRF pattern, treatment, and functional outcomes. Methods: Part 1 was a retrospective review of patients who sustained a DRF after a fall from standing height with no prior reduction or treatment. Radiographs were classified as “simple” or “complex.” Part 2 consisted of contacting patients from Part 1 and obtaining a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Retrospective review also identified patients who failed initial nonoperative treatment. Fracture pattern, failure of nonoperative treatment, and QuickDASH scores were compared with BMI at the time of injury. Results: For Part 1, 130 patients (132 wrists) were identified. Average age was 57 years, 77% were female, and average BMI was 28.2 kg/m2. Each point increase in BMI increased the chance of having a complex DRF (odds ratio = 1.07). Part 2 identified 50 patients who completed a QuickDASH at an average of 4.6 years after injury. Those with a BMI <25 kg/m2 (n = 15) had an average QuickDASH score of 37; patients with a BMI ≥25 kg/m2 (n = 35) had an average QuickDASH score of 18. Increasing BMI was suggestive of a lower QuickDASH score ( P = .08). No significant difference was found with respect to BMI and failure of nonoperative treatment. Conclusions: A higher BMI increases the odds of a complex DRF. Despite more complex fractures, overweight patients may experience less disability after sustaining a DRF.

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Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant

Journal of Wrist Surgery ◽

10.1055/s-0038-1669438 ◽

2018 ◽

Vol 07 (05) ◽

pp. 358-365

Author(s):

Schneider Rancy ◽

Stephanie Malliaris ◽

Eric Bogner ◽

Scott Wolfe

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Distal Radius ◽

Fracture Fixation ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Level Of Evidence ◽

Promising Alternative ◽

Pain Scores

Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3–20), VAS pain scores averaged 0.6 (range, 0–8) and PRWE averaged 12.1 (range, 0–53.5). Grip strength of the operated hand averaged 58 lbs (range, 20–130). ROM included: wrist flexion 73° (50–95), wrist extension 78° (60–110), pronation 77° (60–90), supination 79° (60–90), ulnar deviation 31° (5–45), and radial deviation 17° (10–30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.

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The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417721446 ◽

2017 ◽

Vol 43 (2) ◽

pp. 131-136 ◽

Cited By ~ 4

Author(s):

M. Å. Wadsten ◽

G. O. Sjödén ◽

G. G. Buttazzoni ◽

C. Buttazzoni ◽

E. Englund ◽

...

Keyword(s):

Quality Of Life ◽

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Pain Visual Analogue Scale ◽

Level Of Evidence

Late displacement of distal radius fractures, still in acceptable radiological position after 1–2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10–14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires. Level of evidence: II

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Changing To Removable Casts During The Coronavirus Pandemic – Has It Affected Outcomes For Distal Radius Fractures?

10.21203/rs.3.rs-619698/v1 ◽

2021 ◽

Author(s):

Samuel Newman ◽

Amit Singh ◽

Ashwanth Ramesh ◽

Ebrahim Mahomed ◽

Timothy Millar

Keyword(s):

Distal Radius ◽

District General Hospital ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Casting Technique ◽

Significant Difference ◽

The Mean ◽

Limb Fractures ◽

Upper Limb Fractures

Abstract Background: BOAST (British Orthopaedic Association Standards for Trauma & Orthopaedics) guidelines recommended that during the coronavirus pandemic most upper limb fractures should be treated conservatively, and removable casts should be used, where possible. As a result, our district general hospital started using a new soft combination (soft-combi) casting technique for conservative management of distal radius fractures (DRFs) in an attempt to reduce follow-up attendances.Aims: To assess if radiological outcomes of soft-combi casts are better or worse than previously used rigid casts for DRFs.Methods: 20 DRFs treated with soft-combi casts were compared with 20 DRFs treated with the old rigid cast types. Radiological parameters were measured pre-manipulation, post-manipulation, at 2-week follow-up, and at final follow-up. Statistical analysis was performed to assess for significant differences seen at follow-up between the groups.Results: The mean loss of volar angulation seen at 2-week follow-up was 4.9 degrees for the rigid casts vs. 1.5 degrees for the soft-combi casts (p=0.158). The mean loss of radial height after 2 weeks was 0.2 mm vs 0.5 mm (p=0.675), and the mean loss of radial inclination was 2.0 degrees vs 1.0 degrees (p=0.349), respectively.Conclusion: The soft-combi casts appeared to be equally effective at maintaining the reduction of DRFs compared to their rigid counterparts, as no statistically significant difference was seen in our study. We can be reassured that continued use of these removable casts in the current climate is unlikely to have a detrimental effect on outcomes for DRFs.

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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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“Age Is Just a Number”: Distal Radius Fractures in Patients Over 75

Hand ◽

10.1177/1558944720906552 ◽

2020 ◽

pp. 155894472090655

Author(s):

Jacob E. Tulipan ◽

Aron Lechtig ◽

Tamara D. Rozental ◽

Carl M. Harper

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Activity Level ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Post Injury ◽

Significant Difference ◽

Outcome Differences

Background: Management of distal radius fractures in patients over 65 is a topic of significant study, but there are variations within this group in terms of independence and activity level. This study compares the outcomes of operative distal radius fracture treatment in patients over 75 with those aged 65 to 74, to evaluate the effects of patient demand and advanced age on outcome. Methods: A retrospective review of a single-institution distal radius fracture database was performed. All patients over age 65 were evaluated for inclusion. Patient factors including activity, independence level, and quick disabilities of the arm, shoulder and hand (QuickDASH) score were recorded. Patients were selected for open reduction and internal fixation (ORIF) based on a discussion between the patient and the treating surgeon. Outcome measures including QuickDASH were recorded at 1-year post-injury. Patients aged 65 to 74 and 75 and over were compared to evaluate for demographic, functional, and outcome differences. Results: In all, 75 patients were included in the study. Fifty-one patients were aged 65 to 74, and 24 patients were aged over 75. The majority of patients rated themselves as “completely independent” and “active,” the highest levels of each. There was no difference in QuickDASH scores between those patients who rated themselves as completely partially independent, or active versus moderately active. There was no statistically significant difference in QuickDASH or range of motion parameters at final follow-up. Conclusions: This study demonstrates that, in a group of patients with high levels of independence and activity, outcomes are similar in patients aged 65 to 74 and over 75 at 1 year following distal radius ORIF.

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