scholarly journals Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study

2019 ◽  
Vol 08 (05) ◽  
pp. 408-415
Author(s):  
Marcio Aurelio Aita ◽  
Fabio Lucas Rodrigues ◽  
Karyse Helena Crispim Ribeiro Alves ◽  
Ricardo Kaempf de Oliveira ◽  
Gustavo Mantovani Ruggiero ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Grip Strength ◽  
External Fixation ◽  
Distal Radius ◽  
Randomized Study ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Dynamic Fixation ◽  
The Mean

Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.

scholarly journals A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients Following Distal Radius Fractures Treated With 4- and 6-Week Cast Immobilization

2021 ◽  
Vol 10 (24) ◽  
pp. 5774
Author(s):  
Jarosław Olech ◽  
Grzegorz Konieczny ◽  
Łukasz Tomczyk ◽  
Piotr Morasiewicz
Keyword(s):  
Muscle Strength ◽  
Elderly Patients ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Cast Immobilization ◽  
The Mean

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: 1) muscle strength, 2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mulrain ◽  
K Joshi ◽  
F Doyle ◽  
A Abdulkarim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Volar Plating ◽  
Radius Fractures ◽  
Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

2017 ◽  
Vol 22 (04) ◽  
pp. 423-428 ◽  
Author(s):  
Yoshihiro Abe ◽  
Masahiro Suzuki ◽  
Hiromasa Wakita
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Locking Plates ◽  
Radius Fractures ◽  
Radial Inclination ◽  
The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

scholarly journals The relationship between radiological alignment of united distal radius fractures and functional and patient-perceived outcomes in elderly patients

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668497 ◽  
Author(s):  
Erik Hohmann ◽  
Mahendrakumar Meta ◽  
Vasudev Navalgund ◽  
Kevin Tetsworth
Keyword(s):  
Elderly Patients ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Pinch Strength ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Perceived Outcomes ◽  
The Relationship

Purpose: The purpose of this study was to investigate the relationship between radiological alignment and functional outcomes including strength, range of motion (ROM), and disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores in elderly patients with united distal radius fractures. Methods: We reviewed 118 patients (mean age of 76.2 ± 9.5 years, mean follow-up 36.3 ± 17.6 months). Outcome measures included the DASH and PRWE scores, ROM, and grip and pinch strength were measured using a validated mobile hand-held dynamometer. Radial height, radial inclination, ulnar variance, and palmar tilt were measured on standard radiographs. Results: The mean total score for DASH was 4.9 ± 7.4 and 6.9 ± 11 for the PRWE. There were significant differences in ROM for palmar flexion and ulnar deviation between the affected wrist and the normal wrist. Linear regression revealed significant relationships for the following variables: between DASH and radiological palmar tilt, between PRWE and radiological palmar tilt, between grip strength and radial inclination, between grip strength and radial height, and between grip strength and ulnar variance. Conclusion: This study suggests that minor deformities of the distal radius following distal radius fractures treated with either operative or nonoperative treatment are unlikely to be clinically relevant and have no impact on patient perceived outcomes for elderly patients.

scholarly journals Lessons learned with the Cobra prosthesis in elderly patients with complex distal radius fractures—a retrospective follow-up study

2021 ◽  
Author(s):  
Stefan Benedikt ◽  
Peter Kaiser ◽  
Gernot Schmidle ◽  
Tobias Kastenberger ◽  
Kerstin Stock ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
Lessons Learned ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Extensor Pollicis Longus ◽  
Follow Up Study ◽  
Alternative Treatment Option ◽  
The Mean

Abstract Introduction Recently, the Cobra prostheses were introduced in the treatment of distal radius fractures (DRF) of elderly patients. Fracture prostheses provide an alternative treatment option for complex fractures where conservative therapy seems not acceptable and osteosynthesis seems not possible. Data reporting the feasibility of the Cobra prosthesis are sparse. Therefore, this retrospective follow-up study investigated the clinical and radiological mid-term outcome of the Cobra implant in complex DRFs of elderly patients. Materials and methods Thirteen patients (mean age 73.5 years, range 65–87 years) were retrospectively evaluated with at least a 1-year follow-up after surgery. Objective and subjective clinical parameters as well as the radiological outcome and complications were analyzed. Results The mean follow-up period was 31.2 months. Seven cases required a cemented prosthesis. The mean relative range-of-motion compared to the healthy side was 72.3% and 51.8% for extension and flexion, respectively, and 87.9% and 85.7% for pronation and supination, respectively. The mean grip strength was 78.3% compared to the non-operated side. Eight patients were very satisfied, five patients were partly satisfied with the result. The DASH, PRWE, MHQ and Lyon-Scores averaged 39.1, 36.2, 64.9 and 63.3 points, respectively. The mean VAS-Score for pain was 1.1 at rest and 3.2 during activities. Perioperative complications included one dissection of the extensor pollicis longus tendon, one heterotopic ossification, one radiocarpal dislocation and two cases of an ulnar impaction syndrome due to implant subsidence. Conclusion The prosthetic treatment of complex DRFs in elderly patients with the Cobra implant led to clinically and radiologically satisfactory mid-term results. The Cobra prosthesis still does not represent a gold standard but can be regarded as a feasible salvage option for complex DRFs when osteosyntheses may not be possible and non-operative treatment will lead to further functional restrictions and wrist pain during performing activities of daily life in high functional demand patients.

Volar locking plate fixation versus external fixation of distal radius fractures: a meta-analysis

2017 ◽  
Vol 43 (9) ◽  
pp. 954-960 ◽  
Author(s):  
Conor J. C. Gouk ◽  
Randip R. Bindra ◽  
Drew J. Tarrant ◽  
Michael J. E. Thomas
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Cochrane Library ◽  
Complication Rates ◽  
Locking Plates ◽  
Radius Fractures ◽  
Radiographic Parameters ◽  
Operation Rate

This meta-analysis evaluates reported outcomes of volar locking plates versus external fixation for management of distal radius fractures. A comprehensive literature search was carried out using PubMed, embase, MEDLINE, and the Cochrane Library. Multiple outcomes were analysed: study characteristics, objective/subjective outcome measures, radiographic parameters, and complication rates. Nine studies containing 780 participants met the outlined inclusion criteria. Disabilities of the arm, shoulder, and hand scores significantly favoured volar locking plates, but only at 3 months was the difference clinically meaningful. Grip strength, extension, and supination were better in the volar locking plates group in the early post-operative period, but were similar at 12 months. Ulnar variance was better restored by volar locking plates. The volar locking plates group was associated with higher re-operation rate, and the external fixation group had a higher infection rate. Current literature suggests that volar locking plates can provide better subjective scores and radiographic parameters, especially in the first 3 months, but may be associated with a higher re-operation rate.

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

2018 ◽  
Vol 23 (02) ◽  
pp. 238-242 ◽  
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.

scholarly journals Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis

2013 ◽  
Vol 8 (2) ◽  
pp. 67-75 ◽  
Author(s):  
J. C. Goslings ◽  
Monique M. J. Walenkamp ◽  
Abdelali Bentohami ◽  
M. Suzan H. Beerekamp ◽  
Rolf W. Peters ◽  
...  
Keyword(s):  
Functional Outcome ◽  
External Fixation ◽  
Distal Radius ◽  
Locking Plate ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Plate Versus ◽  
Volar Locking Plate ◽  
Radius Fractures

Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

2021 ◽  
Author(s):  
Lili E. Schindelar ◽  
Richard M. McEntee ◽  
Robert E. Gallivan ◽  
Brian Katt ◽  
Pedro K. Beredjiklian
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Open Reduction ◽  
The Elderly ◽  
Distal Radius Fractures ◽  
Implant Design ◽  
Complication Rates ◽  
Radius Fractures ◽  
Hardware Failures

Abstract Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.

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