Isolated Carpal Dislocation of the Pisiform with Distal Radius Fracture in Two Adults: A Rare Entity

Abstract Background Pisiform dislocations are an extremely rare injury. There are reports in the literature of isolated dislocations, but to our knowledge there are no reports of distal radius fractures with associated pisiform dislocations. Methods and Results We present two cases of isolated pisiform dislocation and distal radius fracture in the adult population. Both patients were managed conservatively with closed reduction in both the distal radius and pisiform, and subsequently achieved good pain relief and progressive return of wrist function. Conclusion For adult patients with distal radius fractures and an associated pisiform dislocation, successful closed reduction and immobilization can result in symptomatic improvement and return of function.

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Distal Radius Fractures: Evaluation of Closed Reduction and Percutaneous Kirschner Wire Pinning

Journal of Hand and Microsurgery ◽

10.1055/s-0038-1648334 ◽

2018 ◽

Vol 10 (03) ◽

pp. 134-138

Author(s):

Sezai Özkan ◽

Ritsaart Westenberg ◽

Lydia Helliwell ◽

Chaitanya Mudgal

Keyword(s):

Range Of Motion ◽

Distal Radius Fracture ◽

Distal Radius ◽

Closed Reduction ◽

Kirschner Wire ◽

The United States ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Urban City

Abstract Objective Closed reduction and percutaneous pinning (CRPP) is losing popularity as a treatment modality for distal radius fractures. However, in select cases, CRPP may have advantages relative to open reduction and internal reduction. We aimed to retrospectively assess the outcomes after CRPP for the treatment of distal radius fractures. Study Design This is a retrospective cohort study. Methods We used billing records to identify all skeletally mature patients with a distal radius fracture who were treated with CRPP by a single surgeon at a level I trauma center in an urban city in the United States. We assessed the medical charts and recorded demographics, trauma and treatment characteristics, radiographic characteristics, and outcomes. Results All patients had a good or excellent range of motion regarding forearm rotation, and almost 80% had good or excellent range of motion regarding flexion or extension of their wrist. One patient had a concern for pin tract infection, and one had subcutaneous migration of a pin, which were both treated by pin removal. Conclusion CRPP is a good option in patients with few and sizeable fracture fragments in patients with a distal radius fracture, and it should be considered as an effective tool to restore radiographic parameters and functional outcomes.

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Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽

10.1177/1558944721999733 ◽

2021 ◽

pp. 155894472199973

Author(s):

Nicholas Munaretto ◽

Adam Tagliero ◽

Raahil Patel ◽

Peter C. Rhee

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Case Series ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Functional Classification ◽

Radius Fractures ◽

Radiographic Outcomes ◽

Ipsilateral Hemiparesis

Background Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia. Methods Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union. Results There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries. Conclusions Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

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The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415624669 ◽

2016 ◽

Vol 41 (5) ◽

pp. 516-520 ◽

Cited By ~ 4

Author(s):

K. Kasapinova ◽

V. Kamiloski

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Triangular Fibrocartilage Complex ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Wrist Arthroscopy ◽

Radius Fractures ◽

Level Of Evidence ◽

Triangular Fibrocartilage ◽

A Prospective Study

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. Level of evidence: III

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Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417690464 ◽

2017 ◽

Vol 42 (5) ◽

pp. 487-492 ◽

Cited By ~ 7

Author(s):

M. J. Park ◽

J. P. Kim ◽

H. I. Lee ◽

T. K. Lim ◽

H. S. Jung ◽

...

Keyword(s):

Multicentre Study ◽

Distal Radius Fracture ◽

Distal Radius ◽

The Elderly ◽

Plaster Cast ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Cast Immobilization ◽

Level Of Evidence

We conducted a prospective randomized, multicentre study to compare short arm and long arm plaster casts for the treatment of stable distal radius fracture in patients older than 55 years. We randomly assigned patients over the age of 55 years who had stable distal radius fracture to either a short arm or long arm plaster cast at the first review 1 week after their injury. Radiographic and clinical follow-up was conducted at 1, 3, 5, 12 and 24 weeks following their injury. Also, degree of disability caused by each cast immobilization was evaluated at the patient’s visit to remove the cast. There were no significant differences in radiological parameters between the groups except for volar tilt. Despite these differences in volar tilt, neither functional status as measured by the Disabilities of the Arm, Shoulder and Hand, nor visual analogue scale was significantly different between the groups. However, the mean score of disability caused by plaster cast immobilization and the incidence rate of shoulder pain were significantly higher in patients who had a long plaster cast. Our findings suggest that a short arm cast is as effective as a long arm cast for stable distal radius fractures in the elderly. Furthermore, it is more comfortable and introduces less restriction on daily activities. Level of evidence: II

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Perfil epidemiológico das fraturas radiais distais em hospital de referência em Ribeirão Preto, Brasil

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v9i3.5112 ◽

2020 ◽

Vol 9 (3) ◽

Author(s):

Felipe Azevedo Mendes de Oliveira ◽

Thiago Agostini Pereira Albeny ◽

Luis Guilherme Rosifini Alves Rezende ◽

Filipe Jun Shimaoka ◽

Amanda Favaro Cagnolati ◽

...

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Case Series ◽

High Energy ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Distal Radial Fracture ◽

Fracture Treatment ◽

Radius Fractures ◽

Distal Radial Fractures

Objetivo: Avaliar o perfil epidemiológico das fraturas do rádio distal em hospitais de referência em Ribeirão Preto(SP), Brasil. Não existem dados suficientes na literatura nacional que corroborem com o perfil epidemiológico das fraturas do rádio distal. Métodos: 245 pacientes apresentaram 254 fraturas do rádio distal, ocorridas entre 2014 a 2017 foram avaliadas retrospectivamente para obtenção do perfil epidemiológico. Os fatores analisados foram idade e sexo, mecanismo do trauma, sazonalidade, tipo de fratura baseada na Classificação AO, presença de exposição óssea, lesões associadas, tipo de tratamento realizado (conservador ou cirúrgico) e o tipo de implante utilizado nos tratamentos cirúrgicos. Resultados: 60,2% dos pacientes participantes eram do sexo masculino e 39,8% do sexo feminino, distribuídos de forma bimodal. A média de idade foi 45,4 anos. Fraturas expostas corresponderam a 92,1% das fraturas e 7,9% representaram as expostas. Pacientes politraumatizados representaram 62,6%. O tempo médio de internação foi 8,09 dias. Conclusão: Apesar do padrão de fraturas mostrar semelhanças com outros estudos, o padrão apresentado pode não traduzir, de forma homogênea, o padrão obtido em outras metrópoles e grandes centros.Descritores: Fraturas do Rádio; Traumatismos do Punho; Epidemiologia; Hospitais Especializados.ReferênciasBruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-45.Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97.Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-312.Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124-28.Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One. 2012;7(8):e43367.Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-96.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56(5):391-93.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Tsai CH, Muo CH, Fong YC, et al. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int. 2011;22(11):2809-815.Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-13. Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65(4):432-33.Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.Pagano M, Gauvreau K. Princípios de Bioestatística. 2. ed. São Paulo: Pioneira Thompson Learning; 2004. Court-Brown CM. Epidemiologia das fraturas e luxações. In: Court-Brown CM et al. (ed.); Fraturas em adultos de Rockwood Green. 8. ed. Barueri, SP: Manole; 2016.Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313-19.Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):96-106.

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Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-3097-8 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 5

Author(s):

Johanna Rundgren ◽

Alicja Bojan ◽

Cecilia Mellstrand Navarro ◽

Anders Enocson

Keyword(s):

Observational Study ◽

Distal Radius Fracture ◽

Distal Radius ◽

Current Treatment ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Fracture Classification ◽

Radius Fractures ◽

Treatment Regimens ◽

Fracture Register

Abstract Background Distal radius fractures are the most common of all fractures. Optimal treatment is still debated. Previous studies report substantial changes in treatment trends in recent decades. Few nation-wide studies on distal radius fracture epidemiology and treatment exist, none of which provide detailed data on patient and injury characteristics, fracture pattern and mortality. The aim of this study was to describe the epidemiology, fracture classification, current treatment regimens and mortality of distal radius fractures in adults within the context of a large national register study. Methods We performed a descriptive study using prospectively registered data from the Swedish fracture register. Included were all non-pathological distal radius fractures registered between January 1st 2015 and December 31st 2017 in patients aged 18 years and above. Nominal variables were presented as proportions of all registered fractures. Results A total of 23,394 distal radius fractures in 22,962 patients were identified. The mean age was 62.7 ± 17.6 years for all, 65.4 ± 16.0 for women and 53.6 ± 20.0 for men. A simple fall was the most common cause of injury (75%, n = 17,643/23,394). One third (33%, n = 7783/21,723) of all fractures occurred at the patients’ residence. 65% (n = 15,178/23,394) of all fractures were classified as extra-articular AO-23-A, 12% (n = 2770/23,394) as partially intra-articular AO-23-B and 23% (n = 5446/23,394) as intra-articular AO-23-C. The primary treatment was non-surgical for 74% (n = 17,358/23,369) and surgical for 26% (n = 6011/23,369) of all fractures. Only 18% of the AO-23-A fractures were treated surgically, compared to 48% of the AO-23-C fractures. The most frequently used surgical method was plate fixation (82%, n = 4954/5972), followed by pin/wire fixation (8.2%, n = 490/5972), external fixation (4.8%, n = 289/5972) and other methods (4.0%, n = 239/5972). The overall 30-day mortality was 0.4% (n = 98/23,394) and the 1-year mortality 2.9% (n = 679/23,394). Conclusion This nation-wide observational study provides comprehensive data on the epidemiology, fracture classification and current treatment regimens of distal radius fractures in a western European setting. The most common patient was an eldery woman who sustained a distal radius fracture through a simple fall in her own residence, and whose fracture was extra-articluar and treated non-surgically.

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Management of Distal Ulnar Fracture Combined with Distal Radius Fracture

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

10.1142/s2424835516400075 ◽

2016 ◽

Vol 21 (02) ◽

pp. 155-160 ◽

Cited By ~ 5

Author(s):

Jae Kwang Kim ◽

Jong-Oh Kim ◽

Yong-Do Koh

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Surgical Approaches ◽

Radius Fractures ◽

Ulnar Styloid ◽

Cast Immobilization ◽

Distal Ulna ◽

Ulnar Styloid Fracture

The distal ulna is composed of the ulnar styloid, ulnar head, and distal ulnar metaphyseal area. Most of distal ulnar metaphyseal fractures are associated with distal radius fractures and this incidence tends to be greater in osteoporotic elderly. Consideration of the treatment of distal ulna metaphyseal fracture should be addressed after treating a distal radius fracture. If it is stable, cast immobilization is preferred, however, if it shows malalignment or instability, an operative method should be considered. More than half of distal radius fractures are combined with an ulnar styloid fracture, and considerable cases of ulnar styloid fractures result in nonunion. However, ulnar styloid nonunion usually does not cause any problems on the wrist. Recent studies of distal radius fractures treated using a volar locking plate have reported that neither the initial displacement nor the size of a concomitant ulnar styloid fracture affects clinical outcome, which suggests surgical approaches may usually not be indicated for ulnar styloid fractures.

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Patients at Increased Risk of Major Adverse Events Following Operative Treatment of Distal Radius Fractures: Inpatient versus Outpatient

Journal of Wrist Surgery ◽

10.1055/s-0037-1599216 ◽

2017 ◽

Vol 06 (03) ◽

pp. 220-226 ◽

Cited By ~ 5

Author(s):

Paul Whiting ◽

Christopher Rice ◽

Frank Avilucea ◽

Catherine Bulka ◽

Michelle Shen ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Distal Radius Fracture ◽

Operative Treatment ◽

Distal Radius ◽

Outpatient Surgery ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Matching Algorithm

Purpose The purpose of this study was to compare complication rates following inpatient versus outpatient distal radius fracture ORIF and identify specific complications that occur at increased rates among inpatients. Methods Using the 2005–2013 ACS-NSQIP, we collected patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complications following isolated ORIF of distal radius fractures. A propensity score matched design using an 8-to-1 “greedy” matching algorithm in a 1:4 ratio of inpatients to outpatients was utilized. Rates of minor, major, and total complications were compared. A multinomial logistic regression model was then used to assess the odds of complications following inpatient surgery. Results Total 4,016 patients were identified, 776 (19.3%) of whom underwent inpatient surgery and 3,240 (80.3%) underwent outpatient surgery. The propensity score matching algorithm yielded a cohort of 629 inpatients who were matched with 2,516 outpatients (1:4 ratio). After propensity score matching, inpatient treatment was associated with increased rates of major and total complications but not with minor complications. There was an increased odds of major complications and total complications following inpatient surgery compared with outpatient surgery. There was no difference in odds of minor complications between groups. Conclusion Inpatient operative treatment of distal radius fractures is associated with significantly increased rates of major and total complications compared with operative treatment as an outpatient. Odds of a major complication are six times higher and odds of total complications are two and a half times higher following inpatient distal radius ORIF compared with outpatient. Quality improvement measures should be specifically targeted to patients undergoing distal radius fracture ORIF in the inpatient setting.

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Acute Isolated Flexor Tendon Laceration Associated With a Distal Radius Fracture

Hand ◽

10.1177/1558944716668850 ◽

2016 ◽

Vol 12 (3) ◽

pp. NP39-NP42 ◽

Cited By ~ 2

Author(s):

J. Ryan Hill ◽

Ram K. Alluri ◽

Alidad Ghiassi

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Flexor Tendon ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Flexor Tendon Rupture ◽

Tendon Laceration

Background: Subacute rupture of the flexor tendons secondary to distal radius fractures is well documented. Recently, accounts of flexor tendon rupture following open reduction internal fixation have been associated with volar plate fixation. However, discovery of an occult traumatic flexor tendon laceration during fixation of an acute distal radius fracture is not well described. This case indicates the importance of careful preoperative and intraoperative examination of the flexor tendons in the setting of comminuted distal radius fractures. Methods: A forty-seven-year-old male sustained a comminuted, dorsally displaced distal radius fracture. Initial and post-reduction examinations revealed no gross functional abnormalities. Upon operative fixation of the fracture, laceration of the flexor digitorum profundus (FDP) tendon to the index finger was incidentally noted at the level of the fracture site. Results: Due to extensive dorsal comminution, shortening, and the presence of a lunate facet fragment, we performed volar fragment-specific and dorsal spanning bridge plate fixation. The proximal and distal ends of the FDP tendon were marked, but repair was deferred until implant removal. This allowed for proper informed consent and avoided potential compromise of the repair given the presence of a volar implant. Conclusions: Acute flexor tendon rupture secondary to closed distal radius fractures may go unnoticed if a high index of suspicion is not maintained. Delayed diagnosis of these ruptures convolutes the mechanism of injury and disrupts the recovery process. Hand surgeons should be vigilant in examining flexor tendon function during the preoperative evaluation, especially in the setting of acute high-energy injury.

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Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173932 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1004 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Dash ◽

Manish Kumar Sharma ◽

Sanket Mishra ◽

Hatia Marandi ◽

Aurobinda Das ◽

...

Keyword(s):

Internal Fixation ◽

Distal Radius Fracture ◽

Distal Radius ◽

Functional Recovery ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Dash Score ◽

Radius Fractures ◽

Articular Fractures ◽

Group I

Background: Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An attempt was made to analyze patients treated with Ex-Fix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Ex-fix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications.Methods: A prospective trial was undertaken at our hospital with 35 patients,all aged >20 yrs with closed distal radius fracture and divided into two groups: group I (Ex-fix with or without percutaneous k-wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year, 6 months average.Results: Group I consumed significant less operative time, fluoroscopic exposure, reduced hospital stay, quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with Ex-Fix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &1 case of pin tract infection with ex-fix application was observed. Conclusions: Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext-fixation can be considered as a primary treatment modality in the extra-articular fractures in young or even intra-articular fractures in the elderly.

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