Mini-Invasive Surgery for Distal Radius Fractures: A Double Incision under 12 mm

2020 ◽  
Author(s):  
Elisabete Ribeiro ◽  
Gustavo Campanholi ◽  
Marcelo Acherboim ◽  
Gustavo Mantovani Ruggiero
Keyword(s):  
Distal Radius ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Radiological Results ◽  
Normal Ranges ◽  
Case Series Study ◽  
Clinical And Radiological Results

Abstract Background Distal radius fracture is one of the most common lesions in adults. Surgical techniques have evolved considerably with a clear tendency toward mini-invasive techniques. Objective Our aim is to push the limits to a 12 mm approach and evaluate its clinical and radiological results. Patients and Methods Ten fractures in nine patients were operated by a double incision with mean size 11.50 ± 3.41 mm (range 8.00–1.00) and using a specially designed volar distal locking plate. Results At the latest follow-up, visual analogue scale score for pain (0.20 ± 0.63 during rest and 0.60 ± 1.07 while making efforts) and quick DASH (quick Disabilities of the Arm, Shoulder and Hand) score (6.14 ± 7.43) were extremely low. All the range of motion parameters and grip strength were above the 95% barrier of the contralateral side, with exception of ulnar deviation. Radiological parameters obtained were located within the normal ranges. Time to return to independent daily tasks and work was 6.67 ± 5.15 and 10.14 ± 14.24 days, respectively. One case of transient carpal tunnel syndrome was solved with watchful waiting and one case of extensor tendons impingement was improved after plate removal. All patients were completely satisfied at the end of the treatment. Conclusion In conclusion, mini-invasive volar technique for distal radius fractures with special designed plates in carefully selected patients allowed us to obtain good clinical and radiological results, minimal complications, fast recovery, and high-satisfactory rates. Level of Evidence This is a Level IV, case series study.

scholarly journals PROPOSAL TOMOGRAPHIC CLASSIFICATION FOR INTRA-ARTICULAR DISTAL RADIUS FRACTURES

2018 ◽  
Vol 26 (1) ◽  
pp. 54-58
Author(s):  
VALDÊNIA DAS GRAÇAS NASCIMENTO ◽  
ANTONIO CARLOS DA COSTA ◽  
LEANDRO RODRIGUES DA SILVA ◽  
DIEGO FIGUEIRA FALCOCCHIO ◽  
IVAN CHAKKOUR ◽  
...  
Keyword(s):  
Distal Radius ◽  
Descriptive Analysis ◽  
Case Series ◽  
Descriptive Study ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Tomographic Images ◽  
Fracture Complexity ◽  
Cortical Depression

ABSTRACT Objective: The objective of this study was to present a proposal tomographic classification for intra-articular distal radius fractures. Methods: This descriptive study was based on observing tomographic images from 74 patients with distal radius fractures. The cases were grouped by similarity according to the presence of several parameters which determine fracture complexity; the results of the descriptive analysis were transcribed as tomographic classification. Results: The proposal tomographic classification for intra-articular distal radius fractures comprised three major groups and nine sub-groups, which are organized by increasing severity according to the presence of spacing between articular fragments, angulation, loss of radial height, cortical depression, and associated dislocation. Conclusion: This proposal tomographic classification for intra-articular distal radius fractures can help professionals indicate therapeutic options. Level of Evidence IV; Case series.

scholarly journals Resultados clínico-radiológicos en pacientes jóvenes con fractura articular completa de radio distal tratados con placa palmar bloqueada. [Clinical and Radiological Results in Young Patients with Complete Articular Distal Radius Fractures Treated with Volar Locked Plate.]

10.15417/496 ◽  
2016 ◽  
Vol 81 (1) ◽  
pp. 42
Author(s):  
Pablo De Carli ◽  
Ezequiel Ernesto Zaidenberg ◽  
Gerardo Gallucci ◽  
Nicolas Santiago Piuzzi ◽  
Jorge Guillermo Boretto
Keyword(s):  
Distal Radius ◽  
Young Patients ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Locked Plate ◽  
Radiological Results ◽  
Quick Dash ◽  
Clinical And Radiological Results

<p><strong>Introducción:</strong> Las fracturas articulares completas del radio distal (tipo C - AO) en pacientes jóvenes representan un desafío por la demanda funcional que tiene este subgrupo de pacientes y la necesidad de una reducción articular para evitar artrosis postraumática.</p><p>El <strong><em>objetivo</em></strong> del estudio es evaluar los resultados clínicos y radiológicos de pacientes menores de 65 años con fracturas de radio distal (FRD) tipo C tratadas mediante placa palmar bloqueada (PPB).</p><p><strong>Material y métodos:</strong> Se analizaron 292 pacientes con FRD, de los cuales 71 cumplieron los criterios de inclusión (FRD articular completa, tratados con PPB, edad entre 18-65 años y un seguimiento mínimo de 6 meses). 45 pacientes eran mujeres. La edad media fue de 51 años (20-64 años). El seguimiento promedio fue de 28 meses (6-71 meses). Se realizo una evaluación clinica objetiva (rango de movilidad) y subjetiva de la funcion (Quick DASH y EVA funcional) y del dolor (EVA reposo y escala de Swanson), además de una valoración radiológica.</p><p><strong>Resultados:</strong> El Quick-DASH promedio fue de 8,7 (0 - 60), con un EVA funcional 8,9 (3-10). La movilidad final promedio y comparativa con el lado sano fue: flexo-extensión 91%, pronosupinación 97%, desvíos cubital-radial 90%. Respecto del dolor, la EVA promedio de 0,4  (0 - 10). Recuperación de los parámetros radiológicos extra-articulares en todos los casos, con corrección de 26 de los 29 escalones articulares preoperatorios.</p><strong>Conclusión: </strong>El tratamiento de las fracturas de radio distal tipo C en pacientes jóvenes con placa palmar bloqueada muestra resultados clínicos y radiológicos favorables con corrección de la mayoría de los escalones articulares.

Effective Treatment of Simultaneous Distal Radius and Scaphoid Fractures

2021 ◽  
Author(s):  
Julia Blackburn ◽  
Nick Johnson ◽  
Sasa Pocnetz ◽  
Tommy R. Lindau
Keyword(s):  
Systematic Review ◽  
Effective Treatment ◽  
Distal Radius ◽  
Case Series ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Scaphoid Fractures

Abstract Background There is an increasing trend for most surgeons to choose open reduction and internal fixation of simultaneous distal radius and scaphoid fractures; however, it is not clear if there is any evidence to support this. Case Description The purpose of this systematic review was to investigate the evidence for management of simultaneous distal radius and scaphoid fractures. Literature Review We performed searches of the EMBASE and MEDLINE databases (CRD42020167403). We included a total of 20 studies, involving 178 patients with 182 simultaneous fractures of the distal radius and scaphoid. The distal radius fractures were mostly intra-articular (112/182). The scaphoid fractures were mostly undisplaced (120/148) and at the scaphoid waist (152/178). All distal radius fractures went on to unite, and just 2 of 182 scaphoid fractures went on to nonunion. All included studies were retrospective case series, and therefore all were found to have a critical risk of bias due to confounding. The union rate for both the distal radius and scaphoid fractures is high with both operative and nonoperative treatments. Clinical Relevance Although there are no comparative studies to evaluate the most effective treatment, there is evidence to support operative management. Level of Evidence This is a Level IV, systematic review study.

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

Hand ◽  
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.

Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

2017 ◽  
Vol 43 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Daniel Martinez-Mendez ◽  
Alejandro Lizaur-Utrilla ◽  
Joaquin de-Juan-Herrero
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Distal Radius ◽  
Articular Surface ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

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

2016 ◽  
Vol 41 (5) ◽  
pp. 516-520 ◽  
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

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

2017 ◽  
Vol 42 (5) ◽  
pp. 487-492 ◽  
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

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

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.

scholarly journals Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over

2021 ◽  
Vol 2 (12) ◽  
pp. 1027-1034
Author(s):  
Sondre Hassellund ◽  
Zinajda Zolic-Karlsson ◽  
John Håkon Williksen ◽  
Torstein Husby ◽  
Jan Erik Madsen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Distal Radius ◽  
Controlled Trial ◽  
Cost Effective ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Life Years

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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