Factors Associated with Timely Surgery for Semi-elective Distal Radius Fracture Fixation

2021 ◽  
Author(s):  
Nick A. Johnson ◽  
Joseph J. Dias
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Trauma Surgery ◽  
Radius Fracture ◽  
National Guidelines ◽  
The United Kingdom ◽  
Articular Fractures ◽  
Seasonal Factors ◽  
National Guidance ◽  
The Relationship

Abstract Background In the United Kingdom, national guidance recommends intra-articular distal radius fractures should undergo surgery within 72 hours and extra-articular fractures within 7 days. Purpose We investigated if hospitals can provide timely surgery and meet national guidelines in patients who are sent home following distal radius fracture (DRF) to return for planned surgery. The influence of patient, hospital, and seasonal factors on wait to surgery are investigated. Patients and Methods We reviewed Hospital Episode Statistics (HES) data between April 2009 and March 2013. Proportion of procedures being performed within 3 and 7 days was calculated. A linear regression model was created to investigate the relationship between wait for surgery and patient and hospital factors. Results A total of 9,318 patients were sent home to return for planned acute DRF surgery during the 4-year study period. Mean time to surgery was 3.04 days (range 1–days, standard deviation [SD] 3.14). A total of 6,538 patients underwent surgery within 3 days (70.2%) and 8,747 within 7 days (93.9%). Patients listed for surgery and sent home to return waited longer if listed toward the end of the week. Less surgery was performed at weekends, and patients were less likely to be listed for semielective trauma surgery. Conclusions Acute semielective DRF fixation is generally performed within targets for extra-articular fractures but there is scope for improvement for intra-articular fractures. Day of presentation and increasing number of comorbidities increase wait for surgery. Hospital trusts should focus on improving pathways for patients with multiple comorbidities and strategies to improve accessibility of these services at weekends.

Assessing the Relationship Between Bone Density and Loss of Reduction in Nonsurgical Distal Radius Fracture Treatment

2021 ◽  
Author(s):  
Jason H. Ghodasra ◽  
Imran S. Yousaf ◽  
Kavya K. Sanghavi ◽  
Tamara D. Rozental ◽  
Kenneth R. Means ◽  
...  
Keyword(s):  
Bone Density ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Fracture Treatment ◽  
Loss Of Reduction ◽  
The Relationship

The Role of Early Post-Operative Radiographs Following Distal Radius Fracture Fixation with a Volar Locking Plate: Time for Change?

2019 ◽  
Vol 24 (04) ◽  
pp. 435-439
Author(s):  
Vivek Sharma ◽  
Caroline Witney-Lagen ◽  
Samuel Cullen ◽  
Edward Kim ◽  
Zakir Haider ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Locking Plate ◽  
Clinical Information ◽  
Median Number ◽  
Radius Fracture ◽  
Volar Locking Plate ◽  
Articular Fractures ◽  
Fracture Management

Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient’s first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9–16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

scholarly journals A new method to predict the outcome of the volar locked plate treatment for distal radius fracture

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hui Yao ◽  
Weijia Zhang ◽  
Wenbin Xu ◽  
Kaihua Liu ◽  
Yichun Xu
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Linear Regression Analysis ◽  
Trauma Surgery ◽  
Ct Scans ◽  
Radius Fracture ◽  
Locked Plate ◽  
Locked Plating ◽  
Linear Relationships ◽  
Flexion Extension

Abstract Background Volar locked plate for distal radius fracture is one of the common procedures performed in trauma surgery. There are already some factors which can be used to predict the functional outcome after volar locked plating for distal radius fracture. However their limitations caused that the outcomes couldn’t be satisfactorily predicted. Better factors for predicting the prognosis more precisely are of great interest. The aim of this study is to introduce such a new factor. Methods A total of 56 patients suffered from unilateral distal radius fracture were managed operatively with the volar locked plate. Before operation, all CT scans of the distal radius were obtained. The ratios of soft tissue circumference to bone circumference at the watershed line in the distal radius were calculated based on the preoperative CT scans. Outcomes were evaluated after operation. The correlations between the ratio and the outcomes were analyzed using single factor linear regression analysis. Results Statistically significant linear relationships between the ratio and flexion degrees, extension degrees also patient-rated wrist evaluation (PRWE) scores were discovered. With the increase of the ratios, the flexion and extension range increased and the PRWE scores declined. Conclusions There are obvious linear relationships between the ratio and postoperative wrist flexion-extension degrees also PRWE scores when using volar locked plating for distal radius fracture. So the ratio can be used as a predictor aiding surgeons to predict the outcome.

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

2017 ◽  
Vol 3 (5) ◽  
pp. 1004 ◽  
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

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">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</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective trial was undertaken at our hospital with 35 patients,all aged &gt;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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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 &amp;1 case of pin tract infection with ex-fix application was observed</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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</span><span lang="EN-IN">.</span></p>

scholarly journals The Relationship between Hand Therapy and Long-Term Outcomes after Distal Radius Fracture in Older Adults

2019 ◽  
Vol 144 (2) ◽  
pp. 230e-237e ◽  
Author(s):  
Kevin C. Chung ◽  
Sunitha Malay ◽  
Melissa J. Shauver ◽  
Kevin C. Chung ◽  
H. Myra Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Hand Therapy ◽  
Long Term Outcomes ◽  
The Relationship

Implant Charge Differences Between Distal Radius Fixation Constructs (CPT 25607, 25608, and 25609)

Hand ◽  
2020 ◽  
pp. 155894472096392
Author(s):  
Avi D. Goodman ◽  
Jacob M. Modest ◽  
Joey P. Johnson ◽  
Roman A. Hayda ◽  
Christopher J. Got ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Cost Savings ◽  
Hand Surgery ◽  
Radius Fracture ◽  
Insurance Status ◽  
Potential Cost ◽  
Articular Fractures ◽  
Multivariable Regression ◽  
Fracture Types

Background: Implants are a significant contributor to health care costs. We hypothesized that extra-articular fracture patterns would have a lower implant charge than intra-articular fractures and aimed to determine risk factors for increased cost. Methods: In total, 163 patients undergoing outpatient distal radius fracture fixation at 2 hospitals were retrospectively reviewed stratified by Current Procedural Terminology codes. Implants and associated charges were noted, as were sex, age, insurance status, surgeon specialty, and location. Bivariate and multivariable regression were used to determine associations. Results: Total implant charges were significantly lower for 25607 (extraarticular, $3,348) than 25608 (2-part intraarticular, $3,859) and 25609 (3+ part intraarticular, $3,991). In addition, intra-articular fractures had higher charges for distal screws/pegs and bone graft. Charge was lower when surgery was performed at a trauma center. There was no charge difference associated with insurance status, age, sex, hand surgery specialty, or fellow status. Substantial intersurgeon variation existed in all fracture types. Conclusion: Distal radius fractures may represent a good model for examining implant costs. Extra-articular fractures had lower implant charges than intra-articular fractures. These data may be used to help construct pricing for distal radius fracture bundles and potential cost savings.

Ultrasound changes in the extensor pollicis longus and flexor pollicis longus tendons following open reduction and internal fixation of displaced intra-articular fractures of the distal radius

2012 ◽  
Vol 38 (2) ◽  
pp. 129-132 ◽  
Author(s):  
K. L. Owers ◽  
P. P. Grieve ◽  
S. Mee ◽  
N. S. Chew ◽  
G. Ansede ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Flexor Pollicis Longus ◽  
Extensor Pollicis Longus ◽  
Longus Tendon ◽  
Articular Fractures ◽  
Pin Fixation ◽  
Active Mobilization ◽  
Extensor Pollicis Longus Tendon

A previous ultrasound study showed inflammation around the extensor pollicis longus tendon and surrounding structures at 6 weeks after manipulation, with or without pin fixation, and immobilization for distal radius fracture. Ultrasound examination after plating of distal radius fracture followed by early active mobilization of the wrist showed a short-lived inflammatory response, evident at 2 weeks but not at 6 weeks, around the extensor pollicis longus tendon (26 wrists examined) and flexor pollicis longus tendon (18 wrists examined). Early active mobilization of the wrist appears to limit the duration of inflammation around these tendons.

INVESTIGATION OF RADIOLUNATE RELATIONS IN NORMAL AND FRACTURED WRISTS

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 105-112 ◽  
Author(s):  
M. R. Broadbent ◽  
I. Stevenson ◽  
C. MacEachern ◽  
A. J. Johnstone
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Upper Limb ◽  
Assessment Method ◽  
Radius Fracture ◽  
Easy Method ◽  
Limb Injuries ◽  
Anatomical Relationship ◽  
Relationship Of ◽  
The Relationship

As the distal radius fracture is one of the most commonly encountered upper limb injuries, the aim of this study was to provide a quick and easy method to aid in the assessment of fractured wrists, both pre- and post-fixation, by utilising the relationship of the radial shaft and the lunate. A retrospective analysis on 100 consecutive patients with normal wrist radiographs was performed. The results demonstrated that the variations of radiolunate anatomy followed a normal distribution. The normal anatomical relationship was then described. A second part to the study consisted of reviewing our method of radiocarpal analysis on a cohort of patients who had sustained a distal radius fracture. Carpal alignment pre- and post-fixation was measured, with the results demonstrating that by using this assessment method, it was possible with a quick glance of the radiograph, to determine whether satisfactory correction of the fracture had been achieved.

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