Invited Commentary on the Article of M. Jakob, S. Mielke, H. Keller und U. Metzger: Clinical Results of Conservative Treatment of Distal Radius Fractures in Patients Older than 65 Years

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

Download Full-text

CLINICAL APPLICATION OF DOUBLE DORSAL PLATES FOR THE DISTAL RADIUS FRACTURES

Hand Surgery ◽

10.1142/s0218810405002838 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 213-224

Author(s):

Noriyuki Yoshida ◽

Kazuhiko Matsushita ◽

Takeshi Arai ◽

Ko Izumiyama ◽

Moroe Beppu ◽

...

Keyword(s):

Cortical Bone ◽

Clinical Application ◽

Distal Radius ◽

Three Dimensional ◽

Clinical Results ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Radial Margin ◽

Dimensional Models ◽

Three Dimensional Models

The purpose of this study was to develop plates that fit the contour of the distal radius of the Japanese and can be inserted less invasively. Three-dimensional models of 36 radii of 18 volunteers were prepared. Using these models, the shape of the cortical bone on the radial margin of the distal radius and just below the dorsal fourth compartment of the wrist, to which the plates were expected to be applied, was measured, and the curves of the plates were determined. The functions of approximated curves of the plates were: [ y = -2 × 10-8 x 5 - 2 × 10-6 x 4 + 0.0006 x 3 - 0.0312 x 2 + 0.3274 x + 15.224 on the radial margin of the distal radius and [ y = 7 × 10-7 x 5 - 0.0001 x 4 + 0.0078 x 3 - 0.2355 x 2 + 3.1815 x - 5.6383 just below the fourth compartment. The clinical results of the application of double dorsal plates were satisfactory in clinical cases for the distal radius fractures.

Download Full-text

Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-003-0597-6 ◽

2004 ◽

Vol 124 (1) ◽

pp. 38-41 ◽

Cited By ~ 58

Author(s):

Jaydeep K. Moro ◽

R. Brett Dunlop ◽

Anthony Adili ◽

Scott McKenzie ◽

James Leone ◽

...

Keyword(s):

Conservative Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Late Instability

Download Full-text

OUTCOME OF UNSTABLE DISTAL RADIUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION VERSUS EXTERNAL FIXATION

Hand Surgery ◽

10.1142/s0218810412500165 ◽

2012 ◽

Vol 17 (02) ◽

pp. 173-179 ◽

Cited By ~ 4

Author(s):

Emmanuel P. Estrella ◽

Paulo L. Panti

Keyword(s):

Grip Strength ◽

Distal Radius ◽

Clinical Results ◽

Distal Radius Fractures ◽

Wrist Flexion ◽

Radius Fractures ◽

Wrist Extension ◽

Ulnar Deviation ◽

Mayo Wrist Score ◽

Score Range

The objective of this study was to compare the clinical results of unstable distal radius fractures treated with ORIF with plate and screws compared to EF. Patients with unstable distal radius fractures treated with ORIF or EF from January 2005 to December 2010 were reviewed in terms of the Modified Mayo Wrist Score, range of motion, pain, grip strength, and radiologic parameters. Results showed that there was no difference in the Modified Mayo Wrist Score between ORIF (17 patients) and EF (11 patients) (p = 0.07). The ORIF group had better wrist flexion, wrist extension, pronation and supination compared to the EF group (p < 0.05). There were no significant differences in terms of radial and ulnar deviation, grip strength, pain and postoperative radiologic parameters (p < 0.05). Better wrist flexion, wrist extension and forearm rotation can be expected in ORIF compared to EF in the management of unstable distal radius fractures.

Download Full-text

Conservative treatment of distal ulna metaphyseal fractures associated with distal radius fractures in elderly people

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2018.07.020 ◽

2018 ◽

Vol 104 (7) ◽

pp. 1101-1105 ◽

Cited By ~ 2

Author(s):

Kotaro Sato ◽

Kenya Murakami ◽

Yoshikuni Mimata ◽

Norio Numata ◽

Hideo Shiraishi ◽

...

Keyword(s):

Conservative Treatment ◽

Elderly People ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Distal Ulna ◽

Metaphyseal Fractures

Download Full-text

Clinical Results of External Fixation for Distal Radius Fractures.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.48.966 ◽

1999 ◽

Vol 48 (3) ◽

pp. 966-969

Author(s):

Ryuya Ochi ◽

Tetsuo Nakano ◽

Yasuyuki Abe ◽

Yasuhiro Shimizu ◽

Ichiro Seike ◽

...

Keyword(s):

External Fixation ◽

Distal Radius ◽

Clinical Results ◽

Distal Radius Fractures ◽

Radius Fractures

Download Full-text

Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate—Which Has Fewer Complications?

Hand ◽

10.1177/1558944716675129 ◽

2016 ◽

Vol 12 (6) ◽

pp. 561-567 ◽

Cited By ~ 7

Author(s):

Yoshihiro Abe ◽

Susumu Tokunaga ◽

Takuro Moriya

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Clinical Results ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Volar Approach ◽

Pathologic Fractures ◽

Dorsal Plating ◽

Plate System

Background: The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use. Methods: Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky’s plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures. Results: Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures. Conclusions: The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.

Download Full-text

Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1530-1 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Gaetano Caruso ◽

Francesco Tonon ◽

Alessandro Gildone ◽

Mattia Andreotti ◽

Roberto Altavilla ◽

...

Keyword(s):

Conservative Treatment ◽

Clinical Outcomes ◽

Distal Radius ◽

Randomised Trial ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Radiological Parameters ◽

Cast Group

Abstract Background Distal radial fractures are common traumatic injuries, but their management remains controversial also in case of conservative treatment regarding the type of immobilisation. Hence, we conducted a two-arm, parallel-group, prospective randomised trial to compare the capacity of long casts (above-elbow) and short casts (below-elbow) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (AO/OTA classification: 2R3A2.2). Methods Seventy-four eligible patients with AO/OTA 2R3A2.2 fractures treated with closed reduction and cast immobilisation were randomised to the long cast group (n°= 37) or to the short cast group (n°= 37). Baseline radiological parameters, radial inclination (RI), radial height (RH), ulnar variance (UV) and palmar tilt (PT) were taken, and compared with clinical (DASH, Mayo Wrist and Mayo Elbow) and radiological scores taken at 7–10 days, 4 weeks and 12 weeks. Furthermore, to evaluate correlations between radiological parameters and functional outcomes, patients were divided into two groups according to whether or not their radiological parameters at Follow-ups 2 and 3 were acceptable, i.e. within the range 11–12 mm for RH, 16°–28° for RI, − 4–+ 2 mm for UV and 0°–22° for PT. Results Patient demographic and baseline radiological parameters were similar between groups. At follow-up, there were no statistically significant differences between the two types of cast in terms of RI, RH, UV or PT, or Mayo wrist or DASH scores. Short cast group patients displayed better Mayo elbow score at follow-up 2 (4 weeks), but this difference was no longer statistically significant at follow-up 3 (12 weeks). No statistically significant differences in clinical outcomes were found between patients who presented acceptable radiographic parameters at follow-up and those who did not. Conclusion As there were no significant differences between short casts and long casts in terms of fracture reduction maintenance or clinical outcomes, short casts are an effective method of post-reduction immobilisation in AO/OTA 2R3A2.2 fracture of the radius. Radiological parameters outside the range conventionally considered acceptable do not preclude a satisfactory clinical outcome. Trial registration ClinicalTrials.gov PRS, NCT04062110. Registred 20 August 2019.

Download Full-text