The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant?

Abstract Purpose The position of the wrist during cast immobilisation following closed reduction of distal radius fractures is disputed. A systematic review was initiated to assess if there was any relation between wrist position in the cast and outcome in adult patients with non-operatively treated distal radius fractures. Methods A comprehensive search was performed in the bibliographic databases Medline, Embase and Wiley/Cochrane Library from inception up to 27 November 2020. Eligible studies were: randomised controlled trials, prospective and retrospective comparative cohort studies, analysing different positions of the wrist in cast-immobilisation following closed reduction. Primary outcome of the study was functional outcome measured by range of motion. Secondary outcomes were functional outcomes measured by grip strength, patient-reported outcome, radiological outcome and complications such as secondary dislocation and pain. Results The initial search yielded 2733 studies. Five trials, with 519 patients, were included in this systematic review. Range of motion and radiological outcome was significantly better in patients who were immobilised in dorsiflexion compared to palmar flexion or neutral position, although no clinical important difference was found. There were no significant differences in patient-reported outcome, pain, grip strength or complications. Due to heterogeneity of the included studies, data were unsuitable for a meta-analysis. Conclusion This systematic review showed statistically significant better results in favour of cast immobilisation in dorsiflexion, although this small difference does not seem to be relevant in patients daily activities. Systematic review registration number Systematic review registration number: PROSPERO 2018 CRD42018085546.

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Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2004.07.002 ◽

2004 ◽

Vol 29 (6) ◽

pp. 1121-1127 ◽

Cited By ~ 119

Author(s):

Alexander Anzarut ◽

Jeffrey A. Johnson ◽

Brian H. Rowe ◽

Robert G.W. Lambert ◽

Sandra Blitz ◽

...

Keyword(s):

Distal Radius ◽

Functional Outcomes ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Patient Reported ◽

Elderly Cohort

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Interpreting Patient-Reported Outcome Results: Is One Minimum Clinically Important Difference Really Enough?

Hand ◽

10.1177/1558944718812180 ◽

2018 ◽

Vol 15 (3) ◽

pp. 360-364

Author(s):

Dylan L. McCreary ◽

Benjamin C. Sandberg ◽

Debra C. Bohn ◽

Harsh R. Parikh ◽

Brian P. Cunningham

Keyword(s):

Distal Radius ◽

Treatment Modality ◽

Emotional Health ◽

Minimum Clinically Important Difference ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Time Points ◽

Injury Characteristics ◽

Clinically Important Difference ◽

Patient Reported

Background: Patient-reported outcomes (PROs) are the gold standard for reporting clinical outcomes in research. A crucial component of interpreting PROs is the minimum clinically important difference (MCID). Patient-Rated Wrist Evaluation (PRWE) is a disease-specific PRO tool developed for use in distal radius fractures. The purpose of this study was to determine the influence of injury characteristics, treatment modality, and calculation methodology on the PRWE MCID in distal radius fractures. We hypothesize the MCID would be significantly influenced by each of these factors. Methods: From 2014 to 2016, 197 patients with a distal radius fracture were treated at a single level I trauma center. Each patient was asked to complete a PRWE survey at preoperative baseline, 6-week postoperative, and 12-week postoperative dates. The MCID was derived utilizing 2 distinct strategies, anchor and distribution. Anchor questions involved overall health anchor and mental and emotional health anchor. Patient variables regarding demographics, injury characteristics, and treatment modality were collected. Results: The MCID was unique between analytical methods at all time points. The distribution MCID presented commonality across assessed variables. However, the anchor MCID was unique by AO/OTA fracture classifications, treatment modality, and time points. Conclusions: Our study found the MCID was heavily influenced by assessment time points, analytical method, treatment modality, and fracture classification. These results suggest that to accurately interpret PRO data in clinical trials, an anchor question should be included so that the MCID can be determined for the specific patient population included in the study.

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The role of concomitant ligament injury in the development of post-traumatic osteoarthritis after distal radius fractures: a protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-039591 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039591

Author(s):

Malou E Slichter ◽

Gerald A Kraan ◽

Wichor M Bramer ◽

Joost W Colaris ◽

Nina M C Mathijssen

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ligament Injury ◽

Original Research ◽

Cochrane Central Register ◽

Radius Fractures ◽

Patient Reported ◽

Post Traumatic

IntroductionTreatment of distal radius fractures (DRFs) aims to restore anatomic position of the fracture fragments and congruity of the articular surface to optimise functional outcomes and prevent osteoarthritis in the long term. While ligament injury of the wrist is often associated with DRFs and sole ligament injuries of the wrist lead to osteoarthritis, it is plausible that concomitant ligament injury in DRFs may aggravate degenerative changes of the wrist. The relationship between concomitant ligament injury and post-traumatic osteoarthritis in patients with DRFs is unclear. This study aims to identify the types of associated ligament injury in patients with a DRF and to elucidate the association of ligament injury on the development of post-traumatic osteoarthritis.Methods and analysisThis protocol is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines. An electronic search in MEDLINE, Embase, Web of Science, Cochrane Central Register of Trials and Google Scholar has been created and performed by a Health Sciences librarian with expertise in systematic review searching. Original research articles in English literature, which report on concomitant ligament injury of the wrist in relation to post-traumatic osteoarthritis, patient-reported outcome measures or clinician-reported outcome measures in patients (aged ≥18 years) with DRFs will be included. Two reviewers will independently screen and appraise articles and perform data extraction. In case of any disagreements, a third reviewer will be consulted. A systematic qualitative synthesis will be performed using text and tables.Ethics and disseminationNo ethical approval is required, since this is a protocol for a systematic review. The systematic review will be submitted for publication in a peer-reviewed scientific journal and for presentation at relevant conferences.PROSPERO registration numberCRD42020165007.

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Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction

Journal of Orthopaedic Surgery and Research ◽

10.1186/1749-799x-5-51 ◽

2010 ◽

Vol 5 (1) ◽

pp. 51 ◽

Cited By ~ 6

Author(s):

RE Anakwe ◽

LAK Khan ◽

RE Cook ◽

JE McEachan

Keyword(s):

Distal Radius ◽

Patient Reported Outcomes ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Patient Reported

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Objective Outcome Measures Continue to Improve from 6 to 12 Months after Conservatively Treated Distal Radius Fractures in the Elderly—A Prospective Evaluation of 50 Patients

Journal of Clinical Medicine ◽

10.3390/jcm10091831 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1831

Author(s):

Rikke Thorninger ◽

Daniel Wæver ◽

Jonas Pedersen ◽

Jens Tvedegaard-Christensen ◽

Michael Tjørnild ◽

...

Keyword(s):

Outcome Measures ◽

Distal Radius ◽

Case Series ◽

The Elderly ◽

Patient Reported Outcome Measures ◽

Distal Radius Fractures ◽

Fracture Dislocation ◽

Radius Fractures ◽

Patient Reported ◽

Prospective Case Series

Distal radius fractures (DRF) in the elderly population above 65 years represent 18% of all fractures and are thereby the second most frequent fracture in the elderly. Fracture dislocation and comminution are often used to determine whether non-operative or operative treatment is indicated. The purpose of this prospective case series of minimally displaced DRF treated with a dorsal cast was to assess the complication rate and patient-reported outcome measures. This single-centre, single-blinded, prospective case series followed 50 conservatively treated DRF patients for one year. Primary outcomes were complications and Quick Disability of Arm Shoulder and Hand (qDASH) score. Secondary outcomes were range of motion (ROM), grip strength and pain, and Patient-Rated Wrist/Hand Evaluation (PRWHE). Results showed only minor complications with a return to prior ROM, qDASH, and pain after 12 months and improvement in outcomes after 6–12 months. In conclusion, the majority of DRF patients who were treated non-operatively with five-week dorsal casting recover fully after minimally displaced DRF. This standard approach is thus considered safe, and the present results provide a reference for other studies.

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Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730393 ◽

2021 ◽

Vol 49 (01) ◽

pp. 024-036

Author(s):

Marcio Aurelio Aita ◽

Ricardo Kaempf ◽

Bruno Gianordoli Biondi ◽

Gary Alan Montano ◽

Fernando Towata ◽

...

Keyword(s):

Return To Work ◽

Distal Radius ◽

Patient Reported Outcomes ◽

Distal Radius Fractures ◽

Joint Surface ◽

Wrist Arthroscopy ◽

X Rays ◽

Radius Fractures ◽

Patient Reported ◽

The Mean

AbstractArticular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly.

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Functional Outcomes Following Fixation of an Ultra-distal Radius Fracture with Two Commonly used Volar Locking Plates: A Retrospective Cohort Study

10.21203/rs.3.rs-537242/v1 ◽

2021 ◽

Author(s):

Yin-Ming Huang ◽

Chun-Yu Chen ◽

Kai-Cheng Lin ◽

Yih-Wen Tarng ◽

Ching-Yi Liao ◽

...

Keyword(s):

Range Of Motion ◽

Distal Radius Fracture ◽

Distal Radius ◽

Functional Outcomes ◽

Flexor Tendon ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Mayo Wrist Score ◽

Patient Reported

Abstract Introduction: The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, ultra-distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on ultra-distal radius fractures. This study compared functional outcomes in patients with ultra-distal radius fractures treated with two different implants.Materials and Methods: A retrospective study was conducted, all patients who received a Synthes 2.4mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The ultra-distal fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and gripping strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions: Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating ultra-distal radius fractures.

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Treatment Modality of Distal Ulnar Head and Neck Fractures Associated With Operatively Treated Distal Radius Fractures Does Not Affect Outcomes

Hand ◽

10.1177/1558944720922923 ◽

2020 ◽

pp. 155894472092292

Author(s):

Georgina Glogovac ◽

Allison K. Perry ◽

Michael D. Wigton ◽

Peter J. Stern

Keyword(s):

Head And Neck ◽

Distal Radius ◽

Nonoperative Treatment ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Distal Ulna ◽

Ulnar Head ◽

Patient Reported

Background: This study compares the functional outcomes and complications between operatively and nonoperatively treated distal ulnar head and neck fractures associated with internal fixation of concomitant distal radius fractures. Methods: A 7-year retrospective chart review was performed to identify patients with operatively treated distal radius fractures associated with distal ulnar head and neck fractures. Ulnar styloid fractures were excluded. Fifty-eight patients who had a minimum of 6 months of follow-up were identified. Patients were divided into 3 treatment groups: nonoperative, open reduction internal fixation (ORIF), and distal ulna resection. Reviewed data included demographics, injury and treatment details, complications, and patient-reported outcome measures. Outcomes measures included Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Patient-Rated Wrist Evaluation (PRWE) surveys. Due to inadequate power, 5 patients treated with distal ulna resection were excluded from statistical analysis. Results: The average patient age was 56 years, with an average follow-up of 27 months. All patients underwent ORIF of the distal radius fracture. Distal ulna fractures were treated nonoperatively in 25 patients, with ORIF in 28 patients, and with distal ulna resection in 5 patients. There were no statistically significant differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores between ORIF and nonoperative treatment. Conclusion: No differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores were observed between ORIF and nonoperative treatment of distal ulnar head and neck fractures associated with operatively treated distal radius fractures.

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