In-Vitro Evaluation of Thumb Spica and Short Arm Cast Immobilization of the Distal Radius Fracture

1993 ◽  
Vol 7 (2) ◽  
pp. 150
Author(s):  
F. S. Lee ◽  
M. B. Dekutoski ◽  
K. Cervone ◽  
S. P. DeSilva ◽  
K. H. Yang
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Cast Immobilization ◽  
In Vitro Evaluation

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

Management of Distal Ulnar Fracture Combined with Distal Radius Fracture

2016 ◽  
Vol 21 (02) ◽  
pp. 155-160 ◽  
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.

Simulating Distal Radius Fracture Strength Using Biomechanical Tests: A Modeling Study Examining the Influence of Boundary Conditions

2011 ◽  
Vol 133 (11) ◽  
Author(s):  
W. Brent Edwards ◽  
Karen L. Troy
Keyword(s):  
Boundary Conditions ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Fracture Strength ◽  
Wrist Joint ◽  
Biomechanical Testing ◽  
Load Carriage ◽  
Radius Fracture ◽  
Cortical Shell

Distal radius fracture strength has been quantified using in vitro biomechanical testing. These tests are frequently performed using one of two methods: (1) load is applied directly to the embedded isolated radius or (2) load is applied through the hand with the wrist joint intact. Fracture loads established using the isolated radius method are consistently 1.5 to 3 times greater than those for the intact wrist method. To address this discrepancy, a validated finite element modeling procedure was used to predict distal radius fracture strength for 22 female forearms under boundary conditions simulating the isolated radius and intact wrist method. Predicted fracture strength was highly correlated between methods (r = 0.94; p < 0.001); however, intact wrist simulations were characterized by significantly reduced cortical shell load carriage and increased stress and strain concentrations. These changes resulted in fracture strength values less than half those predicted for the isolated radius simulations (2274 ± 824 N for isolated radius, 1124 ± 375 N for intact wrist; p < 0.001). The isolated radius method underestimated the mechanical importance of the trabecular compartment compared to the more physiologically relevant intact wrist scenario. These differences should be borne in mind when interpreting the physiologic importance of mechanical testing and simulation results.

Biomechanical Testing of Distal Radius Fracture Treatments: Boundary Conditions Significantly Affect the Outcome of In Vitro Experiments

2016 ◽  
Vol 32 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Alexander Synek ◽  
Yan Chevalier ◽  
Christian Schröder ◽  
Dieter H. Pahr ◽  
Sebastian F. Baumbach
Keyword(s):  
Boundary Conditions ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Biomechanical Testing ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Radius Fracture ◽  
Compression Tests

The variety of experimental setups used during in vitro testing of distal radius fracture treatments impairs interstudy comparison and might lead to contradictory results. Setups particularly differ with respect to their boundary conditions, but the influence on the experimental outcome is unknown. The aim of this biomechanical study was to investigate the effects of 2 common boundary conditions on the biomechanical properties of an extra-articular distal radius fracture treated using volar plate osteosynthesis. Uniaxial compression tests were performed on 10 synthetic radii that were randomized into a proximally constrained group (ProxConst) or proximally movable group (ProxMove). The load was applied distally through a ball joint to enable distal fragment rotation. A significantly larger (ProxConst vs ProxMove) stiffness (671.6 ± 118.9 N·mm−1 vs 259.6 ± 49.4 N·mm−1), elastic limit (186.2 ± 24.4 N vs 75.4 ± 20.2 N), and failure load (504.9 ± 142.5 N vs 200.7 ± 49.0 N) were found for the ProxConst group. The residual tilt did not differ significantly between the 2 groups. We concluded that the boundary conditions have a profound impact on the experimental outcome and should be considered more carefully in both study design and interstudy comparison.

scholarly journals Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures

2019 ◽  
Vol 08 (04) ◽  
pp. 288-294 ◽  
Author(s):  
Jill M. Cancio ◽  
Nicole M. Sgromolo ◽  
Peter C. Rhee
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Control Group ◽  
Radius Fractures ◽  
Cast Immobilization ◽  
Rehabilitation Protocol ◽  
Flow Restriction ◽  
Radiographic Outcomes ◽  
Therapy Program

Background Blood flow restriction (BFR) therapy is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol. Literature review A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between May 1, 2015 and August 1, 2016. BFR therapy was performed with a restrictive tourniquet applied to the upper brachium, performing the same strengthening exercises as the control group but with the restrictive tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from the date of initial cast immobilization. Outcome measures collected included wrist range of motion; grip strength; pinch strength; visual analogue scale for pain with activity and at rest; patient-rated wrist evaluation (PRWE) scores; and disabilities of the arm, shoulder, and hand scores. Results Thirteen patients were enrolled and randomized between the BFR (n = 6) and control (n = 7) groups. The BFR group noted significantly greater reduction in pain with activity compared to the control group after 8 weeks of therapy (Δ −4.0 vs. −2.3, p = 0.03). Similarly, patients in the BFR group displayed greater reduction in PRWE scores compared to the control group after 8 weeks of BFR therapy (Δ −57.9 vs. 30.8, p = 0.01). The two groups did not demonstrate any significant difference in radiographic outcomes at any time point or throughout the course of the study. All patients tolerated the BFR therapy program and there were no complications. Clinical relevance The addition of BFR therapy to the rehabilitative program after closed management of a distal radius fracture is safe, well tolerated by patients, without any deleterious effects on radiographic outcomes. This pilot study noted that BFR therapy in patients with nonoperative distal radius fractures may result in a larger reduction in pain with activity and greater improvement in overall self-perceived function.

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.

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