An Analysis of the Impact of Timing and Technique on Outcomes after Surgery for Distal Radius Fractures: The Wrist and Radius Injury Surgical Trial Collaborative Study

Background: Distal radius fractures (DRFs) are the most common upper extremity fractures in adults. This study seeks to elucidate the impact age, fracture type, and patient comorbidities have on the current treatment of DRFs and risk of complications. We hypothesized that comorbidities rather than age would relate to the risk of complications in the treatment of DRFs. Methods: A retrospective review of data was performed for patients treated between 2007 and 2014 using Truven Health MarketScan Research Databases. Patients who sustained a DRF were separated into “closed” versus “open” treatment groups, and the association between patient demographics, treatment type, and comorbidities with complication rates was analyzed, along with the trend of treatment modalities throughout the study time interval. Results: In total, 155 353 DRFs were identified; closed treatment predominated in all age groups with the highest percentage of open treatment occurring in the 50- to 59-year age group. Between 2007 and 2014, there was an increase in the rate of open reduction and internal fixation (ORIF) in all age groups <90 with the largest increase (11%) occurring in the 70- to 79-year age group. Higher complication rates were observed in the open treatment group in all ages <90 years with a trend toward decreasing complication rates as age increased. Comorbidities were more strongly associated with the risk of developing complications than age. Conclusions: Closed treatment of DRFs remains the predominant treatment method among all age groups, but DRFs are increasingly being treated with ORIF. Emphasis on the patients’ comorbidities rather than chronological age should be considered in the treatment decision-making process of elderly patients with DRFs.

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Epidemiology of Distal Radius Fractures in Children and Adults During the COVID-19 Pandemic – A Two-Center Study

10.21203/rs.3.rs-132986/v1 ◽

2020 ◽

Author(s):

Jarosław Olech ◽

Mariusz Ciszewski ◽

Piotr Morasiewicz

Keyword(s):

Hospital Stay ◽

Distal Radius ◽

Distal Radius Fractures ◽

Adult Patients ◽

Individual Treatment ◽

Trauma Centers ◽

Radius Fractures ◽

Treatment Type ◽

Number Of Patients ◽

The Impact

Abstract Bacground: The purpose of our study was a comprehensive assessment of the impact of theCOVID-19 pandemic on distal radius fractures(DRF)epidemiology,including both children and adults and various fracture fixation methods in two large trauma centers in Poland.Methods: This study compared the data on the treatment of distal radius fractures in Poland in two periods:the period of the COVID-19 pandemic and the corresponding period prior to the pandemic.We assessed detailed data from two trauma centers for pediatric and adult patients.We compared epidemiological data,demographic data,treatment type,and hospital stay duration.Results: The total number of patients hospitalized due to DRF during the pandemic was 15.1% lower than that from the pre-COVID-19 pandemic period.In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly(by 22%) from132 to103patients.Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably(by 30.3%)significantly lower in the period of the COVID-19 pandemic.Compared to the figures from the pre-pandemic period,the number of surgically treated adults was significantly higher(by 53.8%).Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7%during the pandemic,with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%.Conclusions: Our study showed decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic.The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age,shorter significantly durations of hospital stay, and an increased number of men with DRFs.

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1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

British Journal of Surgery ◽

10.1093/bjs/znab259.1033 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Hafez ◽

A Shaat ◽

M Zain ◽

M A Sajid ◽

A Butt

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Open Reduction ◽

Group Versus ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Volar Approach ◽

Normal Ranges ◽

Significant Difference ◽

The Impact

Abstract Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

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The Impact of the Soong Index on Hardware Removal and Overall Reoperation Rates After Volar Locking Plate Fixation of Distal Radius Fractures

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2021.06.021 ◽

2021 ◽

Author(s):

Maximilian A. Meyer ◽

Kyra A. Benavent ◽

Cassandra M. Chruscielski ◽

Stein J. Janssen ◽

Philip E. Blazar ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Hardware Removal ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Fixation ◽

The Impact ◽

Reoperation Rates

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The impact of mirror therapy on body schema perception in patients with complex regional pain syndrome after distal radius fractures

British Journal of Pain ◽

10.1177/2049463718782544 ◽

2018 ◽

Vol 13 (1) ◽

pp. 35-42 ◽

Cited By ~ 2

Author(s):

Viktor Kotiuk ◽

Olexander Burianov ◽

Olexander Kostrub ◽

Ludmila Khimion ◽

Ivan Zasadnyuk

Keyword(s):

Complex Regional Pain Syndrome ◽

Distal Radius ◽

Body Schema ◽

Pain Syndrome ◽

Distal Radius Fractures ◽

Mirror Therapy ◽

Radius Fractures ◽

The Impact

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Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches

Journal of Wrist Surgery ◽

10.1055/s-0039-3402081 ◽

2019 ◽

Vol 09 (01) ◽

pp. 052-057

Author(s):

Christopher M. Jones ◽

Roshan Melvani ◽

Keith T. Aziz ◽

Pooyan Abbasi ◽

Kenneth R. Means

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Flexor Tendon ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Flexor Tendons ◽

Flexor Carpi Radialis ◽

Significant Difference ◽

The Impact ◽

Contact Pressures

Abstract Background Flexor tendon irritation or rupture following open reduction and volar plate fixation of distal radius fractures can cause significant morbidity and necessitate additional surgical intervention. Objectives To compare the impact of the extended flexor carpi radialis (e-FCR) and standard flexor carpi radialis (FCR) approaches on contact pressures between the flexor tendons and volar distal radius plates. Methods Eight matched pairs of fresh frozen cadavers had each limb randomized to undergo either the e-FCR or standard FCR approach. After the approach, a locking plate was applied to the volar distal radius more distally than ideally to create a worst-case scenario for the digital flexor tendons. Electronic pressure sensors were secured to the volar aspect of each locking plate. Each wrist was pinned in 20 degrees of extension during testing. Using a computer-controlled stepper motor system attached to the digital flexor and extensor tendons, the digits were taken through 4,000 cycles simulating 12 weeks of active flexion and extension. Results There were no statistically or clinically significant differences when comparing the contact pressures of the e-FCR approach with the standard FCR approach at any time intervals. The e-FCR had statistically significantly higher radial-sided contact pressures than ulnar-sided contact pressures during early-to-intermediate testing intervals. These differences resolved at late and final testing intervals. Conclusions When comparing the standard FCR approach with the e-FCR approach, with the wrist in 20 degrees of extension, there is no significant difference in contact pressures that occur between the digital flexor tendons and volar distal radius plates. Clinical Relevance Further study and technique modifications may eventually lead to better methods of avoiding flexor tendon rupture during the volar plating of distal radius fractures.

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The Impact of Malnutrition on 30-Day Postoperative Complications following Surgical Fixation of Distal Radius Fractures

Journal of Hand and Microsurgery ◽

10.1055/s-0039-3400433 ◽

2020 ◽

Vol 12 (S 01) ◽

pp. S33-S38

Author(s):

Jared M. Newman ◽

Marine Coste ◽

Karan Dua ◽

Andrew Yang ◽

Frank S. Cautela ◽

...

Keyword(s):

Distal Radius ◽

Fragility Fractures ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Improvement Program ◽

Surgical Quality ◽

Preoperative Serum ◽

Surgical Fixation ◽

The Impact ◽

Prolonged Life Expectancy

Abstract Introduction Distal radius fractures (DRFs) are increasingly managed surgically among fragility fractures due to prolonged life expectancy and surgical advancements. Yet, malnutrition can impact postoperative outcomes and complications. We sought to determine the impact of malnutrition on open reduction and internal fixation (ORIF) of DRFs during the perioperative and 30-day postoperative periods. Materials and Methods Using the National Surgical Quality Improvement Program database, all patients who underwent ORIF of a DRF between January 1, 2008, and December 31, 2016, were identified and stratified by preoperative serum albumin levels: normal (≥3.5 g/dL; n = 2,546) or hypoalbuminemia (<3.5 g/dL; n = 439). Demographical and perioperative data were compared. Operative complications were stratified into major and minor complications, and data were analyzed using descriptive statistics and multivariate regression models. Results Compared with patients with normal levels, a higher proportion of hypoalbuminemia patients had ASA scores > 3 (9.1 vs. 2%) and a longer mean length of stay (3.16 vs. 0.83 days). Hypoalbuminemia patients also had 625% greater odds for developing major complications during the 30-day postoperative period (odds ratio = 7.25; 95% confidence interval: 1.91–27.49). Conclusion Malnutrition significantly affected outcomes and complications of distal radius ORIF. This study highlights the importance of prevention and treatment of malnutrition in the setting of fragility fractures.

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The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2019.08.017 ◽

2019 ◽

Vol 44 (12) ◽

pp. 1037-1049 ◽

Cited By ~ 5

Author(s):

Matthew J. Hall ◽

Peter J. Ostergaard ◽

Arriyan S. Dowlatshahi ◽

Carl M. Harper ◽

Brandon E. Earp ◽

...

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Volar Plate Fixation ◽

The Impact

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Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic – a two-center study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04128-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jarosław Olech ◽

Mariusz Ciszewski ◽

Piotr Morasiewicz

Keyword(s):

Hospital Stay ◽

Distal Radius ◽

Distal Radius Fractures ◽

Adult Patients ◽

Medical Attention ◽

Individual Treatment ◽

Trauma Centers ◽

Detailed Data ◽

Radius Fractures ◽

The Impact

Abstract Background Distal radius fractures (DRFs) constitute 15–21% of all fractures. There are no detailed data on the possible changes in the epidemiology and treatment of DRFs in children and adults during the Covid pandemic. The purpose of our study was a comprehensive assessment of the impact of the COVID-19 pandemic on distal radius fractures (DRF) epidemiology, including both children and adults and various fracture fixation methods in two large trauma centers in Poland. Methods This study compared the medical data on the treatment of distal radius fractures in Poland in two periods: the period of the COVID-19 pandemic (from March 15 to October 15, 2020) and the corresponding period prior to the pandemic (from March 15 to October 15, 2019). We assessed detailed data from two trauma centers for pediatric and adult patients. Outpatients seeking medical attention at emergency departments and inpatients undergoing surgery at trauma-orthopedic wards were evaluated. We compared epidemiological data, demographic data, treatment type, and hospital stay duration. Results The total number of patients hospitalized due to DRF during the pandemic was 180, it was 15.1% lower than that from the pre-COVID-19 pandemic period (212). In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly (by 22%) from 132 to 103 patients. Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably (by 30.3%) significantly lower in the period of the COVID-19 pandemic, from 119 to 83 patients. Compared to 13 patients from the pre-pandemic period, the number of surgically treated adults statistically increased to 20 patients (by 53.8%). Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7% during the pandemic, with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%. Conclusions Our study showed a significant impact of the COVID-19 pandemic on the epidemiology and treatment of DRFs in children and adults. We found decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic. The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age, shorter significantly length of hospital stay, and an increased number of men with DRFs.

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