scholarly journals Surgical fixation with K-wires versus plaster casting in the treatment of dorsally displaced distal radius fractures: protocol for Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT 2)

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e028474 ◽  
Author(s):  
Juul Achten ◽  
William Sones ◽  
Joseph Dias ◽  
Helen Hedley ◽  
Jonathan A Cook ◽  
...  
Keyword(s):  
Distal Radius ◽  
Closed Reduction ◽  
Controlled Trial ◽  
Demographic Data ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Plaster Casting ◽  
Surgical Fixation ◽  
K Wires ◽  
Displaced Fracture

IntroductionOptimal management of distal radius fractures in adults remains controversial. Previous evidence and current clinical guidelines tell us that, if a closed reduction of a dorsally displaced fracture is possible, Kirschner wires (K-wires) are the preferred form of surgical fixation. However, the question remains whether there is any need to perform surgical fixation following a successful closed reduction, or is a simple plaster cast as effective? This is the protocol for a randomised controlled trial of manipulation and surgical fixation with K-wires versus manipulation and casting in the treatment of dorsally displaced distal radius fractures.Methods and analysisAdult patients with an acute dorsally displaced fracture of the distal radius are potentially eligible to take part. Prior to surgery, baseline demographic data, radiographs, data on pain/function using the Patient-Rated Wrist Evaluation Score (PRWE) and health-related quality of life (HRQoL) using the EuroQoL 5-dimension 5-level (EQ-5D-5L) will be collected. A randomisation sequence, stratified by centre, intra-articular extension of the fracture and age, will be administered via a secure web-based service. Each patient will be randomly allocated to either ‘manipulation and surgical fixation with K-wires’ or ‘manipulation and plaster casting’. A clinical assessment, radiographs and records of early complications will be recorded at 6 weeks. PRWE and HRQoL outcome data will be collected at 3, 6 and 12 months post-randomisation. Further information will be requested with regard to healthcare resource use and any complications.Ethics and DisseminationThe National Research Ethic Committee approved this study on 6 October 2016 (16/SC/0462).The National Institute for Health Research Health Technology Assessment monograph and a manuscript to a peer-reviewed journal will be submitted on completion of the trial. The results of this trial will substantially inform clinical practice on the clinical and cost-effectiveness of the treatment of this injury.Trial registration numberISRCTN11980540; Pre-results.

scholarly journals 181 Preoperative Blood Investigations in Surgical Fixation of Distal Radius Fractures (Jan-Apr 2020)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H A S K Mohamed
Keyword(s):  
Distal Radius ◽  
Previous History ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Nice Guideline ◽  
Health Care Professions ◽  
Audit Period ◽  
History Of ◽  
Surgical Fixation ◽  
K Wires

Abstract Background Venepuncture is not a risk-free procedure; 1 in 125 000 risk of nerve injury and risk of spreading MRSA. Blood biochemistry and haematology testing is expensive; a Group & Save can cost up to £20 (Inc. VAT). Distal Radius fractures are common injuries seen and treated at the Worthing Hospital. ORIF or MUA + K-wires of Distal Radius are highly unlikely to result in the need for intra-operative transfusion. Aim and Objective Aim to reduce unnecessary preoperative bloods from wards under T&O “control” during re-audit period to zero. Results This audit included 27 patients (4 male, 23 female) (average age 58 years). four patients were ≥ ASA 3, 23 were ASA 1- 2. About 20/27 (74.1%) patients had FBC performed. About 3/4 (75%) patients with ASA ≥ 3 had FBC done and 17/23 (73.9%) patients with ASA 1-2 had FBC. Almost 11/27 (40.7%) patients had Coagulation screen performed, with no previous history of anticoagulation. About 16/27 (59.2%) LFTs performed. About 14/27 (51.8%) G&S performed with 21 samples sent of these figures 7/27 patients had two G&S samples sent and 7/27 patients had only 1 sample sent to pathology lab. Conclusions The practice of doctors at Worthing hospital does not meet NICE guideline recommendations in Pre-operative blood investigations for Distal Radius fractures. This can add more cost to the trust, wasting resources and putting extra load on health care professions working in pathology department.

“COMPARATIVE STUDY OF DISTAL END RADIUS FRACTURE TREATED BY PERCUTANEOUS 5 PIN TECHNIQUE V/S CLOSED REDUCTION AND CASTING METHOD”.

2021 ◽  
pp. 29-31
Author(s):  
Vibhor Khandal ◽  
Ashwani Kumar Mathur ◽  
Mohit Kumar ◽  
Rajkumar Bairwa
Keyword(s):  
Distal Radius ◽  
Closed Reduction ◽  
Soft Tissues ◽  
Hand Function ◽  
Early Mobilization ◽  
Fracture Site ◽  
Distal Radius Fractures ◽  
Point System ◽  
Casting Method ◽  
Radius Fractures

Introduction: Distal end radius fractures crush the mechanical foundation of most useful tool, the hand. No other fracture has a such potential to devastate hand function, and no other metaphysis of bone is embraced by more soft tissues. Closed reduction and percutaneous pinning is one of the standard treatments for management of distal radius fractures, and its modication 'The percutaneous 5 pin technique improves the reliability of xation thus combining the benets of non-invasiveness as in casting and stability achieved is comparable to open reduction and plating. Material and method: This prospective study was done between December 2018 to December 2020 in department of orthopedics, including 60 patients with fracture of distal radius Among them 30 patients subsequently underwent ve pin xation and 30 patients were treated with closed reduction and casting method. Result: Radiological analysis of the data was done using Sarmiento's Modication of Lidstrom Criteria. Activities of daily life (ADL) were examined by using the demerit point system of Gartland and Wereley based on objective and subjective criteria, residual deformity and complications. Radiological parameters were assessed for at the end of 6months. There was signicant difference in all the three parameters i.e, Volar tilt, Radial length, Radial inclination between both groups at the end of 6 months. Closed reduction with ve pinning technique group had shown not only better but also statistically signicant anatomical reduction compared to other groups. Functional outcome was better in patients treated with percutaneous 5 pinning technique. Conclusion: The ve pin technique carries the advantage of early mobilization, DRUJ stability. Radio Ulnar pins and the pins across the fracture site provide enough stability to permit early mobilization leading to less post operative stiffness in joint. Although the study series is small and further research is essential to provide directions for treatment, it is safe to conclude that the ve pin technique is a technically less demanding, lessinvasive and an effective way of treating displaced distal radius fractures without severe articular or metaphyseal comminution

scholarly journals Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over

2021 ◽  
Vol 2 (12) ◽  
pp. 1027-1034
Author(s):  
Sondre Hassellund ◽  
Zinajda Zolic-Karlsson ◽  
John Håkon Williksen ◽  
Torstein Husby ◽  
Jan Erik Madsen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Distal Radius ◽  
Controlled Trial ◽  
Cost Effective ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Life Years

Aims The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.

scholarly journals Anesthesia for Closed Reduction of Distal Radius Fractures in the Emergency Department

Hand ◽  
2016 ◽  
Vol 11 (1_suppl) ◽  
pp. 58S-58S
Author(s):  
Ronit Wollstein ◽  
Lior Koren ◽  
Eyal Ginesin ◽  
Shahem Elias ◽  
Shlomo Israelit
Keyword(s):  
Emergency Department ◽  
Distal Radius ◽  
Closed Reduction ◽  
Distal Radius Fractures ◽  
Radius Fractures
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