Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures

Background: Quality of reduction in distal radius fractures (DRF) is assessed using radiographic parameters, however few studies examine the association between radiographic measurements and functional outcomes. Our purpose was to evaluate the relationship between radiographic measurements and clinical outcome measures following surgery for DRF using detailed testing to demonstrate further associations between post-surgical radiographic measurements and function. Methods: Measurements were performed on postoperative radiographs of 38 patients following ORIF of DRF. Measurements included: radial inclination, radial height, ulnar variance, volar tilt, radiocarpal interval (d2/w2), and the intra-articular step-off. Clinical outcome measures included motion, grip strength, functional dexterity testing, Moberg pick-up test, specific activities of daily living, DASH score, pain scale, manual-assessment questionnaire. Results: Different radiographic parameters correlated with different specific tasks. The parameter correlated with most functional tasks was ulnar-variance. Radial inclination, radial-styloid scaphoid distance, and fracture classification correlated with some functions. Intraarticular step-off, and radial height were not associated with functional testing. Conclusions: Surgical radiographic results may affect post-operative function. Detailed task specific testing may enable a better evaluation of surgical outcomes. Further study and refinement of functional assessment may change our surgical goals in DRF.

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USE OF THE VOLAR FIXED ANGLE PLATE FOR COMMINUTED DISTAL RADIUS FRACTURES AND AUGMENTATION WITH A HYDROXYAPATITE BONE GRAFT SUBSTITUTE

Hand Surgery ◽

10.1142/s0218810411005023 ◽

2011 ◽

Vol 16 (01) ◽

pp. 29-37 ◽

Cited By ~ 7

Author(s):

Akira Goto ◽

Tsuyoshi Murase ◽

Kunihiro Oka ◽

Hideki Yoshikawa

Keyword(s):

Elderly Patients ◽

Bone Graft ◽

Distal Radius ◽

Bone Graft Substitute ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Radius Fractures ◽

Fixed Angle ◽

Radial Inclination ◽

Metaphyseal Comminution

Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone.We treated elderly patients suffering from distal radius fractures with metaphyseal comminution, using both volar fixed angle plate with or without augmentation with a hydroxyapatite bone graft substitute to investigate the benefit of augmentation for maintaining a fracture reduction. We evaluated the differences among radiographic parameters including palmar tilt, radial inclination, and ulnar variance on immediate postoperative and final follow-up radiographs to analyse the maintenance of the initial reduction.There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05).It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.

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Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500447 ◽

2017 ◽

Vol 22 (04) ◽

pp. 423-428 ◽

Cited By ~ 1

Author(s):

Yoshihiro Abe ◽

Masahiro Suzuki ◽

Hiromasa Wakita

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Locking Plates ◽

Radius Fractures ◽

Radial Inclination ◽

The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

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The relationship between radiological alignment of united distal radius fractures and functional and patient-perceived outcomes in elderly patients

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684976 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668497 ◽

Cited By ~ 2

Author(s):

Erik Hohmann ◽

Mahendrakumar Meta ◽

Vasudev Navalgund ◽

Kevin Tetsworth

Keyword(s):

Elderly Patients ◽

Grip Strength ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Pinch Strength ◽

Radius Fractures ◽

Radial Inclination ◽

Perceived Outcomes ◽

The Relationship

Purpose: The purpose of this study was to investigate the relationship between radiological alignment and functional outcomes including strength, range of motion (ROM), and disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores in elderly patients with united distal radius fractures. Methods: We reviewed 118 patients (mean age of 76.2 ± 9.5 years, mean follow-up 36.3 ± 17.6 months). Outcome measures included the DASH and PRWE scores, ROM, and grip and pinch strength were measured using a validated mobile hand-held dynamometer. Radial height, radial inclination, ulnar variance, and palmar tilt were measured on standard radiographs. Results: The mean total score for DASH was 4.9 ± 7.4 and 6.9 ± 11 for the PRWE. There were significant differences in ROM for palmar flexion and ulnar deviation between the affected wrist and the normal wrist. Linear regression revealed significant relationships for the following variables: between DASH and radiological palmar tilt, between PRWE and radiological palmar tilt, between grip strength and radial inclination, between grip strength and radial height, and between grip strength and ulnar variance. Conclusion: This study suggests that minor deformities of the distal radius following distal radius fractures treated with either operative or nonoperative treatment are unlikely to be clinically relevant and have no impact on patient perceived outcomes for elderly patients.

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Carpal Translocation Following Dorsal Bridge Plate Fixation of Distal Radius Fractures: A Cadaveric Study

Journal of Wrist Surgery ◽

10.1055/s-0039-1683434 ◽

2019 ◽

Vol 08 (03) ◽

pp. 234-239 ◽

Cited By ~ 1

Author(s):

Ali Azad ◽

Jessica M. Intravia ◽

J. Ryan Hill ◽

Hyuma Leland ◽

Venus Vakhshori ◽

...

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Radius Fractures ◽

Volar Approach ◽

Radial Inclination ◽

Bridge Plate ◽

Radiocarpal Joint ◽

Distal Fixation

Background Dorsal bridge plate fixation is an effective technique for stabilization of highly comminuted, complex distal radius fractures. However, it is unknown whether fixation to the second or third metacarpal is optimal. Given dorsal bridge plating spans the radiocarpal joint, it is unclear if the dorsal spanning plate affects carpal position. This study investigates differences in carpal translocation resulting from bridge plate distal fixation to either the second or third metacarpal. Methods Ten paired cadaveric upper extremities without evidence of gross deformity or prior surgery distal to the elbow were evaluated with three-view wrist fluoroscopic images for baseline radiographic measurements. An unstable distal radius fracture model was created via a volar approach using a 1-cm osteotomy. Following fracture creation, a dorsal bridge plate was applied with random to the second metacarpal on one limb, and the third metacarpal on the contralateral limb. Laterality for distal fixation was chosen randomly. Fluoroscopic images were repeated and radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, radial rotation index, and carpal translocation were measured. Results Radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, and radioscaphoid angle were not statistically different before and after fixation, or when comparing the second or third metacarpal fixation. Additionally, there was no difference in Taleisnik's ulnar translocation index, Chamay's ulnar translation index, or McMurtry's carpal translation index based on which metacarpal was used for distal fixation. Conclusions Dorsal bridge plate fixation of distal radius fractures restores preoperative physiologic measures of the radius, ulna, and carpus. Carpal translocation was similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a bridge plate. Level of Evidence This is a Level V, therapeutic study.

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The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1071 ◽

2016 ◽

Vol 6 (1) ◽

pp. 56-60

Author(s):

Alexander J Lampley ◽

Priyesh D Patel ◽

Riikka EK Nomides ◽

Suhail K Mithani

Keyword(s):

Functional Outcome ◽

Distal Radius Fracture ◽

Distal Radius ◽

Functional Outcomes ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Anatomical Reduction ◽

Radiographic Measurements ◽

Outcome Scores

ABSTRACT Background While there have been multiple studies published that have stressed the importance of restoring various different radiographic parameters to improve functional outcome scores, there is no consensus on the parameter that correlates most with patients’ functional outcomes. We hypothesize that obtaining near anatomical reduction of the palmar lunate facet is critical to improving functional outcome scores. The purpose of this study is to determine the effects of reduction and stabilization of the palmar lunate facet on functional outcomes in patients with intra-articular distal radius fracture. Materials and methods We prospectively collected clinical examination data, radiographic measurements, and functional outcome scores on 157 patients who were treated operatively for multifragmentary intra-articular fractures of the distal radius (AO Type C3) between 1996 and 2006. Prospective data were acquired at 3, 6 months, and 1 year postsurgical intervention in clinical follow-up. Based on radiographic measurements, patients were designated into a nondisplaced palmar lunate facet group and a displaced palmar lunate facet group. Clinical and functional outcomes were then compared between the groups. Results Patients without displacement had a significantly higher value of wrist extension and forearm supination when compared with the patients with displacement. In addition, the Gartland and Werley score was significantly higher in patients with displacement of the palmar lunate facet. Conclusion This study demonstrates that patients with near anatomical reduction of the palmar lunate facet after surgical treatment of an intra-articular distal radius fracture had improved range of motion and better functional outcome scores compared with patients with residual displacement of the palmar lunate facet. Richard MJ, Lampley AJ, Patel PD, Nomides REK, Mithani SK, Leversedge FJ, Ruch DS. The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures. The Duke Orthop J 2016;6(1):56-60.

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The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2015.04.011 ◽

2015 ◽

Vol 101 (7) ◽

pp. 827-831 ◽

Cited By ~ 9

Author(s):

L. Cai ◽

S. Zhu ◽

S. Du ◽

W. Lin ◽

T. Wang ◽

...

Keyword(s):

Clinical Outcome ◽

Elderly Patients ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Radiographic Parameters ◽

The Relationship

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Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures Following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis

Hand ◽

10.1177/1558944719855445 ◽

2019 ◽

pp. 155894471985544 ◽

Cited By ~ 1

Author(s):

Michael Okoli ◽

Matthew Silverman ◽

Jack Abboudi ◽

Christopher Jones ◽

William Kirkpatrick ◽

...

Keyword(s):

Outcome Measures ◽

Distal Radius ◽

Functional Outcomes ◽

Statistical Difference ◽

Cohort Analysis ◽

Distal Radius Fractures ◽

Bony Union ◽

Radius Fractures ◽

Ulnar Styloid

Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P = .47) or the PRWE total score (4.8 vs 7.5, P = .24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P = .112; PRWE 14.8 vs 5.4, P = .185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated.

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Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1729439 ◽

2021 ◽

Author(s):

Lili E. Schindelar ◽

Richard M. McEntee ◽

Robert E. Gallivan ◽

Brian Katt ◽

Pedro K. Beredjiklian

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Functional Outcomes ◽

Open Reduction ◽

The Elderly ◽

Distal Radius Fractures ◽

Implant Design ◽

Complication Rates ◽

Radius Fractures ◽

Hardware Failures

Abstract Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.

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