Clinical Outcome after Plaster Cast Fixation for 10 Days Versus 1 Month in Reduced Distal Radius Fractures: A Prospective Randomized Study

Introduction: This study aimed to evaluate clinical results after plaster cast fixation for 10 days versus 1 month of moderately displaced and reduced distal radius fractures. Material and Methods: In a prospective randomized study, 109 patients with moderately displaced and conservatively treated distal radius fractures (age ≥50 years) were randomized 10 days after reduction to either removal of the plaster cast and immediate mobilization (active group) or to continued plaster cast fixation for another 3 weeks (control group). Grip strength, pincer strength, range of motion, and pain were assessed at 1, 4, and 12 months after reduction. Clinical outcome was evaluated using three functional assessment scores at 12 months. Results: Treatment failed in 3/54 (6%) patients in the active group. One of these patients had the plaster cast reinstituted because of feelings of instability. The fractures in the other two patients displaced severely after mobilization and were therefore treated surgically. For the remaining 51 patients in the active group, the range of wrist motion was slightly better at 1 month compared with the controls, but there were no differences in grip or pincer strength or pain at the 1-month follow-up. There were no differences between the active and control group in any outcome at 4 or 12 months, including functional assessment scores at 12 months. Conclusion: Treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. The only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. Plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.

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Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽

10.1177/1558944721999733 ◽

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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Operative Treatment of Distal Radius Fractures in Patients With Parkinson Disease

Hand ◽

10.1177/15589447211028931 ◽

2021 ◽

pp. 155894472110289

Author(s):

Anthony L. Logli ◽

Marco Rizzo

Keyword(s):

Parkinson Disease ◽

Operative Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

High Rate ◽

Successful Outcome ◽

Time To Failure ◽

Radius Fractures ◽

Locked Plating

Background: Owing to the many unique disease characteristics of Parkinson disease (PD)—namely resting tremors, muscular rigidity, and poor bone quality—we hypothesized that this patient population would have inferior outcomes with surgical management of acute distal radius fractures (DRFs) compared with the literature available on the general population. Methods: This is a retrospective observational study performed at a single, level 1, academic center from 2001 to 2020 capturing all adult patients with an isolated, acute, and closed DRF that ultimately underwent operative treatment. International Classification of Diseases 10 codes were used to identify 30 patients for manual chart review. Several patient and fracture characteristics were accounted for and complications, reoperations, and failures of surgical intervention were recorded. Results: There was a total of 7/30 failures (23%), 6/30 reoperations (20%), and 12 complications in 9/30 wrists (complication rate, 30%) at a mean latest follow-up of 11 months (1.2-158 months). Of the 7 failures, 5 were due to loss of reduction, and 2 of them were deep infections with mean time to failure of 8.3 weeks (range, 11 days-5.2 months). Conclusions: This study found a high rate of complications, reoperations, and early failure despite a short follow-up period and a small cohort of patients with PD treated surgically for a DRF. We recommend locked plating if suitable for the fracture type and early involvement of a multidisciplinary team to assist with medical optimization of PD to increase chances of a successful outcome.

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145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

British Journal of Surgery ◽

10.1093/bjs/znab135.012 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J Mulrain ◽

K Joshi ◽

F Doyle ◽

A Abdulkarim

Keyword(s):

External Fixation ◽

Distal Radius ◽

Plate Fixation ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Complication Rates ◽

Volar Plating ◽

Radius Fractures ◽

Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

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Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-15-250 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 10

Author(s):

Paul Ruckenstuhl ◽

Gerwin A Bernhardt ◽

Patrick Sadoghi ◽

Mathias Glehr ◽

Lukas A Holzer ◽

...

Keyword(s):

Quality Of Life ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Locked Plating ◽

Follow Up Study

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Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex Improved the Clinical Outcomes in Patients with Persistent Symptomatic Distal Radio-Ulnar Joint Instability After Plate Fixation of Distal Radius Fractures: Minimum 2-year Follow-Up

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.11.047 ◽

2021 ◽

Author(s):

Young-Chang Park ◽

Sung-Chul Shin ◽

Ho-Jung Kang ◽

So-young Jeon ◽

Jun-Hoe Song ◽

...

Keyword(s):

Clinical Outcomes ◽

Distal Radius ◽

Joint Instability ◽

Plate Fixation ◽

Triangular Fibrocartilage Complex ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Triangular Fibrocartilage

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Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417690464 ◽

2017 ◽

Vol 42 (5) ◽

pp. 487-492 ◽

Cited By ~ 7

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

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Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-017-2743-6 ◽

2017 ◽

Vol 137 (9) ◽

pp. 1187-1191 ◽

Cited By ~ 18

Author(s):

N. L. Weil ◽

M. El Moumni ◽

S. M. Rubinstein ◽

P. Krijnen ◽

M. F. Termaat ◽

...

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures

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Minimally angulated pediatric wrist fractures: Is immobilization without manipulation enough?

CJEM ◽

10.1017/s1481803500014676 ◽

2007 ◽

Vol 9 (01) ◽

pp. 9-15 ◽

Cited By ~ 27

Author(s):

Khalid Al-Ansari ◽

Andrew Howard ◽

Brian Seeto ◽

Solina Yoo ◽

Salma Zaki ◽

...

Keyword(s):

Distal Radius ◽

Sagittal Plane ◽

Normal Function ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Post Injury ◽

Radiographic Findings ◽

Fractures In Children ◽

Plaster Immobilization

ABSTRACT Background: Emergency department (ED) manipulation of complete minimally angulated distal radius fractures in children may not be necessary, due to the excellent remodeling potential of these fractures. Objectives: The primary objective of this study was to determine the proportion of minimally angulated distal radius fractures managed in the ED with plaster immobilization that subsequently required manipulation. Our secondary objective was to document, at follow-up, changes in angulation for each wrist fracture. Methods: This retrospective cohort study reviewed consecutive records of all children with bi-cortical minimally angulated (≤15° of angulation in the sagittal plane and ≤0.5 cm of displacement) distal metaphyseal radius fractures, alone or in combination with distal ulnar fracture. Details of treatment, radiographic findings, and clinical outcomes during the subsequent orthopedic follow up were recorded. Results: Of 124 patients included in the analysis, none required manipulation after their ED visit. All but 14 (11.3%) fractures were angulated ≤20° within the follow-up period. Two (1.6%) fractures that were initially angulated ≤15° progressed to 30°–35°, but remodeled within 2 years to nearly perfect anatomic alignment. By 6 weeks post-injury, no patients had clinically apparent deformity and all had normal function. Conclusions: Minimally angulated fractures of the distal metaphyseal radius managed in plaster immobilization without reduction in the ED are unlikely to require future surgical intervention.

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Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0211 ◽

2019 ◽

Vol 101 (3) ◽

pp. 203-207

Author(s):

S Hassan ◽

R Shafafy ◽

A Mohan ◽

P Magnussen

Keyword(s):

Distal Radius ◽

Simple Procedure ◽

Case Series ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Radius Fractures ◽

Ulnar Shortening Osteotomy ◽

Shortening Osteotomy ◽

The Uk

Introduction Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. Materials and methods Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability. Patients were treated with a short oblique ulnar shortening osteotomy, using a Stanley jig and small AO compression plate system. Pre- and postoperative radiographical measurements of inclination, dorsal/volar angulation and ulnar variance were made. Patients were scored pre- and postoperatively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation scores by two orthopaedic surgeons. Mean follow-up was 24 months after surgery. Results Radiographical analysis revealed a change in the ulnar variance with an average reduction of 5.74 mm. Mean preoperative scores were 61.1 (range 25–95.5) for QuickDASH and 70.4 (range 33–92) for Patient-Rated Wrist Evaluation. At the latest follow-up, mean postoperative QuickDASH scores were 10.6 (range 0–43.2) and 17.2 (range 0–44) for Patient-Rated Wrist Evaluation. Differences in scores after surgery for both QuickDASH and Patient-Rated Wrist Evaluation were statistically significant (P < 0.01). Conclusions The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna–carpal impaction.

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