Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Hand ◽  
2020 ◽  
pp. 155894472093030
Author(s):  
Stella J. Lee ◽  
Derek S. Stenquist ◽  
Jamie E. Collins ◽  
Ariana N. Mora ◽  
Brett A. Teplitz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Matched Cohort ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Surgical Fixation

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

scholarly journals A Cohort Study of One-Year Functional and Radiographic Outcomes following Intra-Articular Distal Radius Fractures

Hand ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Emily A. Lalone ◽  
Vaishnav Rajgopal ◽  
James Roth ◽  
Ruby Grewal ◽  
Joy C. MacDermid
Keyword(s):  
Cohort Study ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
One Year

A Comparison of Radiographic Outcomes between 3D Preoperative Planning and Conventional Planning in the Osteosynthesis of Distal Radius Fractures

2019 ◽  
Vol 24 (03) ◽  
pp. 303-310 ◽  
Author(s):  
Yuichi Yoshii ◽  
Yasukazu Totoki ◽  
Wen-lin Tung ◽  
Kenichi Akita ◽  
Tomoo Ishii
Keyword(s):  
Distal Radius ◽  
Preoperative Planning ◽  
Distal Radius Fractures ◽  
Control Group ◽  
Radius Fractures ◽  
Correction Loss ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Healthy Side ◽  
And Control

Background: To assess the usefulness of three-dimensional (3D) digital pre-operative planning, we compared the radiographic parameters of the distal radius from 3D planning and conventional planning after osteosynthesis of distal radius fractures. We hypothesized that the use of 3D digital planning may improve radiographic outcomes for reduction and decrease the risk of correction loss.Methods: Sixty wrists of 60 distal radius fracture patients were randomly divided into two groups according to the order of hospital visits. Thirty wrists were treated with 3D preoperative planning as the plan group. Another thirty wrists were treated with conventional preoperative planning as the control group. Both groups were treated with volar locking plates. In the plan group, 3D digital preoperative planning and a surgical simulation were performed in order to determine the reduction and placement of the implants in addition to the plate/screw size prior to surgery. In the control group, conventional preoperative planning was performed. Ulnar variance, volar tilt, and radial inclination were measured at one week, three and six months after surgery. Difference of the measurement of radiographic parameters between operated and healthy side wrists were compared between plan and control groups at one week after surgery. Loss of corrections for radiographic parameters were compared between plan and control groups.Results: The differences between the operated and healthy side wrists were significantly smaller in the plan group compared to the control group for the volar tilt and radial inclination (p < 0.05).The loss of corrections for ulnar variance and volar tilt were significantly smaller in the plan group compared to the control group at six months after surgery (p < 0.05).Conclusions: 3D preoperative planning offers better reduction accuracy and reduces correction loss in the osteosynthesis of distal radius fractures.

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.

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.

Radial Overgrowth after Surgical Treatment for Pediatric Distal Radius Fractures

2016 ◽  
Vol 51 (5) ◽  
pp. 365
Author(s):  
Min-Wook Kim ◽  
Choong-Young Kim ◽  
Dae-Hyun Yoon ◽  
Dae-Hee Kim ◽  
Jung-Ho Lee ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures

scholarly journals Is the Additional Effort for an Intraoperative CT Scan Justified for Distal Radius Fracture Fixations? A Comparative Clinical Feasibility Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2254 ◽  
Author(s):  
Sascha Halvachizadeh ◽  
Till Berk ◽  
Alexander Pieringer ◽  
Emanuael Ried ◽  
Florian Hess ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radiation Dose ◽  
Ct Scan ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ct Scans ◽  
Radius Fractures ◽  
Ao Classification ◽  
Intraoperative Ct ◽  
Duration Of Surgery

Introduction: It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans. Methods: Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT). Exclusion criteria: Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization. Results: A total of 187 patients were included (Group Conv n = 96 (51.3%), Group CT n = 91 (48.7%)). AO Classification: Type A fractures n = 40 (50%) in Group Conv vs. n = 16 (17.6%) in Group CT, p < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), p < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, p < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization. Conclusion: The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.

scholarly journals Plating Distal Radius Fractures Using Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia: A Cohort Study

2020 ◽  
Vol 2 (6) ◽  
pp. 331-338
Author(s):  
Liew Mei Yi ◽  
Amir Adham Ahmad ◽  
Shairil Rahayu Ruslan ◽  
Shalimar Abdullah ◽  
Abdul Rauf Ahmad
Keyword(s):  
Cohort Study ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Wide Awake ◽  
No Tourniquet

Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Hand ◽  
2019 ◽  
pp. 155894471986264
Author(s):  
Michael C. Daly ◽  
Taylor A. Horst ◽  
Chaitanya S. Mudgal
Keyword(s):  
Distal Radius ◽  
Null Hypothesis ◽  
Independent Predictor ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Fracture Geometry ◽  
Plain Radiographs ◽  
Fracture Patterns ◽  
Discrete Fracture ◽  
Surgical Fixation

Background: Volar Barton fractures involve the volar articular margin of the distal radius with proximal and volar subluxation of the carpus. Although traditionally conceptualized as partial articular, some volar Barton fractures are complete articular injuries due to a dorsal cortical break in the distal radial metaphysis. While dorsal cortical breaks can affect surgical strategy, they may be difficult to identify on plain radiographs and their epidemiology remains poorly characterized. Some authors have hypothesized an association with osteoporosis; however, this hypothesis remains untested. To better characterize volar Barton fractures, we analyzed fracture geometry on pre-operative computed tomography (CT) scans to: (1) determine the frequency of a dorsal cortical break; and (2) test the null hypothesis that a dorsal cortical break is not associated with age or gender. Methods: We retrospectively reviewed adults with a volar Barton distal radius fracture and an available pre-operative CT who underwent surgical fixation. Using multivariable logistic regression, we assessed whether age or gender was an independent predictor of a dorsal cortical break. Results: Forty patients (mean age 52 years, 57% female) were identified. Including the shaft as a fragment, 32 (80%) had 3 or more discrete fracture fragments. Thirty patients (75%) had a dorsal cortical break. Dorsal cortical breaks were not associated with either age or gender ( P > 0.05). Conclusions: Most (75%) patients with volar Barton distal radius fractures had a dorsal cortical break. Dorsal cortical breaks were not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously hypothesized.

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