Operative Treatment of Distal Radius Fractures in Patients With Parkinson Disease

Hand ◽  
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.

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

2014 ◽  
Vol 15 (1) ◽  
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

scholarly journals Complications of Volar Locked Plating of Distal Radius Fractures: A Prospective Investigation of Modern Techniques

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 698-706
Author(s):  
Tyler S. Pidgeon ◽  
Peter Casey ◽  
Rita E. Baumgartner ◽  
Harrison Ferlauto ◽  
David S. Ruch
Keyword(s):  
Distal Radius ◽  
Complication Rate ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Locked Plating ◽  
Type C ◽  
The Mean ◽  
Removal Of Hardware

Although volar locked plating (VLP) of distal radius fractures is common, complications remain a considerable concern for upper extremity specialists using modern techniques. Complications following VLP of DR fractures were recorded prospectively from January 2005 to January 2017. Fractures were characterized using the AO classification, and complications were described by severity. Severe complications required operative treatment and/or resulted in permanent impairment, moderate complications required nonoperative treatment, and mild complications resolved without intervention. The available Current Procedural Terminology data for uncomplicated VLP were used to calculate the complication rate. Statistical analysis compared severe and nonsevere complications. Thirty-seven patients (27 women; 39 radii) experienced complications following VLP of DR fractures, resulting in a complication rate of 13.2%. For those with complications, the mean age was 48.5 ± 13.5 years (range: 19-78 years) and the mean follow-up was 13.7 ± 9.0 months (range: 3-36 months). A majority (28/39: 71.8%) had type C fractures. The most common complications were hardware complication requiring removal (18) and malunion (6). There were only 3 tendon ruptures. There were 25 unplanned returns to the operating room in 24 radii (22 patients). The most common reason was removal of hardware (18). Patients with severe complications more commonly had AO type C fractures and required longer follow-up. Modern VLP of DR fractures has a complication rate of 13.2%. Hardware complication requiring removal was the most notable complication of VLP. Tendon rupture has become rare with modern techniques. AO type C fractures were associated with more severe complications.

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.

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

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.

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

2017 ◽  
Vol 137 (9) ◽  
pp. 1187-1191 ◽  
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

A55 Numbers and locations of screws influence fixation stability in palmar locked plating of distal radius fractures

Injury ◽  
2011 ◽  
Vol 42 ◽  
pp. S15
Author(s):  
G. Stein ◽  
C. Reissig ◽  
G. Gradl ◽  
K.J. Burkhart ◽  
L.P. Müller
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Locked Plating ◽  
Fixation Stability

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

CJEM ◽  
2007 ◽  
Vol 9 (01) ◽  
pp. 9-15 ◽  
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.

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.

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