scholarly journals Perioperative management of distal radius fractures

2020 ◽  
pp. 175045892094946
Author(s):  
Jiang An Lim ◽  
Bryan LC Loh ◽  
George Sylvestor ◽  
Wasim Khan
Keyword(s):  
Professional Development ◽  
Distal Radius ◽  
Upper Limb ◽  
Perioperative Management ◽  
Continuing Professional Development ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Upper Limb Fracture ◽  
Complex Injuries

Fractures of the distal radius are the most common upper limb fracture and account for over a sixth of all fractures seen in emergency departments. Although most of these fractures are managed non-operatively, a significant number of complex injuries undergo operative management. This educational review of up to date guidelines discusses the perioperative management of distal radius fractures and provides readers with continuing professional development activities.

scholarly journals The theoretical impact on corrective upper limb elective services following analysis of distal radius fractures managed nonoperatively during COVID-19 pandemic

2020 ◽  
Vol 1 (10) ◽  
pp. 612-616
Author(s):  
Joanna Baawa-Ameyaw ◽  
Rakan Kabariti ◽  
Arjun Chandra ◽  
Jae Rhee
Keyword(s):  
Distal Radius ◽  
Upper Limb ◽  
Elective Surgery ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Operative Intervention ◽  
Radius Fractures ◽  
Clinical Notes ◽  
Radial Inclination ◽  
British Orthopaedic Association

Aims To assess the proportion of patients with distal radius fractures (DRFs) who were managed nonoperatively during the COVID-19 pandemic in accordance with the British Orthopaedic Association BOAST COVID-19 guidelines, who would have otherwise been considered for an operative intervention. Methods We retrospectively reviewed the radiographs and clinical notes of all patients with DRFs managed nonoperatively, following the publication of the BOAST COVID-19 guidelines on the management of urgent trauma between 26 March and 18 May 2020. Radiological parameters including radial height, radial inclination, intra-articular step-off, and volar tilt from post-reduction or post-application of cast radiographs were measured. The assumption was that if one radiological parameter exceeds the acceptable criteria, the patient would have been considered for an operative intervention in pre-COVID times. Results Overall, 92 patients formed the cohort of this study with a mean age of 66 years (21 to 96); 84% (n = 77) were female and 16% (n = 15) were male. In total, 54% (n = 50) of patients met at least one radiological indication for operative intervention with a mean age of 68 years (21 to 96). Of these, 42% (n = 21) were aged < 65 years and 58% (29) were aged ≥ 65 years. Conclusion More than half of all DRFs managed nonoperatively during the COVID-19 pandemic had at least one radiological indication to be considered for operative management pre-COVID. We anticipate a proportion of these cases will require corrective surgery in the future, which increases the load on corrective upper limb elective services. This should be accounted for when planning an exit strategy and the restart of elective surgery services. Cite this article: Bone Joint Open 2020;1-10:612–616.

Predictors of Management of Distal Radius Fractures in Patients Aged >65 Years

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Amanda Walsh ◽  
Nelson Merchan ◽  
David N. Bernstein ◽  
Bailey Ingalls ◽  
Carl M. Harper ◽  
...  
Keyword(s):  
Distal Radius ◽  
Operative Management ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Total N ◽  
Fracture Characteristics ◽  
Time Period ◽  
Tertiary Center ◽  
Comorbidity Index

Background Treatment of distal radius fractures (DRFs) in patients aged >65 years is controversial. The purpose of this study was to identify what patient and fracture characteristics may influence the decision to pursue surgical versus nonsurgical treatment in patients aged >65 years sustaining a DRF. Methods We queried our institutional DRF database for patients aged >65 years who presented to a single academic, tertiary center hand clinic over a 5-year period. In all, 164 patients treated operatively were identified, and 162 patients treated nonoperatively during the same time period were selected for comparison (total N = 326). Demographic variables and fracture-specific variables were recorded. Patient and fracture characteristics between the groups were compared to determine which variables were associated with each treatment modality (operative or nonoperative). Results The average age in our cohort was 72 (SD: 11) years, and 274 patients (67%) were women. The average Charlson Comorbidity Index (CCI) was 4.1 (SD: 2.1). The CCI is a validated tool that predicts 1-year mortality based on patient age and a list of 22 weighted comorbidities. Factors associated with operative treatment in our population were largely related to the severity of the injury and included increasing dorsal tilt (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.12; P < .001) and AO Classification type C fractures (OR, 5.42; 95% CI, 2.35-11.61; P < .001). Increasing CCI was the only factor independently associated with nonoperative management (OR, 0.84; 95% CI, 0.72-0.997; P = .046). Conclusion Fracture severity is a strong driver in the decision to pursue operative management in patients aged >65 years, whereas increasing CCI predicts nonoperative treatment.

Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

2020 ◽  
pp. 175319342094131
Author(s):  
Brent R. DeGeorge ◽  
Holly K. Van Houten ◽  
Raphael Mwangi ◽  
Lindsey R Sangaralingham ◽  
Sanjeev Kakar
Keyword(s):  
Upper Extremity ◽  
Distal Radius ◽  
Complication Rate ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Specific Complication ◽  
Secondary Procedures ◽  
Non Operative Management

To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. Level of evidence: III

scholarly journals Operative fixation of distal radius fractures: Radiological outcomes and the role of upper limb trauma lists

2014 ◽  
Vol 12 ◽  
pp. S62
Author(s):  
Maire-Clare Killen ◽  
Andrew Berg ◽  
Christopher Lodge ◽  
Simon Chambers ◽  
Cho Ee Ng ◽  
...  
Keyword(s):  
Distal Radius ◽  
Upper Limb ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Limb Trauma ◽  
Operative Fixation

scholarly journals Beneficial Effects of Pulsed Electromagnetic Field during Cast Immobilization in Patients with Distal Radius Fracture

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Lucyna Krzyżańska ◽  
Anna Straburzyńska-Lupa ◽  
Patrycja Rąglewska ◽  
Leszek Romanowski
Keyword(s):  
Electromagnetic Field ◽  
Distal Radius ◽  
Upper Limb ◽  
Distal Radius Fractures ◽  
Control Group ◽  
Pulsed Electromagnetic Field ◽  
Radius Fractures ◽  
Cast Immobilization ◽  
Beneficial Effects ◽  
Pulsed Electromagnetic

To assess whether pulsed electromagnetic field therapy during cast immobilization of distal radius fractures has beneficial effects on pain and limb function, the study included 52 patients (mean age 60.8 ± 15.0 years) with distal radius fractures treated with cast immobilization. Patients were allocated to a pulsed electromagnetic field group (n = 27) or a control group (n = 25). Pain; forearm and arm circumference; range of motion; disabilities of the arm, shoulder, and hand score; and touch sensation were evaluated on the day of the plaster cast dressing and 3 and 6 weeks after. In comparison to the control group, the pulsed electromagnetic field group reported significant changes after 3 and 6 weeks of treatment: lower pain levels (p=0.0052; p<0.0001, respectively), greater mobility of upper-limb joints, improvement in exteroceptive sensation, and reduction in disability of the upper limb (disabilities of the arm, shoulder, and hand) (p=0.0003; p<0.0001, respectively). Our results suggest that early addition of pulsed electromagnetic field treatment, during cast immobilization of distal radius fractures, has beneficial effects on the pain, exteroceptive sensation, range of motion, and daily functioning of patients.

scholarly journals Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study

2020 ◽  
Vol 09 (04) ◽  
pp. 345-352
Author(s):  
Nicole M. Sgromolo ◽  
Jill M. Cancio ◽  
Peter C. Rhee
Keyword(s):  
Distal Radius ◽  
Operative Management ◽  
Rehabilitation Program ◽  
Distal Radius Fractures ◽  
Controlled Study ◽  
Radius Fractures ◽  
Safety And Efficacy ◽  
Rehabilitation Protocol ◽  
Flow Restriction ◽  
Randomized Controlled

Abstract Background Blood flow restriction (BFR) therapy is an emerging addition to rehabilitative programs that allows patients to increase strength at lower loads over shorter time periods. Therefore, we conducted a study to evaluate the safety and efficacy of a rehabilitation program using BFR to a traditional rehabilitation protocol following operative fixation of distal radius fractures. Methods A randomized controlled study was conducted comparing a standardized rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients treated with volar plate fixation following a displaced distal radius fracture. The same exercises done in the control group were performed by the BFR group with a restrictive tourniquet in place. Patients were followed with serial radiographs to ensure fracture stability. Outcome measures included wrist range of motion, grip strength, pinch strength, visual analog scale (VAS) pain scores at rest and during activity, patient rated wrist evaluation scores (PRWE), and disabilities of the arm, shoulder, and hand scores. Results Nine patients were randomized and enrolled within the BFR group (n = 5) and control (n = 4) groups. Patients within the BFR group had a significantly greater reduction in pain with activity over the course of the rehabilitation program. Additionally, the BFR group had a significant improvement in PRWE scores during the 8-week rehabilitation program. There was no difference in radiographic measures after initiation of BFR, and all patients tolerated therapy without noted complications. Conclusion BFR therapy is safe and well tolerated after operatively treated distal radius fractures. The addition of BFR therapy can result in quicker reduction in pain with activity and improvement in patient disability when used early following operative management of a distal radius fracture. Level of Evidence This is a Level 1, prognostic study.

scholarly journals Distal radius fractures: an evidence-based approach to assessment and management

2020 ◽  
Vol 81 (6) ◽  
pp. 1-8
Author(s):  
Kalpesh R Vaghela ◽  
Diana Velazquez-Pimentel ◽  
Aashish K Ahluwalia ◽  
Anika Choraria ◽  
Alistair Hunter
Keyword(s):  
Distal Radius ◽  
Soft Tissue Injuries ◽  
Operative Management ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Management Options ◽  
Patient Profiles ◽  
K Wires ◽  
Non Operative Management

Distal radius fractures account for one in five bony injuries in both primary and secondary care. These are commonly the result of a fall on outstretched hands or high-energy trauma. On assessment, clinicians should determine the mechanism of injury, associated bony or soft tissue injuries, and neurovascular symptoms. Investigations should always include radiographs to evaluate for intra-articular involvement and fracture displacement. Owing to the heterogeneous injury patterns and patient profiles, the preferred management should consider the severity of the fracture, desired functional outcome and patient comorbidities. Non-operative management in select patients can give good results, especially in older adults. Immobilisation with or without reduction forms the mainstay of non-operative treatment. Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation. Patients should be encouraged to mobilise as soon as it is safe to do so, to prevent stiffness. Median nerve compression is the most common complication followed by tendon rupture, arthrosis and malunion. This article outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures.

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