Predictors of unstable distal radius fractures: a systematic review and meta-analysis

2015 ◽  
Vol 41 (5) ◽  
pp. 501-515 ◽  
Author(s):  
M. M. J. Walenkamp ◽  
S. Aydin ◽  
M. A. M. Mulders ◽  
J. C. Goslings ◽  
N. W. L. Schep
Keyword(s):  
Systematic Review ◽  
Distal Radius ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Closed Treatment ◽  
Secondary Displacement ◽  
Type 3

The aim of this study was to perform a systematic review in order to identify predictors of secondary displacement in distal radius fractures. We performed a systematic review and identified all studies that reported secondary displacement following distal radius fractures. Where possible, we pooled the odds ratios of predictors. The initial search yielded 3178 studies of which 27 were included. Multiple studies found that age, shortening, volar comminution, loss of radial inclination, the presence of a volar hook, AO type 3 fractures (A3, B3, C3) and the Older classification were significant predictors of secondary displacement. Pooling revealed a significantly increased risk of secondary displacement in fractures with dorsal comminution, in women and in patients aged >60 years. An associated ulna fracture or intra-articular involvement does not result in an increased risk of secondary displacement. The overview provided in this study can help surgeons to inform patients of the chances of success of closed treatment regarding the radiological outcome and facilitate shared decision making. Level of evidence: II

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 Complications of Distal Radius Fractures in the Elderly: A Systematic Review and Meta-analysis

2017 ◽  
Vol 42 (9) ◽  
pp. S8 ◽  
Author(s):  
Paul Kooner ◽  
Rajeshwar S. Sidhu ◽  
Joy MacDermid ◽  
Ruby Grewal
Keyword(s):  
Systematic Review ◽  
Distal Radius ◽  
Meta Analysis ◽  
The Elderly ◽  
Distal Radius Fractures ◽  
Radius Fractures

Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
Nathaniel Fogel ◽  
Kevin Mertz ◽  
Lauren M. Shapiro ◽  
Allison Roe ◽  
Sahitya Denduluri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Outcome Measures ◽  
Distal Radius ◽  
Meta Analysis ◽  
Final Analysis ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Patient Reported ◽  
Level I

Background The inclusion of patient-reported outcome measures (PROMs) serves to better quantify aspects of patient outcomes missed with objective measures, including radiographic indices and physical examination findings. We hypothesize that PROMs are inconsistently and heterogeneously captured in the treatment of distal radius fractures. Methods We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of all level I and II randomized controlled trials (RCTs) of distal radius fracture treatment of any modality for those older than 50 years of age from January 2008 to January 2018. A total of 23 studies were included in the final analysis. The metrics used by each study to assess outcomes were collected, compared, and described. Results Physical examination findings and radiographic measures were reported in 70% and 74% of studies, respectively. Patient-reported outcomes measures were used to assess outcomes in 74% of studies. Only the Disabilities of the Arm, Shoulder, and Hand was used in greater than half of the studies (57%). Pain scores were assessed in 39% of studies and complications in only 26%. Conclusions There is substantial heterogeneity and lack of standardization in the collection of both objective outcome measures and PROMs in level I and II RCTs for the treatment of distal radius fractures. The ability to compare between studies or aggregate data among studies is therefore limited. Radiographic and physical examination findings remain frequently reported despite known limitations of these metrics. The routine collection of PROMs after the treatment of distal radius fractures can ensure care is directed toward improving what is most important to patients.

Percutaneous pinning versus volar locking plate internal fixation for unstable distal radius fractures: a meta-analysis

2017 ◽  
Vol 43 (2) ◽  
pp. 158-167 ◽  
Author(s):  
Fei Peng ◽  
Yuan-xiang Liu ◽  
Zhen-yu Wan
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Meta Analysis ◽  
Pain Syndrome ◽  
Open Reduction Internal Fixation ◽  
Distal Radius Fractures ◽  
Percutaneous Pinning ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Randomised Controlled

This meta-analysis compared outcomes between percutaneous pinning/wiring and open reduction internal fixation (ORIF) with locking plates for treatment of unstable distal radius fractures. Medline, Cochrane, EMBASE, and Google Scholar were searched through December 30, 2015. Twenty randomised controlled trials (RCTs) and non-randomised two-arm studies were included. Outcomes included scores of Disabilities of the Arms, Shoulders and Hands (DASH), visual analogue scale (VAS) pain, and patient rated wrist evaluation (PRWE) score, as well as range of motion (ROM) and complication incidence. ORIF/plating was associated with lower DASH scores but longer procedure time, while there was no difference between the two methods with respect to VAS pain score and PRWE score. The overall incidence of complications, including complex regional pain syndrome, was higher with pinning/wiring, though the incidence of carpal tunnel syndrome and nerve defects was not different. Supination and grip strength were better with ORIF. Radiographically, ulnar variation was greater with pinning/wiring. These results suggest that ORIF/plating is the preferred method of managing unstable distal radius fractures. Level of evidence: II

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