The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life

2017 ◽  
Vol 43 (2) ◽  
pp. 131-136 ◽  
Author(s):  
M. Å. Wadsten ◽  
G. O. Sjödén ◽  
G. G. Buttazzoni ◽  
C. Buttazzoni ◽  
E. Englund ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Pain Visual Analogue Scale ◽  
Level Of Evidence

Late displacement of distal radius fractures, still in acceptable radiological position after 1–2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10–14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires. Level of evidence: II

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

Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

2017 ◽  
Vol 22 (04) ◽  
pp. 423-428 ◽  
Author(s):  
Yoshihiro Abe ◽  
Masahiro Suzuki ◽  
Hiromasa Wakita
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Locking Plates ◽  
Radius Fractures ◽  
Radial Inclination ◽  
The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

scholarly journals Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant

2018 ◽  
Vol 07 (05) ◽  
pp. 358-365
Author(s):  
Schneider Rancy ◽  
Stephanie Malliaris ◽  
Eric Bogner ◽  
Scott Wolfe
Keyword(s):  
Internal Fixation ◽  
Grip Strength ◽  
Distal Radius ◽  
Fracture Fixation ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Promising Alternative ◽  
Pain Scores

Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3–20), VAS pain scores averaged 0.6 (range, 0–8) and PRWE averaged 12.1 (range, 0–53.5). Grip strength of the operated hand averaged 58 lbs (range, 20–130). ROM included: wrist flexion 73° (50–95), wrist extension 78° (60–110), pronation 77° (60–90), supination 79° (60–90), ulnar deviation 31° (5–45), and radial deviation 17° (10–30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.

scholarly journals Volar Locking Plate for Distal Radius Fractures: Functional Outcomes and Complication Rates with a Minimum of One Year Follow-Up

2021 ◽  
Vol 6 (05) ◽  
pp. 358-365
Author(s):  
Kastanis G ◽  
Pantouvaki A ◽  
Kapsetakis P ◽  
Spyrantis M ◽  
Magarakis G ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
One Year ◽  
Quick Dash

Distal radius fractures (DRF) are the most common type of fractures of the upper extremities with an incidence of 44% of all types of forearm and hand fractures. In unstable DRF, the aim of surgical treatment is to restore a functional wrist. Volar locking plate is supported in literature as a promising surgical method in treatment of these fractures. The aim of this study is to analyze the type and complication rate with applied volar locking plate, the percentage of revision surgery and the functional outcomes in a minimum of one year follow up. Material &Methods: 104 fractures in 98 patients with a mean range of 48,5 years-old age underwent for unstable distal radius fractures with volar locking plate. The main cause was simple fall to an outstretched hand. In ten cases the fracture was open while in 28 cases the DRF was accompanied with ulnar styloid. All fractures classified by AO/OTA in A2-3 27 cases, B1-3 in 45 and C1-3 in 32 cases. The majority of patients were operated within 48-72 hours after injury. In all cases an extended flexor carpi radialis approach was performed and a volar locking plate was applied in all DRF’s. In sixteen cases with base of ulnar styloid fractures, low profile locking plates were applied, while in the rest of patients Kirschner wires were used. Postoperatively all patients followed a standard protocol rehabilitation program with passive and active motion of fingers and wrist. Results: Patients were evaluated according to complication (type and rate), time to fracture union, range of motion, Visual analogue pain scale, Quick Dash Score and patients-rated wrist evaluation score. Complications were distinguished in major and minor. Patients under 60 years-old with type fracture A2-3 and B1-3 showed better range of motion and grip strength than patients over 65 years old. In cases with type fractures C1-3 and age over 65 years old, ROM and grip strength decreased compared with the unilateral side. The percentage of complication and reoperation appeared more increased in type C1-3 related to the other two types of fractures. Finally the mean Quick DASH was 11,1±12,8, RPWE was 9.8±13,6 and the range of motion was in extension 75,2±7,3, in flexion 74±8,9, in pronation 85,6±1,9, in supination 88,5±2,4 in radial deviation 9,8±1,2 and in ulnar deviation 41,1±4,6 and grip strength was an average of 84,7% of uninjured hand. Conclusion: Unstable fractures required operative treatment with volar locking plate to be the gold standard in recently years. Unfortunately VPL presents postoperative complications related with plate and screw position with comminuted fracture or soft tissue damage which cannot be ignored, and for these reasons may be inadequate for all types of distal radius fractures.

Mid-Term Functional Outcome after Volar Locking Plate Fixation of Distal Radius Fractures in Elderly Patients

2018 ◽  
Vol 23 (02) ◽  
pp. 238-242 ◽  
Author(s):  
Haruhiko Shimura ◽  
Akimoto Nimura ◽  
Koji Fujita ◽  
Takashi Miyamoto
Keyword(s):  
Elderly Patients ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Significant Difference

Background: The volar locking plate is frequently used in the fixation of unstable distal radius fractures, but despite this there is a paucity of mid to long term outcome studies. The purpose of this study was to investigate the mid-term functional outcomes of elderly patients treated with a volar locking plate for unstable distal radius fractures. Methods: Thirty-two patients with a mean age of 74.1 (range, 65–85) years were followed for a mean of 39.1 (range, 30–81) months. Patients with follow-up periods of < 24 months were excluded from this study to investigate the mid-term clinical outcomes. The Mayo wrist score (MWS), grip strength and wrist range of motion were retrospectively reviewed at 12 months, 24 months and the latest follow-up (mean 39.1 months). Osteoarthritis status according to the system of Knirk and Jupiter was assessed at 24 months. Results: Significant improvements in MWS and grip strength were observed between 12 and 24 months but not between 24 months and the final follow-up. There was no significant difference in wrist range of motion between 12 and 24 months. The MWS of 14 patients with radiographic signs of osteoarthritis was not significantly different from that of 18 patients without radiographic signs of osteoarthritis. Conclusions: Elderly patients treated with the volar locking plate showed improved MWS and grip strength postoperatively after 12 months. Improvement in grip strength was slower than range of motion.

Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

2017 ◽  
Vol 43 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Daniel Martinez-Mendez ◽  
Alejandro Lizaur-Utrilla ◽  
Joaquin de-Juan-Herrero
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Distal Radius ◽  
Articular Surface ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

scholarly journals Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

2018 ◽  
Vol 07 (05) ◽  
pp. 409-414
Author(s):  
J. Hill ◽  
Gabriel Bouz ◽  
Ali Azad ◽  
William Pannell ◽  
R. Alluri ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Outcome Measures ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Dash Score ◽  
Radius Fractures ◽  
Volar Plate Fixation

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

scholarly journals Volar locking plate versus external fixation in distal radius fractures: A meta-analysis

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Giuseppe Maccagnano ◽  
Giovanni Noia ◽  
Giovanni Vicenti ◽  
Marco Baglioni ◽  
Maria Rosa Masciale ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Distal Radius ◽  
Systematic Reviews ◽  
External Fixator ◽  
Meta Analysis ◽  
A Priori ◽  
Wrist Fracture ◽  
Distal Radius Fractures ◽  
Radius Fractures

The purpose of this meta-analysis is to evaluate the efficacy of plate or external fixator treatments in distal radius fractures, based not only on clinical and radiographic parameters but on Health Related Quality of Life (HRQOL) parameters. The Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) guidelines were followed when conducting this systematic review. The Revised Assessment of Multiple Systematic Reviews (RAMSTAR) checklist was additionally consulted in order to ensure a high-quality methodological process, encompassing such elements as an ‘a priori’ design, independent reviews and comprehensive search. The literature search was carried out on PubMed, MEDLINE and Scopus. The search terms used were “Radius fracture AND osteosynthesis”, “Wrist fracture AND external fixator” and “Wrist fracture AND plate”. Two reviewers independently screened titles, abstracts and full texts. To determine inter-reviewer agreement, a k score was calculated after each screening state. Of the 5753 studies collected through the initial databases search, two studies were included in the final meta-analysis (125 treated with external fixator vs 132 with volar plate). There was a substantial inter-reviewer agreement as to the title (0.73; 95% confidence interval, 0.67-0.79) abstract (0.65; 95% CI, 0.46-0.83) and fulltext screening stages (0.89; 95%CI, 0.67-1). The meta-analysis reported a mean difference equal to 0.00 (95%CI= -0.05 – 0.05), in accordance with I2= 0% and p test for the heterogeneity value=0.089. This meta analysis confirms and quantifies that the two techniques are superimposable as regards the quality of life reported by patients at least one year of follow-up.

scholarly journals Preexisting Carpal and Carpometacarpal Osteoarthritis Has No Impact on Function after Distal Radius Fractures

2017 ◽  
Vol 06 (04) ◽  
pp. 301-306
Author(s):  
Jonah Davies ◽  
Hugo Centomo ◽  
Stéphane Leduc ◽  
Pierre Beaumont ◽  
G.-Yves Laflamme ◽  
...  
Keyword(s):  
Distal Radius ◽  
Functional Outcomes ◽  
Short Form ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Treatment Type ◽  
Significant Difference

Background Functional outcomes of distal radius fractures vary widely regardless of treatment methods. Purpose This study aims to verify whether preexisting carpal and carpometacarpal (CMC) osteoarthritis (OA) will negatively impact wrist functional outcome in patients with distal radius fractures. Patients and Methods A retrospective case–control study was done using a prospective trauma database. Patients were matched 1:1 in two groups based on the presence of wrist or carpal arthritis (OA). The groups were matched for sex, follow-up, and treatment type. Patients were followed up for a minimum of 1 year and functional outcomes were assessed using validated scores. Results A total of 61 patients were included. Mean age was 63 years (range: 20–85) and average follow-up was 26 months. There were 31 patients in the OA+ group and 30 in the OA− group. Forty-one patients were treated surgically and 20 nonoperatively. None of the patients in the OA− developed OA during follow-up. Both groups were comparable for sex, residual deformity, and follow-up. There was no significant difference for the visual analog scale, Short Form-12, Quick Disability Arm Shoulder Hand, and Patient-rated Wrist Evaluation, or for radiographic outcomes. Conclusion Preexisting OA in the wrist or CMC does not seem to impact outcomes of distal radius fractures, regardless of treatment, age, or sex. Although this is a negative study, the results are important to help counsel patients with distal radius fractures. Further work must be done to identify other potential causes for negative outcomes. Level of Evidence Level III, prognostic study.

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