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.

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 418 The Management of Distal Radius Fractures in Adults with A Removable Soft Cast During the Peak Of The Covid-19 Pandemic: Patient Reported Outcomes And Experiences

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Baawa-Ameyaw ◽  
R Kabariti ◽  
J Rhee
Keyword(s):  
Distal Radius ◽  
Functional Outcomes ◽  
Operative Management ◽  
Distal Radius Fractures ◽  
Functional Score ◽  
Dash Score ◽  
Radius Fractures ◽  
Patient Reported ◽  
Functional Scores ◽  
Non Operative Management

Abstract Introduction Immobilisation tools for non-operative management of distal radius fractures (DRFs) in adults, include plaster casts, orthotic splints, and recently removable soft cast as per the BOAST COVID-19 guidelines. Limited evidence exists on the effectiveness of removable soft casts in adults with DRFs. We assessed patient reported functional outcomes and experiences of adults with DRFs managed non-operatively in a removable soft cast during the COVID-19 pandemic. Method We retrospectively reviewed adults with DRFs, treated with a removable soft cast for 6 weeks between 9th April 2020 and 18th May 2020. Functional scores - Disabilities of the Arms, Shoulders and Hands (DASH) and a 7-question Patient Reported Experience Questionnaire (PREQ) were conducted at 6 weeks, along with a record of complications. A DASH score of &lt; 25 was deemed a satisfactory functional score. Results 34 patients formed our cohort, with a 65% (22patients) completion rate, mean age of 69years. 82% had a DASH score &lt; 25 and 18% had a DASH score &gt; 25 at 6 weeks. 86% reported satisfactory comfort in the PREQ with 14% reporting discomfort. Two patients re-attended hospital with soft cast related problems. Conclusions Most adults with DRFs managed in a removable soft cast reported good early functional outcomes, satisfactory experiences, and no clinic visits at 6weeks.

scholarly journals 873 The Keystone Challenge- Volar Displaced Intra-Articular Distal Radius Fractures with Lunate Fossa Fragment

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M S Cheruvu ◽  
D Dass ◽  
D J Ford ◽  
I Roushdi
Keyword(s):  
Distal Radius ◽  
Operative Management ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Fixation Failure ◽  
Complex Injury ◽  
Articular Fractures ◽  
K Wires ◽  
Lunate Fossa

Abstract Aim Volar displaced fractures of the distal radius are unstable and warrant operative management. A subset of patients with volar displaced fractures also has a separate lunate fossa fragment, a specific injury with greater instability that may precipitate carpal subluxation. We aim to review our long-term experience in the management of this complex injury, exploring surgical technique which may improve treatment. Method We retrospectively reviewed all volar displaced distal radius fixations between 2015 and 2020. Inclusion criteria: any displaced intra-articular volar distal radius fracture with lunate fragment involvement undergoing volar fixation and over 16 years of age. Exclusion criteria: shaft fractures, extra-articular fractures, open fractures, fractures fixed using k-wires or external fixation, revision surgery and patients without follow-up. We adapted our surgical approach in order to address this more complex fracture pattern, and all operations were performed by specialist hand surgeons. Results 468 distal radius fractures were assessed, of which 29 (6%) cases included a lunate fossa fragment. 20 (69%) of patients were female, mean age was 59 years (SD 12.4). Mean length of stay was 5 hours and mean operative time was 96 mins (range 79-95). No patients had carpal subluxation, fracture fixation failure or return to theatre for any reason. Conclusions From our experience as a specialist orthopaedic institution, we recommend the extended FCR approach and intra-focal exposure to manage this complex injury. In particular, the lunate fossa fragment is the keystone which requires dedicated reduction prior to tackling the remaining fracture configuration.

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.

Strategies for Specific Reduction in High-Energy Distal Radius Fractures

Hand Clinics ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 267-278
Author(s):  
Nicholas Pulos ◽  
Alexander Y. Shin
Keyword(s):  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fractures

scholarly journals Perfil epidemiológico das fraturas radiais distais em hospital de referência em Ribeirão Preto, Brasil

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Felipe Azevedo Mendes de Oliveira ◽  
Thiago Agostini Pereira Albeny ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Filipe Jun Shimaoka ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Distal Radial Fracture ◽  
Fracture Treatment ◽  
Radius Fractures ◽  
Distal Radial Fractures

Objetivo: Avaliar o perfil epidemiológico das fraturas do rádio distal em hospitais de referência em Ribeirão Preto(SP), Brasil. Não existem dados suficientes na literatura nacional que corroborem com o perfil epidemiológico das fraturas do rádio distal. Métodos: 245 pacientes apresentaram 254 fraturas do rádio distal, ocorridas entre 2014 a 2017 foram avaliadas retrospectivamente para obtenção do perfil epidemiológico. Os fatores analisados foram idade e sexo, mecanismo do trauma, sazonalidade, tipo de fratura baseada na Classificação AO, presença de exposição óssea, lesões associadas, tipo de tratamento realizado (conservador ou cirúrgico) e o tipo de implante utilizado nos tratamentos cirúrgicos. Resultados: 60,2% dos pacientes participantes eram do sexo masculino e 39,8% do sexo feminino, distribuídos de forma bimodal. A média de idade foi 45,4 anos. Fraturas expostas corresponderam a 92,1% das fraturas e 7,9% representaram as expostas. Pacientes politraumatizados representaram 62,6%. O tempo médio de internação foi 8,09 dias. Conclusão: Apesar do padrão de fraturas mostrar semelhanças com outros estudos, o padrão apresentado pode não traduzir, de forma homogênea, o padrão obtido em outras metrópoles e grandes centros.Descritores: Fraturas do Rádio; Traumatismos do Punho; Epidemiologia; Hospitais Especializados.ReferênciasBruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-45.Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97.Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-312.Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124-28.Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One. 2012;7(8):e43367.Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-96.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56(5):391-93.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Tsai CH, Muo CH, Fong YC, et al. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int. 2011;22(11):2809-815.Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-13. Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65(4):432-33.Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.Pagano M, Gauvreau K. Princípios de Bioestatística. 2. ed. São Paulo: Pioneira Thompson Learning; 2004.                                  Court-Brown CM. Epidemiologia das fraturas e luxações. In: Court-Brown CM et al. (ed.); Fraturas em adultos de Rockwood Green. 8. ed. Barueri, SP: Manole; 2016.Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313-19.Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):96-106.

Wound Complications with Multiple Wrist Incisions in Distal Radius Reconstruction

2021 ◽  
Author(s):  
Joshua J. Meaike ◽  
Christian Athens ◽  
Nicole Sgromolo ◽  
Alexander Y. Shin ◽  
Peter C. Rhee
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Surgical Management ◽  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Wound Complications ◽  
Radius Fractures ◽  
Increased Risk ◽  
Delayed Healing

Abstract Background Placement and spacing of skin incisions are important for maintaining soft tissue perfusion and viability, particularly in the setting of local trauma. Question/Purpose The aim of this article is to determine if multiple skin incisions in the surgical management of distal radius fractures result in an increased risk of postoperative wound complications, particularly in the setting of high-energy mechanisms of injury with substantial initial displacement and associated soft-tissue insult that require multiple incisions for distal radius reconstruction. Patients and Methods A multicenter, retrospective chart review was performed for all adult patients who underwent open reduction, internal fixation of a closed distal radius fracture with multiple (≥2) hand, and wrist incisions with minimum follow-up of 6 weeks. Primary outcome measures included wound healing complications such as partial or complete skin necrosis, dehiscence, delayed healing, and superficial or deep infections. Results For 118 wrists, a total of 305 incisions were utilized, averaging 2.6 incisions per patient (range: 2–6) with the flexor carpi radialis and dorsal distal radius approaches occurring in 86 and 78% of cases, respectively. One patient was identified as having a pyogenic granuloma along an incision. However, two patients were identified as having wound concerns, including fracture blisters (n = 1) and wound margin epidermolysis (n = 1) along the incision. There were no cases of skin bridge necrosis, delayed healing, wound dehiscence, or infection. Conclusions There is no increased risk of wound healing complications with the use of multiple skin incisions (≥2) in the surgical management of distal radius fractures, afforded by the abundant and robust angiosomes around the wrist. Surgeons should have the confidence to utilize the necessary number of skin incisions to effectively reconstruct distal radius fractures.

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.

Kirschner’s Wires Fixation of Unstable Distal Radius Fractures in Children with the Kapandji Technique

2021 ◽  
Vol 18 (2) ◽  
pp. 4-8
Author(s):  
Sabin Shrestha ◽  
Dinesh Kumar Shrestha ◽  
Dipendra KC ◽  
Prateek Karki ◽  
Sushil Yogi
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Additional Tool ◽  
Fractures In Children ◽  
Wire Fixation ◽  
K Wires ◽  
Unstable Distal Radius Fracture

Introduction: Unstable distal radius fractures in children have more tendencies to get displaced with conservative management resulting into deformity. This Kapandji technique of K-wire fixation is on rise to reduce and maintain these fractures in recent days. Aims: The aim of this study was to evaluate the effectiveness of the K-wires fixation in unstable distal radius fracture with Kapandji techniques. Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke in unstable distal radius fracture in children with K-wires fixation using Kapandji method. Results: Twenty eight unstable distal radius fractures in children between 6 to 14 years of age were treated with one intrafocal K-wire and one or two extra focal K-wires to augment fixation. Immobilization of forearm with above elbow slab/cast for four to six weeks was enforced. K-wires were removed between four to six weeks of operation depending upon the union and followed prospectively for four months. The mean age of patients presented was 8.57± 1.79 years. This technique brought near anatomical reduction in all fractures. There was no reduction loss or remanipulation in any case. All fractures achieved union and functional outcome was excellent in 24 cases based on Modified Mayo Wrist Score. There was fewer complications like pin tract infection. Conclusion: This Kapandji technique of K-wire fixation, leverage reduction method, being an additional tool helps to achieve near anatomical alignment, and maintain reduction throughout the duration of healing. So it is an advantageous technique.

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