scholarly journals Wrist function in malunion: Is the distal radius designed to retain function in the face of fracture?

2016 ◽  
Vol 98 (7) ◽  
pp. 442-445 ◽  
Author(s):  
C Uzoigwe ◽  
N Johnson
Keyword(s):  
Distal Radius ◽  
Comparative Studies ◽  
Functional Outcomes ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Human Species ◽  
Radius Fractures ◽  
The Face ◽  
Preserve Function ◽  
Wrist Function

Introduction Fractures of the distal radius are the most common fracture in humans and are the sempiternal hazard of 3.5 million years of bipedalism. Despite the antiquity of the injury, one of the most controversial topics in current orthopaedics is the management of distal radius fractures. It has been suggested that radiographic appearances rarely correlate with functional outcomes. As the success of the human species is predicated almost exclusively on its dexterity and intelligence, it is conceivable that the distal radius has evolved to preserve function even in the face of injury. We therefore hypothesise that the distal radius is designed to accommodate the possibility of fracture. Methods We conducted a review of studies comparing fracture pattern and form with function. We also explore the paleoanthropological evidence and comparative studies with other primates. Findings The evidence points to the human distal radius being highly tolerant of post-fracture deformity in terms of preservation of function. In addition, the distal radius appears to have apparently anatomically ‘redundant’ features that confer this capability. We believe these phenomena to be an evolved trait that developed with bipedalism, increasing the chances of survival for a species whose success depends upon its dexterity.

scholarly journals Distal Radius Fractures: Does Obesity Affect Fracture Pattern, Treatment, and Functional Outcomes?

Hand ◽  
2018 ◽  
Vol 14 (3) ◽  
pp. 398-401 ◽  
Author(s):  
Michael D. Montague ◽  
Jesse T. Lewis ◽  
Obadah Moushmoush ◽  
Jaiyoung Ryu
Keyword(s):  
Distal Radius ◽  
Retrospective Review ◽  
Functional Outcomes ◽  
Nonoperative Treatment ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Complex Part ◽  
Point Increase ◽  
Significant Difference

Background: Distal radius fractures (DRFs) are 16% of fractures treated by orthopedic surgeons. Obesity’s influence on DRF complexity has not been studied. This study was undertaken to determine if body mass index (BMI) affects DRF pattern, treatment, and functional outcomes. Methods: Part 1 was a retrospective review of patients who sustained a DRF after a fall from standing height with no prior reduction or treatment. Radiographs were classified as “simple” or “complex.” Part 2 consisted of contacting patients from Part 1 and obtaining a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Retrospective review also identified patients who failed initial nonoperative treatment. Fracture pattern, failure of nonoperative treatment, and QuickDASH scores were compared with BMI at the time of injury. Results: For Part 1, 130 patients (132 wrists) were identified. Average age was 57 years, 77% were female, and average BMI was 28.2 kg/m2. Each point increase in BMI increased the chance of having a complex DRF (odds ratio = 1.07). Part 2 identified 50 patients who completed a QuickDASH at an average of 4.6 years after injury. Those with a BMI <25 kg/m2 (n = 15) had an average QuickDASH score of 37; patients with a BMI ≥25 kg/m2 (n = 35) had an average QuickDASH score of 18. Increasing BMI was suggestive of a lower QuickDASH score ( P = .08). No significant difference was found with respect to BMI and failure of nonoperative treatment. Conclusions: A higher BMI increases the odds of a complex DRF. Despite more complex fractures, overweight patients may experience less disability after sustaining a DRF.

Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

2021 ◽  
Author(s):  
Lili E. Schindelar ◽  
Richard M. McEntee ◽  
Robert E. Gallivan ◽  
Brian Katt ◽  
Pedro K. Beredjiklian
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Open Reduction ◽  
The Elderly ◽  
Distal Radius Fractures ◽  
Implant Design ◽  
Complication Rates ◽  
Radius Fractures ◽  
Hardware Failures

Abstract Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.

Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis

2013 ◽  
Vol 26 (4) ◽  
pp. 248
Author(s):  
Ki-Chan An ◽  
Gyu-Min Kong ◽  
Jang-Seok Choi ◽  
Hi-Chul Gwak ◽  
Joo-Yong Kim ◽  
...  
Keyword(s):  
Distal Radius ◽  
Functional Outcomes ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Wire Fixation

Distal radius fractures – A volar plate is not just a volar plate

Trauma ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 203-207
Author(s):  
Richard Knight ◽  
Lucy Elliott ◽  
Mark Brewster ◽  
Michelle Spiteri ◽  
Dominic Power
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Cost Savings ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Potential Cost ◽  
Plate Design ◽  
Column Variable

Introduction Increasingly complex distal radius plate designs are available for treating distal radius fractures. As a result, many fractures are being ‘over-treated’ with more complex volar plate designs than necessary. We hypothesise that significant cost savings could be made by rationalising the use of complex locking plate designs. Methods Over a two-year period, radiographs of 250 consecutive distal radius fractures fixed with volar locking plates were reviewed and the type of plate, and type and number of screws used for fixation were noted. Preoperative radiographs were independently reviewed to ascertain if it would have been possible to stabilise the fracture with a simpler, extra-articular plate design. Potential cost savings were then calculated. Results It was deemed that 89 (36.5%) of the 250 cases originally treated with a more complex 2 column variable angle plate could have been treated with an extra-articular construct, leading to potential savings of £19,224. Conclusion It is clear from our data that many distal radius fracture patterns are being ‘over-treated’ with complex locking plate designs with multiple rows of screws and that substantial cost savings could be made by selecting an appropriate construct to suit the fracture pattern.

Fixation of Distal Radius Fractures Using AO Titanium Volar Distal Radius Plate

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 7-15 ◽  
Author(s):  
H. C. Lee ◽  
Y. S. Wong ◽  
B. K. Chan ◽  
C. O. Low
Keyword(s):  
Distal Radius ◽  
Tendon Rupture ◽  
Open Reduction Internal Fixation ◽  
Distal Radius Fractures ◽  
Titanium Plate ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Effective Treatment Modality ◽  
Wrist Function

This study is to assess the effectiveness and outcome of the AO titanium volar distal radius plate (Synthes) in the treatment of peri-articular volar rim fractures of the distal radius. It was conducted on 22 patients with distal radius fractures who underwent open reduction, internal fixation using the AO titanium volar distal radius plate between July 1998 and December 1999 at the Changi General Hospital. The radiographs of the patients were analysed upon fracture union and assessment of wrist function was done using Gartland and Werley criteria. There were four extra-articular AO Type A2(1) and A3(3): the remaining 18 intra-articular fractures consisted of AO B3(2), AO C1(11), AO C2(2) and AO C3(3). The average follow-up period was 12.6 months (range 7–23). Radiological review showed bone healing in 21 patients (95.5%) and good articular congruity for all intra-articular fractures with less than 2 mm step-off. Three patients defaulted follow-up. Complications were few with one wound infection, one tendon rupture and three neuropraxia of the superficial radial nerve. Wrist function was excellent in three patients, good in 12 and fair in four. The AO titanium plate with its distal buttressing ability is an effective treatment modality in patients with distal radius fractures involving the peri-articular volar rim.

scholarly journals Partially Healed Malaligned Distal Radius Fracture. Surgical Treatment in Patients older than 70 Years

2020 ◽  
Vol 48 (01) ◽  
pp. 020-026
Author(s):  
Marcos Cruz-Sánchez ◽  
Jaime De la Torre-Rojo ◽  
Cristóbal Martínez-Andrade
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
High Rate ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Mayo Wrist Score

Abstract Introduction Management of distal radius fractures remains controversial despite their high frequency. Elderly patients specifically present a high rate of secondary displacement, sometimes requiring a complex reconstructive surgery. The surgical treatment of displaced fractures evolving for several weeks in elderly patients has not been clearly reflected in the literature. This study aims to show clinical and radiological outcomes from this particular situation. Material and Methods Retrospective study of 31 cases of distal radius fractures with more than 2 weeks of evolution. Fractures were graded according to the Fernández's classification. Pre- and postoperative radiological studies were carried out to evaluate the degree of correction achieved. A clinical evaluation was performed using the Mayo Wrist Score. Data on arthroscopy and bone substitutes use, specific surgical tips and complications were also collected. Results Thirty-one patients with a mean age of 76 years old were operated for distal radius fracture with a delay in surgical treatment of 22 days. The most frequent fracture pattern was Fernández type III (38.7%). The clinical outcome according to the Mayo Wrist Score was 81.94 points with no relationship to fracture pattern or arthroscopic assistance. A statistically significant improvement was achieved for the correction of radial inclination, joint gap and ulnar variance. No statistically significant improvement was achieved in volar tilt correction. Complications were observed in 12.9% of the cases. Conclusions Delayed surgical treatment of distal radius fracture in elderly patients provides similar results to those observed in other age groups and time of evolution. Despite not being the ideal scenario for the surgeon, it should be considered to avoid functional deterioration in this fragile age group.

scholarly journals A Functional Outcomes Survey of Elderly Patients who Sustained Distal Radius Fractures

Hand ◽  
2011 ◽  
Vol 6 (3) ◽  
pp. 260-267 ◽  
Author(s):  
Louis F. Amorosa ◽  
Mark A. Vitale ◽  
Shervondalonn Brown ◽  
Robert A. Kaufmann
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Distal Radius Fractures ◽  
Radius Fractures

Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures

2004 ◽  
Vol 29 (6) ◽  
pp. 1121-1127 ◽  
Author(s):  
Alexander Anzarut ◽  
Jeffrey A. Johnson ◽  
Brian H. Rowe ◽  
Robert G.W. Lambert ◽  
Sandra Blitz ◽  
...  
Keyword(s):  
Distal Radius ◽  
Functional Outcomes ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Patient Reported ◽  
Elderly Cohort

scholarly journals Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation

2018 ◽  
Vol 12 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Jonathan Lans ◽  
Alejandro Lasa ◽  
Neal C. Chen ◽  
Jesse B. Jupiter
Keyword(s):  
Distal Radius ◽  
Functional Outcomes ◽  
Primary Treatment ◽  
Contralateral Side ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Interosseous Ligament ◽  
Additional Surgery ◽  
Osteoarthritis Of The Wrist

Background:The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable.Objective:The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures.Methods:We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score.Results:There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL.Conclusion:In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.

Sign in / Sign up

Export Citation Format

Share Document