Local injection of leukocyte rich platelet rich plasma produced higher radius union scoring system than local injection of pure platelet rich plasma in conservative therapy of intra-articular closed distal radius fractures

Background: Distal radius fracture often occurs both extra-articular and intra-articular, covering all ages. The use of autologous platelet rich plasma (PRP) consisting of leucocytes rich-PRP (L-PRP) and pure-PRP (P-PRP) thought can help in bone healing process. This study aimed to determine that the administration of L-PRP provides a better healing rate than P-PRP in intra-articular closed distal radius fractures after conservative treatment.Methods: This was a single-blinded experimental study with stratified randomized post-test only group design involving 51 patients with closed distal fractures undergoing closed reduction, consisting of 17 patients per study group. Group 1 received placebo, group 2 received P-PRP, and group 3 with L-PRP. Each group was then re-evaluated using x-ray at week 2, 3, and 6. RUSS score was then measured. Data was analysed using descriptive statistics and normality test, homogeneity test and inferential test were performed to determine the effect of L-PRP, P-PRP on the union rate of fracture distal radius. All obtained data was analysed using SPSS statistics 22 software.Results: Between control and P-PRP group, there was significant difference in mean RUSS with p value of 0.012. Between control and L-PRP injection group, there was a significant difference in mean RUSS with p value of 0.000. Between P-PRP and L-PRP group, there was also significant mean RUSS difference with p value of 0.003.Conclusions: There was a significant difference between the control group given placebo and the group P-PRP and L-PRP in closed fractures of the intraarticular radius after conservative therapy.

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The effect of distal radius fractures involving the distal radioulnar articular joint on forearm rotation

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02091-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lingde Kong ◽

Meng Fu ◽

Jian Lu ◽

Yanqing Zhou ◽

Zuzhuo Zhang ◽

...

Keyword(s):

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

Control Group ◽

Case Group ◽

Radius Fractures ◽

Forearm Rotation ◽

Sigmoid Notch ◽

Significant Difference ◽

And Control

Abstract Background The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. Methods We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients’ basic data and postoperative data were collected and compared. Results A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). Conclusion This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.

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The Effect of Distal Radius Fractures Involving Distal Radioulnar Articular Joint on Forearm Rotation

10.21203/rs.3.rs-76689/v1 ◽

2020 ◽

Author(s):

Lingde Kong ◽

Meng Fu ◽

Jian Lu ◽

Yanqing Zhou ◽

Zuzhuo Zhang ◽

...

Keyword(s):

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

Control Group ◽

Case Group ◽

Radius Fractures ◽

Forearm Rotation ◽

Sigmoid Notch ◽

Significant Difference ◽

And Control

Abstract Background: The objective of this study was to predict the function of forearm rotation on basis of articular surface of sigmoid notch from three-dimensional reconstruction images. Methods: We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of sigmoid notch on fractured distal radius was reconstructed and looked up from ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on sigmoid notch were included in case group or control group respectively. The patients’ basic data and postoperative data were collected and compared. Results: A total of 81 patients were included. There were 33 patients in case group, and 48 patients in control group. There was no significant difference between the two groups at baseline. Total range of motion (ROM) of rotation in case group and control group were 130.3±6.2 degrees and 145.3±6.7 degrees respectively (P<0.001). Percentage of rotation ROM of contralateral limb in case group and control group were 72.3±3.1% and 80.7±3.6% respectively (P<0.001). VAS during forearm rotation were 2.1±0.7 in case group, which is significantly higher than that in control group (1.5±0.5, P<0.001). Conclusion: This study proposed a new method to assess the articular surface of sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement.

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Clinical Outcomes in Distal Radius Fractures Accompanied by Volar Lunate Facet Fragments: A Comparison between Dorsal and Volar Displaced Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835520500447 ◽

2020 ◽

Vol 25 (04) ◽

pp. 417-422 ◽

Cited By ~ 1

Author(s):

Hiroyuki Obata ◽

Kiyohito Naito ◽

Ayaka Kaneko ◽

Keniji Goto ◽

Yoichi Sugiyama ◽

...

Keyword(s):

Range Of Motion ◽

Distal Radius ◽

Fragment Size ◽

Perioperative Complications ◽

Postoperative Outcome ◽

Distal Radius Fractures ◽

Bone Fragment ◽

Radius Fractures ◽

Mayo Score ◽

Significant Difference

Background: The treatment strategy for distal radius fractures accompanied by volar lunate facet fragment is controversial. In most cases, only the bone fragment size was discussed and a plate for distal placement is selected due to the accompanying volar lunate facet fragment regardless of the direction of bone fragment displacement. In this study, we divided distal radius fractures accompanied by volar lunate facet fragment into dorsal and volar displaced fractures, and treated these surgically based on different treatment strategies. Methods: The subjects were 25 patients with distal radius fractures accompanied by volar lunate facet fragment treated by reduction and fixation using a volar locking plate (VLP) (male: 14, female: 11, mean age: 57.8 years old). A proximal VLP (PVLP) was selected for 13 dorsal displaced fractures and a distal VLP (DVLP) was selected for 12 volar displaced fractures. The range of motion, VAS, Q-DASH, and Mayo score were evaluated at 12 months after surgery, and compared. Results: No significant difference due to the difference in the direction of displacement was noted in the range of motion, VAS, Q-DASH, or Mayo score at 12 months after surgery and there were no perioperative complications. In addition, no re-displacement of volar lunate facet fragment was noted after surgery in any patient and bone fusion was observed. Conclusions: Reduction and fixation with a PVLP are possible even for dorsal displaced distal radius fractures accompanied by volar lunate facet fragment. For the volar displaced distal radius fractures, a favorable postoperative outcome is possible by applying a DVLP to the distal ulnar.

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Hematoma block for distal radius fractures – prospective, randomized comparison of two different volumes of lidocaine

Journal of International Medical Research ◽

10.1177/0300060518799883 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4535-4538 ◽

Cited By ~ 1

Author(s):

Hagay Orbach ◽

Nimrod Rozen ◽

Barak Rinat ◽

Guy Rubin

Keyword(s):

Distal Radius ◽

Analgesic Efficacy ◽

Fracture Site ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Vas Score ◽

Significant Difference ◽

Group A ◽

Vas Scores ◽

Group B

Objective This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. Methods Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. Results Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. Conclusion VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

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1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

British Journal of Surgery ◽

10.1093/bjs/znab259.1033 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Hafez ◽

A Shaat ◽

M Zain ◽

M A Sajid ◽

A Butt

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Open Reduction ◽

Group Versus ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Volar Approach ◽

Normal Ranges ◽

Significant Difference ◽

The Impact

Abstract Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

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

BioMed Research International ◽

10.1155/2020/6849352 ◽

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.

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

Journal of Wrist Surgery ◽

10.1055/s-0037-1602800 ◽

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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Dorsal Bridge Plating versus External Fixation for Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0039-1694063 ◽

2019 ◽

Vol 09 (02) ◽

pp. 177-184

Author(s):

William L. Wang ◽

Asif M. Ilyas

Keyword(s):

External Fixation ◽

Distal Radius ◽

Meta Analysis ◽

Pain Syndrome ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Hardware Failure ◽

Pubmed Database ◽

Significant Difference ◽

Bridge Plating

Abstract Background External fixation and dorsal bridge plating are wrist spanning fixation options for distal radius fractures; however, their comparative effectiveness is not well understood. A meta-analysis was conducted to compare the clinical outcomes between these two techniques. Materials and Methods A PubMed database query of all distal radius fracture cases managed with spanning external fixation or dorsal bridge plating was performed. A total of 28 articles met inclusion criteria, yielding 895 patients for data extraction and comparative analysis. Results Dorsal bridge plating demonstrated lower rates of infection (2 vs. 10%, p = 0.05) and complex regional pain syndrome (1 vs. 4%, p = 0.04) but higher rates of hardware failure (4 vs. 1%, p = 0.026). Bridge plating also demonstrated higher rates of excellent/good ratings under the Gartland and Werley outcome score (91 vs. 83%, p = 0.016). There was no significant difference in DASH (Disability of the Arm, Shoulder, and Wrist) scores, radiographic parameters, or unplanned reoperations between the two spanning fixation options. Conclusion Bridge plating and external fixation both appear to be comparable for spanning fixation constructs for distal radius fractures, but with bridge plating having a potentially lower complication profile.

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The distal radius palmar cortical angle in adolescent versus adult populations

Journal of Orthopaedic Surgery ◽

10.1177/2309499018772378 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877237

Author(s):

Shane Breheny ◽

Angela Christine Chang ◽

April De Silva ◽

Paul Allcock

Keyword(s):

Distal Radius ◽

Age Groups ◽

Open Reduction Internal Fixation ◽

Distal Radius Fractures ◽

Control Group ◽

Loss Of Function ◽

Radius Fractures ◽

Interclass Correlation ◽

Adolescents And Adults ◽

The Mean

Purpose: Volar distal radius plates are pre-contoured to aid restoration of anatomy during open reduction internal fixation of distal radius fractures. Incorrectly contoured plates can result in malreduction, leading to malunion, pain, and loss of function. The purpose of this study was to investigate whether adolescent distal radius anatomy on the palmar cortical surface differs from that in adults, in order to determine whether adult plates are suitable for use in adolescents. Methods: Lateral wrist radiographs were used to measure the distal radius palmar cortical angle (PCA) in adolescent age groups (12–13, 14–15, and 16–17 years old) and compared to a skeletally mature control group (30–50 years old). Two assessors measured 423 PCAs twice. Results: There was a statistically significant ( p = <0.05) difference in the PCA of the control group compared to each adolescent group. The mean PCA for both males and females decreased as age increased (increasing curvature of the volar distal radius with age). The mean PCA (male/female) was 164.38°/163.00° in ages 12–13, 162.14°/160.92° in ages 14–15, 157.52°/158.18° in ages 16–17, and 149.65°/154.03° in the control group aged 30–50 years. Agreement between assessors was high with an Interclass correlation coefficient (ICC) of 0.97. Conclusion: There is a statistically significant and potentially clinically important difference in the curvature of the distal radius volar cortex between adolescents and adults. This difference persists even in the 16–17 age group. As the PCA curvature is significantly greater in adults compared to adolescents, plates pre-contoured for adults may lead to malreduction of distal radius fractures into flexion in adolescent patients.

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Comparison of Forearm and Conventional Bier’s Blocks for Manipulation and Reduction of Distal Radius Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2006.10.002 ◽

2007 ◽

Vol 32 (1) ◽

pp. 57-59 ◽

Cited By ~ 12

Author(s):

A. K. S. CHONG ◽

D. M. K. TAN ◽

B. S. OOI ◽

M. MAHADEVAN ◽

A. Y. T. LIM ◽

...

Keyword(s):

Distal Radius ◽

Controlled Trial ◽

Hand Surgery ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Pain Scores ◽

Significant Difference ◽

Emergency Room Setting ◽

Randomised Controlled ◽

Bier Block

Forearm-based Bier’s block has been advocated as a useful anaesthesic technique in hand surgery. However, there is limited data comparing forearm blocks with the conventional Bier’s block. We conducted a randomised controlled trial ( n = 30) comparing the two techniques of anaesthesia for manipulation and reduction of closed distal radius fractures in an emergency room setting. Pain scores measured using the Visual Analogue Scale during the procedure were used as the primary outcome assessment. There was no significant difference in pain scores between the forearm and conventional Bier’s block (mean VAS 18.4 SD 22.10 versus 33.7 SD 29.6). No major complications were observed in either group. The forearm-based Bier block is an effective alternative to the conventional block.

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