scholarly journals An analysis of functional outcome following conservative versus surgical management in fractures of the distal radius

2017 ◽  
Vol 4 (1) ◽  
pp. 99
Author(s):  
Yeshwanth Subash ◽  
Ravikrishna R. ◽  
Jagadeesh B.
Keyword(s):  
Surgical Management ◽  
Distal Radius ◽  
Treatment Method ◽  
Fracture Pattern ◽  
Distal Radial Fractures ◽  
Orthopaedic Department ◽  
Conservative Group ◽  
Advantages And Disadvantages ◽  
Articular Fractures ◽  
Type 3

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Distal radial fractures are one of the most common injuries seen in the orthopaedic department, which can be managed both conservatively and surgically. There are advantages and disadvantages in each method of management. The aim of this study was to compare the functional and radiological outcomes of intra-articular fractures of the distal end of the radius with conservative and surgical management</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">80 cases of intra articular fractures of the distal radius managed by both conservative and surgical means were studied between January 2011 to January 2013 and were followed up for a minimum period of two years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">In our series of 80 patients, there 53 males and 27 females. Most of the patients were between 20-30 years of age with the mean age being 40.35 years. RTA was the most common mode of injury (45%). Frykman’s type 3 (41.7%) was the most common fracture type seen followed by type 8. All fractures united by the end of 6 months. Excellent results were seen in 47.5% of cases in the surgical group and 30% of cases in the conservative group</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">From this study, we conclude that surgical management is better than conservative in the treatment of intra articular fractures of the distal end of radius. Therefore, one treatment method of treatment cannot be generalized for all types of fractures and treatment should be individualized to a particular fracture in terms of age, fracture pattern, degree of displacement and amount of communition present</span><span lang="EN-IN">.</span></p><p class="abstract"> </p>

scholarly journals Correlação clínico-radiográfica das fraturas articulares completas do rádio distal tratadas cirurgicamente

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Thiago Agostini Pereira Albeny ◽  
Breno Alves de Souza Vaz ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Filipe Jun Shimaoka ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Outcome Evaluation ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Articular Fractures ◽  
Intraarticular Fractures ◽  
Anatomic Reduction

Introdução: As fraturas da extremidade distal do rádio representam uma das fraturas mais comuns. Diversos fatores descritos na literatura influenciam nos seus resultados após manejo cirúrgico; como a fragmentação articular, a restauração cirúrgica da anatomia do rádio, a reabilitação pós-operatória, entre outros. Objetivo: analisar o resultado funcional dos pacientes operados de fraturas articulares completas da extremidade distal do rádio e correlacionar estes resultados com os parâmetros radiológicos comumente utilizados. Métodos: 18 pacientes entre 18 a 65 anos, submetidos ao tratamento cirúrgico das fraturas do rádio distal do tipo AO 23C, no período de janeiro de 2014 a julho de 2016. Os seguintes parâmetros clínicos e radiográficos foram avaliados e submetidos a análise estatística: ADM (amplitude de movimento) do punho e antebraço, força de pinças e de preensão, PRWE (Patient Rated Wrist Evaluation), classificação AO da fratura e parâmetros radiográficos pós-operatórios. Resultados: A análise de regressão linear mostrou correlação estatisticamente significativa considerando a inclinação radial e o desvio ulnar. Conclusão: Correlação estatisticamente significativa entre os parâmetros radiográficos e resultados funcionais é de difícil determinação. Novos estudos com maior amostragem e que correlacionem os parâmetros radiográficos e idade são necessários para melhor estudo do tema abordado.Descritores: Fraturas do Rádio; Traumatismos do Punho; Fraturas Intra-Articulares.ReferênciasCourt-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97. Wolf WS. Distal Radius Fracture. In: Green’s Operative Hand Surgery 7. ed. Philadelphia, PA: Elsevier.Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am. 2016;41(8):845-54.McQueen MM. Fractures oh the distal radius and ulna. In: Rockwood and Green's fractures in adults 8. ed. Philadelphia, PA: Wolters Kluwer Health.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuheia R, Ohtonen P  et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-12.Róbertsson GO, Jónsson GT, Sigurjónsson K. Epidemiology of distal radius fractures in Iceland in 1985. Acta Orthop Scand. 1990;61(5):457-59.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.Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014;3(4):325-32.Metz VM, Gilula LA. Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am. 1993;24(2):217-28.Reis FB, Faloppa F, Saone RP, Boni JR, Corvlo MC. Fraturas do terço distal do rádio: classificação e tratamento. Rev Bras Ortop. 1994;29(5):326-30.Isani A, Melone CP Jr. Classification and management of intra-articular fractures of the distal radius. Hand Clin. 1988;4(3):349-60.AO Surgery Reference. Disponível em: https://surgeryreference.aofoundation.org/. Acesso em: 04 de janeiro de 2020.Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208-10.Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647-59.Szabo RM, Weber SC. Comminuted intraarticular fractures of the distal radius. Clin Orthop Relat Res. 1988;(230):39-48.Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 1999;48:465-80.Lipton HA, Wollstein R. Operative treatment of intraarticular distal radial fractures. Clin Orthop Relat Res. 1996;(327):110-24.Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am. 1989;71(6):839-47.Melone CP Jr. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 1993;24(2):239-53.Xavier CRM, Molin DCD, Santos RMM, Santos RDT, Ferreira Neto JC. Tratamento cirúrgico das fraturas do rádio distal com placa volar bloqueada: correlação dos resultados clínicos e radiográficos. Rev Bras Ortop. 2011;46(5):505-13.Karnezis IA, Panagiotopoulos E, Tyllianakis M, Megas P, Lambiris E. Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius. Injury. 2005;36(12):1435-39.Schneiders W, Biewener A, Rammelt S, Rein S, Zwipp H, Amlang M. Die distale Radiusfraktur. Korrelation zwischen radiologischem und funktionellem Ergebnis [Distal radius fracture. Correlation between radiological and functional results]. Unfallchirurg. 2006;109(10):837-44Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19(2):325-40. Fernandez DL. Should anatomic reduction be pursued in distal radial fractures?. J Hand Surg Br. 2000;25(6):523-27.Kasapinova K, Kamiloski V. Outcome evaluation in patients with distal radius fracture. Prilozi. 2011;32(2):231-46.Paranaíba VF, Santos JBG, Raduan Neto J, Moraes VY, Belotti JC, Faloppa F. Aplicação do PRWE na fratura da extremidade distal do rádio: comparação e correlação dos desfechos consagrados.  Rev bras ortop. 2017;52(3):278-83.da Silva Rodrigues EK, de Cássia Registro Fonseca M, MacDermid JC. Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): Cross-cultural adaptation, internal consistency, test-retest reliability and construct validity. J Hand Ther. 2015;28(1):69-76.

scholarly journals 206 Audit of Time to Surgical Fixation of Distal Radial Fractures Compared to British Orthopaedic Association Standard for Trauma (BOAST) Guidelines at Busy District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Sooriyamoorthy
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Joint Surface ◽  
Distal Radial Fractures ◽  
Orthopaedic Department ◽  
Articular Fractures ◽  
Surgical Fixation ◽  
Manipulation Under Anaesthesia ◽  
The Difference ◽  
Mean Time

Abstract Aim BOAST guidelines state that intra-articular distal radial fractures should be operated on within 72 hours of injury and extra-articular distal radial fractures which require surgical management should be operated on within 7 days. The aim of this audit was to see how the orthopaedic department at a busy district general hospital compared to these guidelines. Method Retrospectively looked at operations carried out over a 10-month period. All Manipulation Under Anaesthesia, K wire and Open Reduction Internal Fixations of distal radial fractures were included. Results Over the 10-month period, 49 intra-articular and 60 extra-articular fractures were operated on. 65% of intra-articular fractures were fixed within 72 hours and 82% of extra-articular fractures were fixed within one week. Mean time from date of injury to operation was 3.88 days for intra-articular and 2.98 days for extra-articular fractures. Mean time from decision of surgery to operation was 2.32 days for intra-articular and 2.18 days for extra-articular fractures. Conclusions Clearly, the management of extra-articular fractures is closer to the standards set by BOAST guidelines. It can be difficult to establish from an x-ray whether a fracture is extending into a joint surface - this can delay the fracture clinic appointment and the operation. The difference between the mean time of injury to operation and mean time of decision of surgery to operation for intra-articular fractures show that once the decision to operate has been made, it is carried out quickly. Educating A+E and orthopaedic staff on recognising intra-articular fractures could expedite the time to surgery.

scholarly journals Management of intra-articular fractures of distal end radius in adults

2016 ◽  
Vol 2 (4) ◽  
pp. 220
Author(s):  
Satish R. Gawali ◽  
Hardikar S. M. ◽  
S. Prakash ◽  
Sunil Nadkarni
Keyword(s):  
Treatment Plan ◽  
Plaster Cast ◽  
Fracture Pattern ◽  
Distal Radial Fractures ◽  
Fracture Geometry ◽  
Articular Fracture ◽  
Articular Fractures ◽  
Orthopaedic Community ◽  
Almost All ◽  
End Results

<p class="abstract"><strong>Background:</strong> Incidence of intra articular fracture L/3rd radius is significantly on rise due to high velocity accidents in young and adults. Painless wrist function is of vital importance for functioning of upper extremity in almost all activities of daily living and precise function of hand. Intra articular fracture of L/3rd radius has generally gross comminution and so also small articular fragments. Orthopaedic community differ about specific implants to fix this complex injury. The present study was undertaken to know efficacy of different modalities of treatment for different fracture pattern. Comminuted intra articular fracture geometry varies widely, to fix these small fragments to achieve stable anatomical reduction is a challenging task.   </p><p class="abstract"><strong>Methods:</strong> It is a combined i.e. retrospective and prospective study conducted at Hardikar Hospital, Pune, India from 1999 to December 2000. Patients of intra-articular fracture of distal end radius by different modes of treatment are included in the study. 1 patient with unilateral fracture was lost for follow-up. Thus 50 fractures, in 49 patients. were included in study. Clinico-radiological assessment was carried out by Lidstrom's (1959) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Satisfactory early functional end results with plaster treatment is 72.2% whereas with other modality of treatment it rises to 87.5%, indicating superiority of other modalities of treatment as far as early functional end results are concerned.</p><strong>Conclusions:</strong> Manipulation and plaster cast method continues to be the treatment of choice in the stable intra articular distal radial fractures. Hence there is a need for a "differentiated therapy for distal radial fractures". The treatment plan for patients must be based not only on fracture pattern identified on plain radiographs but also on factors such as bone quality, bone comminution, energy of injury and associated soft tissue damage. Additional factors to be considered in individual patient are-life style associated medical conditions and compliance.

scholarly journals Does Simultaneous Fixation of Both Distal Radius and Distal Ulnar Fractures Improve Outcomes? A Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
pp. 215145932110380
Author(s):  
Taketo Kurozumi ◽  
Hideaki Miyamoto ◽  
Takashi Suzuki ◽  
Yoshinobu Watanabe
Keyword(s):  
Distal Radius ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Conservative Group ◽  
Patient Demographics ◽  
Active Range Of Motion ◽  
Significant Difference ◽  
Surgical Fixation ◽  
Healthy Side ◽  
Physical Findings

Introduction: Distal metaphyseal ulnar fractures are often found in conjunction with distal radius fractures. However, there is no consensus on optimal management. The purpose of this study was to determine whether simultaneous fixation of both distal radius and distal ulnar fractures would improve outcomes. Materials and Methods: Patients treated for distal radial fractures over a 4-year period at our trauma center were identified, and their medical records were analyzed. Twenty-three patients met the inclusion criteria for this study. All radius fractures were fixed using a volar locking plate. Fourteen ulnar fractures were treated with surgical fixation, and nine were treated conservatively. Data were collected on patient demographics, mechanism of injury, whether it was a closed or open fracture, Gustilo classification, AO/OTA classification, immobilization period, follow-up period, and type of treatment. Physical findings comprising the active range of motion and grip strength and radiological findings, including the ulnar variance compared to the healthy side and bone union, were evaluated. Clinical outcomes were assessed using the quick Disabilities of the Arm, Shoulder, and Hand scores. Results: There was no significant difference between the groups in the quick Disabilities of the Arm, Shoulder, and Hand scores, but the arc of dorsi-palmar flexion was more restricted in the operative group than in the conservative group. Other results were not significantly different between the two groups. Discussion: Fixation of distal metaphyseal ulnar fractures can be challenging, and several studies have shown the validity of conservative treatments. This supports the view that if the distal radius fracture is anatomically and rigidly fixed, distal metaphyseal ulnar fractures can be successfully managed conservatively. Conclusion: Our results did not show any merit in the simultaneous fixation of both distal radius and distal ulnar fractures. Thus, needless surgery should be avoided.

scholarly journals Treatment of Comminuted Intra-articular Fractures of Distal Radius by External Fixator

2014 ◽  
Vol 1 (2) ◽  
pp. 30-34
Author(s):  
MH Mohammad Alamgir ◽  
Md. Monowarul Islam ◽  
M Ershadul Haque ◽  
M Nazrul Islam ◽  
Abdul Kader
Keyword(s):  
Distal Radius ◽  
External Fixator ◽  
Case Series ◽  
Distal Radial Fractures ◽  
Medical College ◽  
Articular Fractures ◽  
Satisfactory Outcome ◽  
The Mean ◽  
Plexus Block

Background: Treatment of comminuted intra-articular fractures of distal radius by external fixator is an important. Objective: The aim of study was to investigate the usefulness of external fixator as a treatment option for displaced comminuted intra-articular fractures of distal radius. Methodology: This case series was conducted in the Department of orthopaedic Surgery at Shaheed Suhrawardy Medical College& Hospital, Dhaka during the period of November 2011 to July 2013.  All the patients having comminuted intra-articular distal radial fractures were being treated with mini uniaxial external fixator under brachial plexus block. The average follow up was performed in about 6 month.Result: A total number of fifteen patients were enrolled for this study. The mean age with SD was 50.21±9.473. Patient outcomes were measured by modified Knirk and Jupiter score and were categorized as satisfactory and unsatisfactory groups. In this study satisfactory outcome was found in 86.0%. All fractures (100.0%) were united nicely. Few complications were encountered. Postoperative osteoarthritis was not found during follow up.Conclusion: The use of external fixator for treating the comminuted intra-articular distal radial fractures produces satisfactory result.DOI: http://dx.doi.org/10.3329/jcamr.v1i2.20516 Journal of Current and Advance Medical Research Vol.1(2) 2014: 30-34

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.

Association of scapholunate dissociation and two-part articular fractures of the distal radius

2019 ◽  
Vol 44 (5) ◽  
pp. 468-474 ◽  
Author(s):  
Grace T.W. Sun ◽  
Simon B.M. MacLean ◽  
Justin J. Alexander ◽  
Richard Woodman ◽  
Gregory I. Bain
Keyword(s):  
Distal Radius ◽  
Ct Scans ◽  
Distal Radial Fracture ◽  
Fracture Type ◽  
Radial Fracture ◽  
Scapholunate Dissociation ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Articular Fracture ◽  
Articular Fractures

Scapholunate dissociation may occur in association with distal radial fractures and is easily missed at initial presentation. The aim of this study was to examine variances in the scapholunate distance with respect to subtypes of two-part partial articular distal radial fractures. Axial computed tomography (CT) scans of acute two-part intra-articular radial fractures were assessed retrospectively from 80 patients and compared to 20 controls. From each scan, two images were analysed to identify the scaphoid, lunate and articular fracture line in the distal radius for fracture type categorization. The images were overlaid on a standardized distal radius template and the scapholunate distance measured. Significant increase in the scapholunate distance was noted in fracture subtypes: radial styloid oblique; dorsal ulnar column; sagittal ulnar column; and volar coronal. We conclude that these findings support the need for a higher index of suspicion for scapholunate dissociation in these distal radial fracture subtypes. Level of evidence: III

scholarly journals Local Osteopenia Associated with Management of Intra-Articular Distal Radial Fractures by Insertion of External Fixation Pins in the Distal Fragment: Prospective Study

2002 ◽  
Vol 10 (2) ◽  
pp. 179-184 ◽  
Author(s):  
JA Mehta ◽  
JP Slavotinek ◽  
J Krishnan
Keyword(s):  
Bone Density ◽  
Distal Radius ◽  
Distal Radial Fracture ◽  
Distal Fragment ◽  
Radial Fracture ◽  
Distal Radial Fractures ◽  
Density Measurements ◽  
Articular Fractures ◽  
The Mean

Purpose. To assess the restoration of the bone mass of the distal radius following the use of implants in the distal radial fragment. Highly comminuted Frykman type 7 and 8 fractures were studied to determine whether the use of fixation pins in the comminuted distal radial fragment leads to osteopenia in the distal radial fragment after healing of the fracture. Methods. As part of a clinical trial, 30 patients with comminuted intra-articular fractures of the distal radius were treated with closed reduction, external non-bridging fixation, and early postoperative mobilisation. To detect local osteopenia, bone density measurements were taken at the distal metaphysis and mid-diaphysis following healing of the fractured radius and the contralateral unaffected radius in 12 patients. Results. The mean age of the 12 patients for whom bone density measurements were recorded was 52.5 years (range, 39–87 years). There were 9 females and 3 males included in the study. Seven patients had a Frykman type 8 fracture and 5 patients had a Frykman type 7 fracture. Significant osteopenia was absent despite the use of four 2.5-mm fixation pins in the distal fragments of the healed distal radial fracture. The median value of the maximal step was 2.8mm (range, 0–9.1mm). The median value of the intra-articular interfragmentary gap was 1.8 mm (range, 0–13.4mm). Conclusion. The findings of this study do not suggest long-term osteopenia following the use of four 2.5-mm pins in the distal fragments. The non-bridging fixator, by allowing early physical activity, possibly led to satisfactory functional and structural results.

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