scholarly journals Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years

2019 ◽  
Vol 4 (2) ◽  
pp. 26 ◽  
Author(s):  
Gianluca Testa ◽  
Andrea Vescio ◽  
Paola Di Masi ◽  
Giulio Bruno ◽  
Giuseppe Sessa ◽  
...  
Keyword(s):  
Distal Radius ◽  
Short Form ◽  
Articular Surface ◽  
Surgical Reconstruction ◽  
Dash Score ◽  
Conservative Group ◽  
Significant Difference ◽  
Role Limitation ◽  
Sf36 Score ◽  
Orthopedic Injuries

Background: Fractures of the distal radius (DRF) are the most common orthopedic injuries, representing one of the typical fractures indicating underlying osteoporosis. The aim of the study was to compare conservative and surgical treatment, analyzing quality of life and clinical outcome in an over 65 years old population. Methods: Ninety one patients were divided into two groups: the ORIF group (39 patients) underwent surgery, and the conservative group (52 patients) was treated conservatively. The clinical and functional outcomes of all patients were evaluated using Short Form 36 (SF36), Modified Mayo Wrist Score (MMWS), Disability of the Arm Shoulder Hand (DASH), and Visual Analogue Scale (VAS). Range of motion at the joint was measured and compared with the contralateral healthy wrist. Results: No significant difference was found between the overall SF36 score, DASH score, MMWS, and VAS results. Role limitation was significantly better in the surgical group (p < 0.05), and complication incidence was significantly higher (p < 0.05) in the conservative group. Conclusion: The results of this study conform to recent literature, suggesting that a surgical reconstruction of the radius articular surface in an elderly population provides no clear clinical advantage. Treatment decisions must arise from careful diagnoses of the fracture and communication with the patient.

scholarly journals The Usefulness of Radial Column Plate in Distal Radius Fracture: Indications and Results

2021 ◽  
Author(s):  
Sung Jin An ◽  
Sang Hyun Lee ◽  
Dong Hee Kim ◽  
Hyo Seok Jang ◽  
Sung Min Hong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Articular Surface ◽  
Radius Fracture ◽  
Dash Score ◽  
Locking Plates ◽  
Radial Inclination ◽  
Significant Difference ◽  
Radial Length

Purpose: The most common surgical treatment for distal radius fracture is internal fixation using volar locking plates, but it is sometimes difficult to maintain reduction with them. Therefore, this research reports the results of surgical treatment with additional radial column plates.Methods: We analyzed 12-month follow-up results in 100 cases. The patients had the B or C types of distal radius fractures, in accordance with AO classification, and underwent surgical treatment at our hospital from May 2013 to December 2019. There were 16 cases of B-type and 84 cases of C-type fractures. Out of these, 87 were treated with volar locking plates (V group) and 13 had additional radial column plates (VR group). The results of surgical treatment were examined clinically by measuring the disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score, and radiologically by measuring the radial length, radial inclination, and volar tilt, before and after surgery.Results: After treatment, the radiographic average in the V group showed a radial length of 12.3 mm, radial inclination of 20.2°, and volar tilt of 5.8°, while the VR group showed 11.6 mm, 22.3°, and 9.0° respectively. A statistically significant difference was found in the DASH score, and the DASH score showed good results in the VR group.Conclusion: Additional radial column plate fixation is worth considering because it provides clinically and radiologically satisfactory results in treatment of B and C types distal radius fracture involving articular surface.

A comparative study on treatment outcomes of bandage and casting in non-displaced extra-articular fracture of distal radius: A clinical trial study

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
Hamid Reza Arti ◽  
Reza farahnak
Keyword(s):  
Clinical Trial ◽  
Distal Radius ◽  
Dash Score ◽  
Articular Fracture ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
Vas Scores ◽  
The Difference ◽  
Fracture Of Distal Radius

Background: There are some therapeutic choices in non-displaced extra-articular fracture of distal radius that confront with some controversy in their selection. We tried to study these two methods in this article. Methods: This was a prospective randomized clinical trial conducted on the patients (n=62) with NDEA fracture of distal radius, during 2015. The patients were randomly assigned to casting (n-32) or bandage (n=30) group to receive the respective fracture healing procedure. The patients were followed-up at the first, second, third, and sixth weeks after the treatment. The Disabilities of the DASH and the VAS questionnaire were completed. All patients underwent an X-ray radiographic assessment to evaluate any potential complication. Results: At the end of the study, in the bandage and casting group 30 and 32 patients finished the study. The statistical analyses showed that the bandage group showed significantly higher mean DASH score than the casting group at the first week, but for the second week the difference decreased so that for the third week, the casting group showed significantly higher value than the bandage group. Finally, at the sixth week the two groups showed no significant difference in the DASH value. The two groups showed no significant differences in the VAS scores for all follow up assessments. The returning time to work was shorter in the bandage group and the treatment cost was also lower in this group. Conclusion: Bandage is more appropriate treatment option for the NDEA fractures of distal radius.

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.

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

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.

The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures

2008 ◽  
Vol 33 (3) ◽  
pp. 322-326 ◽  
Author(s):  
H. BOMBACI ◽  
A. POLAT ◽  
G. DENIZ ◽  
O. AKINCI
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Random Order ◽  
Distal Radioulnar Joint ◽  
X Rays ◽  
Distal Radial Fractures ◽  
Ulnar Styloid Fracture ◽  
Significant Difference ◽  
Mri Scans ◽  
Triangular Fibrocartilage

In this prospective study, the plain X-rays and MRI scans of 60 patients with intraarticular distal radius fractures were examined in random order. MRI evaluation revealed that 27 of the 60 patients (45%) had triangular fibrocartilage lesions. No correlation was found between triangular fibrocartilage injury and the Melone classification system, the presence of an ulnar styloid fracture, comminution of the articular surface of the distal radius, >20° dorsal angulation of the distal radius or subluxation/dislocation of the distal radioulnar joint on the plain X-rays. When Frykman Type VI and VIII fractures were compared with all the other Frykman subtypes, a significant difference in the incidence of triangular fibrocartilage complex tears was observed. We conclude that triangular fibrocartilage injury should be considered with all distal radial fractures, especially the Frykman Types VI and VIII.

Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures

2021 ◽  
pp. 1-7
Author(s):  
Tim Coughlin ◽  
Alan R. Norrish ◽  
Brigitte E. Scammell ◽  
Paul A. Matthews ◽  
Jessica Nightingale ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Secondary Outcome ◽  
Dash Score ◽  
Radius Fractures ◽  
Face To Face ◽  
Significant Difference ◽  
One Year

Aims Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. Methods Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. Results A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). Conclusion Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy.

scholarly journals Morphological characteristics of different types of distal radius die-punch fractures based on three-column theory

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jinhua Zhou ◽  
Wen Tang ◽  
Dong Li ◽  
Yongwei Wu
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Morphological Characteristics ◽  
Imaging Data ◽  
Significant Difference ◽  
Single Column ◽  
Different Types ◽  
Intermediate Column ◽  
The Difference ◽  
High Consistency

Abstract Objective The aim of this study is to investigate the morphological characteristics of distal radius die-punch fracture (DRDPF) with different types, based on the three-column theory. Methods The imaging data of 560 patients diagnosed with DRDPF were reviewed and divided into single-column, double-column, or three-column DRDPF according to the three-column theory, and the types, case distribution of DRDPF, and inter- and intra-agreement of classification were further analyzed. Results There were 65 cases of single-column DRDPF, 406 cases of double-column DRDPF, and 89 cases of three-column DRDPF. Among the single-column DRDPF, there were three cases of volar, 13 cases of dorsal, 14 cases of split, and 35 cases of collapse type fractures. Among the radius column fracture, there were 130 cases of metaphseal,155 cases of articular surface, and 210 cases of combined type. The inter-observer Kappa coefficient was 0.877–0.937, and the intra-observer kappa was 0.916–0.959, showing high agreement. At the 12th month’s follow-up, according to the Gartland–Werley score system for the functionary recovery of the wrist and hand, 519 cases (92.68%) of the patients ranked excellent or good, and 41 cases (7.32%) ranked fair. All the cases were fair results, and the intermediate column of the distal radius was collapse type fractures, showing significant difference between the collapse type and other types (χ2 = 23.460, P = 0.000). The excellent and good rate in the single-, double-, and three-column DRDPFs were 93.85%, 92.16%, and 91.01%, respectively (χ2 = 0.018, P = 0.991). Conclusion Due to the difference of the nature and energy of the forces, the position of wrist, and the bone quality of the patients at the moment of the injury, the loading forces transmitted to the intermediate column of the distal radius could result in different types of DRDPF. The classification method in this study included all types of DRDPF, indicating the mechanism, affected sites, and the morphological characteristics of DRDPF with high consistency, which hopefully could provide insight into the treatment and prognosis of DRDPF patients.

TREATMENT WITH OR WITHOUT INTERNAL FIXATION FOR ULNAR STYLOID BASE FRACTURES ACCOMPANIED BY DISTAL RADIUS FRACTURES FIXED WITH VOLAR LOCKING PLATE

Hand Surgery ◽  
2012 ◽  
Vol 17 (02) ◽  
pp. 181-190 ◽  
Author(s):  
Yukichi Zenke ◽  
Akinori Sakai ◽  
Toshihisa Oshige ◽  
Shiro Moritani ◽  
Toshitaka Nakamura
Keyword(s):  
Internal Fixation ◽  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Fixation Group ◽  
Significant Difference

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

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

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.

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.

Sign in / Sign up

Export Citation Format

Share Document