Acute Distal Radius Fractures Research Articles

Measurement of Radiological Parameters of Distal Radius Fracture Using the Ulnar Axis Compared with the Radial Axis.

Background: The long axis of the radius is a standard reference for measuring radiological parameters in distal radius fractures. However, in patients with severe comminution and anatomical variation with distal radius bowing, it is challenging to assess using the long axis of the radius. The long axis of the ulna can be used as an alternative reference. The aim of this study is to assess the reliability and level of agreement using the long axis of the ulna as an alternative reference in comparison to the long axis of the radius. Methods: Posteroanterior (PA) radiography of the wrist in patients with acute distal radius fractures was evaluated in two rounds by four observers. Radial height, radial inclination and ulnar variance were measured using radial and ulnar long axis as references. The intraobserver and interobserver reliability of the measurements with two reference axes was assessed using intraclass correlation coefficient (ICC). The level of agreement was determined using the Bland-Altman plot. Results: In total, 59 patients who underwent PA radiography of the wrist were included in this study. All parameters exhibited good agreement between the two methods, with a mean difference of nearly zero (radial height = -0.03 mm, radial inclination = -0.14° and ulnar variance = 0.03 mm). The limits of agreement in radial height (-2.87, 2.82 mm) and ulnar variance (-0.81, 0.87 mm) were narrow. However, for the radial inclination, it was wider (-6.21, 5.94°). Intraobserver reliability between the long axis of radius and ulna (ICC = 0.85-0.99 and 0.84-0.98, respectively) was good to excellent. The interobserver reliability of each parameter was excellent (ICC = 0.94-0.97). Conclusions: The ulnar long axis can be used as an alternative reference for measuring radial height, radial inclination and ulnar variance in PA radiography of the wrist in acute distal radius fracture, particularly if the radial long axis is distorted. Level of Evidence: Level III (Diagnostic).

Comparison of Short-Arm Immobilization and Long-Arm Immobilization in Conservatively Managed Distal Radius Fractures: A Meta-Analysis and Systematic Review.

Distal radius fractures are often treated conservatively with immobilization. Immobilizing above the elbow limits forearm rotation, though recent literature has suggested the effects on radiographic or functional outcomes may be negligible. This systematic review and meta-analysis aimed to analyze the radiographic and functional outcome scores of distal radius fractures managed with short-arm (SA) immobilization and long-arm (LA) immobilization. An electronic systematic search was performed of the PubMed and EMBASE databases from inception to October 5, 2022. All randomized controlled trials (RCTs) involving patients with acute distal radius fractures undergoing nonoperative treatment (involving application/maintenance of immobilization) comparing above-elbow versus below-elbow constructs were included. The outcomes of interest were changes in radiographic parameters (loss of volar tilt [VT], radial height [RH], and radial inclination [RI]), loss of reduction, requirement for surgery, and patient-reported functional outcomes (Disabilities of the Arm, Shoulder, or Hand [DASH] or Quick DASH survey). The Cochrane Risk of Bias Tool 2.0 was used for study quality assessment. The effect size of the interventions was assessed using random effect models to calculate mean differences (MDs) for continuous variables and odds ratios (ORs) for categorical variables. Standardized mean difference (SMD) was calculated for patient-reported functional outcome scores. Nine studies involving 983 cases were included, including 497 SA and 486 LA. No statistically significant differences were observed with regards to VT (P= 0.83), RH (P= 0.81), RI (P= 0.35), loss of reduction (P= 0.33), requirement for surgery (P= 0.33), or patient-reported functional outcomes (P= 0.10). There was no difference in radiographic outcomes, need for surgery, or functional scores among patients treated with SA and LA immobilization. Utilizing SA immobilization is a safe option for conservative management of distal radius fractures and the benefits of mitigating complications associated with LA immobilization may supersede the theoretical limited forearm rotational stability observed with SA immobilization. Further study is required to determine the optimal method of SA immobilization.

Let's Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study.

Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. DERR1-10.2196/52917.

Time to surgical management of distal radius fractures: effects on health care utilization and functional outcomes.

Distal radius fractures are common injuries. Open reduction and internal fixation with volar locking plates is the most common approach for surgical fixation. This study investigated the association between time to surgery and health care utilization, income, and functional outcomes among patients undergoing open reduction and internal fixation for distal radius fracture. We conducted a retrospective review of patients who underwent open reduction and internal fixation for isolated acute distal radius fracture between 2009 and 2019. Time to surgery was grouped as early (≤ 14 d) and delayed (> 14 d). We performed χ2 (or Fisher exact) and Wilcoxon rank sum (or Kruskal-Wallis) tests to provide statistical comparison of time to surgery by health care utilization and functional outcomes. Univariable and multivariable logistic regression analyses were performed to identify factors significantly associated with time to surgery. We included all significant univariables in the multivariable logistic regression model, which identified factors based on significant adjusted odds ratios (95% confidence intervals excluding the null) after we adjusted for confounding variables. We included 106 patients, with 36 (34.0%) in the group receiving early treatment and 70 (66.0%) in the group receiving delayed treatment. Patients in the delayed-treatment group attended significantly more clinic visits and postoperative hand therapy sessions. The group with delayed treatment demonstrated significantly lower degrees of wrist flexion at the first follow-up, but this difference did not persist. Patients with higher estimated income (> $39 405 per annum) had lower odds of delayed surgery than those with lower estimated income (≤ $39 405). Delayed time to surgery was associated with greater health care utilization and lower degrees of early wrist flexion. Access to care for lower-income patients warrants further evaluation.

Primary Arthroscopy-Assisted Foveal Repair of Triangular Fibrocartilage Complex Associated with Acute Distal Radius Fractures in Young Adults

Abstract Background In distal radius fractures (DRFs) occurring in nonosteoporotic age groups, it is known that triangular fibrocartilage complex (TFCC) injuries are frequently combined, with some experiencing persistent symptomatic instability. However, a gold standard treatment for these associated lesions has not yet been established. Purpose Our purpose was to investigate the outcomes of primary arthroscopy-assisted transosseous foveal repair of the TFCC associated with DRFs in young adults. Methods Fifteen patients aged <65 years who underwent open reduction and internal fixation for DRF and arthroscopy-assisted repair for foveal tear of the TFCC were included. Those patients were observed to have complete peripheral TFCC tear on preoperative wrist magnetic resonance imaging and intraoperative distal radioulnar joint (DRUJ) stability tests. This was confirmed with an arthroscopic examination. The transosseous technique was used to repair the TFCC after firm fixation of the DRF. The patients were immobilized with the long-arm splint in a neutral position for 2 weeks postoperatively and a removable short-arm splint was applied for another 2 weeks. DRUJ stability, grip strength, and patient-reported outcomes, including disabilities of the arm, shoulder, and hand (DASH) and Patient-Rated Wrist Evaluation scores, were evaluated as primary outcomes at 3, 6, and 12 months postoperatively. Results All patients showed a stable DRUJ throughout the follow-up period. The average grip strength ratio compared to the unaffected side was 69, 83, and 90% at 3, 6, and 12 months after surgery, respectively. The mean DASH score was 26.9, 18.4, and 6.7 at 3, 6, and 12 months postoperatively, respectively. Conclusion Primary arthroscopy-assisted transosseous foveal repair of the TFCC with internal fixation of the distal radius resulted in early recovery and good clinical outcomes in young patients. Level of evidence Therapeutic, level IV.

The Effect of Fracture Type on Restoration of Radiographic Parameters and Early Loss of Reduction in Surgical Treated Distal Radius Fractures

Purpose: Early loss of reduction remains a challenging complication in distal radius fracture management. There are limited data on factors that correlate with early loss of reduction. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification has become a popular way of evaluating complex fracture patterns. This study aims to determine the impact of fracture pattern, as determined by the AO classification, on restoration of intraoperative parameters, early loss of reduction, and time to fracture union in operatively treated distal radius fractures. Methods: Following IRB approval, adult patients with surgically treated acute distal radius fractures at a single level I institution were identified. Retrospective chart and radiographic review were used to obtain AO classification, postoperative radiographic parameters, early loss of reduction, time to fracture union, as well as any complications. Results: 422 patients with operatively treated distal radius fractures were included in this study. Across fracture patterns, there were no significant differences in restoration of radial height or inclination. Higher severity fracture classifications had decreased restoration of volar tilt. Overall, simple fractures (A2, C1) and partial articular fractures (B1, B2, B3) had higher rates of satisfactory alignment restoration compared to comminuted fractures (A3, C2, C3). Although there were differences in restoration of radiographic parameters, fracture type did not correlate with loss of reduction within 30 days. C type fractures correlated with increased weeks to radiographic healing. Conclusions: This study establishes that distal radius fracture pattern, as determined by the AO classification, has a significant impact on intraoperative restoration of parameters but does not correlate with early loss of reduction. Furthermore, more difficult fracture patterns may have a longer time to fracture union, but fracture type does not appear to have an effect on postoperative complications.

998 Distal Radius Fractures – Assessing Time to Surgery

Abstract Background The British Orthopaedic Association Standards for Trauma (BOAST guidelines) recommend that intra-articular distal radius fractures should be operated within 3 days and extra-articular fractures within 7 days of a decision to operate (1). Aim The objectives of this audit were to assess compliance with BOAST guidelines for operative management of distal radius fractures within a local trauma unit. Method Three audit cycles were completed between 2018 and 2021 over 3 -4-month periods. The second and third cycles were completed after elective orthopaedic cases were moved to an elective orthopaedic centre, and commencement of a weekly half day dedicated hand trauma list. All skeletally mature patients with acute distal radius fractures were included. Results Despite the addition of a dedicated hand trauma list and elective services moving to a dedicated site, compliance with BOAST guidelines remained almost unchanged. Compliance was at 100% for extra-articular fractures. However, for intra-articular fractures, compliance only slightly improved from 50 % to 53.3%. The average time to surgery improved from 4.25 days to 3.66 days for intra-articular fractures. Average time to surgery for extra-articular fractures was 3 days. Proposed reasons for delay included lack of trauma theatre time, prioritisation of other urgent cases such as femur fractures and lack of appropriate surgeon. Conclusions No distinction was being made to prioritise intra-articular distal radius fractures over extra-articular fractures for surgery. Trauma and Orthopaedic (T&O) staff have been educated and changes made to the T&O department’s trauma database to resolve this.

COMPLICATIONS ASSOCIATED WITH CASTING OF ACUTE DISTAL RADIUS FRACTURES IN ADULTS - A PROSPECTIVE OBSERVATIONAL STUDY

Aim: Closed treatment of distal radius fractures is still a controversy. In children, circumferential casting of acute distal radius fractures is found to be safe. However, research is lacking to demonstrate its safety in adults. The purpose of this study was to assess the risk of complications associated with casting acute distal radius fractures in adult patients. Methods: Study is conducted in 60 patients with a distal radius fracture arriving at the Emergency department in Govt Theni Medical College. Patients were evaluated in the red zone and were provisionally immobilized with plaster of Paris casts. Patients were followed for a minimum of 12 weeks. Complication rates associated with casting were recorded, including rates of fracture displacement, tenosynovitis, carpal tunnel syndrome and malunion. Results: 60 patients were included in this study. A total of 45 patients met inclusion criteria for placement of a short arm cast in the Emergency Department. The majority of patients sustained their injuries from a ground level fall. A minority of patients had radiographic evidence of intra-articular extension or underwent a reduction prior to casting. The majority of patients did not require a cast change. The data analysis showed the complications such as fracture displacement, tenosynovitis, carpal tunnel syndrome malunion were of insignificant value and closed reduction proved to the safest and benefitted method of management in distal radius fractures with lesser complications. Conclusion: There were no major complications associated with casting of acute, distal radius fractures in this series of 45 adult patients. While further studies with larger numbers of patients are necessary to establish safety of casting, this study suggests that casting may be a safe and effective treatment for distal radius fractures in adult patients presenting with a normal neurovascular exam.

Treatment of distal radius fracture by MIPO technique at Thu Duc City Hospital

Objective: To assess the possibility of anatomical correction when treating fractures of the distal radius fracture with a locking plate through a minimally invasive incision and evaluate the possibility of early recovery of wrist function after treatment of the distal radius fracture with minimally invasive incision preserving the pronator quadratus (PQ) muscle. Subject and method: Acute distal radius fracture patients aged 18 to 65 years old, who came for examination and treatment at the Orthopedic and Trauma Department of Thu Duc City Hospital from October 2020 to May 2021. Classification of the distal radius fracture according to AO: A2, A3, B3, C1 and C2. Result: The result of anatomical reduction included VT 6.22o, RI 22.0o, and UV 0.81 mm. X-ray grading gave 75.0% excellent and 25.0% good results, with 100% bone healing after 12 weeks. At 12 weeks, the mean GRIP Strength score was 71.3%, the VAS score was 1.7 points, the Q-DASH score was 18.1 good function points, and the MAYO score was 74. The average time to return to normal activities was 7 weeks. Conclusion: minimally invasive plate osteosynthesis (MIPO) is a method that gives good results for some fracture types in treating distal radius fractures, by indirect reduction with small incisions to help preserve the PQ muscle and early return the wrist function.

The Effects of Novel Pulsed Electromagnetic Field Therapy Device on Acute Distal Radius Fractures: A Prospective, Double-Blind, Sham-Controlled, Randomized Pilot Study.

this pilot study aimed at determining whether the application of a novel new method of generating pulsed electromagnetic field (PEMF), the Fracture Healing Patch (FHP), accelerates the healing of acute distal radius fractures (DRF) when compared to a sham treatment. 41 patients with DRFs treated with cast immobilization were included. Patients were allocated to a PEMF group (n = 20) or a control (sham) group (n = 21). All patients were assessed with regard to functional and radiological outcomes (X-rays and CT scans) at 2, 4, 6 and 12 weeks. fractures treated with active PEMF demonstrated significantly higher extent of union at 4 weeks as assessed by CT (76% vs. 58%, p = 0.02). SF12 mean physical score was significantly higher in PEMF treated group (47 vs. 36, p = 0.005). Time to cast removal was significantly shorter in PEMF treated patients, 33 ± 5.9 days in PEMF vs. 39.8 ± 7.4 days in sham group (p = 0.002). early addition of PEMF treatment may accelerate bone healing which could lead to a shorter cast immobilization, thus allowing an earlier return to daily life activities and work. There were no complications related to the PEMF device (FHP).

Validity and Reliability of Image Intensifier Articular Step-off and Gap Measurements for Distal Radius Fractures Using a Cadaveric Model

Objectives. The purpose of this study was to determine the accuracy and reproducibility of image intensifier(fluoroscopic) measurements of gap and step-off displacements on the articular surface of the distal radius using a standard cadaver osteotomy fracture model.
 Methods. Fourteen orthopedic residents were randomly assigned using the fish bowl method to measure the gap and step-off displacements in cadaveric fluoroscopic images using a digital caliper. Each physician was randomly assigned the images where they examined the images twice and the average taken using a standard technique. The interobserver and intra-observer reliability were calculated using the intraclass correlation coefficient (ICC). Rank Sum test was used to evaluate the validity of measurements.Results. The results of the study showed that there was no significant difference between the cadaveric andmeasured step-off and gap displacements. Intraclass correlation coefficient scores showed moderate (0.41) to perfect (1.0) agreement.Conclusion. The study showed that fluoroscopy can aid in the interpretation of gap and step-off displacements in acute distal radius fractures.

A Systematic 10-Year Review of the Use of Arthroscopy in the Assessment and Treatment of Intercarpal Ligament Injuries Associated with Acute Distal Radius Fracture.

Background: To review the impact that arthroscopy has made on the assessment and treatment of intercarpal (scapholunate [SL] or lunotriquetral [LT]) ligament injuries associated with acute distal radius fractures (DRF). Methods: A systematic review of EMBASE, MEDLINE and COCHRANE databases for articles published between 2011 and 2021 was performed (PROSPERO ID: CRD42021273293) which included studies reported assessment and outcomes of intercarpal ligament injuries associated with acute DRF. Methodological quality was evaluated. The rate of concomitant injury detection, role of arthroscopy and different clinical outcome assessment measurements used were compared between studies. Results: A total of 20 articles were included with data from 1,346 patients (1,358 wrists). A total of 1,024 intra-articular fractures were included and 294 extra-articular fractures (40 not specified). There was a heterogeneous mix of studies; 10 comparative and 10 non-comparative. Some studies investigated initial assessment findings only, while others assessed radiological outcomes, functional outcomes or both domains over 0.3-99 months. The overall rate of SL ligament injury associated with DRF was 35.3%, while LT ligament injury overall was 18.2%. More frequent were concomitant triangular fibrocartilage complex (TFCC) injuries (44.8%), although this review did not aim to review these. The role of arthroscopy was reviewed, which included assistance in anatomic reduction of the articular surface and systematic inspection of the surrounding soft tissues. Included studies investigated either assessment or assessment and management of intercarpal ligament injury. Meaningful meta-analysis in this heterogeneous group of studies was not possible. Outcomes of comparative studies were described in detail. Conclusions: This review suggests that arthroscopy may have a role in improving reduction of intra-articular DRF and diagnosing and managing soft tissue injuries associated with such fractures. Randomised studies are needed to evaluate whether the detection of intercarpal ligament injury in acute distal radial fractures through arthroscopic assessment alters current management and improves clinical outcome. Level of Evidence: Level III (Therapeutic).

The Association Between Depression and Antidepressant Use and Outcomes After Operative Treatment of Distal Radius Fractures at 1 Year

Depression has been linked to inferior clinical outcomes among upper extremity patients. It often is challenging to distinguish the symptoms of depression, symptoms of injury, and the interaction between these 2 entities after a patient has been injured. We aimed to study the differences in clinical outcomes after surgical fixation of distal radius fractures between patients with and without a documented history and treatment for depression. All subjects with an isolated, acute distal radius fracture undergoing operative fixation in a 10-year period at a level 1 academic trauma center were screened. Baseline demographic data were collected, and psychiatric history and antidepressant use were recorded and verified with a pharmacy database. Quick Disability of the Arm, Shoulder and Hand (QuickDASH), range of motion, and grip strength were assessed at 12 months after surgery. Multivariable linear regression analysis was used to assess the association of depression with QuickDASH scores at 1 year after surgery. A total of 211 patients were available for 1-year follow-up, 50 of whom were being treated actively for depression with medication at the time of injury and 161 were without a known diagnosis of, or treatment for, depression. Demographic and injury characteristics were similar between both groups. In a multivariable linear regression model controlling for age, sex, and a history of osteoporosis, active treatment for depression was associated with a slight mean increase in QuickDASH scores, 6.5 (1.3-11.8), 1 year after surgery. This study demonstrates a small increase in QuickDASH scores between subjects with a confirmed diagnoses of depression compared with all others after surgical fixation of distal radius fracture at 1-year follow-up. We suggest that a history of depression may portend worse clinical outcomes, although other factors, such as underreporting of depression may influence results. Prognostic IV.

Assessment of complications associated with casting of acute distal radius fractures in adults

PurposeControversy exists regarding the closed treatment of distal radius fractures. Circumferential casting of acute distal radius fractures has been shown to be safe in children, however, little research has demonstrated its safety in adults. The purpose of this study was to assess the risk of complications associated with casting acute distal radius fractures in adult patients. MethodsPatients with a distal radius fracture treated by a single hand surgeon at a level 1 trauma center were retrospectively reviewed over a 3-year period. Patients were evaluated in the emergency room and were provisionally immobilized either with short-arm fiberglass casts or with splints. Patients were followed for a minimum of 4 weeks. Complication rates associated with casting were recorded, including rates of compartment syndrome and acute carpal tunnel syndrome. ResultsEighty-one patients were included in this study. A total of 30 patients met inclusion criteria for placement of a short arm cast in the Emergency Department. Mean patient age was 63.2 years. The majority of patients sustained their injuries from a ground level fall. A minority of patients had radiographic evidence of intra-articular extension or underwent a reduction prior to casting. There were no patients who developed compartment syndrome or acute carpal tunnel syndrome as a result from the casting. The majority of patients did not require a cast change for at least 4 weeks. None of our patients went on to surgery. ConclusionThere were no major complications associated with casting of acute, low energy distal radius fractures in this series of 30 adult patients. While further studies with larger numbers of patients are necessary to establish safety of casting, this study suggests that casting may be a safe and effective treatment for low-energy distal radius fractures in adult patients presenting with a normal neurovascular exam. Type of study/level of evidenceRetrospective comparative study, Level III.

American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand Clinical Practice Guideline Summary Management of Distal Radius Fractures.

The Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of distal radius fractures in adults older than 18 years. The scope of this guideline is limited to the treatment of acute distal radius fractures and does not address distal radius malunion. This guideline contains seven recommendations to assist orthopaedic surgeons and all qualified physicians managing patients with acute distal radius fractures based on the best current available evidence. It serves as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.

Surgical Technique for Concurrent Endoscopic Carpal Tunnel Release and Distal Radius Fracture Fixation Using the Flexor Carpi Radialis Approach: A Case Series

PurposeMultiple prior studies have assessed the results of open approaches for concurrent carpal tunnel release with distal radius fracture fixation; however, less is known regarding the feasibility of endoscopic techniques, especially in the setting of high-energy trauma. In this study, we assessed the feasibility and results of concurrent endoscopic carpal tunnel release and distal radius fracture fixation using the flexor carpi radialis approach after high- and low-energy trauma.MethodsWe performed a retrospective, single-surgeon study of 17 consecutive adult patients (aged >18 years) who underwent open reduction internal fixation of an acute distal radius fracture with concurrent endoscopic carpal tunnel release at a level 1 trauma center between April 2017 and October 2020. Recovery from median nerve dysfunction was assessed from patient charts at routinely scheduled postoperative follow-up visits (at 2 weeks, 4 weeks, 6 weeks, and 12 weeks).ResultsThe transverse carpal ligament could be visualized and released in all patients. All patients had a return of light touch sensibility with or without intermittent paresthesia by 12 weeks after surgery (the median time from surgery to recovery was 19 days [range, 12–82 days]). There were no patient reports or clinical examination evidence of palmar cutaneous branch, recurrent motor branch, or the third common digital nerve injury. Time to recovery was significantly different in the setting of high- versus low-energy trauma (26 days vs 18 days, respectively; P = .02).ConclusionsIn this study, we demonstrated that concurrent endoscopic carpal tunnel release using the flexor carpi radialis approach for distal radius fracture fixation in the settings of high- and low-energy trauma is safe from major complications and effective at releasing the transverse carpal ligament.Type of study/level of evidenceTherapeutic IV.

The impact of acute fracture on interpretation of bone turnover marker measurements for patients starting anti-resorptive therapies.

Bone turnover markers (BTM) are used in evaluating patients' response to anti-resorptive agents (ARA). Fracture and its healing process, however, can influence the measurements, which might make their interpretation difficult in patients with a recent fracture. We aimed to evaluate the effect of oral ARA on changes in BTM levels in patients with a recent distal radius fracture (DRF). In 143 women who had a new DRF and then received oral ARA including selective estrogen receptor modulator (SERM, n=101), and bisphosphonate (n=42), we measured serum cross-linked C-telopeptides of type I collagen (CTXI) and osteocalcin, at baseline and six months, as well as lumbar and total hip bone mineral density (BMD) at baseline and one year after fracture. We determined the predictive value of BTM at six months in determining one-year responses in BMD. Both BTM levels decreased significantly at six months, with the average decrease of 27±63% for CTX-I and 11%±37% for osteocalcin. The percent changes of BTM at six months were independent predictors of the BMD change. Cutoff points of 50.0% CTX-I decrease and 23.5% for osteocalcin decrease had the highest sensitivities and specificities for detecting BMD responders for bisphosphonate users, but cutoffs could not be found for SERM users. Although a fresh fracture can influence BTM, ARA therapy significantly reduced their levels and their percent change at six months could predict BMD improvement at one year. However, adjusted cutoff points can be necessary to increase sensitivity for detecting patients responsive to ARA treatment after a new DRF.

Factors Associated with Timely Surgery for Semi-elective Distal Radius Fracture Fixation

Background In the United Kingdom, national guidance recommends intra-articular distal radius fractures should undergo surgery within 72 hours and extra-articular fractures within 7 days. Purpose We investigated if hospitals can provide timely surgery and meet national guidelines in patients who are sent home following distal radius fracture (DRF) to return for planned surgery. The influence of patient, hospital, and seasonal factors on wait to surgery are investigated. Patients and Methods We reviewed Hospital Episode Statistics (HES) data between April 2009 and March 2013. Proportion of procedures being performed within 3 and 7 days was calculated. A linear regression model was created to investigate the relationship between wait for surgery and patient and hospital factors. Results A total of 9,318 patients were sent home to return for planned acute DRF surgery during the 4-year study period. Mean time to surgery was 3.04 days (range 1-days, standard deviation [SD] 3.14). A total of 6,538 patients underwent surgery within 3 days (70.2%) and 8,747 within 7 days (93.9%). Patients listed for surgery and sent home to return waited longer if listed toward the end of the week. Less surgery was performed at weekends, and patients were less likely to be listed for semielective trauma surgery. Conclusions Acute semielective DRF fixation is generally performed within targets for extra-articular fractures but there is scope for improvement for intra-articular fractures. Day of presentation and increasing number of comorbidities increase wait for surgery. Hospital trusts should focus on improving pathways for patients with multiple comorbidities and strategies to improve accessibility of these services at weekends.

Intraoperative evaluation of DRUJ instability through dorsal stress radiography in distal radius fractures

IntroductionCertain type of injury of the triangular fibrocartilage complex associated with distal radius fracture can result in distal radioulnar joint instability (DRUJ). Untreated DRUJ instability may lead to poor result in the treatment of acute distal radius fractures. The aim of this study was to evaluate DRUJ instability in distal radius fractures through dorsal stress radiography comparing the affected and unaffected wrists intraoperatively. Materials and methods49 patients with a distal radius fracture who were operatively treated with a volar locking plate were included. Dorsal stress radiography was used to evaluate both affected and unaffected wrists peri-operatively to detect DRUJ instability. Under general anesthesia, a dorsal stress test was performed on the unaffected wrist. Additionally, after fixation of the affected wrist, a dorsal stress test was performed. The ulnar translation ratio (UTR) was measured through the dorsal stress radiograph. Arthroscopic examination was performed on all affected wrists according to Palmer's and Atzei classification. ResultsThe UTR of the affected wrist and the TFCC injury Palmer-type IB tendency were positively correlated (odds ratio: 1.18, p-value: 0.002). Additionally, as the UTR difference between the affected and unaffected wrists enlarged, it revealed a significant DRUJ instability tendency due to Palmer-type IB TFCC injury (p-value: 0.000006, Wilcoxon rank-sum test). ConclusionsDorsal stress radiography is a reliable, simple procedure to evaluate DRUJ instability intraoperatively. UTR value from dorsal stress radiography could be useful for evaluating DRUJ instability associated with distal radius fracture.

The rate and associated risk factors for acute carpal tunnel syndrome complicating a fracture of the distal radius

BackgroundAcute carpal tunnel syndrome (ACTS) is a known complication of distal radius fractures. This study aimed to document the demographics, range of presenting symptoms and risk factors of patients who develop ACTS following a fracture of the distal radius.MethodsA retrospective review of 1189 patients with an acute distal radius fracture treated in the study centre over a one-year period were identified. Demographic and clinical variables were collected and compared between controls (did not develop ACTS) and those patients who did develop ACTS to identify factors associated with developing ACS.ResultsThere were 51 (4.3%) distal radius fractures complicated by ACTS. The mean age of patients who developed ACTS was 56 years (range, 16–89) and 73% were female. The median time of onset post-injury was one week (range, 1–12). There was no association between patient background and comorbidities with the development of ACTS. AO-OTA Type C fractures had significantly increased rates of developing ACTS.ConclusionFour percent of distal radius fractures were complicated by ACTS. There was no association between patient background and comorbidities with the development of ACTS. AO-OTA type C complete articular fractures had a significantly higher rate of ACTS. A suggested treatment algorithm for patients presenting with ACTS has been presented.Level of evidence:III.