Reduction Of Distal Radial Fractures Research Articles

Peripheral nerve blocks for closed reduction of distal radius fractures-A protocol for a systematic review.

Current methods of anaesthesia used for closed reduction of distal radial fractures may be insufficient for pain relief and muscle relaxation, potentially compromising reduction quality and patient satisfaction. Peripheral nerve blocks have already been implemented for surgery of wrist fractures and may provide optimal conditions for closed reduction due to complete motor and sensory blockade of the involved nerves. However, existing literature on peripheral nerve blocks for closed reduction is sparse, and no updated systematic review or meta-analysis exists. This protocol is developed according to the PRISMA-P statement. The systematic review and meta-analysis aim to consolidate the literature regarding the effect and harm of peripheral nerve blocks compared with other anaesthesia modalities for closed reduction of distal radius fractures in adults. The two primary outcomes are the proportion of participants needing surgery after closed reduction and pain during closed reduction. We will only include randomised clinical trials. Two review authors will each independently screen literature, extract data, and assess risk of bias with Risk of Bias 2 Tool. Meta-analysis will be carried out with Rstudio. We will also perform a Trial Sequential Analysis. The certainty of evidence will be judged using GRADE guidelines. We will use up-to-date methodology when conducting the systematic review outlined in this protocol. The results may guide clinicians in their decision-making regarding the use of anaesthesia for closed reduction of distal radius fractures in adults.

Acceptable Distal Radial Fracture Reduction May Not Be Good Enough: Commentary on articles by C.A. Selles, MD, et al.: "Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures. A Randomized Controlled Trial" and "Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures".

Acceptable Distal Radial Fracture Reduction May Not Be Good Enough: Commentary on articles by C.A. Selles, MD, et al.: "Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures. A Randomized Controlled Trial" and "Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures".

Bedside ultrasound in the emergency department for reduction and radial manipulation of distal radial fractures.

Distal radial fracture reduction is a common procedure in the ED. Previous studies have suggested that ultrasound (US)-guided reduction improves outcomes for patients who undergo manipulation and reduction of distal radial fractures in the ED. We aimed to investigate this with the first randomised controlled trial looking at US-guided distal radial fracture reduction. Our primary objective was to compare rates of operative intervention between the study groups. Rate of re-manipulation was compared as a secondary outcome. ED patients were prospectively randomised to either standard landmark guided or US-guided closed reduction of distal radial fractures. The closed reductions were performed by senior emergency clinicians and the USs were performed by emergency physicians experienced in point-of-care US. Following reduction patients were managed equally and referred to the local orthopaedic service who were blinded to whether US was used to assist manipulation or not. This service decided on the need for re-manipulation or operative intervention. One hundred patients were enrolled and randomised equally into each cohort. We found no statistically significant difference between the control and intervention groups of our study. In the control group, 46% of patients underwent operative fixation, compared to 48% in the US-guided group (P = 0.36). Our secondary intervention of re-manipulation in the ED or theatre following the initial reduction showed no statistically significant difference between the groups (P = 1.0). US-guided reduction of dorsally displaced, distal radius fractures in the ED setting, did not improve measured clinical outcomes.

Functional outcome of closed reduction and k-wiring with modified Kapandji technique for distal radial fractures

Kirschner wire osteosynthesis is a widely accepted method for reduction of distal radial fractures. The present study aims to assess the Functional outcome of Closed Reduction and K-Wiring with the Modified Kapandji Technique for Distal Radial Fractures.

Improved Safety and Cost Savings from Reductions in Cast-Saw Burns After Simulation-Based Education for Orthopaedic Surgery Residents.

The purpose of this investigation was to characterize the clinical efficacy and cost-effectiveness of simulation training aimed at reducing cast-saw injuries. Third-year orthopaedic residents underwent simulation-based instruction on distal radial fracture reduction, casting, and cast removal using an oscillating saw. The analysis compared incidences of cast-saw injuries and associated costs before and after the implementation of the simulation curriculum. Actual and potential costs associated with cast-saw injuries included wound care, extra clinical visits, and potential total payment (indemnity and expense payments). Curriculum costs were calculated through time-derived, activity-based accounting methods. The researchers compared the costs of cast-saw injuries and the simulation curriculum to determine overall savings and return on investment. In the 2.5 years prior to simulation, cast-saw injuries occurred in approximately 4.3 per 100 casts cut by orthopaedic residents. For the 2.5-year period post-simulation, the injury rate decreased significantly to approximately 0.7 per 100 casts cut (p = 0.002). The total cost to implement the casting simulation was $2,465.31 per 6-month resident rotation. On the basis of historical data related to cast-saw burns (n = 6), total payments ranged from $2,995 to $25,000 per claim. The anticipated savings from averted cast-saw injuries and associated medicolegal payments in the 2.5 years post-simulation was $27,131, representing an 11-to-1 return on investment. Simulation-based training for orthopaedic surgical residents was effective in reducing cast-saw injuries and had a high theoretical return on investment. These results support further investment in simulation-based training as cost-effective means of improving patient safety and clinical outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Magnetic resonance imaging investigation of radio-lunate relations: use in assessing distal radial fracture reduction.

III, diagnostic study.

Distal radial fractures in children: risk factors for redisplacement following closed reduction.

Distal radial fractures represent one of the most common fractures in children with the majority treated by closed reduction and cast application. Redisplacement after manipulation can occur resulting in potential poor outcome. We performed a prospective study of children undergoing closed reduction of distal radial fracture and evaluated a range of possible risk factors contributing to loss of reduction. The prospective study included 135 displaced distal radial fractures. There were 48 girls (36%) and 87 boys (64%), with a mean age of 9.9 years (range, 3 to 17 y). The risk factors for redisplacement, which were evaluated, were age, sex, location of the fracture, preoperative fracture displacement, presence of ulna fracture, grade of surgeon, quality of reduction, quality of plaster, and residual postreduction displacement. Redisplacement occurred in 39 of 135 cases (28.8%). Initial complete displacement was the most important risk factor for loss of reduction (odds ratio, 6.94; P=0.001). Completely displaced fractures were 7 times more likely to redisplace than fractures with some bony contact or no translation. Achievement of anatomic reduction decreases the risk of redisplacement (odds ratio, 0.29; P=0.046). Ten of the 39 fractures that lost position needed a second procedure (7.4%). Completely displaced distal radial fractures that cannot be anatomically reduced have a high risk of redisplacement after closed reduction. Only a small number of fractures that lose reduction will require a second intervention. Level II.

English

BACKGROUND: Fractures of the distal radius are common, open reduction and internal fixation using an interlocking plate system has gained popularity for the treatment of dorsally displaced distal radius fractures. The aim of the study was to assess how adequately distal radial fracture reduction was reproduced and maintained with the pre-contoured distal radius Indian locking plates and to evaluate the functional and radiological results of treating unstable distal radius fractures with the volar locking plate. PATIENTS AND METHODS: It was conducted on 20 patients with distal radius fractures who underwent open reduction, internal fixation using the pre-contoured distal radius Indian locking plates between May 2012 and September 2013 at the our Hospital. The preoperative, intra-operative, and postoperative films were reviewed. The AO classification was recorded. The volar angulation, radial tilt, radial height and step-off in joint incongruity were measured on intra-operative X-rays and compared with final follow-up X-rays. The last recorded range of motion at follow-up and a functional assessment using Gartland and Werley criteria. RESULTS: Radiological review showed bone healing in 20 patients and good articular congruity for all intrarticular fractures with less than 1 mm step-off. Complications were few with two wound infection and one neuropraxia of the superficial radial nerve. Wrist function was excellent in seven (35%) patients, good in 10 (50%) and fair in three (15%). CONCLUSION: The pre-contoured distal radius Indian locking plates with its distal buttressing ability are an effective treatment method in patients with distal radius fractures.

Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial

ObjectiveWe compared the efficacy and safety of ultrasound-guided haematoma block with that of procedural sedation and analgesia in patients with acute distal radial fracture reduction pain control.MethodsThis was a randomised...

Mastering Distal Radial Fracture Reduction: Lending a Hand with Model-Based Teaching

Mastering Distal Radial Fracture Reduction: Lending a Hand with Model-Based Teaching

TREATMENT OF DISTAL RADIAL FRACTURES WITH THE DVR-A PLATE — THE EARLY BRISTOL EXPERIENCE

The aim of the study was to assess how adequately distal radial fracture reduction was reproduced and maintained with the distal volar radius anatomic DVR-A (Biomet, Inc) locking plate. We looked at a consecutive series of 111 patients treated with the DVR-A plate at our institution from 2007-2010. The preoperative, intra-operative, and postoperative films were reviewed. The AO and Frykman classification was recorded. The sagittal tilt, radial inclination, and radial length were measured on intra-operative X-rays and compared with final follow-up X-rays. The last recorded range of motion at follow-up and a functional assessment using the Disabilities of the Arm, Shoulder, and Hand (DASH) score was recorded. At final follow-up a mean radial inclination of 22.22 degrees (11 to 38 degrees), radial height of 11.85 mm (6 to 18 mm), and sagittal tilt of 6.71 degrees volar (-9 to 19 degrees) was achieved. From initial post-operative films, to final follow-up X-rays there was a mean increase of 0.17 degrees in radial inclination, a mean loss of 0.36 mm radial height, and a mean loss of 2.17 degrees volar tilt. The mean extension was 46.8 degrees, flexion 48.3 degrees, pronation 77.4 degrees, supination 74.8 degrees, radial deviation 15.3 degrees and the ulnar deviation 19 degrees. The mean DASH score was 12.8 (0-68). The DVR-A plate achieved a highly satisfactory reduction of radial length and radial inclination, with a small loss of volar sagittal tilt at final follow-up. A good functional outcome was reported, with a satisfactory range of motion achieved. The DVR-A plate is a safe and effective treatment for unstable and intra-articular displaced distal radius fractures, particularly in younger patients, in the short term.

Distal radial fracture arthroscopic intraarticular gap and step-off measurement after open reduction and internal fixation with a volar locked plate

PurposeA persistent articular gap and a step-off of ≥1mm after a distal radial fracture (DRF) may lead to post-traumatic arthritis of the radiocarpal joint. This study aims to arthroscopically assess the reduction in the articular surface in patients requiring volar locked-plate fixation for DRF via fluoroscopy-guided open reduction and internal fixation (ORIF). MethodsSeventy consecutive patients with DRF were prospectively enrolled. Posteroanterior and lateral radiographs and axial, coronal, and sagittal computed tomography (CT) scans were obtained before ORIF for DRF. The widest articular gap (pregap) and step-off (prestep-off) at the radiocarpal joint surface of the distal radius were measured on all radiographs and CT images. Total predisplacement was defined as the sum of all pregaps and prestep-offs. The DRF was reduced under fluoroscopic guidance, and a volar locked-plate was applied after fluoroscopic ORIF. The residual maximum articular gap and step-off (postgap and poststep-off) were measured arthroscopically with a calibrated probe. Total incongruity was defined as the sum of postgap and poststep-off. The receiver operating characteristic curve was applied within the pregaps, prestep-offs and total incongruity in order to identify the cutoff values of pregap and prestep-off beyond which total incongruity would exceed 1mm. ResultsOf the 70 patients, 40 had a postgap of ≥1mm, and 15 had a poststep-off of ≥1mm. All pregap and pre- step-off cutoff values were judged to be unsuitable as the screening criteria for arthroscopic reduction of DRF because of their low sensitivity and specificity. The cutoff value obtained from total predisplacement was 7.85mm, and its sensitivity and specificity were 90 and 70 %, respectively. ConclusionsSince the cutoff value of 7.85mm derived from total predisplacement is a good indicator of post-ORIF residual total incongruity of ≥1mm, it is also a good indicator of the need for arthroscopic reduction.

Risk Factors Associated With Loss of Position After Closed Reduction of Distal Radial Fractures in Children

Closed reductions of distal radial fractures are among the most common orthopaedic operations but up to 39% of fractures lose position postoperatively. This study was carried out to determine the most significant risk factors for loss of position so that high-risk patients can be identified early and their management tailored accordingly. We retrospectively reviewed 48 consecutive children who had redisplacement of their distal radial fractures after closed reduction and compared them with 48 matched controls. Fourteen risk factors were studied and analyzed with univariate and multivariate logistic regression analysis and receiver operating characteristics analysis. These risk factors included pre-reduction and post-reduction fracture characteristics as well as 4 previously described radiological indices of plaster quality. Significant independent clinical risk factors identified were the initial radial fracture displacement [odds ratio (OR) 1.03, P = 0.001] and obliquity (OR 0.93, P = 0.006), a completely displaced radial fracture (OR 5.21, P =0.003), an ipsilateral ulnar fracture (OR 3.56, P = 0.003), residual radial displacement (OR 1.06, P = 0.009), angulation (OR 1.16, P = 0.011), and failure to achieve anatomical reduction (OR 0.18, P = 0.004). Significant radiological indices included the Padding index (OR >100, P = 0.004), Canterbury index (OR 99, P = 0.014), and 3-point index (OR 19.29, P < 0.001). Nonsignificant risk factors included the angulation of the initial radial fracture, a completely displaced ulnar fracture, plaster changes/splitting and the Cast index. The combined preoperative presence of a completely displaced radial fracture, an ipsilateral ulnar fracture and failure to achieve perfect reduction was found to be the best predictor of redisplacement (receiver operating characteristic area under the curve=0.82). This combination was found to be a better predictor of redisplacement than any of the radiological indices (receiver operating characteristic area under the curve ≤ 0.74) and it is also a more practical risk factor for the operating surgeon to use. The combination of a completely displaced distal radial fracture and an ipsilateral ulnar fracture, which then cannot be perfectly reduced, was the best predictor for redisplacement. We recommend that serious consideration be given to primary wire fixation in these patients. III, prognostic.

Improving surgical reduction in radial fractures using a ‘dowel’ pinning technique in miniature and toy breed dogs

A retrospective approach was used to detail and evaluate a 'dowel' pinning technique in distal radial fractures in miniature and toy breed dogs. Medical records and radiographs from 2003-2009 of miniature and toy breed dog radial fractures were examined. Sixty cases were divided into two groups: 51 radial fractures repaired with a 'dowel' pinning and external skeletal fixation (ESF) and nine radial fractures repaired with closed reduction and ESF. Each dog was evaluated and radiographic images were obtained at presentation, postoperatively, and at 1, 2, 4, 8, and 12 weeks postoperatively. Signalment, reduction, alignment, time to clinical bone healing and ESF removal, and implant morbidity were determined for each group. Radial fractures repaired with a 'dowel' pin and ESF had improved reduction compared to closed reduction and ESF alone (p<0.0001 as evaluated with lateral radiographs and p<0.0004 with cranial/caudal radiographs). Both surgical groups resulted in good clinical outcome with low morbidity, however it was observed that the time to clinical union and ESF removal was an average of 2.5 weeks less with closed reduction technique compared to the open reduction and 'dowel' pinning technique (p<0.031). Incorporating a 'dowel' pin to the surgical repair enhances the reduction of distal radial fractures in miniature and toy breed dogs and results in excellent clinical outcomes but causes a small delay in bone healing.

Conformational Changes in the Carpus During Finger Trap Distraction

Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and midcarpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied. The purpose of this study was to measure the three-dimensional conformational changes of the carpal bones in the normal wrist as a result of a static distractive load. Using computed tomography, the dominant wrists of 14 healthy volunteers were scanned at rest and during application of 98 N of distraction. Load was applied using finger traps, and volunteers were encouraged to relax their forearm muscles and to allow distraction of the wrist. The motions of the bones in the wrist were tracked between the unloaded and loaded trial using markerless bone registration. The average displacement vector of each bone relative to the radius was calculated, as were the interbone distances for 20 bone-bone interactions. Joint separation was estimated at the radiocarpal, midcarpal, and carpometacarpal joints in the direction of loading using the radius, lunate, capitate, and third metacarpal. With loading, the distance between the radius and third metacarpal increased an average of 3.3 mm +/- 3.1 in the direction of loading. This separation was primarily in the axial direction at the radiocarpal (1.0 mm +/- 1.0) and midcarpal (2.0 mm +/- 1.7) joints. There were minimal changes in the transverse direction within the distal row, although the proximal row narrowed by 0.98 mm +/- 0.7. Distraction between the radius and scaphoid (2.5 mm +/- 2.2) was 2.4 times greater than that between the radius and lunate (1.0 mm +/- 1.0). Carpal distraction has a significant (p < .01) effect on the conformation of the carpus, especially at the radiocarpal and midcarpal joints. In the normal wrist, external traction causes twice as much distraction at the lunocapitate joint than at the radiolunate joint.

Rupture de tendons fléchisseurs sur plaque antérieure après fracture du radius distal: À propos de 4 cas et revue de la littérature

We report four cases of flexor tendon ruptures which occurred after distal radial fracture and reviewed the 25 other cases reported in the literature since 1932. Analysis of these 29 cases disclosed the causes of these ruptures. A deformed callus after distal radial fracture or presence of an anterior osteosynthesis plate can under certain conditions lead to secondary flexor tendon tears. It was also found that tears of the flexor pollicis longus rupture predominate, followed by injury to the flexor digitorum profundis and superficialis of the index finger. Other tendons have only been involved in only a few cases. In order to avoid this complication, we propose systematic removal of anterior plates or secondary replacement if the reduction is not totally anatomic. Surgeons should recall the importance of anatomic reduction of distal radial fractures.

Superficial radial nerve damage due to Kirschner wiring of the radius

For displaced fractures of the radius, the use of Kirschner wires (K Wires) is accepted practice either alone or to supplement external fixation. Complications related to K wires include infection, migration and damage to tendons and nerves. We set out to investigate to incidence of superficial radial nerve damage due to radial styloid K wires. Injury to the sensory branch of the superficial radial nerve was seen in eight (20%) out of the 40 patients. K wiring is a popular technique to help maintain anatomic reduction of distal radial fractures. It has the advantage of being a semi-closed procedure, which is simple to perform. However, the morbidity of nerve damage is often underestimated and can be avoided.

Haematoma block in reduction of distal radial fractures.

A total of 35 patients who presented in the Accident and Emergency Department of University College Hospital with displaced distal radial fracture between January 2000 and March 2001 had reduction of the fracture under haematoma block using 10ml of 2% lignocaine. There was significant reduction of the pain following infiltration of the fracture site with lignocaine and significant pain reduction during manipulation compared to pain score at presentation. All the patients had satisfactory reduction of the fracture. The fracture was mobilised in Plaster of Paris 6 weeks in patients with Collens' fracture and 3 weeks in patients with distal radial epiphyseal injury. All patients had good range of movement at 8 weeks after removal of Plaster of Paris and patients expressed satisfaction with this method. We recommend the use of Haematoma block for patients of 15 years and above with displaced distal radial fracture in the Accident and Emergency Department.

Bier's block using prilocaine: safe, cheap and well tolerated

To examine the safety of prilocaine Bier's block performed for Colles fracture manipulation, and assess patient satisfaction. Fifteen-year retrospective review of all patients undergoing Colles fracture manipulation with a prilocaine Bier's block looking for the incidence of significant neurological or cardiovascular events. A confidential questionnaire was administered to 50 consecutive patients to assess patient satisfaction with the method of anaesthesia. 1504 males with mean age 48 years and 5906 females with mean age 66 years received a prilocaine Bier's block for distal radial fracture manipulation. There were no documented incidences of anaphylaxis, arrhythmia, convulsions or collapse. Of 50 consecutive patients, all but two were satisfied with this form of anaesthesia. The pressure cuff inflation was considered the worst part of the procedure. Bier's block performed with prilocaine is at least as safe as other commonly used methods of anaesthesia for distal radial fracture reduction with high patient satisfaction. The procedure can be safely carried out by a single medical practitioner with appropriate patient monitoring and assistance from trained nursing staff.

A traction jig for reduction of distal radial fractures

A traction jig is described which facilitates the closed reduction of extra-articular distal radial fractures and which maintains the reduction whilst a plaster cast is applied. The jig is suitable for use by a single operator in an Accident and Emergency department setting.