Reduction Of Distal Radius Fractures Research Articles

Closed Reduction Of Distal Radius Fractures: Is Finger Trap Traction Superior to Manual Traction?

Closed Reduction Of Distal Radius Fractures: Is Finger Trap Traction Superior to Manual Traction?

A retrospective cohort investigation of active range of motion within one week of open reduction and internal fixation of distal radius fractures

Distal radius fractures stabilized by open reduction internal fixation (ORIF) have become increasingly common. There is currently no consensus on the optimal time to commence range of motion (ROM) exercises post-ORIF.A retrospective cohort review was conducted over a five-year period to compare wrist and forearm range of motion outcomes and number of therapy sessions between patients who commenced active ROM exercises within the first seven days and from day eight onward following ORIF of distal radius fractures.One hundred and twenty-one patient cases were identified. Clinical data, active ROM at initial and discharge therapy assessments, fracture type, surgical approaches, and number of therapy sessions attended were recorded.One hundred and seven (88.4%) cases had complete datasets. The early active ROM group (n = 37) commenced ROM a mean (SD) of 4.27 (1.8) days post-ORIF. The comparator group (n = 70) commenced ROM exercises 24.3 (13.6) days post-ORIF. No significant differences were identified between groups in ROM at initial or discharge assessments, or therapy sessions attended. The results from this study indicate that patients who commenced active ROM exercises an average of 24 days after surgery achieved comparable ROM outcomes with similar number of therapy sessions to those who commenced ROM exercises within the first week.Level of evidence: 2B, retrospective cohort.

Die topografische Beziehung des M. pronator quadratus zum Ansatz des M. brachioradialis - Implikationen für die Refixation nach palmarer Plattenosteosynthese distaler Radiusfrakturen

In open reduction and volar plate fixation of distal radius fractures, the pronator quadratus (PQ) muscle is usually detached at the radial edge of the distal radius. Repair of the muscle is reasonable for coverage of the plate and to maintain normal pronation of the forearm. However, repair of the muscle is not always satisfactory. In this study, the topographic relationship of both the PQ and the brachioradialis muscle (BR) insertions are investigated with regard to optimising the repair of the PQ in open reduction and volar plate fixation of distal radius fractures. Twelve forearm pairs fixed in formalin were examined. The muscular boundaries of the PQ and the insertion of the BR were dissected, photographs were taken and measured digitally. The average distance of the PQ insertion was 4.75 cm. Distally, a close topographic relationship exists between the insertions of both the PQ and BR. A fascial connection of both muscles was detected in all specimens. The average distance of the common insertion was 1.75 cm. After removal of the PQ fascia, 0.85 cm of common insertion remained. In 25 % a muscular connection between both the PQ and BR was detected after removal of the PQ fascia. Both the PQ and BR have a common connective tissue and partially a common muscular insertion. Detaching the PQ insertion with a part of the BR insertion in open reduction and volar plate fixation of distal radius fractures can presumably lead to a more stable repair of the PQ in contrast to a repair within the muscle.

Closed reduction of distal radius fractures: does instability mean irreducibility?

The belief that not all distal radius fractures can be initially anatomically reduced with conservative means is rising. The aim of this study was to examine whether adequate reduction with a closed reduction technique is possible and to assess the importance of each step. We prospectively enrolled 63 distal radius fractures (62 patients). A standardized reduction technique was implemented. Reduction was radiologically evaluated in hanging traction, after reduction, and in plaster. Subgroup analysis was performed for fracture-dependent and fracture-independent factors on their influence on reduction. The mean radiological values (radial inclination, dorsal tilt, ulnar variance) showed near anatomic reduction of all fractures in plaster. Fracture severity according to AO classification, initial displacement, number of instability criteria and patient age did not affect the reduction outcome. All types of enrolled fractures were nearly anatomically reduced. This contradicts the opinion that some "severe" fractures are too unstable to be initially reduced by closed means.

Functional Consequence of Distal Brachioradialis Tendon Release: A Biomechanical Study

Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, this common procedure has the potential to decrease elbow flexion strength. To determine the potential morbidity associated with brachioradialis release, we measured the change in elbow torque as a function of incremental release of the brachioradialis insertion footprint. In 5 upper extremity cadaveric specimens, we systematically released the brachioradialis tendon from the radius and measured the resultant effect on brachioradialis elbow flexion torque. We defined release distance as the distance between the release point and the tip of the radial styloid. Brachioradialis elbow flexion torque dropped to 95%, 90%, and 86% of its original value at release distances of 27, 46, and 52 mm, respectively. Importantly, brachioradialis torque remained above 80% of its original value at release distances up to 7 cm. Our data demonstrate that release of the brachioradialis tendon from its insertion has minor effects on its ability to transmit force to the distal radius. These data imply that release of the distal brachioradialis tendon during distal radius open reduction internal fixation can be performed without meaningful functional consequences to elbow flexion torque. Even at large release distances, overall elbow flexion torque loss after brachioradialis release would be expected to be less than 5% because of the much larger contributions of the biceps and brachialis. Use of the brachioradialis as a tendon transfer donor should not be limited by concerns of elbow flexion loss, and the tendon could be considered as an autograft donor.

T1.5 The spoon technique for the reduction of distal radius fractures

treatedwith closed reduction and intramedullary K-wire, group B (23 patients) was treated one of them open other bone closed reduction and group C (13 patients) was both bones treated open reduction and intramedullary K-wire. We applied long arm cast all patients. Results: Mean age was 14 (5–15) in group A, 9.5 (7–14) in group B and 11 (5–15) in group C. Union was achived 53.5 (33–76) days in group A, 43.5 (35–66) days in group B and 46 (32–68) days in group C. No differences were found between the groups for fracture union at 3 or 6 months. Ten complications occurred in 10 of 63 patients such as eight hardware infection, one decreased range of motion. We didn’t find complications such as epiphyseal damage, angular or rotational deformity, synostosis. Conclusion: Closed or open reduction with intramedullary nailing of unstable pediatric forearm fracture has many advantages such as short operative time, unproblematic wound healing, easy removal of K-wires and good functional results.

New Technique for Dorsal Fragment Reduction in Distal Radius Fractures by Using Volar Bone Fenestration.

Introduction:For intra-articular distal radius fractures (AO Classification, type B2) with a displaced dorsal fragment, there remains much discussion on the fixation method for the dorsal fragment. To reduce the displaced dorsal fragment, we developed a new technique consisting of fenestration of the volar bone cortex, reduction using an intramedullary procedure, and fixation using a volar plate. This avoids necessity of dorsal approach.Technical Note:We performed this surgical technique in 2 patients and achieved a good reduced position without much injury to the bone cortex at the site of volar plate placement. This surgical technique allows reduction of the dorsal fragment using an intramedullary procedure by only a volar approach, and, therefore, does not affect the dorsal soft tissue (extensor tendon). For intra-articular distal radius fractures, complete reduction of the articular surface is extremely difficult, and, in patients with a remaining gap on the articular surface, a variable angle locking screw system may be useful. In the 2 patients, the angle of the locking screw was adjusted to catch the displaced dorsal fragment, and adequate reduction and fixation could be achieved.Conclusion:This technique using fenestration of the volar bone cortex allows reduction and fixation of the displaced dorsal fragment in distal radius fractures and thus avoids the necessity of a dorsal approach.

Accuracy of Ultrasonography in Confirmation of Adequate Reduction of Distal Radius Fractures.

Restoration of normal anatomic alignment is a key component of the treatment of distal radius fractures (DRF). This study aimed to evaluate the accuracy of ultrasonography (US) in determining the adequacy of closed reduction in these fractures. DRF patients admitted to the emergency department of Al-Zahra Hospital, Isfahan, Iran from September 2011 to 2012, were enrolled. After closed reduction, the adequacy was investigated through both US and control plain radiography. Then, sensitivity, specificity, positive and negative predicative values of US in confirmation of closed reduction was evaluated. In addition, inter-rater agreement between the two diagnostic tools was analyzed by calculating Cohen's kappa coefficient. Finally, 154 patients were evaluated (females: 53.9%) with mean age of 40.03±14.7 (range: 22-73). US had sensitivity, specificity, positive and negative predictive value of 99.3% (95%CI: 96.2-99.9), 100.0% (95%CI: 62.9-100.0), 100.0% (95%CI: 97.5-100.0), and 88.9% (95%CI: 51.7-98.1) in confirmation of the adequate reduction, respectively. In addition, inter-rater reliability was 0.94 (95%CI: 0.89-0.99; p<0.0001). It seems that US could be considered as a highly sensitive, accurate, easy to use, noninvasive and safe tool for guidance and confirmation of closed reduction in DRF.

Do patients above the age of 75 with distal radial fractures treated with a DVR plate have more complications?

Introduction: There is an increase in population age and therefore an increase in distal radius fractures. Recently there is a trend to performmore open reduction and fixations of distal radius fractures on all age groups. Objectives: To test the null hypothesis that there is no difference between age groups in complication rates following DVR plating for distal radius fractures and to compare complication rates with published literature. Methods: A total of 137 patients above the age of 55 years of age with distal radial fractures treated with a DVR volar locking plate between November 2008 and February 2010 had data collected retrospectively from patient notes. A total of 131 patients met the inclusion criteria andhad aminimumof 6weeks followup. Patients were divided into three age groups according to age; G1 included patients aged between 55 and 65 years, G2 included patients aged between 66 and 75 years of age andG3 included patientsmore than 75 years of age. Results: The average age was 67 years and 86%were female. The average interval between the fracture and operation was 9 days (0–28). Therewere 70patients inG1, 40 patients inG2 and27 inG3. Nerve injury rate was 8.8% and there was no statistical significance between groups (P=0.13), CRPS occurred in 8% of cases and there was a non-significant difference between groups (P=0.08), tendon injury occurred in 2%, a superficial infection occurred in one case and there was blistering in one patient. Conclusion: There are no increase complication rates with fixing distal radial fracture in elderly patients with good functional demands.

MRI investigation of radio-lunate relations: Use in assessing distal radius fracture reduction

MRI investigation of radio-lunate relations: Use in assessing distal radius fracture reduction

Risk of redisplacement after first successful reduction in paediatric distal radius fractures

The aim of this study was to assess the usefulness of currently available indices for casting in distal radius fractures in children and to identify risk factors associated with displacement. A cohort of 14 patients with redisplacement was compared with a cohort of 41 patients with maintenance of reduction. A significant difference (<0.008) was observed in the three-point index, the degree of comminution (<0.01) and the quality of the initial reduction (<0.003). We recommend careful identification of high-risk factors and appropriate stabilization for potentially unstable fractures at first treatment. Assessment of the three-point index is recommended for judging the moulding technique.

Technical Tips for (Dry) Arthroscopic Reduction and Internal Fixation of Distal Radius Fractures

Contrary to general belief, arthroscopic assisted reduction in distal radius fractures can be done in an expeditious manner and with minimal consumption of operating room resources. This article presents the steps for a pleasant arthroscopic experience in detail. The technique proposed combines the benefits of rigid fixation with volar locking plates (for the extra-articular component) and arthroscopic control of the reduction (for the articular component). It is important that the operation be carried out using the dry arthroscopic technique. However, arthroscopy is just an addition to conventional methods. Thorough knowledge of and facility with classic techniques of distal radius fracture treatment is essential for a good result.

158 A Randomized Controlled Trial of Emergency Department Ultrasound-Guided Reduction of Distal Radius Fractures

158 A Randomized Controlled Trial of Emergency Department Ultrasound-Guided Reduction of Distal Radius Fractures

213 Use of Radiographic Parameters for Distal Radius Fracture Reduction Analysis

Inadequate distal radius fracture reduction could result in significant morbidity including post-traumatic arthritis and decreased wrist strength. The purpose of this study is to investigate the clinical utility of the radiographic measurements in distal radius reductions by the emergency physician.

Dorsally displaced distal radius fractures treated by fixed-angle volar plating: Grip and pronosupination strength recovery. A prospective study

Malunion following open reduction and internal fixation of distal radius fracture threatens wrist function. Fixed-angle palmar plates provide rigid fixation that is stable over time; however, the pronator quadratus sectioning required by the anterior approach entails a risk of pronation strength loss and of distal radioulnar joint destabilization. The present study assessed recovery of grip, pronation and supination strength following such internal fixation. A prospective study included 26 distal radial fractures with dorsal displacement, osteosynthesized using a fixed-angle palmar plate, in 25 patients (mean age: 47.5 years; range: 17-72 years). Assessment concerned the classical parameters, plus grip and pronosupination strength recovery. At a mean 14 months follow-up (range: 6-30 months), patients had recovered 91% grip strength, 88% pronation strength and 85% supination strength with respect to the healthy side. Complications comprised three cases of malunion, two of reflex sympathetic dystrophy syndrome, and four of post-traumatic carpal tunnel syndrome. A study of the literature found 75-95% grip strength recovery following osteosynthesis using fixed-angle plates. Few studies, however, have focused on pronosupination strength, and none reported its evolution following osteosynthesis. The present study found no drawbacks associated with a technique which usually involves sectioning the pronator quadratus. Except in case of malunion or joint stiffness, fixed-angle palmar plate osteosynthesis was followed by recovery of grip and pronosupination strength. Level IV: prospective non-randomized, non-comparative observational study.

Ultrasound-Guided Reduction of Distal Radius Fractures

Ultrasound Quarterly: June 2011 - Volume 27 - Issue 2 - p 115 doi: 10.1097/01.RUQ.0000398733.20528.51

A Prospective Study on the Effectiveness of Cotton Versus Waterproof Cast Padding in Maintaining the Reduction of Pediatric Distal Forearm Fractures

Distal forearm fractures, one of the most common fractures seen in the pediatric population, are regularly treated by closed reduction and casting. Our study investigates the effectiveness of Gore-Tex-lined casting in maintaining the reduction of 100% displaced distal forearm fractures compared with traditional cotton-lined casts. We screened all patients from February 2007 to July 2009 who presented to Children's Hospital in Birmingham, AL with a distal radius fracture. Only patients with 100% displaced distal radius fractures were eligible to be assigned to either the cotton-lined or Gore-Tex-lined cast groups. Power analysis was performed to identify an adequate patient sample size. The mean maximum change between initial post-reduction x-rays and follow-up x-rays for anterior-posterior (AP) angulation, AP displacement, lateral angulation, and lateral displacement of the radius were calculated for both cotton and Gore-Tex groups. The rate of subsequent intervention and/or unacceptable results for each group was also analyzed. Seven hundred and twenty-two patients were treated with distal radius fractures at our hospital with 59 patients eligible for inclusion in our study. Thirty-six of our patients were treated with cotton-lined casts, and 23 patients were treated with Gore-Tex-lined cast. The mean maximum change in AP angulation, AP displacement, lateral angulation, and lateral displacement of the radius after initial reduction was 9.2 degrees, 6.9%, 13.9 degrees, and 13.6%, respectively, for the cotton-lined cast group and 7.7 degrees, 6.1%, 14.6 degrees, and 9.6%, respectively, for the Gore-Tex-lined cast group. There were no statistical differences between the means of the 4 measurements (P=0.33, 0.69, 0.73, and 0.10, respectively). There were also no significant differences between groups for final AP and lateral angulation and displacement. Subgroup analysis showed no significant differences in all measurements between cotton and Gore-Tex groups. Gore-Tex and cotton-lined casts are equally effective in their ability to maintain the reduction of 100% displaced distal forearm fractures. Thus, Gore-Tex-lined casts can be offered to pediatric patients immediately after closed reduction of distal radius fractures of any severity. Therapeutic level II.

Supracondylar Radial Nerve Block for Treatment of Distal Radius Fractures in the Emergency Department

Background Patients with acute distal radius fractures are frequently treated in the emergency department (ED) with closed reduction and splinting. Many of the anesthesia methods frequently employed may either lack efficacy or require additional monitoring and resources. Case Report An 18-year-old woman presented to the ED with a dorsally angulated distal radius fracture (Colles fracture). As an alternative to procedural sedation, an ultrasound-guided block of the radial nerve proximal to its bifurcation into the deep and superficial branches was performed. The resulting anesthesia was adequate to reduce and splint the fracture with minimal discomfort for the patient. Conclusion Ultrasound-guided supracondylar block of the radial nerve proximal to the origin of the deep and superficial branches provides safe and efficacious anesthesia for distal radius fracture reduction in the ED.

Ultrasound-guided reduction of distal radius fractures

Ultrasound-guided reduction of distal radius fractures

The Hematoma Block an Effective Alternative for Fracture Reduction in Distal Radius Fractures

An alternative to general anesthesia was tested against hematoma block by a double-blind, randomized clinical trial in reduction of Colles fracture. 96 patients more than 18 years old with displaced fractures of distal radius were selected from 2007-2009 on the basis of: 1) informed consent; 2) no contraindication to any method of analgesia; 3) no associated injury. Patients were randomized into 2 equal groups. The A group received Propofol intravenously, whereas the B group received 10 ml of 2% Lidocaine Hydrochloride into the fracture hematoma. Fractures are reduced under acceptable criteria. Pain measured by Visual Analogue Scale (VAS) was recorded before, during, and after reduction. Time to Emergency department, to manipulation and to hospital discharge is measured. In radiographic before, after reduction and a week later the radial tilt, ulnar migration and dorsal tilt are measured. Loss of these parameters were study statistically data analysis by KW statistics. 96 patients with displaced fractures of distal radius at mean age 54.3 (19-84) years old, M/F rate 37/59, left/right hand 37/58., from 2005-2008. VAS during reduction was 0 in group A and 0.97 +/- 0.7 in group B and VAS after reduction was 2.72 +/- 0.7 in group A and 2.25 +/- 0.2 in group B. Time to reduction was 2.63 +/- 0.96 hr in A and 0.90 +/- 0.47 hr in B After a week, 21 fractures lose reduction in group A and 22 in group B. Hematoma block by local anesthetic is a safe and effective alternative to intravenous general anesthesia in reduction of Colles fracture.