Treatment Of Distal Radius Fractures Research Articles

Management Options and Clinical Outcomes After Flexor Tendon Ruptures Following Volar Plating of Distal Radius Fractures.

The transition to volar locking plates for the treatment of distal radius fractures has improved patients' range of motion, reduced extensor tendon issues, and hastened return to activity compared to older fixation methods or nonoperative treatment. One drawback to volar plating is the potential for flexor tendon ruptures due to aberrant plate or screw placement. This study aims to describe the reconstruction options and patient outcomes after flexor tendon rupture due to volar plating. This is a single-institution, retrospective review of patients who presented with flexor tendon rupture from 2014 to 2023 after a distal radius fracture previously managed with a volar plate. Patient demographics, operative details, range of motion, complications, and patient-reported outcomes were collected. Ten patients presented with flexor tendon ruptures after volar plating for distal radius fractures from 2014 to 2023. The most common rupture was flexor pollicis longus (FPL) in 7 patients, followed by index finger flexor digitorum profundus (FDP) in 2 patients, and small and ring finger FDP rupture in 1 patient. Flexor pollicis longus (FPL) was reconstructed with a palmaris longus (PL) graft in 4 patients, ring finger flexor digitorum superficialis transfer in 2 patients, and repaired primarily in 1 patient. All patients with FPL ruptures regained functional thumb interphalangeal flexion except for 1 patient who reruptured 4 weeks after surgery. Flexor tendon ruptures can occur following volar plating of distal radius fractures, even years after fixation of the fracture. These are attritional ruptures and generally reconstructed with tendon grafting of transfer, providing functional flexion of the affected digit.

Comparative Outcomes of Percutaneous K-Wires Versus Plate Fixation in the Treatment of Distal Radius Fractures: A Focus on Stability in Osteoporotic Patients and Both-Bone Distal End Fractures.

Background Distal radius fractures (DRFs) are commonly treated with percutaneous K-wire or plate fixation. The relative efficacy and stability of these methods, particularly in osteoporotic patients and in cases involving both distal radius and ulna fractures, remain subjects of clinical debate. Objective This study aims to compare the outcomes of percutaneous K-wire fixation versus plate fixation in patients with distal end radius fractures, focusing on postoperative stability in osteoporotic conditions and both-bone distal end fractures. Methods A total of 50 patients were retrospectively analysed and divided into two groups: 25 underwent percutaneous K-wire fixation, and 25 underwent plate fixation. Outcomes measured included bone healing time, complication rates, functional recovery using the DASH score, and radiological outcomes through standard X-ray imaging. Results Preliminary data suggest that plate fixation offers better stability, especially in osteoporotic patients and cases with both-bone involvement. Complications with K-wire fixation were more frequent in these subgroups. Conclusion Plate fixation may provide superior stability and functional outcomes in treating DRFs, particularly in complex cases involving osteoporosis or bone injuries. Further research with larger sample sizes and prospective design is recommended.

Utilization of Surgical Fixation for Distal Radius Fractures in the United States: A Population-Based Cohort Study

In contrast to younger adult populations, clinical practice guidelines state that there is no difference in long-term functional outcomes in surgically versus nonoperatively treated distal radius fractures in patients ≥65 years old. In this study, we asked the following questions: (1) has treatment for distal radius fractures in younger and older adult populations changed over time? (2) What patient and surgeon factors are associated with treatment trends? Using a national administrative claims database, we identified patients aged ≥18 years with isolated, closed distal radius fractures, subdivided by age (18-64 years, ≥65 years old). We characterized the proportion of patients who underwent open reduction and internal fixation (ORIF) over time. We stratified our analysis by surgeon subspecialty, region, and mean area income. Changes in ORIF utilization over time were evaluated using linear regression models. The proportion of distal radius ORIF, including in patients aged ≥65 years, increased from 10.4% in 2012 to 15.1% in 2020. Of the ORIF procedures performed, hand surgeons accounted for an increasing proportion over time, with a corresponding decrease in those performed by general orthopedic surgeons. The proportion of ORIF increased over time in all US regions, with the largest rate of increase in the Midwest for patients aged ≥65 years and Northeast for patients aged 18-64 years. Patients living in areas with mean family income ≥$65,000 were more likely to undergo ORIF. The proportion of distal radius ORIF including in older adult populations is increasing in all US regions, and an increasing proportion is performed by hand surgeons. Further analysis of the drivers of these trends is warranted, given the rising incidence of surgical treatment in older patients, which could reflect evolving patient activity demands and suggest a need to further evaluate conventional treatment algorithms based on age.

Application of distal radius coronal bone structure matching in the treatment of distal radius fractures

To investigate the clinical effect of coronal bone structure matching(CBSM)in the treatment of distal radius fracture. A total of 39 cases of distal radius fracture between Jannary 2018 and Jannary 2022 were included in this study. Among them there were 22 males and 17 females with an average age of (48.9±16.3) years old, ranged from 22 to 65 years old. All patients were treated with open reduction and internal fixation with plates. Based on the measurement of CBSM value on the X-ray film the next day after surgery. All patients were divided into matched group and mismatched group according to the coronal bone structure matching in the normal range or not. There were 27 patients in the matched group, including 15 males and 12 females, the age ranged from 22 to 64 years old with an average of (48.0±16.2) years old. AO classification of fracture was C1 in 6 cases and C2 in 21 cases;the operation time ranged from 1 to 6 days after injury;9 cases were complicated with ulnar styloid process fracture. There were 12 patients in the mismatched group, including 7 males and 5 females;the age ranged from 22 to 65 years old with an average of (48.8±15.8) years old. AO classification of fracture was C1 in 4 cases and C2 in 8 cases;the time from injury to operation ranged from 1 to 5 days;4 cases were complicated with ulnar styloid process fracture. The X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months after operation. The range of wrist motion(pronation, supination, palmar inclination and dorsiflexion), function outcomes(Gartland-Werley score) and pain levels (visual analogue scale, VAS) were compared between the two groups at the last follow-up. The average follow-up time of 39 patients were(9.5±4.3)months, ranged from 6 to 14 months. All patients healed in one stage without postoperative infection, fracture nonunion and fracture displacement occurred. Compared with match group at the last follow-up, the VAS in the mismatch group was increased[(2.5±1.3)points vs (1.6±1.0)points], the wrist pronation were decreased[(70.5±12.6)° vs (80.5±9.4)°], with statistically significant difference(P<0.05). There was no significant difference in the range of motion(supination, palmar inclination, dorsiflexion)and excellent good rate between the two groups at last follow-up after operation (P>0.05). Wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.

Options and challenges in the treatment of distal radius fractures

Options and challenges in the treatment of distal radius fractures

The Effect of Radial Translation Deformity on Functional Results after the Conservative Treatment of Distal Radius Fracture

The Effect of Radial Translation Deformity on Functional Results after the Conservative Treatment of Distal Radius Fracture

A case report: Surgical Release for De Quervain Syndrome after conservative treatment of distal radius fracture

Objective Describe the clinical and paraclinical characteristics of De Quervain Syndrome and the result of the surgery for De Quervain Syndrome after conservative treatment of distal radius fracture Subjects and methods A case report. Results De Quervain Syndrome is a condition that involves tendon entrapment affecting the first dorsal compartment of the wrist. It has been reported that De Quervain Syndrome can also develops after distal radius fracture. We report a case that the patient was diagnosed with De Quervain Syndrome after conservative treatment of distal radius fracture. During surgery we noticed that the patient had separated tendon sheaths for abductor pollicis longus (APL) and extensor pollicis brevis (EPB). EPB tendon sheath was released and reconstructed to prevent tendon subluxation. After 6 months, patient was feeling no pain and very satisfied. Conclusions De Quervain Syndrome development after distal radius fracture is rare. The successful surgery got the patient came back to work normally.

Surgical Treatment of Periarticular Distal Radius Fracture in Elderly: A Systematic Review

Background/Objectives: The treatment of periarticular distal radius fractures remains challenging. Different surgical treatment options have been proposed as alternatives to conservative treatment. This systematic review aims to compare the functional outcomes, radiological outcomes, and complications among volar locking plates (VLPs), Kirschner-wire fixations, and external fixations (EFs) for distal radius fractures in patients aged 60 years and older. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Science Direct databases assessing the effects of VLP, EF, and K-wire treatments for distal radius fractures in patients aged 60 years and over. The primary outcome was the evaluation of the range of motion (ROM) degrees after three surgical procedures, trying to assess the best treatment option. The secondary outcome included evaluation of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, quick-DASH score, Patient-Rated Wrist Evaluation (PRWE) score, Visual Analog Scale (VAS) score, grip strength, radiographic assessment, and complications comparing VLPs, EFs and K-wires. Results: A total of 23 studies were included, comparing VLP, EF, and K-wire fixation. The overall population comprised 5618 patients, with 4690 females and 1015 males, of which 4468 patients were treated with VLP, 503 with EF, and 647 with K-wire. The most common complications among the VLP group were complex regional pain syndrome (7.5%) and carpal tunnel syndrome (6.8%); for the EF group, infections (9.8%) and carpal tunnel syndrome (6.8%); and for the K-wire group, carpal tunnel syndrome (7.5%) and infections (6.9%). Conclusions: VLP showed better clinical outcomes in the first few months after treatment. However, these differences decreased over time and became similar after one year. EF and K-wire fixations remain easier to manage during surgery.

Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures.

Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures. We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain. We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, "I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion," which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains. Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

A Comparison Between Volar Locking Plates and Percutaneous Pinning in the Treatment of Distal Radius Fractures: A Systematic Review

Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs. We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications. Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups. Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study's limitations. Therapy/Prevention, Etiology/Harm II.

Comparison of Early Versus Late Debridement Outcomes in the Management of Open Distal Radius Fractures

The optimal timing for surgical treatment of open distal radius fractures remains an area of debate. The purpose of this study was to examine the outcomes of open distal radius fractures treated surgically before or after 24 hours. A multicenter retrospective review was performed on all open distal radius fractures treated over 11 years. Patient demographics, injury mechanism, and initial treatment were recorded. Fracture severity was graded by the Gustilo-Anderson classification. Comparisons were made between those treated surgically within and after 24 hours. Outcomes examined included infection, revision surgery, osteomyelitis, and nonunion. A total of 230 cases met the inclusion criteria. The cohorts of early and delayed surgical intervention were similar with regard to preoperative demographics. The most common mechanism of injury was motor vehicle accident. Approximately 40% of cases were graded as type I, 40% as type II, and 20% as type III. Mean time to debridement in the group treated after 24 hours was 5 days. A mean postoperative follow-up of greater than 6 months was obtained in both cohorts. Similar outcomes were found between cohorts with respect to postoperative infection, revision surgery, osteomyelitis, and nonunion. Similar outcomes with regards to infection, revision, osteomyelitis, and nonunion were found between open distal radius fractures treated emergently versus those managed in a delayed fashion. Patient- and injury-specific factors are important in dictating care. Prognostic IIB.

Functional Outcome of Intra-Articular Distal End Radius Fracture Treated Surgically by Volar Locking Plate: A Prospective Study

Background. Unstable distal end intra-articular fractures of the radius pose a greater risk of reduction loss, potentially resulting in malunion and poor functional outcomes. Therefore, the amount of reduction and the technique of fracture fixation play a crucial role in achieving improved functional outcomes and ensuring patient satisfaction.Material and methods. This is a study of prospectively enrolled 27 patients with displaced intra-articular distal end radius fractures treated surgically by volar locking plate through modified Henry’s approach in the department of orthopedics at a tertiary care center. Patients were post-operatively evaluated for functional outcome and complications. Results. Out of the 27 patients 26 came for regular follow up, ranging from 3 months to 18 months and one patient was lost to follow-up. The functional outcome was investigated with the Mayo wrist score. Excellent scores were noted in 34.6%, good in 53.8% and satisfactory in 11.5% of the patients. Conclusion. Irrespective of the direction and degree of displacement, the volar locking plate as a treatment for an intraarticular distal end radius fracture is a good option as it provides stable fixation, and good to excellent outcomes with less complications.

Variation in Treatment of Young Adult Distal Radius Fractures by Pediatric and Adult Orthopaedic Surgeons.

There remains a lack of consensus on the optimal treatment of isolated distal radius fractures in young adults. The primary aim of this study was to identify differences in treatment of isolated distal radius fractures in patients aged 17 to 21 years treated by adult versus pediatric orthopaedic surgeons. The secondary aim was to identify whether there is a variation in utilization of open reduction and internal fixation (ORIF) versus closed reduction and percutaneous pinning when treated surgically by adult versus pediatric orthopaedic surgeons. Patients aged 17 to 21 years with isolated distal radius fractures who were treated by adult or pediatric orthopaedic surgeons at 1 of 3 hospitals were identified through retrospective chart review. 72 patients in the pediatric surgeon cohort and 64 patients in the adult surgeon cohort were included. Demographic details were recorded, and radiographs from the initial clinic visit and final follow-up were obtained. Bivariate analysis was used to evaluate for primary and secondary aims. 40 of 136 patients were treated surgically. Bivariate analysis showed that factors associated with surgical treatment were treatment by an adult orthopaedic surgeon, higher body mass index, radiographic severity, AO classification, intraarticular involvement, distal radial-ulnar joint involvement, and meeting AAOS clinical practice guideline surgical criteria. Factors associated with ORIF compared with closed reduction and percutaneous pinning included treatment by an adult orthopaedic surgeon, older age, higher body mass index, and greater articular step-off. In comparable cohorts of young adult patients with distal radius fractures with similar fracture characteristics, there was notable variation in treatment between adult and pediatric orthopaedic surgeons. Surgical treatment was used more by adult surgeons, and when treated surgically, ORIF was used more by adult surgeons. Variation among surgeons illustrates the persistent lack of consensus on the optimal treatment in this population and highlights the need for additional research on this topic to guide management. Level IV.

Intra-articular fracture reduction: a comparative observational study of clinical results after the surgical treatment of distal radius fractures

Purpose: This study compared the outcomes of intra-articular fracture reduction for distal radius fractures. Methods: Among 180 patients who underwent open reduction and plate fixation, the exclusion criteria were as follows: non-acute fracture (&gt;1 month), an accompanying ulnar neck fracture, a distal ulnar fracture requiring fixation, fixation through the dorsal approach, other accompanying hand fractures, the absence of preoperative or postoperative computed tomography (CT), and follow-up for &lt;1 year. Intra-articular fractures were evaluated through CT. Forty-eight patients with intra-articular fractures were studied. Displaced intra-articular fractures were defined as: (1) articular step-off ≥1 mm, (2) fracture gap ≥2 mm, or (3) gross incongruence. Reduction was classified as good (n=23) or poor (n=25) based on postoperative CT. The pain visual analogue scale (pVAS), the quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and range of motion of the wrist joint were compared between both groups.Results: No significant between-group differences were found in the preoperative demographic data and the postoperative pVAS and quick DASH scores (pVAS: 0.6 vs. 0.8 and quick DASH: 9.4 vs. 10.2 in the good vs. poor reduction groups, respectively). However, the flexion-extension arc was significantly restricted in the poor reduction group (162° in the good reduction group vs. 146° in the poor reduction group, p&lt;0.001).Conclusion: The reduction of the articular surface was not related to pain and functional results at the mid-term follow-up after the surgical treatment of intra-articular distal radius fractures. However, insufficient fracture reduction affected the postoperative range of motion.

Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury

To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05). For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.

Application of improved carpal shoot through view in volar plate internal fixation of distal radius fractures

To explore the application of improved carpal shoot through view (ICSTV) method in the treatment of distal radius fractures with volar plate internal fixation. The clinical data of 67 patients with distal radius fractures who met the selection criteria between January 2020 and January 2023 was retrospectively analyzed. There were 30 males and 37 females with an average age of 53.6 years (range, 18-75 years). According to the AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 25 cases of type B and 42 cases of type C. The time from injury to operation ranged from 2 to 6 days, with an average of 3.8 days. During the operation, bilateral cortical drilling was performed, and the length of the implanted screw was 1-2 mm shorter than that measured by the depth ruler. Standard anteroposterior and lateral (AAL) fluoroscopy and ICSTV fluoroscopy were performed after volar anatomic locking plate fixation, respectively. If the dorsal cortex of the distal radius was detected to be penetrated, the short screw was replaced and ICSTV fluoroscopy was performed again until no screw was penetrated. The detection rate of dorsal cortical screw penetration was compared between AAL fluoroscopy and ICSTV fluoroscopy. Postoperative CT scan was performed to confirm the presence or absence of dorsal cortical screw penetration. Intraoperative AAL fluoroscopy found 5 screws penetrating the dorsal cortex in 4 patients (6.0%), and ICSTV fluoroscopy found 19 screws penetrating the dorsal cortex in 15 patients (22.4%) including the above 4 patients, with a significant difference in the detection rate between the two fluoroscopy methods [ OR=0.267 (0.084, 0.845), P=0.018]; 15 patients were replaced with short screws during operation. At the same time, ICSTV fluoroscopy detected 2 screws penetrating into the distal radioulnar joint in 2 cases (3.0%), which could not be found in AAL fluoroscopy, and the direction of the screws was adjusted and replaced. All patients were reexamined by wrist CT within 3 days after operation, and no dorsal cortical screw penetration or screw penetration into the distal radioulnar joint was found. All the 67 patients were followed up 6-18 months, with an average of 11.3 months. Extensor tendon irritation occurred in 2 patients at 3 months after operation, and no extensor tendon rupture occurred in all patients during follow-up. All fractures healed well, and the healing time was 8-13 weeks, with an average of 10.8 weeks. There was no complication such as internal fixation loosening or fracture displacement. The Gartland-Werley score at last follow-up ranged from 0 to 15, with an average of 5.6. ICSTV fluoroscopy can effectively detect occult dorsal cortical screw penetration of the distal radius that can not be revealed by AAL fluoroscopy.

A Systematic Review of the Optimal Management of Pediatric Distal Radius Displacement Fractures: Open Reduction and Internal Fixation Versus Cast Placement.

Distal radius fracturesare among the most common pediatric injuries, affecting thousands of children each year. These fractures often require clinical intervention to reduce displacement and ensure the proper healing of the growth plate and wrist bone. The primary objective of this comprehensive analysis is to compare the effectiveness of open reduction and internal fixation (ORIF) versus cast placement in the treatment of pediatric distal radius fractures, with the aim of identifying the optimal treatment approach. Therefore, a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on pediatric distal radius displacement fractures using extensive database searches from 2000 to 2024 for specific keywords, ensuring transparency and reproducibility. Our findings indicate that higher displacement necessitates ORIF to minimize long-term complications and ensure better functional outcomes for pediatric patients. Rare studies comparing ORIF and cast placement are analyzed, emphasizing the advantages and limitations of each approach. The document concludes that the choice between ORIF and casting depends on factors such as fracture severity, patient's age, and specific characteristics of the injury to ensure optimal outcomes in pediatric distal radius fracture management. In conclusion, our data suggests that ORIF and cast placement each have pros and cons for pediatric distal radius fractures, with the best treatment depending on fracture specifics and patient factors, but neither method is clearly superior for long-term outcomes.

Effectiveness of Delayed Surgical Treatment for Distal Radius Fractures With Loss of Reduction

This study investigated the effectiveness of volar plate surgery in patients with distal radius fractures (DRFs) initially treated nonsurgically but later experiencing reduction loss during follow-ups. Specifically, it assessed the impact of early surgery (E) (<3 weeks) versus delayed surgery (D) (3-6 weeks) on wrist function in surgically treated DRFs. This retrospective study included 131 patients who underwent surgery after loss of reduction. Among them, 42 patients had delayed surgery, whereas 89 received early surgical treatment. The mean follow-up duration was 18 months. The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand scores. Secondary outcomes included Short Form-12 physical component summary and mental component summary scores, postoperative range of motion, and radiological measurements such as radial length, radial inclination angle, and volar tilt angle. Fracture types were categorized using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification based on radiological images. All 131 DRFs achieved radiological union. Mean Disabilities of the Arm, Shoulder, and Hand scores were 8.0 (range, 0-78) and 10.8 (range, 0-73) for groups E and D, respectively, and the difference was not considered clinically relevant. Short Form-12 physical component summary scores (49.4 for E; 45.3 for D) and Short Form-12 mental component summary scores (52.3 for E; 53.5 for D) were similar in the two groups. Radiological measurements and range of motion were similar in the two groups. Complications, including carpal tunnel syndrome, superficial radial nerve neuropraxia, and complex regional pain syndrome, occurred in 12 (13.5%) E group patients and 9 (21.4%) D group patients. Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced DRF were similar. However, complication rates were higher in delayed surgery. Prognostic IV.

What Have We Learned in the Wrist Joint of Distal Radius Fracture through Wrist Arthroscopy?

Abstract Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy. Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy. Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered. Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.

Percutaneous treatment of type C distal radius fractures using dual-external fixator

BackgroundThis study aimed to introduce a potential alternative percutaneous treatment for AO types C1, C2, and C3 distal radius fractures using dual-external fixator (a no-bridging cemented-pin frame and a conventional wrist-bridging external fixator). Materials and methodsFrom January 2018 to January 2021, 52 patients (52 distal radius fractures) were treated with dual-external fixator. For comparison, 61 patients (61 distal radius fractures) were treated with a plate and screw system. Wrist function was assessed using the Mayo Wrist Score. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction. A P < 0.05 was considered statistically significant. ResultsFracture healing was achieved in all patients. At the final follow-up of 29 months (range, 24–34 months) vs 36 months (range, 26–39 months) (P > 0.05), the patients treated with dual-external fixator and a plate and screw system achieved mean ulnar deviations of 31° vs 29° (P < 0.05), mean Mayo Wrist Scores of 91.12 ± 5.98 vs 88.12 ± 7.54 (P < 0.05), and mean patient satisfaction scores of 23.42 ± 2.47 vs 23.04 ± 2.32 (P > 0.05). ConclusionsAO types C1, C2, and C3 distal radius fractures can be treated successfully using dual-external fixator. The technique is a potential alternative in addition to the conventional treatments. Level of evidenceLevel IIa.