Extra-articular Distal Radius Fractures Research Articles

Effectiveness of supervised physiotherapy versus a home exercise program in patients with distal radius fracture: a randomized controlled trial with a 2-year follow-up

ObjectiveTo determine in the long term whether supervised physiotherapy is more effective than a home exercise program for functional improvement and pain relief in patients with distal radius fracture (DRF). DesignRandomized controlled trial. SettingRehabilitation hospital. ParticipantsA total of 74 patients older than 60 years with extra-articular DRF were randomly allocated into two groups. InterventionsThe experimental group received 6 weeks of supervised physiotherapy (n = 37) and the control group received 6 weeks of home exercise program (n = 37). Main outcome measuresThe primary outcome was wrist/hand function assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire; secondary outcomes were the pain visual analogue scale (VAS), grip strength and wrist flexion–extension active range of motion. ResultsAll patients completed the trial. For the primary outcome, at 6-weeks and 1-year follow-up, the PRWE questionnaire showed a mean difference between groups of 18.6 (CI 95% 12.8 to 24.3) and 18.5 points (CI 95% 12.7 to 24.2) respectively, these differences are clinically important. Conversely, at 2-year follow-up this effect decreases to 3.3 points (CI 95% −2.4 to 9.0). For secondary outcomes, at 6-weeks and 1-year follow-up, in all measurements the effect size range from medium to large. Conversely, at 2-year follow-up only grip strength showed large effect size in favor of supervised physiotherapy, the rest of outcomes did not show difference between groups. ConclusionAt the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief compared with a home exercise program in patients older than 60 years with extra-articular DRF. However, this effect decreases over time, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy. Contribution of the Paper•Current evidence has shown controversial results regarding the effectiveness of supervised physiotherapy versus a home exercise program in elderly patients with DRFs.•At the 6-week and 1-year follow-up, supervised physiotherapy is more effective for functional improvement and pain relief.•However, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy in these patients.

Distinct patterns of fracture propagation in distal radial fractures and the relationship to the ulnar head

BackgroundThe aim was to assess the direction of distal radius fractures and their relationship to the ulnar head. MethodsWe reviewed the 160 wrist radiographs. The fracture line was measured on the postero-anterior and lateral radiographs relative to the long axis of the forearm and the relationship to the ulnar head. FindingsPA radiographs: the fracture line ran distal ulnar to proximal radial (ulnar to radial) in 11%, transverse in 74% and distal radial to proximal ulnar (radial to ulnar) in 16%. Lateral radiographs: the fracture line ran distal volar to proximal dorsal in 88%, transverse in two 1% and dorsal to volar in 11%. Radial shift (7.5%) only occurred with ulnar to radial or transverse fractures.The ulnar to radial fracture line started at the proximal end of the ulnar head/distal radio-ulnar joint in 88%. The radial to ulnar fracture line started ended a mean of 2.5 mm proximal to the distal radio-ulnar joint (p < 0.01). The transverse fracture line started at the base of the distal radio-ulnar joint in 53% and proximally in 47%. InterpretationThere are two distinct coronal patterns: radial to ulnar ending c. 2 mm proximal to the distal radio-ulnar joint; ulnar to radial starting at the proximal distal radio-ulnar joint. There may be third pattern - transverse fractures; these may be variants of the above. Sagittally the main direction is volar to dorsal but 11% are obverse.This is the first description of distinct fracture patterns in extra-articular distal radius fractures. In addition the fracture patterns appear to correlate with different directions of force transmission which fit with our understanding of falling and the relatively uncontrolled impact of the wrist/hand with the ground.These patterns of fracture propagation help understand how the biomechanics of wrist fractures and may enable prediction of collapse.

Radiographic and clinical outcomes of muenster and sugar tong splints for distal radius fractures: a comparative study

BackgroundNon-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs.MethodsIn this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients’ satisfaction after treatments.ResultsThere were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images.ConclusionsThe study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures.Level of evidenceLevel IV; Retrospective Comparison; Treatment Study.

Impact of Pronator Quadratus Muscle Tear in Distal Radius Fractures on Patient Outcomes: Analyses of 55 Patients in a Volar Locking Plate Arm of a Randomized Clinical Trial.

Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed in the literature. The aim of this study was to compare grip strength, patient-reported outcomes, and functional results between patients with an intact PQ and those with a ruptured PQ before undergoing surgery with a volar locking plate for dorsally displaced unstable extra-articular DRFs. Methods A total of 120 patients aged 55 years and older were included in a randomized controlled trial comparing a volar locking plate with a dorsal nail plate. Of the 60 patients randomized to the volar plate group, the integrity of the PQ muscle was recorded during surgery for 55 patients, who were included in this study. The outcomes measured were the Quick Disabilities of the Arm, Shoulder, and Hand Outcome Measure (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE) score, the EQ-5D index, the visual analog scale (VAS) score, grip strength, and range of motion (ROM). Results The median age was 67 years (range 55 to 88), and the one-year follow-up rate was 98%. Patients with an identified intact PQ (28/55) before surgical release had better QuickDASH scores after one year (2.5 vs 8.0, mean difference 5.5, 95% CI: 1.3 to 9.8, p=0.028). Patients in the intact group also had better EQ-5D Index scores after one year (0.94 vs 0.85, mean difference 0.089, 95% CI: 0.004 to 0.174, p=0.031), and demonstrated better grip strength throughout the trial; after one year: 24 kg vs 20 kg (mean difference 3.9; 95% CI: 0.3 to 7.6, p=0.016). After one year, the intact group had regained 96% of their grip strength and the nonintact group had regained 93% of their grip strength compared to the uninjured side. The observed differences may be of questionable clinical importance, as they were lower than those of previously proposed minimal clinically important differences (MCIDs). Conclusions Patients with a DRF and a ruptured PQ prior to surgery exhibited higher QuickDASH scores and lower EQ-5D index scores after one year. The integrity of the PQ should be reported in future studies.

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF DIFFERENT PINNING CONFIGURATION (CROSS PINNING VERSUS DIVERGENT PINNING) IN FIXATION OF EXTRA-ARTICULAR FRACTURE OF DISTAL ENDRADIUS IN ELDERLY PATIENTS

Objective: The objective of the study is to compare the functional and radiological outcomes of different pinning configuration (cross pinning versus divergent pinning) in the fixation of extra-articular fracture of distal end radius in elderly patients. Methods: An observational prospective study was conducted at Sri Aurobindo Medical College and PG Institute, Indore, MP, from December 2019 to May 2021. After the approval of the Institutional Ethics Committee, informed consent was obtained from the 40 elderly patients of the both sex in the age group of more than 50 years with closed fracture. 20 Patients were subjected to divergent pinning and 20 patients were subjected to cross pinning. Regular follow-up with the X-ray imaging. Results: Statistically no significant difference was found in palmar tilt, radial shortening, and loss of radial deviation. Mayo wrist score compare between the two groups. The result showing the functional outcome of configuration B (cross-pinning) is better than that of configuration A (divergent pinning). The only significant complication is pin migration, pin site infection, and stiffness. Pin tract infections are resolved by oral antibiotics, good pin tract care and wrist stiffness treated with vigorous physiotherapy. Conclusion: Cross pinning had better functional and radiological outcome as compared to the divergent pinning in extra-articular fracture of the distal end of the radius. The percutaneous pinning technique is less time-consuming and allows earlier rehabilitation without jeopardizing the fracture alignment.

Influence of ulnar styloid fracture with concurrent extra-articulardistal radius fracture on forearm rotations

Introduction: This study was conducted to evaluate the relation between extra articular distal radius fracture associated with and without ulnar styloid fracture and the rotational movements of wrist and forearm. Materials and Methods: This retrospective study was performed on 86 unilateral, extra articular distal radius fracture, treated conservatively. Associated ulnar styloid fracture was present in 42 (48.8%) group Aand 44 (51.2%) with intact ulnar styloid group B. Men were 54 (62.8%) and women 32 (37.2%). Distal radius fracture involving right, dominant side were 56 (65.1%). All patients were treated by one surgeon with close reduction under anaesthesia with plaster immobilisation. Long arm cast was applied with forearm in supination wrist in ulnar volar flexion and after 2 weeks changed to below elbow cast with wrist in neutral rotation. Results: The mean limitation of supination was 7.82 ± 5.19 for group 1 (intact styloid) and 23.82±14.41 for group 2 (fractured styloid). The mean limitation of pronation was 4.72 ± 3.68 for group 1 (intact styloid) and 3.29 ± 2.79 for group 2 (fractured styloid). The difference between the two groups was statistically significant regarding the limitation of supination, but not about the 0 0 0 limitation of pronation. The average pronation deformity was 120 (range 60 to 190 ) in patients with dorsal malunion and 110 0 (range 50 to 210) in volar malunion. The supination deformity averaged at about 80° (range 40° to 140°) in dorsal and 120 0 0 (range 80 to 170 ) in volarly angulated distal radius malunion. Conclusion: The association of extra articular distal radius fracture with fracture ulnar styloid at two year follow up causes restriction of supination and pronation of forearm

Evaluation of Unicortical Locking Screw Placement for Torsional Loads in Distal Radius Fractures: A Biomechanical Study in Cadavers.

Background We aimed to compare bio-mechanical outcomes of short-length 75%-length uni-cortical screw (SL75UCS) and full-length 100%-lengthscrews (FL100S) under axial compression (AXC) and torsional compression (TRC) in cadaveric distal radius volar plate model. Methodology A total of 20 wrists from 10 fresh frozen cadavers were included. A 2.5 mm titanium alloy distal radius anatomical platewas placed to the distal radii in full anatomical position, just proximal to the watershed line. Three bi-cortical screws to the shaft of the radius, followed by uni-cortical drilling for distal screwing were placed. Measurement by pulling the drill once it reached the opposite cortex was applied. We selected the screw lengths such that they corresponded to the SL75UCS. In the same configuration for each of the cadavers, we delivered six screws from distal radius holes of the anatomical plate. An oscillating handsaw was used to create an extra-articular distal radius fracture model (AO 23-A3.2). We created a dorsal AP model by performing a 1-cm wedge osteotomy from the dorsal aspect. Complete separation of the volar cortex was achieved. Potting was performed by embedding the shaft of the prepared radius into the polyurethane medium. We placed aluminum apparatus into the distal end to ensure applying of AXC and TRC in bio-mechanistic tests. Results No statistically significant difference of stiffness between the SL75UCS and FL100S both under AXC (p=0.88) and TRC (p=0.82). SL75UCSand FL100S groups did not differ in elastic limit under AXC (p=0.71) and TRC (p=0.71). Maximal force on SL75UCSand FL100S groups were also similar under both AXC (p=0.71) and TRC (p=0.50). Conclusions Our study findings suggest that drilling the dorsal cortex may not be necessary in the management of distal radius fractures. Instead, utilizing SL75UCS could serve as a viable alternative. This approach offers potential advantages in reducing the risk of extensor tendon complications associated with drilling or screw protrusion. It is a safe method under torsional load to avoid drilling of the dorsal cortex and SL75UCS could be performed in order to prevent from extensor tendon complications secondary to drilling or screw protrusion.

Development of a testing device for external wrist bridging dynamic fixators used for distal radius fractures

BackgroundStabilization of extra-articular distal radius fractures by wrist joint bridging (WB) dynamic fixation allows for early motion of the wrist, but relies on exact positioning of the device. In fact, physiological movement appeared to be compromised with even distinctly aberrant positioning of such device. To investigate this issue in more detail, we developed an in-vitro testing apparatus suitable for assessing the forces required for flexion and extension of the wrist. MethodsThe experimental set-up enables the transmission of the translational movement of the traverse of a universal testing machine into the main physiological movement (flexion and extension) of the wrist. An external WB dynamic fixator was assembled to an artificial saw bone wrist model prior and after performing a wedge-shaped osteotomy on the distal radius about 1.5 cm proximal to the joint line, i.e. generation of a fracture model. The functionality of the fixator was evaluated under either condition and the effect of misalignment of the external WB dynamic fixator was quantified by purposeful violation of the manufacture's instructions. Results were statistically analyzed using the generalized linear mixed model. FindingsSignificantly higher loading was noted as the degree of misalignment increased. The normalized force was significantly higher at a misalignment of 20° compared to 10° (10°: 4.13; 20°: 6.93, P < 0.001). InterpretationThe proposed set-up turned out to allow highly reproducible and sensitive recording of the reaction forces during flexion and extension of the wrist and thus is feasible for the evaluation and comparison of different external WB devices.

Automatic classification of distal radius fracture using a two-stage ensemble deep learning framework

Distal radius fractures (DRFs) are one of the most common types of wrist fracture and can be subdivided into intra- and extra-articular fractures. Compared with extra-articular DRFs which spare the joint surface, intra-articular DRFs extend to the articular surface and can be more difficult to treat. Identification of articular involvement can provide valuable information about the characteristics of fracture patterns. In this study, a two-stage ensemble deep learning framework was proposed to differentiate intra- and extra-articular DRFs automatically on posteroanterior (PA) view wrist X-rays. The framework firstly detects the distal radius region of interest (ROI) using an ensemble model of YOLOv5 networks, which imitates the clinicians’ search pattern of zooming in on relevant regions to assess abnormalities. Secondly, an ensemble model of EfficientNet-B3 networks classifies the fractures in the detected ROIs into intra- and extra-articular. The framework achieved an area under the receiver operating characteristic curve of 0.82, an accuracy of 0.81, a true positive rate of 0.83 and a false positive rate of 0.27 (specificity of 0.73) for differentiating intra- from extra-articular DRFs. This study has demonstrated the potential in automatic DRF characterization using deep learning on clinically acquired wrist radiographs and can serve as a baseline for further research in incorporating multi-view information for fracture classification.

The use of a laminar spreader for the reduction of extra-articular distal radius fractures: A technical trick.

Extra-articular distal radius fractures are often accompanied with shortening, loss of radial height, and radial displacement of the articular segment relative to the shaft of the radius, all seen in the coronal plane. Reduction can be somewhat challenging when reliance on traction and ligamentotaxis fails, especially in subacute or osteoporotic fractures. In this technical report, we describe a technique where application of a laminar spreader between the radius and the ulna in the metaphyseal region can easily reduce the fracture and help attain anatomic alignment in the coronal plane. An acute and a subacute fracture are shown for illustration of the technique.

Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials.

We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs. Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at -4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications. Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.

DISTAL RADIUS FRACTURE CLASSIFICATION USING DEEP LEARNING ALGORITHMS

Distal radius fractures (DRFs) are one of the most common types of fracture and one which is often treated surgically. Standard X-rays are obtained for DRFs, and in most cases that have an intra-articular component, a routine CT is also performed. However, it is estimated that CT is only required in 20% of cases and therefore routine CT's results in the overutilisation of resources burdening radiology and emergency departments. In this study, we explore the feasibility of using deep learning to differentiate intra- and extra-articular DRFs automatically and help streamline which fractures require a CT.Retrospectively x-ray images were retrieved from 615 DRF patients who were treated with an ORIF at the Royal Brisbane and Women's Hospital. The images were classified into AO Type A, B or C fractures by three training registrars supervised by a consultant. Deep learning was utilised in a two-stage process: 1) localise and focus the region of interest around the wrist using the YOLOv5 object detection network and 2) classify the fracture using a EfficientNet-B3 network to differentiate intra- and extra-articular fractures.The distal radius region of interest (ROI) detection stage using the ensemble model of YOLO networks detected all ROIs on the test set with no false positives. The average intersection over union between the YOLO detections and the ROI ground truth was Error! Digit expected.. The DRF classification stage using the EfficientNet-B3 ensemble achieved an area under the receiver operating characteristic curve of 0.82 for differentiating intra-articular fractures.The proposed DRF classification framework using ensemble models of YOLO and EfficientNet achieved satisfactory performance in intra- and extra-articular fracture classification. This work demonstrates the potential in automatic fracture characterization using deep learning and can serve to streamline decision making for axial imaging helping to reduce unnecessary CT scans.

Can an Ulnar Styloid Fracture Affect the Range of Motion of Wrist Joint when Associated with Extra Articular Distal Radius Fracture Undergo Non-Surgical Treatment?

Can an Ulnar Styloid Fracture Affect the Range of Motion of Wrist Joint when Associated with Extra Articular Distal Radius Fracture Undergo Non-Surgical Treatment?

A survey on the educational value of an mHealth referral app for orthopaedics in South Africa

BACKGROUND: A WhatsApp orthopaedic referral group (ORG) was created in 2017 by orthopaedic specialists at a district hospital to provide support to primary healthcare doctors in order to manage traumatic fractures and dislocations. This study assessed the educational value and user satisfaction of the ORG platform METHODS: An online, cross-sectional survey was conducted among ORG users from May to June 2021. Demographic information, user satisfaction, the educational value of ORG, and perceived improvement in managing closed fractures and dislocations were captured using descriptive and inferential statistics RESULTS: There were 80 respondents, with 50% females. The median age was 30 (interquartile range [IQR] 28-35) years, duration of practice was 5 (IQR 3-10) years, and length of ORG use was 10 (IQR 5-24) months. Seventy-two (90%) reported that ORG enabled them to receive timely advice for orthopaedic case management and 75 (93.8%) considered it an easy referral facilitation tool. Most (76.3%) felt that the advice, pictures, and videos shared on ORG helped novice doctors successfully complete fracture reduction. The percentage of participants who felt very capable in managing the following fractures increased after ORG membership: extra-articular distal radius fracture (12.5% to 45.0%, p &lt; 0.001); bimalleolar ankle fractures (16.3% to 43.8%, p &lt; 0.001) and shoulder dislocation (35.0% to 61.3%, p = 0.001 CONCLUSION: ORG is an easy-to-use and well-accepted platform for the management, referral facilitation and teaching of acute orthopaedic conditions. Similar platforms can be introduced in other settings where surgical specialists are scarce. Additional studies should measure the feasibility and effectiveness of these mHealth platforms Level of evidence: Level 3

Management of extra-articular distal radius fracture treated with plaster and percutaneous pinning

A break in the distal radius is among the most common types of bone fractures. These fractures manifest themselves at the wrist, which is where the radius bone comes to an end. However, there has been no consensus reached regarding the proper manner in which these injuries should be defined, treated, or evaluated (1). An effective method to restore articular congruity following a distal radius fracture was to use a volar approach, indirect reduction, and locked plate fixation. Methods: An extensive search of all materials related to the topic was carried out in the PubMed and Google Scholar search engines. Relevant research articles focusing on “Management Of Extra -Articular Distal Radius Fracture Treated With Plaster And Percutaneous Pinning” published in the period 1999–2019 were included in the review. A total of 11 studies similar to the current study objectives were included in the study and analyzed. Conclusion: As reviewed the literature, Patient has better outcome in range of motion and less stiffness in percutaneous pinning compared to plaster immobilization group. Functional outcome and radiological outcome is better in percutaneous pinning compared to plaster immobilization.

Comparison between closed reduction plaster casting and percutaneous Kirschner wire pinning in the management of distal radius fractures in patients aged 65 years and older

Aim: Closed reduction plaster casting (CRPC) and percutaneous pinning (CRPP) remain an important treatment modalities for extra-articular distal radius fractures especially in elderly patients. These two treatment methods have advantages and disadvantages compared to each other. The ideal treatment of extra-articular distal radius fractures is still debatable. We aimed to retrospectively evaluate the clinical and radiological results after CRPC and CRPP for the treatment of distal radius fractures in the patient population over 65 years of age.&#x0D; Material and Method: Between 1 January 2015 and 1 January 2019, patients older than 65 years of age who presented with extra-articular noncomminuted distal radius fractures were retrospectively evaluated. 95 patients diagnosed with distal radius fracture were separated into 2 groups, who were administered the following: CRPC (n:51), CRPP (n:44). We compared the characteristics of the patients, the mechanisms of injury, fracture types and treatment methods, pre-reduction and post-reduction radiological parameters and clinical functions for the two groups. Volar tilt, radial inclination, ulnar variance, and radial length were compared. Clinical results were also compared.&#x0D; Results: The mean follow-up period was 19.8 months (range, 12-29 months; SD=11.0) in the CRPC group and 18.6 months (range, 12-26 months; SD=10.9) in the CRPP group. Mean range of motion and grip strength were maintained in both treatment groups at one-year follow-up. There was no statistically significant difference between the groups (p&gt;0.05). There was no statistically significant difference between the groups in terms of the scores evaluating the daily activity, pain and mental status of the patients after the treatment (p&gt;0.05). There are no statistically significant differences between fixation with CRPC and CRPP in terms of clinical and radiological results (p&gt;0.05). &#x0D; Conclusion: Closed reduction plaster casting and closed reduction percutaneous pinning are equally effective in the treatment of extra-articular distal radius fractures in the elderly.

Open reduction through original fracture line and fixation with locking plate is a feasible approach for extra-articular distal radius fracture malunion.

This study aims to investigate the effectiveness of open reduction through original fracture line and fixation with locking plate in treatment of extra-articular distal radius fracture (DRF) malunion. Between January 2015 and December 2018, a total of 69 patients (27 males, 42 females; mean age: 62.0±8.9 years; range, 46 to 70 years) suffering from symptomatic extra-articular DRF malunion were included. All patients were followed for more than six months. Patient's demographics, hand dominance, data including Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, pain on a Visual Analog Scale (VAS) score, radius height, ulnar variance, wrist range of motion, volar tilt and radial inclination before and after surgery were analyzed. The median follow-up was 14.13 months, and the median time to fracture healing after the operation was 14.25 weeks. The mean QuickDASH score and VAS score were significantly reduced from 63.4±13.97 and 4.6±1.23 preoperatively to 7.8±4.67 and 1.3±0.76 at the final follow-up, respectively. Radius height, ulnar variance, volar tilt, radial inclination and wrist range of motion (flexion, extension, pronation, supination) were all significantly improved (p<0.001). Images showed good radius height, ulnar variance, volar tilt and radial inclination. The range of motion of wrist and forearm were improved substantially. Among 69 patients, two patients received allograft due to osteoporotic bone collapse. No serious complication was developed, except for minor pain in three patients during follow-up. Open reduction through original fracture line and fixation with locking plate is a feasible and effective treatment for selective DRF malunion.

The Functional Outcomes in Treatment of Displaced Extra Articular Distal Radius Fracture by Pop Alone or K-Wire Augmentation

Background &amp; Objective: A distal radius fracture is responsible for one-sixth visit to the orthopedic emergency room. Although these fractures are common, the best treatment for these fractures is still controversial. The objective of the study was to compare the functional outcomes in terms of union in displaced extra articular distal radius fracture by POP alone or k-wire augmentation. Methods: A comparative study was conducted in the department of orthopedic surgery, Pakistan Institute of Medical Science, Islamabad from June to December 2021. A total of sixty (n=60) adult patients irrespective of gender with distal radial fracture were included in the study. Patients allocated in two groups, Group A included patients who were treated with above elbow POP casting after reducing the fracture, under sedation or blockage of hematoma and Group B included the patients in whom surgery was performed with k-wire by closed reduction and internal fixation. The main outcome measure of the study was functional outcomes in terms of excellent, good and fair. The chi square test was used between study groups for comparison of acceptable outcomes (excellent to good). A p value ≤ 0.05 was considered significant. Results: The average age of the patients of both groups was 38.6±15.8 years. Among 60 patients, 70% (n=42) were male and 30% (n=18) were females. In group A (POP) 30% (n=9) patients showed excellent, 23.3% (n=7) showed good and 46.7% (n=14) showed fair outcome as per our study outcomes. In group B (k-wire) 56.7% (n=17) patients showed excellent, 36.7% (n=11) showed good and 6.6% (n=2) showed fair outcome with p value 0.002. Conclusions: The study concluded that the functional outcomes in terms of union of displaced extra articular distal radius fractures, K-wire fixation showed better results than POP cast alone. Keywords: Bone wires; Casts, Surgical; Internal fixators; Radius fractures.

Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern?

The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.

Comparison of functional outcomes for displaced extra-articular distal radius fractures managed by operative and non-operative methods: A prospective cohort study

: Fractures of the distal radius are one of the most common injuries seen in our day-to-day practice. It accounts for almost 4% of the injuries seen in the emergency department. Despite its high incidence and the substantial possible implications of suboptimal management, no high-level evidence regarding the best treatment method yet exists. The study aimed to compare the functional outcomes of extra articular distal radius fractures managed operatively with those managed conservatively. In this prospective cohort study conducted between November 2018 to September 2020, 18 to 65 years old patients with displaced extraarticular distal radial fracture were treated surgically or conservatively. DASH and Modified Mayo Wrist Score were calculated after a follow up of one year.: At the end of 12 months the patients were evaluated, and it was noticed that patients who were treated operatively had significantly better functional and clinical outcomes, as indicated by significantly higher Mayo scores than patients treated conservatively by casting (all p values &amp;#60; 0.05). The DASH scores were lower in the patients who had undergone operative management. Patients treated with volar plate fixation were able to resume activities of daily living few weeks earlier compared to those managed with K-wire fixation and conservative group. Therefore, we can conclude that volar plate fixation gives significantly better clinical and functional results than other methods of treatment.