Osteoporotic Distal Radius Fractures Research Articles

Impact of Adding Distal Forearm Bone Mineral Density Measurement to Axial Bone Mineral Density Measurement for the Diagnosis of Osteoporosis: Prevalence and Risk Factors for Diagnostic Discordance

Background: Studies have demonstrated the superiority of distal forearm bone mineral density (BMD) measurement over axial BMD measurement for prediction of osteoporotic fractures of distal radius. However, distal forearm BMD measurement is not routinely performed at most centers. Objective: To demonstrate the prevalence of discordance in diagnosis of osteoporosis using axial and distal forearm BMD measurement, and to assess whether age and other potential risk factors can predict major discordance. Materials and Methods: Postmenopausal women aged 45 years or older and men aged 50 years or older who underwent lumbar spine, hip, and distal forearm BMD measurement at Prompt Health Center, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand, between January 2021 and December 2021 were recruited. The T-scores of axial site and distal forearm were categorized based on World Health Organization classification to determine the prevalence of diagnostic discordance. Major discordance was defined as having one osteoporotic and one normal T-score. Factors potentially associated with major discordance were explored using univariate and multivariate logistic regression models. Results: Eight hundred eighty-one participants including 621 women and 260 men with a mean age of 59.2±6.7 years were analyzed. There were 13.2% participants diagnosed with osteoporosis of the axial site, and 16.0% of the one-third (1/3) radius. The rates of major discordance, minor discordance, and concordance between axial and 1/3 radius T-scores were 3.2%, 40.5%, and 56.3%, respectively. Age of 65 years or older was significantly associated with major axial and 1/3 radius T-score discordance, with an adjusted odds ratio of 2.7 and 95% confidence interval 1.24 to 5.87 (p=0.012). Conclusion: Diagnostic discordance is observed for at least one-third of the participants using axial and distal forearm BMD measurement. The age of 65 years or older is a risk factor for major discordance. Keywords: Bone mineral density; Osteoporosis; Spine; Hip; Distal forearm; Discordance

Assessment of distal forearm dexa scan as a screening tool for primary osteoporotic fractures of distal end radius in postmenopausal women

Abstract Background: Fragility fractures, which most typically afflict postmenopausal women’s wrists, hips, and spines, are frequently caused by osteoporosis. In comparison to other times and places, the incidence is approximately two times higher during perimenopause. The risk of future wrist fractures is markedly increased by a prior fracture. Many studies have emphasized the importance of screening as a preventative measure against future fractures in these people with osteoporosis. This study aimed to assess the utility of distal forearm dual-energy X-ray absorptiometry (DEXA) as a screening tool to assess the risk of development of primary osteoporotic fractures at the distal end radius (DER) in postmenopausal women. Objectives: The study’s objective was to determine whether DEXA at the distal end of the radius could be used as a screening technique to determine the fragility fractures. Materials and Methods: The method followed included a cross-sectional study conducted on 60 patients (30 in group A: postmenopausal women with DER fracture, and 30 in group B: postmenopausal women without fractures), who fulfilled the inclusion criteria. Results: All patients underwent DEXA scan at three sites (hip, spine, and distal radius). On comparison of T-score between Hip, Spine, DER in group A , T-score with value <−2.5 was 53.33% at Hip, 70% at Spine and 70 % at DER with Total of 64.44%. mean±S.D at Hip was −2.73±1.27, at Spine was −3.23±1.25 and at DER was −3.42±162. P-value 57 was 0.298, Hip vs Spine: 0.184 , Hip vs DER : 0.184, Spine vs DER : 1. On comparison of Tscore between Hip, Spine, DER in group B, T-score with value <−2.5 was 30% at Hip, 56.67% at Spine, 13.33% at DER with total of 33.33%. mean±SD was −2.09±0.9 at Hip, −2.54±1.32 at Spine and −1.64±0.78 at DER. P-value was 0.002,Hip vs Spine : 0.037, Hip vs DER: 0.209, spine vs DER: 0.0009. this supports above study and we can use DER DEXA Scan as a screening tool in postmenopausal women. There was a significant deterioration of T-score at DER and hip and spine in the fracture group compared with the control group (P < 0.001). Conclusion: Some postmenopausal women showed preferential bone loss at the distal region of the radius, which would make them more susceptible to fragility fractures there. In general, forearm DXA for the evaluation of local bone density may prove beneficial to screening people at risk for distal radial fractures and makes it easier to identify patients who need osteoporosis treatment early on.

The clinical necessity of a distal forearm DEXA scan for predicting distal radius fracture in elderly females: a retrospective case-control study

BackgroundRecent studies have demonstrated that the distal forearm dual-energy X-ray absorptiometry (DEXA) scan might be a better method for screening bone mineral density (BMD) and the risk of a distal forearm fracture, compared with a central DEXA scan. Therefore, the purpose of this study was to determine the effectiveness of a distal forearm DEXA scan for predicting the occurrence of a distal radius fracture (DRF) in elderly females who were not initially diagnosed with osteoporosis after a central DEXA scan.MethodsAmong the female patients who visited our institutes and who were over 50 years old and underwent DEXA scans at 3 sites (lumbar spine, proximal femur, and distal forearm), 228 patients with DRF (group 1) and 228 propensity score-matched patients without fractures (group 2) were included in this study. The patients’ general characteristics, BMD, and T-scores were compared. The odds ratios (OR) of each measurement and correlation ratio among BMD values of the different sites were evaluated.ResultsThe distal forearm T-score of the elderly females with DRF (group 1) was significantly lower than that of the control group (group 2) (p < 0.001 for the one-third radius and ultradistal radius measurements). BMD measured during the distal forearm DEXA scan was a better predictor of DRF risk than BMD measured during the central DEXA (OR = 2.33; p = 0.031 for the one-third radius, and OR = 3.98; p < 0.001 for the ultradistal radius). The distal one-third radius BMD was correlated with hip BMD, rather than lumbar BMD (p < 0.05 in each group).ConclusionPerforming a distal forearm DEXA scan in addition to a central DEXA scan appears to be clinically significant for detecting the low BMD in the distal radius, which is associated with osteoporotic DRF in elderly females.Level of evidenceIII; case-control study.

Calcium phosphate injection technique for treatment of distal radius fracture

Abstract Introduction: Distal radius fracture (DRF) is 1 of the common sites of osteoporotic fractures. Bone defects near fractures play an important role in the treatment of unstable distal radius fractures in older patients. To prevent this, bone grafts can be considered, and the most easily available and easy-to-use bone grafting materials are synthetic bone grafts. However, the efficacy of using injectable calcium phosphate (CaP), a synthetic bone substitute graft is controversial in terms of the volume required to provide adequate strength. In the case reports, we focus on the use of CaP in conventional surgery for osteoporotic distal radius fracture. Patient concern: In the first case, an 81-year-old woman presented with right wrist pain after a slip and fall accident. She had a right DRF with osteoporosis. In the second case, a 67-year-old woman presented with left wrist pain after falling. She was found to have a left DRF. Diagnosis: Radiography and computed tomography revealed the DRFs, and bone mineral density indicated osteoporosis. We defined these DRFs were unstable due to loss of position following anatomical reduction and the presence of osteoporosis. Interventions: We performed internal fixation using conventional locking plates. After fixation, a hole was made in the middle of the window of the plate, and CaP was injected through this hole. Outcomes: Six months postoperatively, complete bone union was achieved without subsidence of the distal fragment. Conclusion: This novel CaP injection technique can be a safe and effective technique for the treatment of unstable DRF to prevent malunion.

Assessment of Bone Quality Using Radiogrammetric Parameters of Proximal Humerus in India: Defining the Osteoporotic Fracture Risk Limit Value and its Reliability.

World health organization (WHO) has defined osteoporosis clinically on the basis of bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) scan and the presence of fractures. This facility is expensive and not readily available in majority of the centers in India. The authors have attempted to study defined measurements on radiographs (radiogrammetric parameters) to diagnose osteoporosis in Indian population. We prospectively studied 200 proximal humerus radiographs for measuring radiogrammetric parameters and divided into Group A and B (N = 100 in each group). Group A involved patients with age < 50years and without any illness affecting bone quality. Group B involved patients with age > 50years and sustained acute osteoporotic fractures of distal radius/ anterior wedge vertebral fracture/intertrochanteric fracture following trivial trauma. Three parameters (cortical thickness, cortical index and deltoid tuberosity index) were measured by 3 observers at 2 different occasions. The mean age of patients was 37.87years and 58.38years for group A and B, respectively. The 'cortical thickness' of the proximal humerus diaphysis had the mean value for Group A and B to be 0.4 ± 0.07cm and 0.33 ± 0.06cm respectively. The mean values for the 'cortical index' of proximal humerus came out to be 0.4 ± 0.07 for group A and 0.32 ± 0.06 for group B. The 'deltoid tuberosity index' measurements showed the mean values for group A and B were 1.81 ± 0.23 and 1.55 ± 0.16, respectively. Inter-observer reliability for single measures was excellent for deltoid tuberosity index (ICC 0.8077) and good for cortical thickness (ICC 0.7032) and cortical index (ICC 0.7357). Observer 1 had excellent intra-observer reliabilities for all the three parameters. Observer 2 and 3 had excellent reliability for deltoid tuberosity index and good intra-observer reliability for cortical thickness and cortical index. The cortical thickness had a cut off of ≤ 0.372cm with a sensitivity of 86.02 and specificity of 82.12. The cortical index had a cut off of ≤ 0.378 with a sensitivity of 89.16 and specificity of 84.22. The deltoid tuberosity index had a cut off of ≤ 1.684 with a sensitivity of 96.61 and specificity of 84.08. The outcome of this study is likely to help in early diagnosis of osteoporosis at the community level in the absence of DXA scan as it identifies threshold values for radiogrammetric parameters which can be a predictor of the osteoporosis. The deltoid tuberosity index was found to be the most suitable of these parameters.

Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years.

ObjectiveWe evaluated hybrid nonbridging external fixation (NBEF) supplemented by K-wires as an effective and safe treatment option for osteoporotic distal radius fractures (DRFs) in a retrospective case series.MethodsSixteen extra-articular and one intra-articular DRF were treated by NBEF from 2016 to 2018 (mean patient age, 61.8 years; 15 women, 1 man). Radiographic parameters (volar tilt, radial inclination, and ulnar variance), range of motion, grip power, the visual analog scale score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed at 4 weeks, 6 weeks, 6 months, and 12 months postoperatively.ResultsThe volar tilt and radial inclination were restored after surgery and maintained well. The mean visual analog scale score was 4 ± 1 at 4 weeks. Range of motion was restored to 79% to 91% at 6 weeks. The DASH score was good before NBEF device removal. Two superficial pin-tract infections were easily treated with antibiotics.ConclusionsHybrid NBEF transfixes DRFs in a multiplanar fashion, and augmentation with percutaneous K-wires provides direct fixation in radial shift and withstands axial loads in fracture fragments. It allows early mobilization with rigid fixation. Hybrid NBEF is reliable for unstable extra-articular and simple intra-articular DRFs in older patients.Clinical Study registration numberChiCTR1900021712

A clinical prospective study of volar plating in distal radius fracture

Background and objective: Incidence of fractures of distal radius are increasing due to more geriatric population and road traffic accidents and at the same time surgical treatment option for the same are modified continuously. The fundamental goal & treatment of distal radial fractures is restoration of normal or near normal alignment and articular congruity.Method: 30 patients with fractures of distal radius were selected who were admitted in JSS Hospital, Mysore between September 2015 and September 2018.Patients were treated with open reduction and internal fixation with volar plate through a volar approach and followed up till functional recovery and assessed clinico radiologically.Result: The study comprised of 22 male and 8 female patients aged from 21 to 62 years with mean age of 43.35 years. The average duration from date of injury to date of surgery was 2.35 days. The follow up ranged from 9 to 18 months. Using the demerit scoring system of Gartland and Werley, we had 40% excellent, 46.66% good, 6.66% fair and 6.66% poor results.Interpretation and Conclusion: In carefully selected patients even in the face of osteoporosis, fixation of fractures of distal end of radius with a volar plate has satisfactory outcome for both the patient and the surgeon and must be considered part of a surgeons Armamentarium in the contemporary treatment of osteoporotic fractures of distal radius.

Considerations in the Treatment of Osteoporotic Distal Radius Fractures in Elderly Patients.

With the incidence of distal radius fractures increasing in the elderly population, we sought to summarize the current orthopedic and medical management of these fractures in the elderly osteoporotic population. The number of osteoporotic patients undergoing surgical fixation for distal radius fractures has increased in recent years. This is likely due to the improved outcomes seen with volar locking plates, as well as an increase in the number of fellowship-trained hand surgeons. Despite this potential improvement in acute fracture management, a majority of these patients are underdiagnosed and undertreated for their underlying osteoporosis or endocrinopathies. The implementation of fracture liaison services and the ability of the treating orthopedist to recognize this gap in patient care result in a higher number of patients initiating appropriate treatment. It is vital that when discussing acute fracture management, a thorough discussion is had with patients regarding functional outcome and the benefits of both surgical and non-operative management. As these fractures become more prevalent and a greater percentage undergo surgical intervention, the economic burden of distal radius fractures will continue to rise. It is imperative that the treating surgeon view these fractures as sentinel events that are predictive of future hip and vertebral fractures. While relatively new, the use of fracture liaison services to help aide in proper screening and treatment of osteoporotic patients is of great value. Non-pharmacologic therapy such as physical therapy, smoking and alcohol cessation programs, and dietary modifications are crucial in treating patients with osteoporosis. While bisphosphonates remain the first-line treatment in patients with osteoporosis, novel therapies show promise for future use.

Fracture du radius discal chez le patient âgé par plaque à vis verrouillée polyaxiale : positionnement optimal des vis dans l’os sous-chondral à 2 niveaux avec respect de la corticale dorsale

BackgroundDouble-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking plate system for the treatment of osteoporotic distal radius fractures in elderly patients. MethodsA total of 122 patients (mean age, 73.3 years; age range, 65–88 years) with distal radius fracture were treated using a variable-angle volar locking plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs and postoperative DDD values were compared. ResultsVolar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group. ConclusionThe use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients. Level of evidenceIII, therapeutic study.

Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly.

Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients. One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared. Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group. The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients. III Therapeutic study.

Comparison of Bone Mineral Density and Appendicular Lean Body Mass between Osteoporotic Distal Radius Fracture and Degenerative Rotator Cuff Tear in Women Patients.

BackgroundAuthors assessed lean body mass (fat free tissue), upper and lower, and bone mineral density (BMD) in patients of osteoporotic bone distal radius fracture (DRF) and degenerative rotator cuff tear (RCT) patients of shoulder. We predict inferior muscle mass and osteoporosis are more frequent in DRF group than RCT group.MethodsBetween January 2016 and June 2017, overall 38 of DRF and 30 of RCT were eligible for this retrospective comparison study after excluding of patients with compounding factors. BMD and other body composition, fat and lean body mass, were assessed with a single dual energy X-ray absorptiometry in one hospital.ResultsT-score of spine were −2.2 and −1.6 in DRF and RCT patients with significant difference (P=0.040). Final BMD score, lower score of patient between spine and femoral score, of both group also presented difference with significance, −2.4 of DRF and −1.9 of RCT patients (P=0.047). Diagnosis of osteoporosis was confirmed in 19 patients (50%) from DRF compared with 9 patients (30%) from RCT. The mean lean soft tissue mass of the arm was 3.7 kg and 3.8 kg in the DRF and RCT, respectively, without significant difference (P=0.882). The mean lean body mass of the leg was 11.0 kg and 10.5 kg in the DRF and RCT, respectively, without significant difference (P=0.189). The relative overall appendicular lean mass was not significantly different between groups.ConclusionsEven though BMD difference, we did not find muscle mass difference between DRF and RCT patients.

When is the stability of a fracture fixation limited by osteoporotic bone?

This article is concerned with the search for threshold values for bone quality beyond which the risk of fixation failure increased. For trochanteric fractures we recognized a BMD lower than 250mg/cm3 as an additional risk for cut out. For medial femoral neck fractures since joint replacement surgery is available and produces excellent functional results, we see no indication for further differentiation or analysis of bone quality in relation to fracture fixation. In the area of osteoporotic vertebral body fractures, there are many experimental studies that try to identify BMD limits of screw fixation in the cancellous bone on the basis of QCT analysis. However, these values have not yet been introduced for application in clinical practice. In case of indication for surgical fixation, we favor minimally invasive, bisegmental, fourfold dorsal instrumentation with screw-augmentation for a T-value less than −2.0 SD (DXA analysis, total hip or total lumbar spine). For proximal humerus fractures, BMD value of 95mg/cm3 could be seen as a threshold value below which the risk of failure rises markedly. In relation to osteoporotic distal radius fractures, based on our clinical experience and scientific analyses there are virtually no restrictions as far as bone quality is concerned on the application of palmar locking implants in the surgical management of distal radius fractures. Optimization of preoperative diagnostics might help to revise the treatment algorithm to take bone density into account, thus reducing the risk of failure and, at the same time, acquiring additional data for future reference.

Is there a benefit of proximal locking screws in osteoporotic distal radius fractures? – A biomechanical study

IntroductionThe distal radial fracture is a common fracture and frequently seen in geriatric patients. During the last years, volar plating has become a popular treatment option. While the application of locking screws at the distal fragment is widely accepted, there is no evidence for their use at the radial shaft. Materials and methodsIn six osteoporotic pairs of matched human cadaver radii an extra-articular model creating an AO 23-A2.1 fracture was employed. Osteosynthesis were performed using the APTUS 2.5 Adaptive TriLock Distal Radius System (Medartis AG) with locking (LS) or non-locking screws (NLS) for proximal fixation. Biomechanical testing was performed in a staircase fashion: starting with 50 cycles at 200N, the load was continuously increased by 50N every 80 cycles up to a maximum force of 400N. Finally, load to failure was analyzed with failure defined as sudden loss of force measured (20%) or major deformation of the radii (10mm). ResultsAt 200N, 250N, 300N, 400N and load to failure, the NLS group showed a higher degree of elastic modulus. In contrast, the LS group showed higher elastic modulus at 350N. Maximum force was higher in the LS group without reaching statistical significance. Reasons for loss of fixation were longitudinal shaft fractures, horizontal peri-implant fractures and distal cutting out. No difference was seen between the two groups concerning the development of the above mentioned complications. ConclusionOur study did not show biomechanical superiority for distal radius fracture fixation by using locking screws in the proximal holes in an osteoporotic cadaver study. At load to failure, longitudinal shaft fractures and peri-implant fractures seemed to be a more relevant problem rather than failure of the proximal fixation.

Distal radius isoelastic resurfacing prosthesis – a preliminary report

Background Here, we present a preliminary case series of unicompartmentalisoelastic resurfacing prosthesis of distal radius to treat comminuted articular fractures of osteoporotic elderly patients. Materials and methods Our study included 12 patients, mean age 76-year-old, who presented which a comminuted osteoporotic distal radius fracture. Because of the severity of injury and poor bone quality + osteosynthesis was not deemed to be a good option. Description of technique The surgery was performed through a dorsal approach. The subchondral bone of the entire distal radial articular was excised and a unicompartmental prosthesis was applied. Results The average follow-up was 32 months. Patients reported an average of pain on a VAS score of 2.8/10. The QuickDASH was 37.4/100. The grip strength was in neutral 49.9%, in supination 59.0%, in pronation 56.2% of the contralateral side respectively. The wrist range of motion in flexion and extension were 56.1% and 79.3%, in supination and pronation 87.7% and 91.0%, respectively compared to the contralateral side. Four postoperative complications were noted. Two patients experienced a complex regional pain syndrome type II + these resolved spontaneously. One patient experienced distal radio-ulnar joint stiffness, this improved after an ulna head resection. Finally, one patient required revision surgery after a secondary traumatic fracture. This was revised with another Unicompartmental prosthesis. Radiographically+ the average volar tilt was 9.8° + the average of radial inclination was 11.6°. Conclusion The concept of a unicompartmental isoelastic resurfacing prosthesis offers a promising option for the treatment of comminuted, osteoporotic distal radius articular fractures of elderly patients.

Distal Radius Isoelastic Resurfacing Prosthesis: A Preliminary Report.

Background Here we present a preliminary case series of unicompartmental isoelastic resurfacing prosthesis of the distal radius to treat comminuted articular fractures of osteoporotic elderly patients. Materials and Methods Our study included 12 patients, mean age 76 years, who presented with comminuted osteoporotic distal radius fracture. Because of the severity of injury and poor bone quality; osteosynthesis was not deemed to be a good option. Description of Technique The surgery was performed through a dorsal approach. The subchondral bone of the entire distal radial articular was excised and a unicompartmental prosthesis was applied. Results At an average follow-up of 32 months, the pain was 2.8/10, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) 37.4/100, grip strength in neutral 49.9%, in supination 59.0%, and in pronation 56.2% of the contralateral normal side. The wrist ranges of motion in flexion and extension were 56.1% and 79.3%, in supination and pronation 87.7% and 91.0% of the contralateral normal side. Two patients experienced a complex regional pain syndrome (CRPS) type II; these resolved spontaneously. One patient experienced distal radioulnar joint (DRUJ) stiffness, which improved after an ulna head resection. Finally, one patient required revision surgery after a secondary traumatic fracture. Radiographically; the average volar tilt was 9.8°; the average of radial inclination was 11.6°. Conclusion The concept of a unicompartmental isoelastic resurfacing prosthesis offers a promising option for the treatment of comminuted, osteoporotic distal radius articular fractures of elderly patients. Level of Evidence IV.

Efficacy of compound Xiatianwu tablets in elderly patients with osteoporotic distal radius fractures

Xiatianwu tablet is based on the theory of traditional Chinese medicine (TCM), combined with modern TCM pharmacology and selected 33 famous traditional Chinese crude drugs to compose. Its recipe helps cure rheumatism, relax tendons, promote blood circulation to relieve pain, et al. Although Xiatianwu tablets are widely applied to clinical remedy such as rheumatic arthritis, lumbar disc hernia, osteoarthritis and so on, there is no report about its application in fracture. This article is to observe the efficacy of compound Xiatianwu tablets in elderly patients with osteoporotic distal radius fractures and its impact on the wrist function and complications. 180 elderly patients with osteoporotic distal radius fractures, from January 2011 to June 2014, were divided into observation group and control group by the method of random number table, each group had 90 cases. The control group were gave Caltrate D after manipulative reduction and plaster immobilization, observation group were treated with compound Xiatianwu tablets in the basis of the control group. Efficacy, wrist function and complication rates were observed in two groups after treatment. The excellent and good rate was 95.56% in observation group better than 77.78% in control group, the difference was statistically significant (χ2 = 4.712, P < 0.05). The complication rate in observation group was significantly lower compared with the control group (P < 0.05). This study shows that compound Xiatianwu tablets can improve the efficacy in elderly patients with osteoporotic distal radius fractures, reduce the incidence of complications and relieve the pain of patients which plays a significant role in improving the quality of life.

Wrist Hemiarthroplasty for Acute Irreparable Osteoporotic Distal Radius Fractures (DRF) in the Elderly: Preliminary Study

Introduction Freeland was the first to coin the term “irreparable DRF” in a series of young patients treated with early wrist arthrodesis. There is currently no definition of irreparable DRF in the osteoporotic elderly population.

Osteokonduktive Eigenschaften von Beta-Trikalzium­phosphat in osteoporotischen, metaphysären Radiusdefekten

Surgical treatment of osteoporotic distal radius fractures with locking plates does not completely prevent loss of reduction. Additional bone deficit stabilisation with the use of bone substitute materials is receiving increased attention. Most knowledge on the in vivo behavior of bone substitutes originates from a small number of animal models after its implantation in young, good vascularized bone. This paper investigates the osteoconductivity, resorption and biocompatibility of beta-tricalcium phosphate as a temporary bone replacement in osteoporotic type distal radius fractures. 15 bone samples taken from the augmented area of the distal radius of elderly people during metal removal were examined. The material was found to be osteoconductive, good degradable, and biocompatible. Degrading process and remodelling to woven bone seem to require more time than in available comparative bioassays. The material is suitable for temporary replacement of lost, distal radius bone from the histological point of view.

Erratum to: Evaluation and treatment of osteoporotic distal radius fracture in the elderly patient

Erratum to: Curr Rev Musculoskelet Med 2013 DOI 10.1007/s12178-012-9153-8 This article was published in the March 2013 issue of Current Reviews in Musculoskeletal Medicine (volume 6, issue 1). The title of this article should read “Evaluation and Treatment of Osteoporotic Distal Radius Fracture in the Elderly Patient,” not “Evaluation and Treatment of Osetoporotic Distal Radius Fracture in the Elderly Patient.”

Treatment of the Distal Radius Fractures in the Elderly Patients

Distal radius fractures are one of the most common types of fractures in the elderly. It is well documented that increased risk of a distal radius fracture in older patients is associated with decreased bone mineral density. Also, low bone mineral density increased severity of fracture and instability of fracture after reduction. Fracture displacement in the elderly does not necessarily result in functional impairment. Therefore, conservative treatment has been a mainstay treatment even in unstable fracture in the elderly. However, there is an increasing trend toward operative treatment recently, because functional demand increased in the elderly due to active life style and volar locking plate fixation enables the elderly early return to daily activity even in osteoporotic distal radius fracture.