Outcome Of Distal Radial Fractures Research Articles

Assessment of Functional Outcome of Distal Radius Fracture Treated with Kirschner’s Wire

Introduction: Distal radial fractures are most common fracture which accounts 8-15 % of all bony injuries. There is a wide variety of treatment options and selection mainly depends on age, occupation, type of fracture. Fracture realignment is most important element for good functional outcome. Closed reduction and percutaneous k-wire fixation is most convenient method as it is cost effective.
 Aims: To evaluate the functional outcome of distal radial fractures treated with closed reduction and percutaneous pinning.
 Methods:This prospective observational study was conducted in Nepalgunj medical college Teaching hospital, Kohalpur from September 2021 to August 2022. Patient aged above 18 and below 70 years who had isolated distal radius fracture with k wire fixation. Functional results were assessed at a follow up of 6 months, by modified Gartland and Werley scoring system.
 Results: In this study out of 45 cases there were male preponderance 29 (65%). The mean age of our patient was 36.8 (SD±12.80) years. K-wires were removed between four to six weeks of operation depending upon the union and followed for six months. On final follow up variables assessed according to Modified Gartland and Werley scoring system which shows, 25 patients had excellent (51.11%) and 13 good (33.33%) functional outcome. Overall, 84.44% of the patients achieved an excellent to good functional outcome. Still residual pain and dorsal angulation were complications post-operatively and was in acceptable limits in majority of cases.
 Conclusion: Closed reduction and percutaneous pinning for distal radius fractures have shown to achieve good functional outcome. Most of the complications after the procedure were within the acceptable limits. Further studies are required to assess its efficacy in various other fracture types.

Functional Outcome of Distal Radial Fractures in Patients With a Mean Age of 75 Years at a Mean Follow-Up of 5.4 Years.

PurposeDistal radial fractures in the elderly are common and present in a wide spectrum of severity. Their management is varied. The aim of this retrospective case review is to evaluate the late functional outcome of surgically treated distal radial fractures in the elderly population.MethodsForty-two patients (36 female and six male) were surgically treated for an unstable distal radial fracture. The mean age of the patients was 75 years. Frykman classification was used to assess the severity of the injury. Surgical options used were reduction and K wires (19 patients) or open reduction and internal fixation (ORIF) using volar distal radial plate fixation (23 patients). At a mean follow-up of 5.4 years, a validated questionnaire (Patient Rated Wrist Evaluation-PRWE) of the functional ability was completed for each patient.ResultsThe outcome in both groups was satisfactory (PRWE 40-50) with no significant statistical difference, however, a better functional outcome (<40 PRWE) was achieved in the K wire group compared to the ORIF group. Factors such as post injury fear from fall, weakness of grip, wrist pain, and other comorbidities altered the predicted functional outcome score.ConclusionIn conclusion, surgically treated fractures in the elderly generally lead to good outcomes. However, confounding factors can contribute to unpredictable results despite good surgical reduction and fixation.

Percutaneous pinning versus conservative management in distal radius fractures: A prospective analysis

Background: Fracture of the distal end of radius is one of the more common fractures encountered in the Orthopaedic practice. As longevity of the population increases and as accidents also increase, the incidence of this fracture is expected to increase. Achievement of good realignment of the fracture is essential from a functional and cosmetic point of view. The modalities for treatment of these fractures are varied and much confusion is present as regards appropriate treatment of various fracture types. A cost effective method of treatment is closed reduction and percutaneous pinning with K-wires. This study was conducted to analyze the outcome of Distal Radial Fractures treated with closed reduction and percutaneous pinning. Methods: The present study was a prospective study of 60 cases of Distal Radius Fractures admitted to Bokaro General Hospital between the study period of November 2015 to October 2017. Cases were selected according to inclusion and exclusion criteria i.e., patients with distal radius fractures above the age of 18yrs and presenting within two weeks of injury. Medically unfit patients or those not willing for surgery or who presented with open fractures were excluded from the study.Results: In our series of 60 cases there were 30 males and 30 females, with a maximum age of 72yrs, minimum age of 19yrs and an average age of 45 years. There was a no predominance of the side of the fracture. At the final follow up assessment with ‘The Functional Assessment by The Gartland and Werley Criteria’ 36 patients (72%) achieved ‘Excellent’ result, 11 patients (22%) achieved ‘Good’ result, 2 patients (4%) achieved ‘fair’ result and 1 patient (2%) achieved ‘poor’ result. Overall, 94% of the patients achieved an excellent or good result. On anatomical evaluation using ‘Sarmiento’s Criteria’ 90% of patients achieved a excellent or good result, while 10% achieved only a fair result. Conclusion: Closed reduction and percutaneous pinning for distal radius fractures have shown to achieve good anatomical and functional outcome. The complications arising from the procedure were within acceptable limits. Further studies are required to assess its efficacy in various other fracture types.

Study of functional outcome of distal radial fractures treated by conservative and surgical methods

Study of functional outcome of distal radial fractures treated by conservative and surgical methods

The study of outcome of non comminuted lower end radius fractures treated by closed reduction and internal fixation with percutaneous pinning

Introduction: Fractures of the distal radius constitute one of the most common skeletal injuries treated by orthopaedic surgeons. Colle’s fracture was first described by Abraham Colle of Dublin in Ireland. There are variety of treatment modalities in treating extraarticular non-comminuted fractures of distal radius. Each one has got their own advantages and disadvantages. Increased life expectancy of the population increases and as accidents also increase, the incidence of this fracture is expected to increase. Percutaneous pinning is one of the most simple, cost effective, easy procedure with good results. This study was conducted to analyze the outcome of Distal Radial Fractures treated with closed reduction and percutaneous pinning.Materials and Methods: This is a prospective study of 30 cases of distal radius fractures. non-comminuted aged between 20 to 70 years of age. They were treated with closed reduction and internal fixation with Percutaneous pinning with 2-3 K-wires. Postoperatively they were immobilized with below elbow dorsal slab. After 3 weeks slab was removed and physiotherapy started, K-wires were removed after 6 weeks. Post operative xrays were done at 3 weeks, 6 weeks and 6 months.Results: There were 30 cases in our study. 60% (18) males and 40% (12) females. The mean age of the patients was 52 years. The mechanism of injury in most cases was fall on out stretched hand 76.6% (23). The side of involvement was right in 56% (17) and 44% (13) in left hand. 66% (19) belonged to type A, 34% (10) belonged to Type C according to Fernandez classification. 54% (16) patients belonged to A type, 36% (11) belonged to type B as per AO classification. 60% (18) showed excellent outcome under subject evaluation, 67% (20) patients showed excellent end results. Total 13% (4) showed complications in the study. Among them 7% (2) were pin tract infection, followed by malunion and Reflex Sympathetic Dystrophy each 3% (1).

Outcomes of surgically treated distal radial fractures with associated triangular fibrocartilage complex injury

Study DesignProspective cohort. IntroductionClinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radial fractures expressed with the patient-rated disability are missing. Purpose of the StudyTo evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC. MethodsPatients undergoing operative treatment for distal radial fracture were prospectively enrolled (n = 70). The TFCC was examined by wrist arthroscopy, and injuries were classified according to Palmer. Comparative analyses were performed on data from 45 patients with TFCC injury (the injured group) and 25 patients with an intact TFCC (the intact group). The outcome measures included The Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury. ResultsThe TFCC was injured in 45 patients (64%). In patients with an intact TFCC, the mean total PRWE score was 27 (at 3 months) and 16 (at 12 months), whereas in patients with TFCC injury, it was 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 for the intact group and 39 and 27 for the injured group at 3 and 12 months, respectively. PRWE and DASH results showed significant difference at 3 and 12 months when compared using the Mann-Whitney test. ConclusionsDisability outcomes were worse in patients with distal radial fracture where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radial fractures.

Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies

PurposeAn ulnar styloid fracture often occur in association with a distal radial fracture. Whether an ulnar styloid fracture interfere with the results of a distal radial fracture still remains controversial. The aim of this study was to analyse the effects of an accompanying ulnar styloid fracture on clinical outcomes in patients with distal radial fractures. MethodsA meta-analysis of published studies comparing outcomes of distal radial fractures with an ulnar styloid fracture versus isolated distal radial fractures was performed. Outcomes of function results, radiological evaluation, and patient reported scores were analyzed. ResultsTen studies including 1403 distal radius fractures were identified fitting inclusion criteria. There was no significant difference in wrist motion, grip strength, radial height, volar angle, ulnar variance, pain score, PRWE score, or SF-36 score for distal radial fractures associated with an ulnar styloid fracture versus isolated distal radial fractures. In final follow up, patients with associated an ulnar styloid fracture had lower radial inclination and higher DASH scores. But there was no significant clinical difference. In addition, we found there was no significant difference of outcomes between union and non-union ulnar styloid fractures. ConclusionsBased on this meta-analysis, we suggest that an associated ulnar styloid fracture does not affect the outcomes of a distal radial fracture and clinicians should be caution in electing operative treatment for patients with an ulnar styloid fracture.

Effect of calcitonin in the outcome of distal radial fractures in elderly patients

Background: Distal radial fractures are common and produce significant morbidity in elderly osteoporotic individuals. Calcitonin prevents bone resorption in osteoporotic individuals and hence can reduce morbidity in the immediate post fracture period. But scientific evidence regarding its efficacy in improving pain and functional abilities is lacking. Hence this study is being done to assess the clinical and radiological parameters after calcitonin usage in immediate post fracture period. Methods: 50 elderly patients with distal radial fractures treated conservatively with plaster application were randomly divided into two groups. One group received 400 IU of nasal salmon calcitonin daily for 6 months and the other group did not receive it. Demographic data of patients, co-morbid illnesses, and AO type were recorded. Patients were followed at 2, 4, 6, 8, 12 and 24 weeks post fracture. Their pain score (VAS), functional abilities with Mayo wrist score and radiological union were assessed. Statistical analysis was done with student t test and pearson correlation. Results: VAS score improved significantly from 9.57 to 2 in calcitonin group compared to 9.31 to 4.42 in non-calcitonin group. Mayo wrist score showed significant difference in calcitonin group. Fracture union and radiological parameters were comparable in both groups with no statistical significance. CRPS was less frequent in patients who took calcitonin. Conclusion: Calcitonin improves pain and functional outcome in elderly patients with distal radial fractures, reducing the incidence of CRPS. We recommend its routine usage in osteoporotic individuals with distal radial fractures predisposed for CRPS.

A prospective study of surgical management of distal radius fracture in adult with plate fixation

Distal end radius fracture is one of the most common injuries and management of these fractures is still a challenge for orthopaedic surgeon in achieving good functional results. The present study was undertaken to assess the functional outcome of distal radial fractures in adults treated by plate fixation. All the patients were operated with open reduction and internal fixation with volar plate and screws with or without K-wire fixation. The functional outcome was assessed by demerit-point system of Gartland and Werley score. 8 (40%) patients had excellent results, 11 (55%) had good results, 1 (5%) patient had fair results and no patient had poor results. Distal end radius fractures treated by fixation with volar plate and screws or K-wire gives good result in terms of union, functional recovery and prevent stiffness. Open reduction and internal fixation provides best chance for restoring joint congruity and therefore patients treated by this method have a lesser chance of developing secondary osteoarthritis with minimal complications and is a better option for surgical management of these fractures.

A clinical study of various management techniques in distal end radius fractures in adults

Objectives: The present study was conducted to evaluate the functional outcome of distal radial fractures in adults with surgical treatment using closed reduction and K-wire fixation, external fixation with or without K-wire augmentation and assess the complications of various surgical procedures done for distal radial fractures. Material and Methods: A prospective study was carried out on 20 adult patients with distal radial fractures. The fracture fragments were analysed and involvement of radio-carpal and distal radio-ulnar joints were assessed and classified according to the Frykman’s classification Regular follow up was done at an interval of 6 weeks, 3, 6 and 12 months. The follow up ranged from 5 to 12 months. The results were assessed at 3 months after the procedures. Results: The functional outcome evaluated using the demerit score system of Gartland and Werley based on objective and subjective criteria and residual deformity, we achieved excellent results in 4 (20%) cases, good results in 12 (60%) cases, fair results in 3 (15%) cases and poor result in 1 (5%) case. Conclusion: Surgical management of distal radial fractures, regardless of the type of fixation, produced excellent to good results with proper pre-operative evaluation, selection of the method based on fracture pattern, reducibility, stability and quality of bone, early fixation, proper wound and pin site care, early post-operative rehabilitation and patient education. Mal-union should be avoided by proper selection of implant and procedure, early reduction and fixation, better surgical skills.

Does socioeconomic status influence the epidemiology and outcome of distal radial fractures in adults?

The aim of this study in adult patients with a distal radial fracture was to determine whether socioeconomic status influenced the epidemiology, mechanism of injury, fracture severity, or the outcome according to function, radiographic assessment, and rate of associated complications. We identified 3983 distal radial fractures over a 7-year period. Socioeconomic status was assigned using the Carstairs score, and the population was divided into quintiles depending on deprivation. Patient demographics, mechanism of injury, fracture severity, and radiographic assessment at time of injury were assessed for epidemiological differences according to social quintile. Functional outcome was assessed using grip strength, Moberg pickup test, return to normal use of the hand, and range of movement. Radiographs were assessed at 1week, 6weeks, and 1year. Complications were defined as malunion, carpal tunnel syndrome, complex regional pain syndrome (CRPS), persistent pain, and subjective cosmetic deformity of the wrist. Socioeconomically deprived patients were significantly younger (p<0.001) and more likely to be male (p=0.017); after adjusting for confounding factors, deprived patients were 3.1 (95% CI 1.4-4.7)years younger than the most affluent patients (p<0.001). Deprived patients were more likely to sustain their fracture by a high-energy mechanism (p=0.004). There were no significant differences between quintiles in outcome. There was a significantly greater prevalence of CRPS in more affluent patients (p=0.004). Socioeconomically deprived patients sustaining a distal radial fracture are more likely to be younger and male. Outcome is not influenced by socioeconomic status, but the prevalence of CRPS is greater in more affluent patients.

Intra-articular comminution worsens outcomes of distal radial fractures treated by open reduction and palmar locking plate fixation.

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Radiological and Clinical Outcome of Distal Radial Fractures Managed by Variable Angle 2.4 mm Titanium Volar Plate

Objective: To evaluate radiological and clinical outcome in fractures of the distal radius treated with internal fixation by applying variable angle 2.4 mm volar locking plate. Study design: Prospective interventional study. Place and duration of study: Hand and Upper Limb Surgery (HULS), Lahore, Pakistan between January 2014 and December 2015. Methodology: Forty two patients (34 males, 08 females) with different types of fractures of distal radius were treated. Open reduction and Internal fixation was performed by applying 2.4 mm titanium variable angle volar locking plate. Anatomical restoration was evaluated by good-quality postero-anterior and lateral radiographs obtained preoperatively, immediately postoperatively and 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Data was analyzed by One way repeated measure ANOVA test. Results: There was perfect anatomical restitution in AO type A and B fractures that retained till 09 months follow up. In type C fractures, there was significant postoperative improvement but slight loss in radiological parameters by 09 months that was insignificant with P-value less than 0.01. There was credible improvement in wrist movements and grip. Conclusion: The rigid characteristics of variable angle volar plate provide the best anatomical restoration and fixation of distal radius fractures and maintain stability to promote early postoperative wrist motion.

Treatment of extra-articular and simple articular distal radial fractures with intramedullary nail versus volar locking plate

The purpose of this prospective, randomized and blinded study was to compare the clinical outcomes of distal radial fractures treated with either an intramedullary nail or a volar locking plate. Sixty two patients were enrolled in the study and randomized to treatment with a MICRONAILTM (Group 1, 31 patients) or an adaptive plate (Group 2, 31 patients). Fracture types included were unstable extra-articular metaphyseal distal radial fractures and simple or multifragmentary sagittal articular distal radial fractures (AO classification types A2, A3, B1.1 and B1.2). All patients were evaluated at 6 weeks, 3 months and 12 months after surgery. Outcome measures included standard radiographic parameters, active wrist range of motion, the disabilities of the arm, shoulder and hand (DASH) and Mayo wrist scores. We concluded that treatment of this subset of distal radius fractures with minimally invasive intramedullary nailing gives better clinical outcomes at 6 weeks after surgery than treatment with a volar locking plate. By 3 and 12 months following surgery, there are no significant differences in outcome between the two treatment methods. Disadvantages of the MICRONAIL™ fixation system include risk of injury to the superficial branch of the radial nerve and a narrower spectrum of indications than volar locking plates.

Bisphosphonates Are Safe After ORIF for Distal Radial Fractures

In their well-designed randomized trial, Gong et al. concluded that early initiation of bisphosphonate treatment has no effect on the clinical or radiographic outcomes of distal radial fractures treated with volar plate fixation. Bisphosphonates are currently the most commonly used anti-resorptive medications, and their primary mechanism of action involves inhibition of osteoclastic bone resorption. Because bisphosphonates cause a pronounced suppression of both bone resorption and bone formation, it has been suggested that treatment can interfere with normal fracture-healing. Animal studies, however, have provided controversial evidence1,2, and randomized clinical trials of bisphosphonates have not demonstrated any adverse events associated with fracture-healing. The majority of patients with a distal radial fracture …

Mentales Training beeinflusst Bewegungseinschränkung des ruhiggestellten Handgelenks – eine prospektive Experimentalstudie

Distal radial fracture is the most common bony injury in man. Still there are unsatisfying treatment results, such as limited joint movement, muscle atrophy and pain, resulting from immobilisation while the fracture is healing. During this period, also joint movement seems to be "forgotten". This study experimentally examined if the method of mental practice, meaning the systematic repetition of a consciously imagined movement or action without simultaneous practical execution, can positively influence these findings. 21 right-handed males had application of a circular forearm plaster for immobilisation of their left radiocarpal joint, simulating a distal radial fracture for three weeks. Following randomisation, half of the study participants learned mental practice for "virtual movement" of their radiocarpal joint and had to perform it, the others were not treated at all. At beginning and end of the experiment, joint movement was measured, and an MRI examination of the forearm muscles was performed. The brain (cortex) areas, responsible for radiocarpal joint movement, were examined concerning their activity with functional MRI at the beginning and also at the end of the three weeks. The experiment was also performed on three "real" patients suffering from a distal radial fracture demanding plaster immobilisation, all of them were mentally treated. Mental practice significantly ameliorated dorsal extension and ulnar abduction after plaster removal in comparison to those not having been mentally trained. Muscle atrophy of forearm muscles, measured via MRI, was significantly less in those having mental training. The cortex areas responsible for radiocarpal joint movements (supplementary motor area, precentral gyrus, putamen, nucleus caudatus, prefrontal cortex, thalamus and cerebellum) showed significant signal changes at the end of the three weeks in those having been mentally trained. There were significant correlations between MRI and functional MRI findings. The findings in the three "real" patients were similiar. The results of this experimental study show that mental practice can have a positive influence on the outcome of distal radial fractures demanding immobilisation. A study with a larger number of "real patients" should follow.

The number of instability markers is a significant predictor of outcome in distal radial fractures and can be used as a guide to devise a standardized management strategy for these fractures

The number of instability markers is a significant predictor of outcome in distal radial fractures and can be used as a guide to devise a standardized management strategy for these fractures

The Number of Instability Markers is a Significant Predictor of Outcome in Distal Radial Fractures and Can Be Used as a Guide to Devise a Standardised Management Strategy for These Fractures

The Number of Instability Markers is a Significant Predictor of Outcome in Distal Radial Fractures and Can Be Used as a Guide to Devise a Standardised Management Strategy for These Fractures

Outcome of distal radial fractures treated with Kirschner wires

Outcome of distal radial fractures treated with Kirschner wires

Comparative outcome of distal radial fractures treated by percutaneous k-wire fixation and internal fixation

The purpose of our study was to compare the outcome of dorsally displaced distal radial fractures treated either by open reduction and internal fixation or with percutaneous k-wire stabilisation. Twenty two consecutive patients with a dorsally displaced distal radial fracture treated surgically were reviewed. A clinical and radiological evaluation was performed and each patient completed a patient-rated wrist evaluation form. The range of movement and strength of the wrist was determined by the occupational therapist. There was no significant difference between the groups for range of movement, grip strength or radiological findings. The k-wire group produced better results for pain, function and disability scores but, the difference was not significant. There were, however, more complications in the internal-fixation group. Percutaneous k-wire stabilisation, being a less invasive and shorter surgical procedure, is the preferred method of treatment for dorsally displaced distal radial fractures.