Outcome Of Distal Radius Fractures Research Articles

Clinical results of distal radius fractures in children

Clinical results of distal radius fractures in children

La chirurgia della Coxa Manus nel salvataggio del polso post-frattura dell’EDR

Frequent outcome of distal radius fractures is radio-carpal stiffness. This can be resolved by Coxa Manus Surgery using a radius-lunate-emiscaphoid arthrodesis and/or wrist arthroplastic by a capitate’s head prosthesis. So the adaptation is optimized to normal, in which the Uman bi-articular mechanism is bypassing the suffering radio-carpic joint and putting on an “ancestral” mono-articular order. To support, some cases are introduced with reliable and satisfactory results.

Operative Treatment of Distal Radius Fractures

The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.

Effect of Patient Age on the Radiographic Outcomes of Distal Radius Fractures Subject to Nonoperative Treatment

Our study assessed the radiographic outcomes of nonsurgically treated distal radius fractures of patients who were 18 to 44 years old (group 1), 45 to 64 years old (group 2), and 65 years old or older (group 3). All distal radius fractures seen in our emergency department from April 2002 to September 2004 that had nonsurgical management (either casting alone or closed reduction with immobilization) were considered for this study (n = 124; 50 casted, 74 closed reduced). Patients were further classified by age. Change in fracture alignment was assessed at the time of fracture union (approximately 8 weeks) and included measurements of angulation, articular gap/step-off, and radial shortening. When the fractures (n = 124) were evaluated at union, there was an overall secondary displacement rate of 64% (n = 79), with 42% in the group whose fractures were immobilized in a cast and 78% in the group whose fractures were treated by closed reduction and cast. There was an increase in displacement rate that was associated with increasing patient age. Among fractures that were only casted, there was no such age-matched increase in rates of secondary displacement. However, when considering those fractures that were subject to closed reduction (n = 74), rates of secondary displacement significantly increased with age (58% in group 1, 81% in group 2, and 89% in group 3; p = .03). Our study found that secondary displacement of distal radius fractures increased with increasing patient age, primarily among fractures subject to closed reduction. Older patients with these fractures require closer management after initial reduction, therefore allowing for better monitoring of expected subsequent fracture collapse. Further, given these high rates of secondary displacement after nonoperative treatment (58% to 89%), it is also important to consider that surgical treatment of these fractures may be necessary.

Bedeutung der postoperativen Übungsbehandlung für das Outcome der distalen Radiusfraktur

The value of consequent and structured tutorial treatment on the outcome of distal radius fractures was examined within a prospective randomized study. Due to assessment criteria, 198 out of 380 consecutive distal fracture patients could be included in the study and randomly assigned to either an intervention group (focused management) or a control group (transition physician process). Recommendations about character, extent and degree of the exercise treatment conducted were given to therapists, in the intervention group post-treatment recommendations were carried out according to standard practice. In the interventions group there was a low degree of prescribed therapy, however, these therapies were carried out in a more structured way and within a shorter time frame. The outcome revealed that only 12.3% of cases treated within the intervention group, as measured by the reduction of earning capacity, showed a reduction despite apparently shorter periods of work incapacity. In contrast, a reduction of earning capacity was found in 27.4% of the cases treated within the control group despite apparently longer post-treatment periods. Working incapacity time periods and the outcome (reduction of earning capacity) were significantly shorter and better within the intervention group and higher therapy costs were not observed The relevance of structured post-treatment in terms of a combined therapy has therefore been underestimated and supportive control appears to be necessary. Combining both therapies assures higher treatment success in cooperation with all parties involved.

Predictors of Functional Outcomes After Surgical Treatment of Distal Radius Fracture

Purpose: The purpose of this study was to identify predictors of outcomes of distal radius fractures (DRF) treated with open reduction internal fixation with the volar-locking plating system (VLPS). In this study, it was hypothesized that age, socioeconomic status, severity of fracture pattern, and post-op X-ray measure would be predictors of outcome.

Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period

Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. This study reports a total number of 104 DRFs in 102 patients, operatively treated, over a 2-year period with a mean follow up time of 15.6 +/- 7.2 months The patient's average age was 59.9 +/- 18.0 years. The results were evaluated according to the scores of Gartland and Werley, Castaing and the disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire. Ninety-three patients were evaluated at final examination. Excellent and good results were achieved for 92 (98.9%) patients according to score of Gartland and Werley and for 86 (92.5%) patients regarding the scoring system of Castaing. The DASH outcome questionnaire averaged 8.0 +/- 13.7 points. This study shows, in a representative number of cases, that palmar plating of unstable fractures of the distal radius is a safe and effective treatment modality. Early surgical treatment results in optimal outcome regarding patient's quality of life.

Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year

Background Non-bridging external fixation has been introduced to achieve better fracture fixation and functional outcomes in distal radius fractures, but has not been specifically evaluated in a randomized study in the elderly. The purpose of this trial was to compare wrist-bridging and non-bridging external fixation for displaced distal radius fractures.Method The inclusion criteria were women ≥ 50 or men ≥ 60 years, acute extraarticular or intraarticular fracture, and dorsal angulation of ≥20° or ulnar variance ≥ 5 mm. The patients completed the disabilities of the arm, shoulder and hand (DASH) questionnaire before and at 10, 26 and 52 weeks after surgery. Pain (visual analog scale), range of motion and grip strength were measured by a blinded assessor.Results 38 patients (mean age 71 years, 31 women) were randomized at surgery (19 to each group). Mean operating time was shorter for wrist-bridging fixation by 10 (95% CI 3–17) min. There was no significant difference in DASH scores between the groups. No statistically significant differences in pain score, range of motion, grip strength, or patient satisfaction were found. The non-bridging group had a significantly better radial length at 52 weeks; mean difference in change in ulnar variance from baseline was 1.4 (95% CI 0.1–2.7) mm (p = 0.04). Volar tilt and radial inclination were similar in both groups.Interpretation For moderately or severely displaced distal radius fractures in the elderly, non-bridging external fixation had no clinically relevant advantage over wrist-bridging fixation but was more effective in maintaining radial length.

当科における小児とう骨遠位端骨折の治療の検討（骨端線損傷も含む）

We evaluated the clinical results of distal radius fractures in children accompanied by epiphyseal injury. We treated 36 patients between July 1999 and June 2002. The average age was 9.8 years (range : 3 to 15 years). Twenty-two patients underwent conservative treatment and 14 patients pinning. All 7 patients under 7 years of age were treated conservatively. Both conservative treatment and pinning provided good results. Because the natural corrective power in the children was very strong, under 30°bone deformity healed satisfactorily. However both methods required a long time to achieve correction. Conservative treatment is the treatment of first choice, but if reduction is difficult or after reduction position is unstable, pinning is a useful method.

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability.

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.

Clinical outcome of distal radius fracture treated by percutaneous pinning augmented with calcium phosphate bone cement in elderly patients

Clinical outcome of distal radius fracture treated by percutaneous pinning augmented with calcium phosphate bone cement in elderly patients

Computerized analysis of radiographs in Colles' fractures.

Several radiographic parameters correlate with clinical outcome in distal radius fractures. This study describes a new, computerized routine that automatically defines the longitudinal axis of the radius, deriving the radial tilt, radial width, and radial height on anteroposterior radiographs of the wrist. The intraobserver and interobserver variability is reported in a series of 33 anteroposterior radiographs of the wrist. An edge-finding filter is used to determine accurately the cortices in several lines of each image. The midpoints between these two edges are used to determine the best-fit line, thereby defining the longitudinal axis of the bone. The operator marks the tip of the radial styloid and the lunate angle of the radius at the distal radioulnar joint. Radial shortening, widening, and loss of angle are calculated. The 33 radiographs were measured twice by two independent observers, and 12 sets of paired readings were analyzed using the two-tailed paired t test. The mean difference between readings was reduced to a fraction of degree or millimeter, virtually eliminating the intraobserver and interobserver errors. Thus, the current study shows the computer is a reliable and effective instrument for measuring radiographs. The computer-aided system of measurements can be extended to prostheses, fractures, and to other orthopaedic measurements.

女性のとう骨遠位端骨折に対する手術成績

The purpose of this study is to report the surgical results of distal radius fractures in females. Fifty-five female patients who were operated for distal radius fractures were studied. Three types of the fracture 47 colles type, 4 smith type, and 4 volar Barton fracture were seen Three types of fractures were reen; Colles type (41 patients), Smith type (4 patients), and Volar Barton type (4 patients). In the Colles type, 24 patients were treated by pinning, 11 patientes by plating, 7 patients by the Kpandji method, and 5 patients using external skeltal fixator. In the smith type, 2 patients were treated by pinning, and 2 patients by plating. In the Volar Barton fracture, all 4 patients were treated by plating. The follow-up range was from 4 months to 6 years and 3 months, averaging about 1 year and 9 months. Post operative results were evaluated using Saito's criteria.In the Colles type, 31 cases were excellent, 15 cases were good, and 1 case was poor. In the Smith type, 2 cases were excellent, and 2 cases were good. In the Volar Barton fracture, all 4 cases were excellent. Especially in the Colles type, plating is superior at general appreciation, subjective appreciation, and X-ray measurement, pinning is superior at range of motion, and hand grasping power, and Kapandji method is superior at keeping volar tilt. Three patients showed complications of cutanoous tunnel syndrome, 1 patient injury of the superficial branch of the radius nerve, and 1 patient tendon tear of abductor pollicis longus.

Outcome of Distal Radius Fractures Using the Short Form 36 Health Survey

The Short Form 36, a survey designed to accurately study subjective findings, was applied to analyze the outcome of distal radius fractures and its' relation to extrinsic and intrinsic factors. The survey was administered to 50 adults (mean age, 49.6 years) requiring fixation of a distal radius fracture with a mean followup of 2.4 years. Treatment included external fixation and pins in 24 patients, buttress plating in 20 patients, pins alone in four patients, and external fixation alone in two patients. The Short Form 36 scores were correlated with components possibly affecting outcome and compared with those of the general population. There was no correlation with residual radial height, radial tilt, or palmar tilt. No differences were observed between treatment or fracture groups. Intraarticular incongruence of 1 mm or greater correlated with a lower Short Form 36 score and with the development of arthrosis. Those injured while working were more than four times less likely to return to work than those injured while away from work. The Short Form 36 was found an effective and precise tool for measuring subjective patient information.