Outcome Of Distal Radius Fractures Research Articles

Long Term Effects Of Covid-19 Pandemic On Management And Outcomes Of Distal Radius Fractures

Purpose: The purpose of this study was to assess the long-term effects of conservative orthopaedic practice during Covid-19 pandemic on management and long-term outcomes. Methods: Current longitudinal retrospective cohort study included patients at a single tertiary care center in India. Successive distal radius fractures of patients in pre-COVID (2018-19), COVID (2020-21) and postCOVID (2022-23) time period groups were treated and analysed. The primary outcome was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and secondary outcomes included wrist range of motion, grip strength and pain. Cohort findings were compared employing Repeated-measures analysis of variance. Results: In pre-COVID group 97(82.4%) patients presented within 3 days of injury which significantly declined to 48(49%) in COVID and 94(71.2%) in post-COVID group. There was a significant reduction in admissions for inpatient care (p<0.05). The mean QuickDASH score at 1 year follow-up was 7.2(8.6) in COVID group that was clinically better than pre-COVID [8.5(9.2)] and post-COVID [9.7 (12.4)] cohorts. The number of reoperations or secondary surgeries required were significantly lower in the COVID group [1 (1%) patient]. Conclusions: COVID-19 pandemic had minimal long-term effects on results of distal radius fractures as the conservative treatment approach utilised was realistic and beneficial to patients as well as to the treating surgeons. Timely corrections of arising early treatment complications through efficient virtual clinics/telemedicine kept the prevalence of major late complications minimal. Comparatively minimal complications and prompt recovery were seen in patients being operated by percutaneous Kirschner wires fixation. Categories: Infectious Disease, Orthopaedics, Trauma

Functional outcome of distal radius fractures in adults after conservative treatment.

Functional outcome of distal radius fractures in adults after conservative treatment.

Impact of body mass index on fracture severity, clinical, radiological and functional outcome in distal radius fractures: a retrospective observational study after surgical treatment

IntroductionDistal radius fracture (DRF) is one of the three most common fractures of the human body with increasing incidences in all groups of age. Known causes of increasing incidence, such as ageing of the population or increased obesity, have been described and discussed. So far, literature reports ambivalent effects of body mass index (BMI) on bone physiology. It is worthwhile to examine the influence of BMI on the outcome of fractures more detailed. This study aims to investigate the influence of an abnormal BMI on fracture severity and treatment, as well as clinical, radiological, and functional outcome to improve clinical decision making.Materials and methodsA retrospective observational study was conducted on data obtained from patients, who underwent open reduction and internal fixation (ORIF) of a DRF at a local Level 1 Trauma Center between May 2018 and October 2021. Follow-up examinations were performed approximately 1 year after surgical fracture treatment, during which various questionnaires and functional measurements (CMS, DASH, NRS, ROM) were applied. In addition, postoperative complications were recorded and radiological examinations of the affected hand were performed. After excluding incomplete data sets and applying set exclusion criteria, the complete data of 105 patients were analyzed.Results74 patients were female and 31 male with significant difference in mean BMI [p = 0.002; female: 23.8 (SD ± 3.3), men: 26.2 (SD ± 3.9)]. Patients with higher BMI had significantly more severe fractures (p = 0.042). However, there was no significant difference in surgery time for fracture management. At follow-up, patients with lower BMI showed a smaller difference in hand strength between the fractured and the other hand (p = 0.017). The BMI had no significant effect on the clinical and radiological outcome.ConclusionDespite the ambivalent effects of BMI on the skeletal system, our findings indicate that a higher BMI is associated with more severe DRF. Thereby BMI does not correlate with surgery time for fracture treatment. Furthermore, no evidence of an influence on the clinical and radiological outcome could be detected.

Functional and Radiographic Outcomes of Distal Radius Fractures Managed Non-Operatively at Western Visayas Medical Center during the Covid-19 Pandemic

Functional and Radiographic Outcomes of Distal Radius Fractures Managed Non-Operatively at Western Visayas Medical Center during the Covid-19 Pandemic

Size and fixation options of dorsoulnar fragments in distal radius fractures

PurposeThis study aimed to investigate the influence of size and fixation options of dorsoulnar fragments on the clinical outcomes of distal radius fractures (DRFs). MethodsThis retrospective analysis was performed on 94 patients with DFR accompanied by dorsoulnar fragments, spanning the period from October 2018 to November 2022. Mean follow-up was 15.5 (range, 12–20) months. Patients were divided into small- (<5 %, n = 28), middle- (5–15 %, n = 50), and large- (>15 %, n = 16) sized groups according to articular involvement of dorsoulnar fragments determined by three-dimensional (3D) computed tomography (CT) modeling. Subdivision also took place for the presence of postoperative fragment displacement (>2 mm) and fixation methods including volar locking plate (VLP), VLP combined with dorsal hollow compression screw (VDS), and VLP combined with dorsal low-profile mini plate (VDP). The radiographic parameters (volar tilt, radial inclination, and radial height) and functional outcome measures of wrist range of motion, wrist function (DASH, PRWE), and wrist pain (VAS) were evaluated and compared between groups. ResultsFracture healing was observed in all patients at final follow-up. No instances of dorsoulnar fragment displacement were observed in patients undergoing VDS and VDP treatment and the incidence of the dorsoulnar fragment displacement was 35 % (n = 8) in small-sized group, 21 % (n = 7) in middle-sized group, and 7 % (n = 1) in large-sized group when patients were treated with VLP. In small-sized group, no significant differences were found between patients with and without dorsoulnar fragment displacement in dorsiflexion restriction (10.6 ± 2.8°, 9.1 ± 2.3°, P = 0.159), pronosupination restriction (9.6 ± 2.1°, 8.6 ± 1.7°, P = 0.188), DASH (11.5 ± 4.1, 10.7 ± 3.2, P = 0.562), PRWE (11.9 ± 4.2, 10.6 ± 3.6, P = 0.425), and VAS (1.1 ± 1.1, 0.9 ± 1.0, P = 0.528). In middle-sized combined with large-sized group, the functional outcome measures of dorsiflexion restriction (12.5 ± 3.7°, 9.8 ± 2.9°, P = 0.022), DASH (14.6 ± 5.2, 11.4 ± 3.7, P = 0.030), and PRWE (15.0 ± 4.5, 11.3 ± 3.9, P = 0.016) were superior in patients without dorsoulnar fragment displacement. In patients treated with VLPs, no significant differences were found in dorsiflexion restriction (9.8 ± 2.5°, 10.8 ± 3.5°, 9.4 ± 2.5°, P = 0.299), pronosupination restriction (9.2 ± 1.9°, 10.1 ± 2.8°, 8.9 ± 1.5°, P = 0.200), DASH (11.1 ± 3.5, 12.9 ± 4.3, 11.1 ± 3.6, P = 0.162), PRWE (11.1 ± 3.9, 12.8 ± 4.2, 10.8 ± 3.9, P = 0.188), and VAS (1.0 ± 1.0, 1.4 ± 1.1, 0.9 ± 0.9, P = 0.151) between small-sized, middle-sized, and large-sized groups. In middle-sized group, no significant differences were found in dorsiflexion restriction (10.8 ± 3.5°, 9.4 ± 2.2°, 9.4 ± 2.4°, P = 0.316); pronosupination restriction (10.1 ± 2.8°, 8.8 ± 1.9°, 9.0 ± 2.5°, P = 0.314), DASH (12.9 ± 4.3, 10.3 ± 3.7, 10.5 ± 3.7, P = 0.133), PRWE (12.8 ± 4.2, 10.4 ± 3.8, 10.6 ± 4.1, P = 0.199), and VAS (1.4 ± 1.1, 0.8 ± 0.7, 1.0 ± 1.1, P = 0.201) between subgroups of VLP, VDS, and VDP. No significant differences were found in radiographic parameters between all groups compared. ConclusionThis study indicated that the strict reduction and fixation of a dorsoulnar fragment might be not essential when its articular involvement was less than 5 %. The volar locking plate (VLP) fixation was commonly effective in treating distal radius fractures accompanied by a dorsoulnar fragment involving over 15 % of the articular surface. Additionally, the use of an additional dorsal hollow compression screw or a dorsal low-profile mini plate can get good wrist function in the early-term follow-up when the dorsoulnar fragment involve 5–15 % of the articular surface.

“Does Hook Type Matter in Articular Distal Radius Fixation? Re. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-specific Fixation”

“Does Hook Type Matter in Articular Distal Radius Fixation? Re. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-specific Fixation”

Functional Outcome of Distal Radius Fractures in Elderly Treated By Close Reduction And Cast Application under Hematoma Block

Introduction: Distal radius fractures are common in elderly population. Various options of treatment are available. Very good clinical outcomes have been reported in elderly patients with distal radius fractures treated by close reduction and cast application. The purpose of this study was to assess functional outcome of distal radius fractures in elderly treated by close reduction and cast application under hematoma block. Methods: Sixty two patients (19 males,42 females; mean age 67.7± 5.7 years) aged &gt;60 years with distal radius fractures Frykman I to IV were treated with close reduction and cast application under hematoma block. Pain level was assessed using VAS score. Anatomical and functional results were assessed with radiological parameters, range of motion and DASH score at 2,6,12,24 and 52 weeks follow up. Results: Union was achieved in all fractures with mean time of 6.1±0.4weeks.At final follow up, mean radial height, radial inclination and radial tilt were 6.39 mm, 18.4°and 4.2° respectively. Mean VAS score and DASH score were 0.76 and 10.1 respectively. Complications were seen in 5 ( 6 % ) patients. Conclusion: Distal radius fractures in elderly treated by close reduction under hematoma block and cast application has good functional outcome.

Distal Radioulnar Joint Instability in Distal Radius Fractures Managed with Volar Locking Plates

Abstract Introduction: Distal radioulnar joint (DRUJ) injuries are the most common cause of residual wrist disability after fractures of the distal radius. There is a lack of consensus regarding the diagnosis of these injuries along with their management when being accompanied by a fracture of the distal radius. The present prospective study aimed to assess the effect of the involvement of DRUJ on the outcome of distal radius fractures. The study also evaluated the role of clinical and radiographic indices in the diagnosis, management and outcome of these injuries. Materials and Methods: This prospective study involved 51 patients aged &gt;18 years with distal radius fractures treated using volar plating. The intra-operative assessment was done clinically using a piano key or ballotment test after fixation of distal radius fracture using K-wire stabilisation. The mean follow-up was 24 months. The patients were all clinically evaluated using the Modified Gartland and Werley scoring system. Radiographically, we calculated the dorsal/volar tilt, radial inclination, radial height and the ulnar variance. Results: A total of 44 patients with distal radius fractures were managed with the volar plate. The mean age was 45 years (range = 18–77; SD = ±13.6). The majority were men. The maximum cases were found to be of 2R3C type of AO/OTA fractures. Axial instability was observed in 12 cases, with 5 having negative and 7 showing positive axial instability. No statistically significant correlation was identified between the instability of the DRUJ and the overall outcome of distal radius fractures treated with volar plating (P = 0.241). However, a significant association was observed between fractures involving the base of the ulnar styloid (US) and the final clinical outcome (P = 0.023). The mean modified Gartland and Werley score was calculated at 6.09 ± 5.36, and 28.9% of cases suffered from loss of dorsiflexion. Conclusion: The present study revealed that it is important to recognise DRUJ instability in both axial and anteroposterior (AP) planes through clinical and radiological parameters. US base fractures cause DRUJ instability and also create a negative impact on the outcome of distal radius fracture fixed with volar plating. Ulnar variance is a good marker for checking instability in the AP plane by ballotment test. We found that in cases of DRUJ instability, fractures of the ulnar base should be examined and fixed if needed.

Correlation between radiographic and functional outcome of distal radius fracture managed by closed reduction and plaster of Paris cast application: A prospective study

Correlation between radiographic and functional outcome of distal radius fracture managed by closed reduction and plaster of Paris cast application: A prospective study

Outcomes of Distal Radius Fractures in Solid Organ Transplant Recipients

Outcomes of Distal Radius Fractures in Solid Organ Transplant Recipients

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.&#x0D; Aims: To evaluate the functional outcome of distal radial fractures treated with closed reduction and percutaneous pinning.&#x0D; 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.&#x0D; 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.&#x0D; 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.

A Case Series of Surgically Treated Distal Radius Fractures: Implant Costs and Their Effect on Patient Outcomes

Introduction: Distal radius fractures (DRFs) are common injuries, warranting a need to analyze the cost of treatment. The purpose of this study was to analyze the effect of implant costs on patient-reported outcomes in DRFs. Methods: A PRO registry was retrospectively reviewed for isolated, surgically treated DRF patients. A total of 140 patients met criteria to be included in this study. Implant cost was obtained from the chargemaster database. Results: The average total implant cost was $1,289.67 ± 215.32. The average Patient-rated Wrist Evaluation scores preoperatively, at 6 weeks, and at 12 weeks were 70.8 ± 20.1, 36.6 ± 21.1, and 22.8 ± 18.0, respectively. No statistically significant relationships were observed between cost and Patient-rated Wrist Evaluation scores at 6 weeks or 12 weeks (r = −0.05, P = 0.59; r = −0.04, P = 0.64, respectively). Implant costs were shown to not be affected by fracture complexity (AO/OTA classification: 23A = $1,335.50, 23B = $1,246.86, and 23C = $1,293.14). Discussion: The total cost of implants did not influence patient outcomes indicating that patients receive no additional benefit from more costly constructs.

Distal radial fractures in adults: 4 versus 6weeks of cast immobilisation after closed reduction, a randomised controlled trial.

In this study, we aim to evaluate whether the functional outcome of Distal Radius Fractures (DRFs) could be enhanced by shortening the period of immobilisation from six weeks to four weeks. This study is a single blinded randomised controlled trial. Four week plaster cast immobilisation was compared with six week plaster cast immobilisation in adult patients (older than 18years) with adequately reduced DRFs. The primary outcome parameters were functional outcome measured by Quick DASH score after 1-year follow-up. Secondary outcomes were: Quick DASH after three months, 6months, range of motion, and complications (such as number of re-interventions, secondary displacement, delayed and non-union). 80 patients (16 male and 64 female, mean age, 61.76years) were included and randomized. 65 patients completed the 1-year follow-up. After 1-year follow up, no significant differences were found between the two groups in the QUICK DASH score (P = 0.55). Moreover, no significant differences in DASH Score after three and six months (P = 0.24, 0.28, respectively). The complication rate among both cohorts was almost similar, (P = 0.51). Reduction in the time of cast immobilisation in patients with DRFs in accepted position reported similar outcomes. Of note, the complication rate in the four and six weeks was also the same. Thus, 4weeks in cast is a safe immobilisation period. Clinical Trials Number Trial registration number and date of registration for prospectively registered trials at http://ClinicalTrials.gov (NCT05012345), on 19/08/2021.

Should ulnar styloid be fixed following fixation of a distal radius fracture?,

IntroductionFracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus, the treatment remains controversial. However, it has been shown that fractures at the base of the ulnar styloid have a higher incidence of tears in the triangular fibrocartilage complex (TFCC) and instability in the distal radioulnar joint (DRUJ), which can lead to nonunion and impaired function. Despite this, there are currently no studies comparing the outcomes of surgically and conservatively treated patients. MethodsA retrospective study was conducted to analyze the outcomes of intra-articular distal radius fractures associated with base of ulnar fracture treated with distal radius LCP fixation. The study included 14 patients who were treated surgically and 49 patients who were treated conservatively, with a minimum follow-up of 2 years. Radiological parameters such as union and amount of displacement, VAS score for ulnar-sided wrist pain, functional assessment using the modified Mayo score and the quick DASH questionnaire and complications were analyzed. ResultsAt the final follow-up, the mean scores for pain (VAS), functional outcomes (modified Mayo score), disability (QuickDASH score), range of motion, and non-union rate were found to be statistically insignificant (p > 0.05) between the surgically treated and conservatively treated groups. However, patients with non-union had statistically significant higher scores for pain (VAS), greater post-operative displacement of the styloid, poorer functional outcomes, and higher disability (p < 0.05). ConclusionWhile there was no significant difference in ulnar-sided wrist pain and functional outcomes between the surgically treated and conservatively treated groups, the conservatively treated cases had a higher risk of non-union, which can negatively impact functional outcomes. The amount of pre-operative displacement was found to be a key factor in predicting non-union and can be used as a guide for determining the management of this type of fracture.

Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-Specific Fixation.

Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t -Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion ( p = 0.08), extension ( p = 0.33), supination ( p = 0.35), or pronation ( p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.

A study of functional outcome of distal end radius fractures treated by dorsal radius plating

Aims: To identify the current pattern of distal end radius fractures (presenting to this institute) requiring internal fixation with dorsal radius plating.To determine the outcome of fixation of distal end radius fractures using dorsal radius plating.To study complications following fracture surgery and to assess possible risk factors for complicationsObjectives: To study patient characteristics, mechanism of injury and fracture morphology of fractures requiring internal fixation using dorsal radius plating.To analyze outcome factors like functional score, surgical complications, radiological parameters, union status and union time of distal end radius fractures.To establish possible patient, fracture and implant characteristics that could contribute to the outcome.This study is an attempt to evaluate 44 cases of dorsal radius plating in case of distal end radius fracture and to assess the functional outcomes of dorsal radius plating. To ascertain whether modifiable characteristics like timing of surgery, implant positioning etc. contribute significantly to the outcome of distal radius fractures treated using dorsal radius plating. In our study out of 44 patients, 27 male and 17 female patients enrolled in study with mean age of 44 years (range 19-70). All patients had union at the final follow up at 3 months. Our study has a male preponderance with 61.36%.In our study dominant side is involved 65.90%. In our study based on AO classification we had 14(31.81%) of type A fracture, 10(22.72%) of type B and 20 (45.45%) of type C fractures. At final follow up 3 patients had less than 60 degree palmar flexion and 5 patients had less than 60 degree dorsiflexion. No patients had difficulty in radial and ulnar deviation.1 patient had movement restriction as a late complication. In our study average duration of fracture union was 7 weeks. Dorsal radius plating remains the standard treatment in dorsally displaced distal end radius fractures. Dorsal plates are used in all age groups, including osteoporotic fractures. Dorsal plating does not significantly increase operative time. Dorsal plating has a significantly low hospital stay. Functional range of motion are achieved for the patients even to continue activities involving labor work. Complications of dorsal plating are minimal and are comparable to any other orthopaedic surgical procedure. Proper reduction of fracture and surgical exposure is required for better outcomes of such fixations. Use of dorsal plates in distal radius fractures provides good to excellent results with correction and maintenance of distal radial anatomy.

Functional outcome of distal radius fractures managed by MIPO: A prospective study of 25 patients

Introduction: A distal radius fracture is a common injury that affects people of all ages. However, there are various therapy approaches that are controversial. The gold standard for treating distal radius fractures is yet unknown. Casting with or without closed reduction has long been considered a feasible option for treating distal radius fractures; alternative options include k-wire fixation and ligamentotaxis with external fixation. However, with limited function and impairments, the results are frequently poor.

A study of functional outcome of clavile fractures treated by clavicle plating

Aims 1. To identify the current pattern of clavicle fractures (presenting to this institute) requiring internal fixation with clavicle plating. 2. To determine the outcome of fixation of clavicle fractures using clavicle plating. 3. To study complications following fracture surgery and to assess possible risk factors for complications Objectives 1. To study patient characteristics, mechanism of injury and fracture morphology of fractures requiring internal fixation using clavicle plating. 2. To analyze outcome factors like functional score, surgical complications, radiological parameters, union status and union time of clavicle fractures. 3. To establish possible patient, fracture and implant characteristics that could contribute to the outcome. This study is an attempt to evaluate 20 cases of clavicle plating in case of clavicle fracture and to assess the functional outcomes of clavicle plating. To ascertain whether modifiable characteristics like timing of surgery, implant positioning etc. contribute significantly to the outcome of distal radius fractures treated using clavicle plating. In our study out of 20 patients, 18 male and 02 female patients enrolled in study with mean age of 34 years (range 19-58). All patients had union at the final follow up at 4 months. Our study has a male preponderance with 90.00%. In our study dominant side (left) is involved 55.00%.in our study based on AO classification we had 0(00.00%) of type A fracture, 17(85.00%) of type B and 3(15.00%) of type C fractures. At final follow up 3 patients had excellent results and 12 patients had good results and 1 patient has poor results No patients had difficulty in abduction up to 100 degree. 1 patient had plate exposed as an complication. In our study average duration of fracture union was 7.3 weeks. Clavicle plating remains the standard treatment in clavicle fractures. Clavicle plating does not significantly increase operative time. Clavicle plating has a significantly low hospital stay. Functional range of motion are achieved for the patients even to continue activities involving labor work. Complications of clavicle plating are minimal and are comparable to any other Orthopaedic surgical procedure. Proper reduction of fracture and surgical exposure is required for better outcomes of such fixations. Use of clavicle plates in clavicle fractures provides good to excellent results with correction and maintenance of clavicle anatomy.

Are the Clinical Results of Locking Plate Fixation for Distal Radius Fractures Inferior in Patients over 80 Years of Age? A Multicentre (TRON Group) Study.

With the aging of the population, the proportion of distal radius fracture patients who are > 80years of age is increasing. In this study, we compared the postoperative clinical and radiographic outcomes between super-elderly patients (age: ≥ 80years) and middle-elderly (age: 65-79years) who were treated with volar locking plate (VLP) fixation for distal radius fractures. Patients of > 65years of age with distal radius fractures treated by VLP fixation between 2015 and 2019, and who were followed for at least 6months after surgery were included in our database (named TRON). Patients with open fractures, multiple-trauma, or who received fixation with implants other than a VLP were excluded. We evaluated postoperative complications, Mayo wrist score (MWS), and radiographic outcomes. We identified 589 patients in this study; 452 were 65-79years of age (Group A) and 137 were ≥ 80years of age (Group B). After propensity score matching, we evaluated 309 patients in Group A and 103 patients in Group B. The mean follow-up period was 10.7 ± 4.6months. Twenty-eight patients (9.1%) in Group A and 5 patients in Group B (4.9%) experienced post-operative complications (non-significant: p = 0.212). The postoperative MWS at 1, 3, and 6months, respectively, was 65.4 ± 11.7, 75.2 ± 11.0, and 79.6 ± 10.5 in Group A and 67.1 ± 9.61, 75.7 ± 10.7, and 80.6 ± 9.7 in Group B (non-significant: p = 0.418, 0.893, 0.452, respectively). The differences in volar tilt, radial inclination, ulnar variance between the postoperative and last follow-up radiographs did not differ between the two groups to a statistically significant extent (p = 0.053, 0.437, 0.529, respectively). Our study showed that the clinical and radiographic outcomes of distal radius fractures treated with VLP in super-elderly patients were comparable to those in middle-elderly patients.

SURGICAL OUTCOMES OF VOLAR LOCKING PLATE VERSUS K-WIRES FIXATION FOR DISTAL RADIUS FRACTURES

Background and Objective: The most common hand fractures among adult population are distal radius fractures and optimal management of these fractures remains controversial. Several surgical strategies are available to treat these fractures. Two most commonly used procedures volar locking plates and percutaneous K-wire fixation are used to treat distal radius fractures.The objective of this study was to compare outcome in distal radius fractures in volar locking plate and in K-wire fixation and in terms of functional and clinical outcome. Methods: We conducted a randomized control trial at department of orthopedic surgery, Services Institute of Medical Sciences Lahore. After approval from the Ethical Review Board, a total number of 80 patients with distal radius fractures fulfilling the inclusion criteria were included. In Group A, distal radius fractures were fixed with volar locking plate and in Group B, K-wires were used to fix the distal radius fractures. Patients with polytrauma, head injury and spine injury were excluded from the study. Follow up was done at 2, 4, 6 weeks, 3 months and final at 6 months. Functional and clinical outcomes were measured with DASH Score and PREW Score at 3 months and 6 months. Results:- Age range was 18-80 years, mean age was 61.3 + 14.5 years. Mechanism of injury was fall on outstretched hands in 45 (56.2%) patients, fall from height in 20 (25.0%) patients, motorbike accidents in 7 (8.8%) patients, injury after fight in 4 (5.0%) patients and 4 (5.0%) patients were having machine injury. No difference in radiological outcomes was recorded in the final follow up. There was no difference in volar tilt loss. It was 0.5o in plate group and 0.7o in K-wires group (p = 0.92). Radial length loss was 1mm in Group A and 1.2mm in Group B (p = 0.55). The loss of angle of radial inclination was 1.2o in Group A and 1.5o in Group B (p = 0.35) at the final follow up. There were 04 cases of superficial infection in Group B (10%) versus 01 in Group A (2.5%, p = 0.001). Conclusion:- Our study shows that no mode of treatment in distal radius fractures is superior to other. The results of volar locking plate as compared to K-wire fixation were slightly better in the initial period but on long term bases both of these techniques have excellent and comparable results. DASH Score and PREW Score were almost equal in both of these techniques. The functional outcomes were almost equal in both of these techniques The complication rate although slightly more in K-wires group but it was insignificant from functional point of view.