Outcome Of Distal Radius Fractures Research Articles

The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients

Purpose of the studyTreatment of distal radius fractures in elderly patients is controversial. This study explored the relationship between radiographic parameters and clinical outcomes of patients with distal radius fractures following conservative treatment. The study was done using radiographic measurements of distal radius fractures in elderly patients. Patients and methodsNinety-two active, healthy patients with conservatively managed distal radius fractures were included in the study. Functional and radiographic assessments were made 1year after injury. Fifty patients who underwent corrective osteotomy comprised the control group. Radiographic parameters and clinical outcomes were compared between the two groups. The correlation coefficients of the radiographic parameters were analysed using multiple regression. ResultRadius height (RH), volar tilt (VT) and Mayo wrist and Disabilities of the Arm, Shoulder and Hand (DASH) scores in the experimental group were significantly superior to those of the control group. There was no significant group difference in radial inclination. Multiple regression analysis revealed that the most important factor affecting functional outcome was RH, followed by VT. DiscussionRH and VT were significantly correlated with the clinical outcomes of conservative treatment of distal radius fractures. RH should be given foremost consideration in elderly patients. Preoperatively, surgeons should evaluate this parameter carefully and be prepared to treat injuries accordingly. Level of evidenceLevel IV retrospective study.

Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome.

We aimed to evaluate the influence of associated scapholunate (SL) and/or lunotriquetral ligament (LT) injury on the outcome of distal radius fractures. This prospective study included 40 patients with surgically treated distal radius fracture. Wrist arthroscopy was used to identify associated lesions of the scapholunate and lunotriquetral ligaments and classify them according to Geissler. Patients were divided in two groups by presence (injured group) or absence (intact group) of associated injury of the SL and/or LT ligament. The patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaires were used to evaluate disability 3 and 6months after injury. Grip strength was also evaluated. Wrist arthroscopy identified SL and/or LT injury in 15 patients (37.5%). Mean total PRWE score for the intact group was 26.64 at 3months and 16.22 at 6months, and 50.47 (at 3months) and 20.7 (at 6months) for the group with ligament injury. Mean DASH scores were 26.03 and 13 at 3 and 6months for the intact group, and 49.5 and 24.11 for the injured group. Mann-Whitney test results showed significant difference for the PRWE and DASH scores and the grip strength for the two examined groups. Patients with distal radius fracture with associated intrinsic ligament injury had worse outcomes than did patients without associated ligamentous injury. Associated injuries of the SL and LT ligament should be considered when treating distal radius fractures, and wrist arthroscopy should be incorporated into the operative protocol.

Functional outcome of distal radius fractures managed by barzullah working classification.

Background:Management of distal radius fractures (DRFs) is still controversial and may be influenced by the initial fracture classification. Even though numerous classification systems have been proposed in this regard, the evaluation and management of this fracture has remained problematic.Objectives:The purpose of this study was to evaluate the functional outcome of DRF managed on the basis of a new classification. This classification named as Barzullah Working Classification represents a modification of Melone classification, which is based on fracture stability.Patients and Methods:A total of 310 DRFs of patients skeletally matured referred to a tertiary care hospital at a period of 18 months were classified as per the new classification system into four types; metaphyseal stable, metaphyseal unstable, radiocarpal stable, and radiocarpal unstable fractures. They were managed and followed over a mean period of 15.10 ± 5.4 months, and the results were recorded at the final follow-up.Results:The mean age of the patients was 51.22 ± 20.58 years. Most of the patients were females (n=189, 64.19%). The minimal follow up was 6 months with a mean of 15.10 ± 5.4 months. Mean mayo wrist scores were 95 ± 4, 80 ± 7.4, 75 ± 7.4, and 70 ± 6.9, for stable metaphyseal fractures, unstable metaphyseal radial, stable radiocarpal fractures and unstable radiocarpal fractures, respectively. The overall mean mayo wrist functional score was 80.58 ± 12.3 (good results) at final follow up.Conclusions:Various modalities of treatment used differentially in different types of DRFs based on the Barzullah Working Classification give good results in spite of conflicting literature.

Effect of ulnar styloid fracture on functional outcome of Colle's fractures: a comparative analysis of two groups

Background: The negative impact of ulnar sided injuries on distal radius fractures has opened another field of research and is gaining more attention. The aim of our study is to assess the impact of ulnar styloid process fracture on functional outcome of distal radius fractures managed conservatively. Methods: Radiological and Medical records of 150 patients of distal radius with and without styloid process fractures were retrospectively reviewed. Fractures were classified as per Frykman’s classification and patients were assessed for pain, grip and range of motion in addition to other parameters in Mayo’s wrist score. The instability at distal radioulnar joint was evaluated and compared in two groups. Results: There was a measurable difference in motion, strength, pain, or functional scores between the two groups. Mean mayo score at final follow up in Group I was 90±5 and in Group II was 80±4 and the difference was statistically significant (P value <0.05). DRUJ instability was noted in 20 % of patients in Group II and most of them were symptomatic. Conclusions: We conclude that presence of a fracture of ulnar styloid process with distal radius fracture results in a weak and painful wrist in a significant number of patients. They should be dealt more vigorously and managed effectively to prevent disabling distal radioulnar joint instability.

Which modality is the best choice in distal radius fractures treated with two different Kirschner wire fixation and immobilization techniques?

The aim of the study was to investigate whether the number and position of Kirschner (K)-wires, and the manner and duration of immobilization influence radiologic and functional outcomes of distal radius fractures treated with percutaneous K-wire fixation. Ninety-two patients were included into the study with a mean follow-up period of 19.84±5.22 months (range, 13-34 months). In Group I, forty-five patients were treated with 3 K-wires and supported with a volar semi-circular cast for the first 3 weeks followed by a removable splint for a further 3 weeks. In Group II, forty-seven patients were treated with 2 K-wires and supported with a below-elbow circular cast for 6 weeks postoperatively. No significant difference in grip strength and DASH scores was found between the two groups. In clinical examination, significantly better functional results were determined in patients supported with a removable volar splint. At 6 weeks postoperatively, volar tilt, radial inclination, and radial length were significantly better in Group I compared to Group II (all p values). Tripod technique with 3 K-wires is a safe and reliable procedure to achieve stability and good radiological results. The use of a removable splint also improves the functional outcomes in the treatment of both intra- and extra-articular distal radius fractures.

Is it really necessary to restore radial anatomic parameters after distal radius fractures?

Small variations within normal range of radiographic parameters, except ulnar variance and volar tilt, do not influence the final functional outcome in distal radius fractures. IntroductionThere are many reports in the literature on the relationship between radiographic variables and their influence on the final outcome of distal radius fractures. Most authors report that a good functional result depends on anatomical restoration of the articular surface and extra-articular alignment. The aim of this study was to verify if it is really necessary to restore anatomic radiographic parameters to obtain satisfactory functional outcome in distal radius fractures treated with volar plate. Materials and methodsWe retrospectively evaluated 51 patients treated with volar locked plate for articular unstable distal radius fractures from December 2006 to March 2009. Each fracture was evaluated according to the AO classification. The average follow-up was 40.5 months. Radiological measurements were performed considering radial height, radial inclination, volar tilt and ulnar variance, both preoperatively and postoperatively, to estimate the correction value. We examined range of motion (ROM), grip strength with a Jamar® dynamometer and Disabilities of the Arm, Shoulder and Hand (DASH) score. The τ Student test was performed for statistical analysis. ResultsThe persistence of articular step-off was assessed in 35.3% of patients. Normal radial inclination (21–25°) was restored in 74.5% of patients (range 15–27.5°). Normal radial height (10–13mm) was restored in 66.6% of patients (range 6.8–17.3mm). Normal volar tilt (7–15°) was achieved in 90.2% of patients (range 3–17°). Normal ulnar variance (0.7–1.5mm) was restored in 86.3% of patients (range 0.7–4.1mm). There was a statistically significant difference between the preoperative and postoperative radiographic values (p<0.01). The majority of patients showed complete recovery of ROM, with no statistically significant difference (p>0.05) in extension, flexion, supination and pronation compared with the contralateral hand. Eight patients who had postoperative volar tilt and/or ulnar variance out of range had a statistically significant difference (p<0.05) in ROM compared with the non-operated side. At final follow-up, all patients had a statistically significant difference (p<0.05) in grip strength compared with the contralateral side, even with good strength values. The mean DASH score was 12.2 (range 0–61). Discussion and conclusionOur experience suggests that ulnar variance and volar tilt are the most important radiographic parameters to be restored to obtain good functional outcome in distal radius fracture. Small variations of other radiographic parameters seem to not affect the final outcome at minimum 3 years’ follow-up.

Percutaneous Distal Radius–Ulna Pinning of Distal Radius Fractures to Prevent Settling

To evaluate the clinical and radiological outcomes of distal radius fractures treated by percutaneous fixation using distal radius-ulna pinning and to assess its effectiveness especially for preventing fracture settling. We retrospectively reviewed 18 distal radius fractures (15 AO type A2 and 3 AO type C1). Range of motion and Disabilities of the Arm, Shoulder, and Hand scores were evaluated. We measured radiographic parameters at the final follow-up and compared them with those on immediate postoperative x-rays. All fractures united and average time to initial healing was 6.9 weeks (range, 6-7 wk). Average follow-up was 29 months (range, 26-43 mo). Average wrist flexion and extension were 70° and 65°, respectively. Average forearm supination and pronation were 82° and 83°, respectively. Average pain score was 1.2 and average Disabilities of the Arm, Shoulder, and Hand score was 13. Mean difference of ulnar variance, volar tilt, and radial inclination between immediate and final follow-up x-rays was 0.7 mm, 1°, and less than 1°, respectively. Percutaneous fixation of distal radius fractures using distal radius-ulna pinning had favorable radiologic and functional outcomes and was effective in preventing fracture settling during initial healing in unstable extra-articular fractures and some simple sagittal split intra-articular fractures. Therapeutic III.

Radiographic outcomes of distal radius fractures treated by close reduction and external fixation with and without percutaneous pins

Background: External fixator is anappropriate device for the treatment of comminuted distal radius fractures, but there is no consensus about simultaneous supplementary percutaneous pinning. The present study was conducted to determine the short-term outcomes of comminuted distal radius fracture treated by close reduction and external fixation with and without supplementary pinning. Methods: This prospective study was carried out on 62 patients with distal radius fracture type III. All consecutive patients were treated by close reduction and External Fixator (EXF) (N=30) and close reduction, External Fixator (EXF) with supplemental percutaneous pinning (N=32). Radiographic images of the wrist were takenbefore treatment and 1 week, 3 weeks and3 months after treatment. Results: There was no significant difference between the Dorsiflexion (DF)means of the wrist in the pin (43.5±9.2) and no-pin (41.3±6.9) groups (P=0.099). There was also a significant difference between the Palmar Flexion (PF) means of the wrist in the pin (50.8±8.6) and no-pin (48.3±10.6) groups (p=0.041). Further, the means of wrist extension in the no-pin and pin groups were 16.3° and 17.2°, respectively, and for the wrist flexion in the no-pin and pin groups were 22° and 13.6°, respectively. The means of radial length difference in the pin and no-pin groups were 1.5 and 1.6 mm, respectively. Moreover, no significant difference was observed between radiographic indices of Radial Inclination (RI) and Volar Tilt (VT) in both groups. Conclusions: Insertion of percutaneous pinning did not contribute to the improvement of comminuted distal radius fractures treated with external fixator.

Contribution of Functional Parameters to Patient-Rated Outcomes After Surgical Treatment of Distal Radius Fractures

Outcomes of distal radius fractures can be measured radiographically, functionally, or via patient-rated questionnaires, but previous studies report conflicting results regarding the relationship between these outcomes. Our specific aim was to explore the role that functional outcomes have in the score of the Michigan Hand Outcomes Questionnaire (MHQ), a patient-rated hand instrument. We obtained data for 207 patients. Demographic information was collected as part of the MHQ. Function (wrist motion and grip and pinch strength) was assessed 3 and 6 months after fracture fixation. We applied linear regression analysis to determine each item's contribution to the total MHQ score. After we applied linear regression analysis, we determined that 3 months after fixation, all included factors contributed 37% of the MHQ score. Only the grip strength difference between the injured and uninjured hands was significantly associated, contributing 22% of the MHQ score. Six weeks and 6 months after fixation, all included factors contributed 43% and 34%, respectively, of the MHQ score. No individual factors were significant contributors. Measured functional outcomes variables account for less than 40% of the total MHQ score. Identifying the unmeasured factors that make up the additional 60% of the total MHQ score would be beneficial in the continued examination of patient-rated outcomes. Furthermore, the use of multiple outcomes assessment modalities should be considered in any study measuring patient-rated outcomes. Prognostic II.

The Association of Education Level on Outcome after Distal Radius Fracture

Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture. A series of patients with distal radius fractures (n = 335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured. Complete demographic and 12-month follow-up data were available on 227 patients (75%). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score. Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patient-related factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.

Radiographic outcomes of distal radius fractures treated by ORIF – Single centre review of 218 cases

Radiographic outcomes of distal radius fractures treated by ORIF – Single centre review of 218 cases

A Simple Method for Choosing Treatment of Distal Radius Fractures

To design an easy-to-use guide for decision making in distal radius fractures in patients older than 50 years and to retrospectively analyze its ability to predict treatment in 164 patients. The present study consisted of 4 parts. The first part was a review of the literature to identify possible important factors that predict treatment outcome of distal radius fractures in patients 50 years old and older. The second part identified which of these first-tier factors that orthopedic surgeons consider to be important by a questionnaire that was sent to 83 orthopedic surgeons qualified by the Japanese Orthopedic Association with response rate of 61%. The third part further identified which of the subsets of factors best predict outcome in a retrospective study of 41 patients 50 years old or older, yielding a final subset of factors to create a scoring system. The fourth part of the study then evaluated the ability of this scoring system to predict the outcome as evaluated by the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score in a retrospective study of 164 distal radius fractures in patients 50 years old or older. The 164 patients were divided into 4 groups by the present scoring system: conservative group, relative conservative group, relative surgical group, and surgical group according to the recommended therapeutic modalities. Clinical outcomes of those that followed the recommendation of the present scoring system resulted in favorable consequences. In contrast, the outcomes of those not following the recommendation were inferior. The present scoring system may be used as an easy-to-use decision-making tool when choosing conservative or surgical treatment for distal radius fractures.

Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research

Lack of standardization of outcome measurement has hampered an evidence-based approach to clinical practice and research. We adopted a process of reviewing evidence on current use of measures and appropriate theoretical frameworks for health and disability to inform a consensus process that was focused on deriving the minimal set of core domains in distal radius fracture. We agreed on the following seven core recommendations: (1) pain and function were regarded as the primary domains, (2) very brief measures were needed for routine administration in clinical practice, (3) these brief measures could be augmented by additional measures that provide more detail or address additional domains for clinical research, (4) measurement of pain should include measures of both intensity and frequency as core attributes, (5) a numeric pain scale, e.g. visual analogue scale or visual numeric scale or the pain subscale of the patient-reported wrist evaluation (PRWE) questionnaires were identified as reliable, valid and feasible measures to measure these concepts, (6) for function, either the Quick Disability of the arm, shoulder and hand questionnaire or PRWE-function subscale was identified as reliable, valid and feasible measures, and (7) a measure of participation and treatment complications should be considered core outcomes for both clinical practice and research. We used a sound methodological approach to form a comprehensive foundation of content for outcomes in the area of distal radius fractures. We recommend the use of symptom and function as separate domains in the ICF core set in clinical research or practice for patients with wrist fracture. Further research is needed to provide more definitive measurement properties of measures across all domains.

R-S1.1 Long-term functional and radiological results of distal radius fractures after treatment with the Locking Compression Plate

R-S1.1 Long-term functional and radiological results of distal radius fractures after treatment with the Locking Compression Plate

Distal Radius Fractures Using Acu-Loc Volar Plate

Objective: We determined the radiographic outcome of distal radius fractures with Acu-loc volar plate. Methods: Forty-one patients were recruited between August 2009 and September 2010. There were 10 males and 31 females, with a mean age 61.2. Fractures were radiologically classification the Frykman. Fifteen fractures were group 8, eight were group 7, ten were group 6, four were group 5 and four were group 3. Distal part of the fractures was dorsally inclined in 37 wrists and inclined to volar side in four wrists. Lateral and anteroposterior radiographs taken after operated day, the fracture were compared with radiographs of the injured wrist and the differences in palmar tilt, ulnar variance; radial height; radial shift and radial inclination were measured. Results: There was significant improvement in the measurements of radial height, radial inclination, volar tilt, ulnar variance and radial shift postoperatively. The radial height improved from an average of 8.5 mm (range, 3 to15 mm) to 11.0 mm (range, 8 to15 mm), the radial inclination improved from an average of 21.5 degree (range, 10 to 40 degree) to 28.1 degree (range, 19 to 44 degree), the palma tilt improved from an average of 12.9 degree (range, 6 to 22 degree) to 17.2 degree (range, 7 to 27 degree), the ulnar variance improved from an average of -2.3 mm (range, -6 to 4 mm) to 1 mm (range, -3 to 7 mm) and the radial shift improved from an average of 18.7 mm (range, 15 to 26 mm) to 17.3 mm (range, 12 to 21 mm). Conclusion: Acu-loc volar plate is a safe and effective device.

The operative results of distal radius fracture using intramedullary nail

The operative results of distal radius fracture using intramedullary nail

Comminution of the dorsal metaphysis and its effects on the radiographic outcomes of distal radius fractures

Comminution of the dorsal metaphysis is a relatively common feature of distal radius fractures. However, its effects on the radiographic outcomes of these fractures are not entirely understood. One hundred and twenty-four conservatively managed distal radius fractures were analysed retrospectively to assess the effect of dorsal metaphyseal comminution on fracture stability, especially with respect to initial displacement (minimally displaced versus displaced) and age group. Seventy-seven fractures (62%) had radiographic evidence of dorsal comminution. The secondary displacement rate of these fractures was 75%, compared to 45% in non-comminuted counterparts (P<0.001). In minimally displaced fractures, the secondary displacement rate was higher in those with dorsal comminution as compared to those without (57% vs. 31%, P=0.086). Dorsal metaphyseal comminution was found in 75% of fractures in patients 65+years old (P=0.05). Among those with dorsal comminution, the secondary displacement rates were similar for both men and women (63% vs. 79%; P=0.20). In conclusion, distal radius fractures with dorsal metaphyseal comminution had significantly higher rates of secondary displacement compared to non-comminuted counterparts, and there exists a correlation with this displacement and increasing patient age but not gender.

The analysis of prognostic relative factors in patients with type-C fractures of distal radius after internal fixation

To explore the clinical relative factors on the therapeutic effect of wrist joint function in patients with type-C fractures of distal radius treated with internal fixation. Retrospectively collect consecutive patients of type-C fractures of distal radius treated surgically with open reduction and internal fixation admitted from January 2001 to October 2007. Making Gartland and Werley Score of wrist joint function as the primary outcome variable, the following were assessed: the postoperative efficacy at the follow-up, and use non-conditional Logistic regression to analysis the correlation of wrist joint function with patients' age, gender, time from injury to operation, classifications of type-C fracture, methods of internal fixation and other clinical factors. In this study, 56 patients met the inclusion were collected. The follow-up time was 3.1 to 29.2 months (mean follow-up 6.3 months). The result of Gartland and Werley Score: 24 patients were excellent, good 26, fair 3, and poor 3; the excellent and good rate was 89.29%. Monovariant and multivariant Logistic regression analysis demonstrated that postoperative efficacy was significantly associated with elder age, time from injury to operation, methods of internal fixation:age (OR = 4.64; 95%CI: 1.48 - 14.54; P = 0.009), time from injury to operation (OR = 9.00; 95%CI: 1.72 - 46.99; P = 0.009), methods of internal fixation (OR = 3.33; 95%CI: 1.10 - 10.12; P = 0.034). Elder age (>or= 65 years) and delay of surgery (>or= 13 d) are the influential factors of postoperative functional outcome of distal radius fractures. For the treatment of intra-articular type-C fractures of distal radius, locking compression plate is more effective than T-type plate.

Fractures of the distal radius treated by internal fixation: a retrospective study of 105 cases

Objective To evaluate the functional and radiological outcomes of distal radius fractures treated with open reduction and internal fixation (ORIF) and to analyze the possible influencing factors. Methods One hundred and five fractures of the distal radius were treated with open reduction and internal fixation. Sixty-three fractures were treated with locking compression plate(LCP), 40 fractures with AO T-plate, 1 fracture with external fixation, 1 fracture with external fixator and Kirschner wire. The functional and radiolngical outcomes were evaluated with Visual Analog Scale(VAS), Gartland & Werley and Batra scoring systems, and the possible influencing factors were analyzed. Results The mean follow-up time was 25 months. By Gartland & Werley scoring, 80.0% of the patients were excellent, 19.0% good, and 1.0% fair. According to Batra radiological scoring system, 60 cases(57.1%) were excellent, 37 cases (35.2%) good, 5 cases (4.8%) fair, and 3 cases (2.9%) poor. The final radiological scores in patients younger than 65 were better than elder ones (P = 0.013). Patients with a modest type of fracture had a higher Gartland & Werley score than those with a severe one (P=0.046) . Patients who had been reduced satis-factorily in the operation had a higher Gartland & Werley score than those less satisfactorily (P=0.042). Conclusions ORIF using plates in the treatment of distal radius fractures will achieve good outcomes. Age may be an influencing factor for radiological scoring, while reduction in the operation and AO types of fractures are the influencing factors for Gartland & Werley scoring. Key words: Radius; Fractures; Fracture fixation; Treatment outcome

Functional and radiological outcomes in distal radius fractures treated with a volar plate vs. an external fixator

Purpose To compare the functional and radiological results obtained in distal radius intraarticular fractures treated by means of internal fixation with a volar buttress plate vs. those treated with an external fixator. Materials and methods We performed a comparative retrospective study of two patient series: 36 distal radius fractures treated with a volar AO T 2.4/2.7 buttress plate and 40 fractures treated with Pennig's dynamic external fixator. We used Müller's AO-ASIF classification following the anteroposterior and lateral x-ray study. We collected data about patient characteristics, mechanism of injury and postoperative complications. Minimum follow-up was 10 months. We performed clinical and radiographic evaluations at the beginning, at 3 months and at the end of follow-up. We used Lidström's scale for the functional assessment. Results In the group treated with a volar buttress plate better results were obtained for ulnar inclination of the radius and volar inclination on the sagittal plane. In this group only one case was left with an intraarticular step-off greater than or equal to 3 mm, as compared with 6 cases in the group treated with external fixation. 80% of patients treated with a volar plate obtained excellent or good results on the Lidström scale, as compared with 72.5% in the external fixation group, there being no statistically significant differences between the two groups. 30% of patients treated with an external fixator developed complications during follow-up, as compared with 22.2% in the volar plate group. OR time in the volar plate group was 74 minutes on average, whereas in the external fixation group it was 42 minutes. Mean time to postoperative mobilization was 12 days in the volar plate group. In patients treated with external fixation, the fixator was dynamized at 40 days on average and withdrawn at 62 days on average. Conclusions Our study shows that both kinds of treatment seem to afford similar radiological and functional results. Direct reduction followed by volar buttress plate fixation seems to provide for a more stable sort of anatomical reduction. Nevertheless, such difference does not lead to better functional outcomes. Both methods of treatment present with an acceptable postoperative complications rate.