Treatment Of Distal Radius Fractures Research Articles

Regional anesthesia is associated with prolonged operative time and unplanned inpatient admission in distal radius fractures

Background: Regional anesthesia is commonly used as an alternative to general anesthesia in the surgical treatment of distal radius fractures. The purpose of this study is to evaluate the effect general versus regional anesthesia has on post-operative outcomes and perioperative time in the open treatment of distal radius fractures. Methods: The National Surgical Quality Improvement Program database was queried to identify adult who underwent open reduction and internal fixation of distal radius fractures between 2005 and 2018. Patients were classified as receiving either general anesthesia or regional anesthesia. Mean perioperative times and length of stay were compared between groups. Univariate analysis and multivariate logistic regression were used to assess the risk of prolonged operative time and of 30-day post-operative complications, based on anesthesia type. Results: A total of 13,059 patients were identified, with 11,761 (90.1%) receiving GA and 1,298 (9.9%) receiving RA. RA was associated with a significantly longer duration of anesthesia (124.5 vs. 115.7 min) and total operative time (77.0 vs. 72.6 min) but shorter wake-up times (11.8 vs. 13.0 min). Using multivariate analysis, RA was independently associated with an increased risk of prolonged operative time (OR 1.448; CI 1.234-1.699; P<0.001) and unplanned inpatient admission (OR 1.225, CI 1.019-1.545, P=0.033). The risk of all other acute postoperative complications was similar between groups. Conclusion: Regional anesthesia is independently associated with prolonged operative time and unplanned inpatient admission but not with acute postoperative complications in the open treatment of distal radius fractures. Level of Evidence: III

Basic principles of surgical treatment of distal radius fractures

Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with alow risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.

Routine follow-up imaging is not necessary in uneventful early recovery after distal radius fractures treated with volar locking plate in working-aged patients: A retrospective single-center cohort study.

The purpose of our study was to evaluate whether routine follow-up radiographs after distal radius fracture (DRF) treated with volar locking plate (VLP) influenced clinical decision-making and treatment in working-aged patients (18-65 years). We evaluated the possible correlation between clinical status and problems with follow-up radiographs and analyzed the overall reoperation rate. The study population of this retrospective cohort study consisted of working-aged (18-65 years) patients with DRF who were treated with VLP between January 2010 and December 2020. Baseline data, follow-up visits, and radiographs were collected. Radiographs were classified as either routinely assigned or according to clinical findings. Patients were divided into four groups based on abnormal radiographic findings or major symptoms leading to reoperation. Patients also received patient-rated wrist evaluation (PRWE) questionnaire, which were analyzed. A total of 861 patients were included in this study. Routine follow-up radiographs were available for 844 (98%) patients. In 7.0% of patients, 6-week radiographs led to a change of standard treatment protocol, most commonly additional imaging and/or clinical follow-up. Nine (1.1%) patients underwent an urgent reoperation, and 15 (1.8%) patients underwent reoperation later in the follow-up period. All these patients were exceptionally painful/symptomatic. In addition, 33 (3.9%) patients who underwent additional imaging and follow-up after abnormal radiograph, but did not undergo reoperation, were asymptomatic or suffered only mild pain. A total of 89 (10.5%) patients had reoperation for any reason during the follow-up period. Routine follow-up radiographs after the treatment of DRF with VLP in the working-aged population rarely leads to changes in treatment strategy or reoperation in asymptomatic patients suggesting that it would be safe and cost-effective to reduce routine follow-up radiographs and focus instead on those patients with moderate-to-severe symptoms.

Radiographic and clinical outcomes of muenster and sugar tong splints for distal radius fractures: a comparative study

BackgroundNon-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs.MethodsIn this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients’ satisfaction after treatments.ResultsThere were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images.ConclusionsThe study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures.Level of evidenceLevel IV; Retrospective Comparison; Treatment Study.

Three-dimensional imaging of the forearm and hand: A comparison between two 3D imaging systems.

The conventional treatment for distal radius fractures typically involves immobilization of the injured extremity using a conventional forearm cast. These casts do cause all sorts of discomfort during wear and impose life-style restrictions on the wearer. Personalized 3D printed splints, designed using three-dimensional (3D) imaging systems, might overcome these problems. To obtain a patient specific splint, commercially available 3D camera systems are utilized to capture patient extremities, generating 3D models for splint design. This study investigates the feasibility of utilizing a new camera system (SPENTYS) to capture 3D surface scans of the forearm for the design of 3D printed splints. In a prospective observational cohort study involving 17 healthy participants, we conducted repeated 3D imaging using both the new (SPENTYS) and a reference system (3dMD) to assess intersystem accuracy and repeatability. The intersystem accuracy of the SPENTYS system was determined by comparison of the 3D surface scans with the reference system (3dMD). Comparison of consecutive images acquired per device determined the repeatability. Feasibility was measured with system usability score questionnaires distributed among professionals. The mean absolute difference between the two systems was 0.44 mm (SD:0.25). The mean absolute difference of the repeatability of the reference -and the SPENTYS system was respectively 0.40 mm (SD: 0.30) and 0.53 mm (SD: 0.25). Both repeatability and intersystem differences were within the self-reported 1 mm. The workflow was considered easy and effective, emphasizing the potential of this approach within a workflow to obtain patient specific splint.

Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi.

Little is known about the burden or management of distal radius fractures (DRFs) in low- and middle-income countries. The purpose of this study was to describe the care of DRFs in Malawi. We retrospectively reviewed a registry of all patients with fractures who presented to the orthopaedic departments at four public hospitals in Malawi. Totally, 1,440 patients (14.5%) were with a DRF. Average age was 40, and 888 (62.0%) were male. Surgery was done for 122 patients (9.5%). Patients presenting to Queen Elizabeth Hospital, patients presenting after a fall, and patients initially evaluated by an orthopaedic registrar or orthopaedic clinical officer had lower odds of receiving surgical treatment. Meanwhile, open injuries had the greatest odds of receiving surgery. The most common musculoskeletal injury among patients in the Malawi Fracture Registry was fractures of the distal radius. These most affected young adult male patients may benefit from surgery; however, the majority were managed nonsurgically. Lack of access to surgical fixation and conservative follow-up may have long-term functional consequences in a predominantly agrarian society. Outcomes-based research is needed to help guide management decisions and standardize patient care and referral protocols.

Treatment of Distal Radius Fractures in Elderly Patients:
 A Review

Background. Distal radius fractures (DRF) are one of the most common injuries in the elderly population. Their incidence increases steadily, with epidemiologists predicting further growth. Despite its growing prevalence, the efficacy of surgical treatment for this pathology in elderly patients remains debatable.
 Aim — to determine the optimal method for treating distal radius fractures in the elderly population basing on a comparative analysis of the literature data on various treatment methods, including conservative and surgical ones.
 Methods. A search was performed in PubMed/MEDLINE, Scopus, Google Scholar, and eLIBRARY databases according to the following keywords, their derivatives and combinations in the titles and abstracts: treatment, distal radius fracture, elderly. Initial analysis for meeting the inclusion criteria was performed on the article titles and abstracts, followed by analysis of the full-text articles. The sources with unavailable full-text versions were excluded from the analysis.
 Results. Current epidemiological data were studied, specific aspects of physical examination of elderly patients with distal radius fractures were described, the main treatment methods were determined. The main treatment method remains the conservative one: closed reduction and immobilisation. Open reduction and internal fixation with a volar locking plate has become the leading surgical treatment method in recent decades, replacing such methods as closed reduction and fixation with wires or external fixation. At early follow-up, elderly patients operated on with volar locking plate show better functional results than those who received conservative treatment. However, at long-term follow-up, most studies show no significant differences in functional outcomes after surgical and conservative treatment, despite the differences in radiological data in favour of surgical treatment.
 Conclusion. For the majority of elderly patients, conservative treatment may be the optimal treatment option. Surgical intervention using a volar locking plate may be justified for certain groups of elderly patients, as this method may accelerate rehabilitation after injury.

Cast immobilization duration for distal radius fractures, a systematic review.

The optimal duration of immobilization for the conservative treatment of non- or minimally displaced and displaced distal radius fractures remains under debate. This research aims to review studies of these treatments to add evidence regarding the optimal immobilization period. A comprehensive database search was conducted. Studies investigating and comparing short (< 3weeks) versus long (> 3weeks) immobilizations for the conservative treatment of distal radius fractures were included. The studies were evaluated for radiological and functional outcomes, including pain, grip strength, and range of motion. Two reviewers independently reviewed all studies and performed the data extraction. The initial database search identified 11.981 studies, of which 16 (involving 1.118 patients) were ultimately included. Patient-reported outcome measurements, grip strength, range of motion, and radiological outcomes were often better after shorter immobilization treatments. Radiological outcomes were better with longer immobilization in two studies and shorter immobilization in one study. Fourteen studies concluded that early mobilization is preferred, while the remaining two studies observed better outcomes with longer immobilization. The data were unsuitable for meta-analysis due to their heterogeneous nature. Shorter immobilization for conservatively treated distal radius fractures often yield equal or better outcomes than longer immobilizations. The immobilization for non- or minimally displaced distal radius fractures could therefore be shortened to 3 weeks or less. Displaced and reduced distal radius fractures cannot be immobilized shorter than 4weeks due to the risk of complications. Future research with homogeneous groups could elucidate the optimal duration of immobilization.

Comparison of time-efficiency of individually wrapped screws and sterile screw racks in distal radius fracture treatment.

Time-efficiency of individually wrapped screws versus screws in a screw rack is not well established. We performed a prospective single-center clinical study timing the interval between the surgeon asking and receiving a screw during plate and screw osteosynthesis of distal radius fractures. Patients were randomized for individually wrapped screws or screws in a screw rack. The study was conducted in a Level 1 Trauma Center and surgeries were performed between March and June 2023. Average handling time for screws from a screw rack was 9 s (SD 5.5; range 3-28) and 22 s for individually wrapped screws (SD 6.1; range 6-38). This average difference of 13 s is significant (p < 0.0001). There is a significant increase in handling time using individually wrapped screws over using a screw rack. Level I (therapeutic, randomized controlled trial).

The Effect of Age and Sex on Early Postoperative Outcomes after Surgical Treatment of Distal Radius Fractures.

Background: We aim to evaluate the impact of advanced age and sex on postoperative complications and radiographic outcomes after open reduction with internal fixation of distal radius fractures (DRF). Methods: We conducted a retrospective chart review, including all patients who underwent open reduction with internal fixation of a DRF between 2012 and 2018 at a single level 1 trauma centre. We recorded patient age, sex, fracture classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA]), time from injury to surgical date, surgical duration, diabetes status, tobacco use, illicit drug use, history of osteoporosis, use of adjuvants, fixation type, postoperative radiographic restoration of normal parameters and early complications including loss of reduction within 30 days postoperatively. Advanced age was defined as age greater than 60 years. Results: A total of 521 patients underwent operative treatment - 264 males and 257 females. Males were twice as likely (23.5% vs. 10.1%; p < 0.0001) to sustain a type C3 fracture and be treated with a wrist spanning plate (5.3% vs. 0; p < 0.0001). A larger percentage of elderly patients undergoing operative treatment of DRF were female (20.2% vs. 5.7%; p < 0.0001) and females were more likely to carry a pre-injury diagnosis of osteoporosis (9.3% vs. 0%; p < 0.0001). And 100% of the elderly patients received were treated with a volar plate. The overall early loss of reduction was 7.5%. The overall complication rate was 8.2%. No differences in early postoperative complications were identified between sexes or age groups. Neither female sex nor advanced age was found to have increased risk of postoperative complications or early loss of reduction. Similar postoperative radiographic parameter measurements were obtained across groups as well. Conclusions: Our results support the idea that operative treatment of unstable DRF in elderly patients and women is a reasonable treatment option without significant increases in early postoperative complications. Level of Evidence: Level III (Therapeutic III).

PANORAMIC REVIEW OF DISTAL RADIUS FRACTURES

Introduction: fractures affecting the distal radius are common, their incidence increases as life expectancy increases, leading to a larger population of individuals at risk of suffering these injuries. They are usually comminuted and intra-articular fractures that are outside the traditional eponymous classification. Objective: to detail current information related to distal radius fractures epidemiology, anatomy, mechanism of injury, clinical evaluation, classification, imaging evaluation, treatment and complications. Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases and books, of which 19 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: distal radius fractures, radius anatomy, Colles fracture, Smith fracture, Barton fracture, treatment of distal radius fractures. Results: distal radius fractures account for about one sixth of all fractures treated in the emergency department, the incidence of distal radius fractures in the elderly correlates with the degree of osteopenia and increases with increasing age. The volar ligaments are stronger and provide greater stability to the radiocarpal joint compared to the dorsal ligaments. The most common mechanism is a fall on the hand in extension with the wrist in dorsiflexion. Currently, there is no consensus on the most optimal classification system for distal radius fractures. Conclusions: knowing correctly the whole picture of distal radius fractures allows to have a better performance when treating them. It is essential not to overlook in the physical examination the exploration of the ipsilateral elbow and shoulder to rule out the presence of associated injuries and to perform a complete evaluation to detect other possible injuries or life-threatening problems. Distal radius fractures can be treated conservatively or surgically depending on several factors, so classification is essential. There are multiple alternatives in surgical treatment, so the most appropriate one should be chosen for each case. The most common complications in this type of fracture are median nerve dysfunction, post-traumatic osteoarthritis, malunion or pseudoarthrosis and stiffness of the fingers, wrist and elbow. KEY WORDS: fracture, distal radius, Colles, Smith, Barton, treatment.

Cone-Beam Computed Tomography Influences the Classification and Choice of Treatment for Distal Radius Fractures

Abstract Background and Purposes The objectives of this study were to investigate the inter- and intraobserver agreement in the classification of distal radius fractures (DRFs) according to the AO and the Buttazzoni classification system, for the two different radiology modalities: conventional radiography (CR) and cone-beam computed tomography (CBCT). Furthermore, we aimed to explore whether the radiological modality used influences the choice of treatment. Patients and Methods Fifty consecutive patients with DRFs were included. The fractures were visualized by both CR and CBCT. All images were independently reviewed by five observers (three orthopaedic surgeons and two radiologists) and the fractures were classified according to the AO and the Buttazzoni classification. Agreement on fracture classification between CR and CBCT, interobserver agreement for all observers, and intraobserver agreement for a repeated assessment after 8 weeks were calculated. Treatment was suggested by the orthopaedic surgeons. Results The Buttazzoni classification showed higher interobserver agreement than the AO classification, but the agreement for the AO classification was increased using CBCT. The agreement between classification of fractures by CR and CBCT for each observer varied from fair to moderate. CBCT was superior for classification of dorsally comminute fractures using both the AO and the Buttazzoni system. In 38% (n = 57) of the observations, the suggested treatment was changed when CBCT was used, both from less advanced to more advanced and vice versa. Conclusion The choice of radiological modality affects both the classification and the choice of treatment for DRFs and CR tends to underestimate the complexity of DRFs. Level of Evidence Level 1.

Dorsal wrist plating for the management of intra-articular distal radius fractures.

The aim of the study was to evaluate the results of Dorsal Wrist Plating in intra-articular distal radius fractures with a dorsal displacement. In this prospective study, a single surgeon treated 20 patients with a (partially) intra-articular distal radius fracture with a dorsal rim avulsion or a dorsal Barton's type fragment. They all underwent an open reduction and internal fixation by Dorsal Wrist Plating. A total of 17 patients had a follow-up period of at least 12 months (mean follow- up of 17 months) and these patients were included in the study. Both functional and radiological outcome parameters were measured. The total range of motion was 92 % of the contralateral side. The mean grip strength and key pinch were 24.6 kg and 6.9kg respectively compared to 29.5 kg and 7.4 kg on the non-operated side. The average Mayo Wrist Score was 89.7 (range 80-100) and the mean Disability of the Arm, Shoulder and Hand score was 4.5 (range 0-9.2). An articular step-off was only noted in 2 patients (1 and 2 mm respectively). Radial inclination was restored in all patients. Palmar tilt was anatomically restored in five patients. In all other patients, the palmar tilt was acceptably restored. There was no significant radial shortening in any of the patients. No infections, no tendon ruptures, no Complex Regional Pain Syndrome, or union problems were observed. Dorsal wrist plating seems to be a safe and reliable procedure in the treatment of intra-articular distal radius fractures with dorsal displacement.

Seasonal variation of surgically treated distal radius fracture in Japan using inpatient database: cross-sectional study.

The purpose of this study was to clarify the relationship between seasonal variation and distal radius fractures using diagnosis procedure combination data in Japan. The participants were hospitalized patients who underwent surgical treatment for distal radius fracture as the primary injury at hospitals that introduced the diagnosis procedure combination system between April 2011 and March 2016. We obtained a summary table of the month of admission, region of residence, age at admission, and sex of the patients from the Ministry of Health, Labour and Welfare and evaluated it by month, region, age group, and sex. The total number of patients for the 5years from 2011 to 2016 was 105,025. There were 29,224 male and 75,801 female participants, with a female-to-male ratio of 2.6. The mean age was 60.2 (standard deviation, 20.8) years. Distal radius fractures occurred more frequently in the winter, especially among female individuals in eastern Japan. Female participants aged ≥ 50years tended to have a higher incidence of distal radius fracture in winter. The incidence of distal radius fracture among male participants aged 0-19years was higher from spring to autumn. Surgically treated distal radius fractures occur frequently during the winter months among female individuals in eastern Japan or those aged ≥ 50years and increase from school age to adolescence, especially in male individuals from spring to autumn. We should be aware of the high incidence of distal radius fractures in winter, especially in regions with snowfall and cold temperatures.

The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture.

Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.

The association of ICUC trauma score and quick DASH in a distal radius fracture cohort

BackgroundThis study evaluates the association between ICUC trauma and short-form Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) scores among patients who underwent surgery for distal radius fractures.MethodsThis research gathered patient-reported outcomes (PROs) from patients registered in the ICUC database at a single trauma center. The study involved 76 adult patients who underwent surgical treatment for distal radius fractures before 2023. These patients received a volar locking plate for their distal radius fracture. The research utilized two different PROs to evaluate the patients’ conditions. The ICUC trauma score measures functional impairment and pain through two 5-point scale questions, allowing patients to self-assess these aspects. The Quick DASH, comprising 11 questions, was used to evaluate symptoms and functionality of the upper extremity.ResultsFor patients aged 55.9 ± 15.3 years and 4.6 ± 3.9 years post-op follow-up, the ICUC trauma score was 0.70 ± 0.95, and Quick DASH was 6.07 ± 10.35. A strong correlation between ICUC and Quick DASH was identified (r = 0.71, P < 0.01). The interaction between the ICUC trauma score and age at the surgery to Quick DASH revealed a significant unstandardized partial regression coefficient of 0.19 (95% confidence interval 0.08–0.31; P < 0.01).ConclusionThis study demonstrated a strong correlation between the ICUC trauma score and the Quick DASH among patients, especially the elderly. It was noted that an elevation in the ICUC trauma score is linked to a more marked increase in the Quick DASH score, particularly in older patients. Given its simplicity and efficacy, the ICUC trauma score may be a viable alternative to the Quick DASH for assessing the patient’s clinical outcomes.

Biomechanical comparison of traditional plaster cast and 3D-printed orthosis for external coaptation of distal radius fractures

IntroductionDistal radius fractures make up around 20% of adult fractures, varying in type and severity, thus requiring different treatments. Cast immobilization is effective in indicated fractures, but is associated with several disadvantages such that 3D-printed orthoses (3D-Braces) have been introduced as a potentially advantageous alternative. The present study was designed to test the hypothesis that short-arm 3D-printed Polylactic Acid (PLA) orthoses would provide superior biomechanical properties when compared to plaster of Paris short-arm casts for immobilization of distal radial fractures. MethodsModified mannequin forearms were utilized as human models for the creation of both the circular casts and the 3D Braces. A total of five plaster cast prototypes were produced, based on a standard cylindrical plaster cast application technique used in the treatment of distal radius fractures, and another five samples were 3D printed braces. Each sample was then subjected to a three-point bend load test, using an Instron 68SC2 testing machine, and the data was collected and exported to an Excel spreadsheet and analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, N.Y., USA). ResultsThe 3D-Braces can withstand significantly higher forces at yield and maximum force, implying they may offer superior mechanical stability. Moreover, our findings indicated a higher strain at yield for the 3D-Braces compared to conventional plaster casts. Conclusions3D-printed Polylactic Acid short-arm orthoses demonstrated superior biomechanical properties when compared to plaster of Paris short-arm casts designed for immobilization of distal radial fractures. Taken together with data from previous studies, preclinical evidence suggests that PLA 3D-Braces can effectively maintain distal radius fracture alignment and stability with potential advantages over traditional casts with respect to biomechanical properties as well as post-fabrication adjustment, patient hygiene, comfort, and daily activities.

Let's Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study.

Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. DERR1-10.2196/52917.

Surgical treatment of distal radius fractures: impact on forearm rotation in non-elderly patients

Forearm rotation restriction (FRR) is common after surgery for distal radius fractures (DRFs). The aim of the current study was to investigate the effect of DRFs on forearm rotation. This retrospective study reviewed patients with DRFs who underwent surgical treatment from January 2019 to December 2021. The patients' basic data and radiographic parameters were analyzed. Forearm rotation, including pronation and supination, was assessed using a standard goniometer. The Patient-Rated Wrist Evaluation (PRWE) score was evaluated, and the incidence of FRR at the 6-month follow-up was recorded. Univariate and multivariate logistic regression analyses were performed to identify risk factors correlated with FRR. A total of 127 patients with DRFs were included in this study. After surgery, 46 cases were considered to have FRR, with a rate of 36.2%, while the remaining 81 cases (63.8%) did not have FRR. The PRWE scores were 22.8 ± 5.2 and 17.9 ± 4.2 in the FRR group and non-FRR group, respectively, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that the involvement of the sigmoid notch (OR, 2.88; 95% CI 1.49–5.56), post-operative volar tilt < 0° (OR, 2.16; 95% CI 1.34–3.50), and post-operative ulnar variance > 0 mm (OR, 1.37; 95% CI 1.06–1.78) were independently associated with the incidence of FRR. The FRR is associated with an increased PRWE score and may have had some impact on the patient's daily life. Fractures involving the sigmoid notch, dorsal angulation, and radial shortening deformity were found to be correlated with the incidence of FRR. Preoperative risk notification and intraoperative preventive measures are necessary for these patients.

Topology-Optimized Splints vs Casts for Distal Radius Fractures

To date, there is currently no evidence-based medical support for the efficacy of topology-optimized splints in treating distal radius fractures. To assess the clinical efficacy and complication rates of topology-optimized splints in the treatment of distal radius fractures after closed manual reduction. This 12-week, multicenter, open-label, analyst-blinded randomized clinical trial (comprising a 6-week intervention followed by a 6-week observational phase) was carried out from December 3, 2021, to March 10, 2023, among 110 participants with distal radius fractures. Statistical analysis was performed on an intention-to-treat basis between June 3 and 30, 2023. Participants were randomly assigned to 2 groups: the intervention group received topology-optimized splint immobilization and the control group received cast immobilization after closed manual reduction for 6weeks. After this period, immobilization was removed, and wrist rehabilitation activities commenced. The primary outcome was the Gartland-Werley (G-W) wrist score at 6 weeks (where higher scores indicate more severe wrist dysfunction). Secondary outcomes encompassed radiographic parameters, visual analog scale scores, swelling degree grade, complication rates, and 3 dimensions of G-W wrist scores. A total of 110 patients (mean [SD] age, 64.1 [12.7] years; 89 women [81%]) enrolled in the clinical trial, and complete outcome measurements were obtained for 101 patients (92%). Median G-W scores at 6 weeks were 15 (IQR, 13-18) for the splint group and 17 (IQR, 13-18) for the cast group (mean difference, -2.0 [95% CI, -3.4 to -0.6]; P = .03), indicating a statistically significant advantage for the splint group. At 12 weeks, no clinically significant differences in G-W scores between the 2 groups were observed. Complication rates, including shoulder-elbow pain and dysfunction and skin irritation, were less common in the splint group (shoulder-elbow pain and dysfunction: risk ratio, 0.28 [95% CI, 0.08-0.93]; P = .03; skin irritation: risk ratio, 0.30 [95% CI, 0.10-0.89]; P = .02). Findings of this randomized clinical trial suggest that patients with distal radius fractures that were managed with topology-optimized splints had better wrist functional outcomes and fewer complications at 6 weeks compared with those who received casting, with no difference at week 12. Therefore, topology-optimized splints with improved performance have the potential to be an advisable approach in the management of distal radius fractures. Chinese Clinical Trial Registry: ChiCTR2000036480.