Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?

Einsiedel, T.; Freund, Wolfgang; Sander, Silvia; Trnavac, S.; Gebhard, Florian; Kramer, Michael D.

doi:10.1007/s00264-008-0568-1

Cited by 13 publications

(13 citation statements)

References 24 publications

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“…22,23 The question rises whether operative treatment should be preserved for those patients who are at risk of failure of nonoperative treatment. 21,24 The present study was initiated to assess the clinical controversy on the duration of the immobilization period of nonoperatively treated DRF. Both non-and minimally displaced, and displaced and reduced DRF, were included.…”

mentioning

confidence: 99%

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

et al. 2019

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Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.

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confidence: 99%

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

et al. 2019

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“…113 Other studies found that age > 60 years; initial shortening, and dorsal angulation exceeding 20°a re significant predictors of redisplacement. 32,82,[117][118][119][120] Surprisingly, more than half the definitions were not based on any of these predictors.…”

Section: Discussionmentioning

confidence: 99%

“…10,33,40,42,43,[60][61][62][63][64][65] The most frequently used classification system to describe an unstable distal radius fracture was the AO classification (8%, 18/213). 23,[66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] An AO type C2 was the fifth most commonly mentioned description used to define an unstable distal radius fracture (5%, 10/213). 66,67,[70][71][72][73][74]79,81,82 In 4% (9/213) of the studies, the description according to Poigenfürst (radioulnar separation; the presence of dorsal comminution, and an associated ulnar fracture) was used.…”

Section: What Were the Most Commonly Mentioned Descriptions Of An Unsmentioning

confidence: 99%

“…23,[66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] An AO type C2 was the fifth most commonly mentioned description used to define an unstable distal radius fracture (5%, 10/213). 66,67,[70][71][72][73][74]79,81,82 In 4% (9/213) of the studies, the description according to Poigenfürst (radioulnar separation; the presence of dorsal comminution, and an associated ulnar fracture) was used. 49,[83][84][85][86][87][88][89][90] An equal number of studies (4%, 9/213) mentioned the definition of an unstable distal radius fracture according to Cooney (severe comminution; intra-articular components and severe displacement defined as >20°dorsal angulation and > 10 mm of radial shortening).…”

Section: What Were the Most Commonly Mentioned Descriptions Of An Unsmentioning

confidence: 99%

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The Unstable Distal Radius Fracture—How Do We Define It? A Systematic Review

et al. 2015

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Background?Unstable distal radius fractures are a popular research subject. However, to appreciate the findings of studies that enrolled patients with unstable distal radius fractures, it should be clear how the authors defined an unstable distal radius fracture. Questions?In what percentage of studies involving patients with unstable distal radius fractures did the authors define unstable distal radius fracture? What are the most common descriptions of an unstable distal radius fracture? And is there one preferred evidence-based definition for future authors? Methods?A systematic search of literature was performed to identify any type of study with the term unstable distal radius fracture. We assessed whether a definition was provided and determined the level of evidence for the most common definitions. Results?The search yielded 2,489 citations, of which 479 were included. In 149 studies, it was explicitly stated that patients with unstable distal radius fractures were enrolled. In 54% (81/149) of these studies, the authors defined an unstable distal radius fracture. Overall, we found 143 different definitions. The seven most common definitions were: displacement following adequate reduction; Lafontaine's definition; irreducibility; an AO type C2 fracture; a volarly displaced fracture; Poigenf?rst's criteria; and Cooney's criteria. Only Lafontaine's definition originated from a clinical study (level IIIb). Conclusion?In only half of the studies involving patients with an unstable distal radius fracture did the authors defined what they considered an unstable distal radius fracture. None of the definitions stood out as the preferred choice. A general consensus definition could help to standardize future research.

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“…Ulnar variance as described in this review (shown in Table 3) study is measured on a posterior-anterior radiograph and measures the distance between horizontal lines (that are perpendicular to the long axis of the radius/ulna) drawn from the distal ulnar and radial articular surfaces (at the level of the distal radioulnar joint). After a detailed examination of the referenced techniques cited in this review, it appeared as though four studies measured ulnar variance according to this definition but instead called it radioulnar index [3] or radial shortening [12,14,33]. Table 5 lists the characteristics of the radiographs (when measured, type of projection and the use of bilateral comparison) as well as the reliability and measurement properties of the radiographic measures.…”

Section: Radiographic Parametersmentioning

confidence: 99%

A Structured Review Addressing the Use of Radiographic Measures of Alignment and the Definition of Acceptability in Patients with Distal Radius Fractures

Lalone

Grewal

King

et al. 2015

Hand (New York, N,Y.)

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Background Standard radiographs are routinely used in clinical care to characterize the severity of a distal radius fracture and to monitor patients following a distal radius fracture. The objective of this review was to describe the range and variability of radiographic measures described in the literature in patients following a distal radius fracture. Methods A structured literature review was conducted using the Embase and PubMed databases. Inclusion criteria included full-text publications which employed radiographic measures to examine 100 or more participants following a distal radius fracture. A standardized data extraction form was used to identify study design, fracture classification systems, the types of and definitions of radiographic measurements, and acceptability criteria following distal radius fractures. Results From an initial 263 studies, 31 studies were included in the final data extraction process. A narrative synthesis of the articles included in this review indicated that there was a set of commonly used radiographic measurements examined in patients with a distal radius fracture which included radial inclination, volar/dorsal tilt, intra-articular step/gap, and a measure of ulnar variance/radial shortening. While 52 % of studies referenced or published a standardized measurement technique, there was substantial variability in the actual description of each radiographic measurement performed. Conclusions Substantial variability in how radiographic measurements are defined in large clinical studies as seen in this review suggest a need for consensus on the assessment and interpretations of radiographic measures used in patients following a distal radius fracture. Guidelines for radiographic measures should be established to ensure consistency between research and treatment centers.

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Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?

Cited by 13 publications

References 24 publications

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

The Unstable Distal Radius Fracture—How Do We Define It? A Systematic Review

A Structured Review Addressing the Use of Radiographic Measures of Alignment and the Definition of Acceptability in Patients with Distal Radius Fractures

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