Current Trends in the Management of Distal Radius Fractures

Eltorai, Adam E.M.; Sobel, Albert E.; Thomas, Nathan P.; Daniels, Alan H.; Born, Christopher T.

doi:10.3928/01477447-20170117-08

Cited by 4 publications

(5 citation statements)

References 65 publications

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“…Vast amounts of literature are available on the management of these injuries. 24 The UK Distal Radius Acute Fracture Fixation trial continues to provoke great debate in the orthopaedic community and has already influenced surgical management of these fractures nationally. 1 This has led to a sharp rise (42% vs 12%) in Kirschner wire fixation for dorsally displaced distal radius fracture since the publication of the paper.…”

Section: Introductionmentioning

confidence: 99%

Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

Hassan

Shafafy

Mohan

et al. 2019

annals

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Introduction Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. Materials and methods Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability. Patients were treated with a short oblique ulnar shortening osteotomy, using a Stanley jig and small AO compression plate system. Pre- and postoperative radiographical measurements of inclination, dorsal/volar angulation and ulnar variance were made. Patients were scored pre- and postoperatively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation scores by two orthopaedic surgeons. Mean follow-up was 24 months after surgery. Results Radiographical analysis revealed a change in the ulnar variance with an average reduction of 5.74 mm. Mean preoperative scores were 61.1 (range 25–95.5) for QuickDASH and 70.4 (range 33–92) for Patient-Rated Wrist Evaluation. At the latest follow-up, mean postoperative QuickDASH scores were 10.6 (range 0–43.2) and 17.2 (range 0–44) for Patient-Rated Wrist Evaluation. Differences in scores after surgery for both QuickDASH and Patient-Rated Wrist Evaluation were statistically significant (P < 0.01). Conclusions The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna–carpal impaction.

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Section: Introductionmentioning

confidence: 99%

Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

Hassan

Shafafy

Mohan

et al. 2019

annals

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“…Even though DRFs account for almost one-sixth of all fractures treated in emergency rooms, without proper treatment, they may lead to permanent impairment of the wrist and hand. The treatment methods of DRFs in clinical practice are diverse [2–4], but in patients with simple fractures, the most common method is manipulation, which includes closed reduction and plaster immobilization [5–7].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the outcome of reduction may be difficult to maintain by plaster immobilization [8]. Nevertheless, a clear consensus regarding a standard for closed reduction of DRFs does not exist [4]. It is generally recognized by us that the analysis of a single radiologic variable in isolation was not as clinically useful as a cluster of X-ray findings when dealing with a three-dimensional structure.…”

Section: Introductionmentioning

confidence: 99%

The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures

et al. 2019

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BackgroundThe aim of this study was to evaluate the influence of distal radius fractures (DRFs) malalignment on the treatment outcomes in patients over age 65 years.Material/MethodsWe retrospectively reviewed the records on fresh DRFs treated with closed reduction from December 2014 to January 2018. After treatment, patients were evaluated for the determination of grip strength, the Visual Analog Scale (VAS) during wrist movement, the Patient-Rated Wrist Evaluation (PRWE), the Disabilities of the Arm, Shoulder and Hand (DASH) score, the appearance satisfaction, and active wrist range of motion (ROM).ResultsA total of 96 patients with complete data were included in our study. During follow-up, there were 75 patients (78.1%) with acceptable reduction and 21 patients (21.9%) with unacceptable reduction. Compared with those having acceptable alignment in the distal radius, patients with unacceptable alignment had weak grip strength, were unsatisfied appearance, and had severe flexion as well as ulnar deviation limitation at 6-month follow-up. A significant correlation was found between ulnar positive variance and grip strength (r=−0.35, P=0.03), as well as dorsal angulation and flexion movement (r=−0.31, P=0.02).ConclusionsConservative treatment should be used differently, even in elderly patients. For low-demand patients, it is not necessary to restore all anatomic radiographic parameters, as malalignment does not increase disability or pain score. However, for patients who are still healthy and active, satisfactory reduction is the first choice, as malalignment can lead to decreased grip strength, dissatisfaction with appearance, and certain wrist limitations.

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“…In the case of a distal radius fracture with a dorsally directed force vector, the dorsal metaphyseal cortex typically fails under compression producing increased comminution than the volar side. Thus, the resultant asymmetric fracture pattern makes adequate restoration of volar tilt a specific challenge [1] , [3] .…”

Section: Discussionmentioning

confidence: 99%

“…Volar plate osteosynthesis is the most common procedure in the operative management of a distal radius fracture [1] . While standard reduction techniques may restore alignment in different planes, complete restoration of desired volar tilt can be challenging in a dorsally angulated fracture pattern with metaphyseal comminution.…”

Section: Introductionmentioning

confidence: 99%

A simple tool for volar tilt restoration during volar plate osteosynthesis of distal radius fracture: A technical note

Metikala¹,

Purudappa²,

Cheppalli³

2023

Trauma Case Reports

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Current Trends in the Management of Distal Radius Fractures

Cited by 4 publications

References 65 publications

Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures

A simple tool for volar tilt restoration during volar plate osteosynthesis of distal radius fracture: A technical note

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