Fractures of the Distal Aspect of the Radius

Simic, P; Weiland, Andrew J.

doi:10.2106/00004623-200303000-00026

Cited by 88 publications

(16 citation statements)

References 67 publications

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“…4 Previous studies of DRF outcomes in persons who are aged 60 years and older report that precise anatomic reduction is not necessary to achieve satisfactory functional results because this population requires less functional recovery than younger patients. [5][6][7][8][9][10][11][12] However, these conclusions cannot be applied to the current population of older adults who are much more active and functionally independent than previous generations. [13][14][15] The perceived effect of disability from DRF will be more pronounced in the current population aged 60 years and older with greater demand in functional capacity.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

et al. 2020

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IMPORTANCE The value of precise anatomic restoration for distal radius fractures (DRFs) in older adults has been debated for many decades, with conflicting results in the literature. In light of the growing population of adults aged 60 years and older, both fracture incidence and associated treatment costs are expected to increase. OBJECTIVE To determine the association between radiographic measures of reduction and patient outcomes after DRF in older patients. DESIGN, SETTING, AND PARTICIPANTS Data were collected from the Wrist and Radius Injury Surgical Trial (WRIST), a multicenter randomized clinical trial of DRF treatments for adults aged 60 years and older (enrollment from April 10, 2012, to December 31, 2016, with a 2-year follow-up). Data analysis was performed from January 3, 2019, to August 19, 2019. WRIST participants who completed 12-month assessments were included in the study. According to the biomechanical principle of alignment, 2-phase multivariable regression models were adopted to assess the association between radiographic measures of reduction and functional and patient-reported outcomes 12 months following treatment. INTERVENTIONS Participants were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Those who opted for nonoperative treatment received casts. MAIN OUTCOMES AND MEASURES Hand grip strength, wrist arc of motion, radial deviation, ulnar deviation, the Michigan Hand Outcomes Questionnaire (MHQ) total score, MHQ function score, and MHQ activities of daily living score were measured at 12 months following treatment. RESULTS Data from 166 WRIST participants (144 [86.7%] women; mean [SD] age, 70.9 [8.9] years) found that only 2 of the 84 correlation coefficients calculated were statistically significant. For patients aged 70 years or older, every degree increase in radial inclination away from normal (22°) grip strength in the injured hand was 1.1 kg weaker than the uninjured hand (95% CI, 0.38-1.76; P = .004) and each millimeter increase toward normal (0 mm) in ulnar variance was associated with a 10.4-point improvement in MHQ ADL score (95% CI, −16.84 to −3.86; P = .003). However, neither of these radiographic parameters appeared to be associated with MHQ total or function scores. CONCLUSIONS AND RELEVANCE The study results suggest that precise restoration of wrist anatomy is not associated with better patient outcomes for older adults with DRF 12 months following treatment. Surgeons can consider this evidence to improve quality of care by prioritizing patient preferences and efficient use of resources over achieving exact realignment. (continued) Key Points Question What is the association between radiographic measures of reduction and patient outcomes 12 months after distal radius fractures treatment for adults aged 60 years or older? Findings This secondary analysis of a multicenter randomized clinical trial on distal radius fractures treatment options included 166 patients who completed 12-month assessments. Radiographic parameters were not assoc...

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Section: Introductionmentioning

confidence: 99%

Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

et al. 2020

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“…Distal radius fractures (DRFs) are, undoubtedly, one of the most common fractures not only of the upper extremity but, also, of the whole skeletal system; for example, in the United States, they account for −20% of cases presented at emergency medicine departments [1]. The incidence is the highest in the pediatric and osteoporotic elderly populations [2] [3].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Zysk¹,

Lewis²,

Taxier³

et al. 2017

WJET

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Background: There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the "surgical modality of choice". While outcomes with each modality are usually good to excellent, each has its share of shortcomings and complications. Thus, there is scope for improvements to existing modalities and/or introduction of new ones. Study Purpose: We introduce a novel modality, namely, the prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system, and investigated its plausibility. Experimental Procedures: The biomechanical performance of a construct comprising a synthetic distal radius (fourth-generation Sawbones ® ) on which a simulated fracture was created (4-mm wide osteotomy positioned 25 mm from the most distal end of the radius) and fixated with a placement of the IPBO system (SIPBO Construct) was compared to that when the fixation was with an approved Ti-6Al-4V alloy VLP system (SVLP Construct), under a clinically-relevant compressive loading protocol. Performance involved determination of quantitative parameters of the construct (initial longitudinal stiffness (ICLS), final longitudinal stiffness (FCLS), and load-to-failure (P f )) and observation and recording of features of the construct at the fracture point. We also determined the quantitative parameters for the intact synthetic distal radius (control). Results: For each of the quantitative parameters, the range of values for SIPBO Construct was within that for SVLP Construct, suggesting that the IPBO System is a plausible modality. Also, for SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Con- 310struct, some failure features were fracture of the cortical wall and of the dorsal proximal fragments. Conclusion: The findings suggest that the IPBO system is plausible. As such, it merits further study; for example, determination of the influence of fracture gap fill ratio (defined as the proportion of the fracture gap that is filled by the expanding balloon as the polymer is injected into the balloon) on a large collection of quantitative biomechanical parameters.

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“…Many fractures of the distal aspect of the radius are relatively uncomplicated and are effectively treated by closed reduction and immobilization in cast. However unstable/ intra-articular fractures can jeopardize the integrity of the articular congruence and/or kinematics of these articulations 9 . The classic fracture described by Sir Abraham Colles in 1814 -low energy, extra articular, osteoporotic distal radius fracture -often does well with closed reduction and cast immobilization.…”

Section: Introductionmentioning

confidence: 99%

“…Bridging external fixation forms the heart of ligamentotaxis as it allows distraction at the radiocarpal joint 9 .…”

Section: Introductionmentioning

confidence: 99%

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Functional Outcome of Distal end Radius Fracture Treated by Ligamentotaxis by External Fixator with or without K Wire Augmentation

Mahajan

Patil

Rathod

et al. 2019

mvpjms

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Background: One of the most common injuries encountered in orthopedic practice are Distal Radius fractures. This comprises of 8%−15% of all fractures in adults 1 . The reason for comminuted DER fractures is high-energy trauma in young and low-energytrauma in elderly. They present as shear and impacted fractures involving the articular surface of the distal radius with displacement of the fragments 2-7 . External fixation for distal radius fracture relies on the principle of Ligamentotaxisin which, a distraction force applied to the carpus aligns the fragments by means of intact ligaments. The length and alignment of fracture fragment is guided by pull and counter pull which are otherwise difficult to control 8 . Objective: To study functional outcome of distal end radius fracture treated by ligamentotaxis with evaluation of functional results according to Disabilities of the Arm, Shoulder and Hand (DASH) score system. Material and Methods: We included 30 patients (Male 24 and Female 6) treated for distal end radius fracture during a period from 2015 to 2017. Patients were evaluated clinically by subjective assessment using DASH Scoring system. Result: After functional evaluation of patients according to the scheduled follow up with mean DASH Score of 76.08 at 1st month, 62.92 at 3rd month and 42.60 at 6th month, and was found to be Highly Significant (p<0.001) among all the compared groups. Conclusion: We concluded that external fixation and ligamentotaxis applied to complex distal radius fractures, when added with augmented K-wire fixation can provide direct augmentation of fracture stability and a good wrist function.

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Fractures of the Distal Aspect of the Radius

Cited by 88 publications

References 67 publications

Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Functional Outcome of Distal end Radius Fracture Treated by Ligamentotaxis by External Fixator with or without K Wire Augmentation

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