Improving Evaluation and Treatment for Osteoporosis Following Distal Radial Fractures

Rozental, Tamara D.; Makhni, Eric C.; Day, Charles S.; Bouxsein, Mary L.

doi:10.2106/jbjs.g.01121

Cited by 163 publications

(127 citation statements)

References 40 publications

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“…Notably absent are any recommendations to consider the role of balance training and physical conditioning when evaluating a patient with a fragility fracture of the forearm or elsewhere. Current practice trends mirror these guidelines, as evaluation for osteoporosis is becoming a common consideration following these injuries 32,33 , and assessment and treatment of fall risk are more often overlooked 34,35 . There were several potential limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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Background: The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. Methods: This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. Results: There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. Conclusions: Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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“…Gong et al 23 with a similar study design to ours, reported that ALN administration two weeks following surgery using locking plate and screws did not affect radiological or clinical outcomes of fracture healing in osteoporotic patients. The incidence of osteoporosis in patients with fragility fractures of the distal radius is reported to range from 30% to 47%, [39][40][41] and several fragility fractures, including at the distal radius, occur when the BMD is in the osteopenic range. 41,42 In our study, 20 patients (25%) had osteoporosis, 28 patients (35%) had osteopenia, and 32 patients (40%) had normal BMD of the spine.…”

Section: Discussionmentioning

confidence: 99%

Effect of early administration of alendronate after surgery for distal radial fragility fracture on radiological fracture healing time

Uchiyama

Itsubo

Nakamura

et al. 2013

The Bone & Joint Journal

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“…One indication for the use of locking plates is fixation of osteoporotic bone [7], and it is well known that there is a high incidence of low bone mineral density in patients who have sustained a distal radius fracture [8]. Therefore, low bone density may be an appropriate indication for locking screws in the shaft of distal radius fractures treated with volar locking plates.…”

mentioning

confidence: 99%

Routine use of Locking Shaft Screws is not Necessary in Volar Plate Fixation of Distal Radius Fractures

Lutsky

Hoffler

Kim

et al. 2015

Hand (New York, N,Y.)

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Hypothesis Volar locking plate fixation is a common treatment method for distal radius fractures. Recently, implants have been designed with an option to use locking screws in the shaft portion of the plate. While there is a high incidence of low bone mineral density in patients who sustain fragility fractures of the distal radius, the need for locking shaft screws is not well defined. Our hypothesis is that the routine use of locking screws in the shaft portion of volar plates is not required to maintain reduction or to prevent hardware failure. Methods A retrospective review was performed in all patients over age 50 years who underwent volar plate fixation using an implant with non-locking shaft screws for a distal radius fracture during a 2-year period. Patients were permitted to perform early range of motion exercises. Radiographs were examined and measurements were obtained to assess maintenance of reduction and incidence of hardware failure. Patients were followed at least until fracture healing. Patients were excluded from analysis if locking shaft screws were utilized or if follow-up was inadequate. Results Forty-one patients met the inclusion criteria. The average age was 62 years (range 50-79). There were 12 men and 29 women. The implant used incorporated 3.5-mm shaft screws in 26 patients and 2.4-mm shaft screws in 15 patients. All patients healed within acceptable radiographic parameters (mean volar tilt=4.9°, mean radial inclination=21.7°, mean radial height=11.6 mm). There were not any instances of hardware failure. Discussion Distal radius fractures frequently occur in patients with low bone mineral density. Non-locking, bicortically placed shaft screws provide adequate stability to allow for early range of motion without loss of reduction or hardware failure. The routine use of locking screws in the shaft portion of volar plates does not appear justified.

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Improving Evaluation and Treatment for Osteoporosis Following Distal Radial Fractures

Cited by 163 publications

References 40 publications

Postural Stability in Older Adults with a Distal Radial Fracture

Postural Stability in Older Adults with a Distal Radial Fracture

Effect of early administration of alendronate after surgery for distal radial fragility fracture on radiological fracture healing time

Routine use of Locking Shaft Screws is not Necessary in Volar Plate Fixation of Distal Radius Fractures

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