No Difference in Adverse Events Between Surgically Treated Reduced and Unreduced Distal Radius Fractures

Teunis, Teun; Mulder, Frans J.; Nota, Sjoerd; Milne, Leslie W.; Dyer, George S.M.; Ring, David

doi:10.1097/bot.0000000000000379

Cited by 13 publications

(9 citation statements)

References 8 publications

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“…Adverse events after volar locking plates include tendon rupture and loss of reduction. 26 One study on volar locking plates, with a majority of female patients, reported postoperative fracture collapse and screw penetration of the radiocarpal joint in 11/40 patients. 27 This could indicate that a volar plate alone is not always sufficient to maintain skeletal anatomy despite using locking screws.…”

Section: Discussionmentioning

confidence: 99%

Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases

et al. 2019

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Background The distal radius fracture (DRF) is the most common fracture among adults. In recent years, there has been a shift toward volar locking plates in the treatment of DRFs, and this shift has taken place with a low degree of evidence. Question/purposes Can combined volar T-plating and dorsal pi-plating of AO type C fractures yield a good functional and radiographic outcome 1 year postoperatively? Patients and Methods In a retrospective cohort study, we evaluated 102 consecutive patients operated with combined dorsal and volar plating, of whom 80 completed the 1-year follow-up. The DRFs were operated between 2012 and 2013. All cases were AO type C2 and C3 fractures. The primary outcome was functional scoring including radiographic examination. Secondary outcome measures included range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results The median Batra radiographic score was 84.5. Wrist extension was 74% of the uninjured side, flexion was 70%, pronation was 94%, and supination was 90%. The Patient-Rated Wrist Evaluation score was 21 points, and the Disabilities of the Arm, Shoulder, and Hand score was 19.4 points. VAS pain scores were 0 at rest and 3 during activity. Hand grip strength was 80% of the uninjured side. Radiographic outcome did not correspond to a patient-reported outcome. Hardware removal was performed in 15/80 cases. Conclusions We conclude that a good outcome can be expected after combined dorsal and volar plating of DRFs. Radiographic outcome is not necessarily associated with functional outcome 1 year postoperatively. The rate of hardware removal was acceptable. Level of Evidence III

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Section: Discussionmentioning

confidence: 99%

Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases

et al. 2019

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“…In addition, Brogren et al 16 reported more deterioration in radiographic parameters after 1 year when the fractures have been reduced compared with when they have not been reduced prior to cast application. With respect to surgically treated distal radius fractures, Teunis et al 6 did not find a difference in adverse events if fractures were left unreduced until surgery; as long as the fractures were not open, the skin tented or the fractures have been otherwise complicated like by neuropathy or compartment syndrome. Fig.…”

Section: Discussionmentioning

confidence: 98%

“…It is widely accepted to perform closed reduction prior to plaster immobilization, before definitive stabilization is conducted by internal fixation. 6 The rationale is to diminish bony impaction and relieve tension in the soft tissue as well as in the median nerve. 6 However, closed reduction is accompanied by significant pain, which necessitates the application of intravenous analgesics or even hematoma blocks.…”

Section: Introductionmentioning

confidence: 99%

“…6 The rationale is to diminish bony impaction and relieve tension in the soft tissue as well as in the median nerve. 6 However, closed reduction is accompanied by significant pain, which necessitates the application of intravenous analgesics or even hematoma blocks. [7][8][9][10] This is thereby accepted in the light of an expected relief of pain and discomfort during plaster immobilization.…”

Section: Introductionmentioning

confidence: 99%

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Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures

Löw

Papay

Eingartner

2019

Journal of Hand and Microsurgery

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Introduction Closed reduction and cast immobilization is a common practice as initial treatment for distal radius fractures. This study examines the pain perception that accompanies this approach. Materials and Methods Thirty dorsally displaced distal radius fractures were reduced and casted under finger-trap traction with intravenous analgesics. Patients rated their pain perception on visual analog scale prior to presentation, during reduction, during casting, and for every day until surgery. Closed reduction improved palmar tilt from −26.3 to −10.8 degrees. Surgery improved palmar tilt from −10.8 to +6.1 degrees. Closed reduction improved radial inclination from 15.5 to 19.1 degrees. Surgery improved radial inclination from 19.1 to 21.6 degrees. Mean pain perception was 5.8 at presentation. Reduction increased pain to 7.5 (p < 0.001), whereas casting was less painful (3.7; p < 0.001). At the evening following casting and the following days until surgery, mean pain was still as high as 4.1, 4.2, 4.1, 3.6, 3.9, 2.8, 3.0, and 3.0, with some patients experiencing more pain than initially. Conclusion Reduction generates significant pain with only minor relief during cast immobilization. The indication for closed reduction prior to cast application is therefore questionable.

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“…When this is the case, our study showed it's safe to forgo an attempt at reduction as we found no difference in adverse events and subsequent surgeries between reduced and unreduced fractures. 1 A very interesting study in the same session presented by Charlotte Lameijer evaluated the optimal questionnaire to assess patient-reported outcome following distal radius fractures. 2 But static questionnaires often include questions that can be considered irrelevant or unrelated.…”

Section: Report Of Estes Congress Grant Winner Teun Teunismentioning

confidence: 99%

ESTES News 4.2015

2015

Eur J Trauma Emerg Surg

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No Difference in Adverse Events Between Surgically Treated Reduced and Unreduced Distal Radius Fractures

Cited by 13 publications

References 8 publications

Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases

Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases

Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures

ESTES News 4.2015

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