Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment

Sharma, Himanshu; Khare, Ghanshyam Narayan; Singh, Saurabh; Ramaswamy, Arun Govindraj; Kumaraswamy, Vinay; Singh, Ashutosh Kumar

doi:10.1007/s00776-014-0560-0

Cited by 69 publications

(62 citation statements)

References 26 publications

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“…The 8 RCTs 31,35,36,38,[46][47][48][49] included 656 patients (29.1%), of whom 322 were treated operatively and 334 nonoperatively. The weighted mean age was 67 years (67 years in the operative group and 68 years in the nonoperative group).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

et al. 2020

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IMPORTANCENo consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift. OBJECTIVESTo compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults. DATA SOURCES The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures. STUDY SELECTION Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019. MAIN OUTCOMES AND MEASURES The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment.RESULTS A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (Յ1 year) DASH score after operative treatment compared with nonoperative treatment (MD,]; P = .005; I 2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I 2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI,]; P = .04; I 2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI,]; P = .007; I 2 = 76%). No improvement in mediumterm DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, −0.98 [95% CI, −3.52 to 1.57]; P = .45; I 2 = 34%]), compared with a larger improvement in (continued)

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Section: Study Characteristicsmentioning

confidence: 99%

“…The studies included 130 men (19.8%). The operative method was open reduction and internal fixation with a volar plate in 6 studies, 35,38,[46][47][48][49] external fixation in 1 study, 31 and percutaneous pinning in 1 study. 36 The conservative method was cast immobilization in all studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

et al. 2020

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“…Fractures treated conservatively are a common cause of malunions, For example, a recent study comparing the outcomes and complications of distal radius fractures between volar plating and non-operative treatment, found that 35% of the patients treated conservatively developed a malunion [31]. Patients treated with volar plate fixation, however, reported no incidence of malunion [31]. In 2010, the AAOS aimed to prevent possible distal radius fracture complications associated with conservative treatment by publishing guidelines for operative fixation.…”

Section: Malunionmentioning

confidence: 99%

“…The flexor tendons are located far from the volar surface and placement of the pronator quadratus over the volar plate has been suggested to prevent irritation [44]. Volar plate fixation has also been found to result in a shorter period of immobilization and an earlier return to previous activity level [31]. …”

Section: Malunionmentioning

confidence: 99%

Management of Complications of Distal Radius Fractures

Mathews

Chung

2015

Hand Clinics

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Synopsis Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased owing to complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius.

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“…Ein systematischer Review von insgesamt 21 Studien mit über 2000 Patienten erbrachte, dass das funktionelle Ergebnis bei Patienten über 60 Jahre bei operativer und konservativer Therapie vergleichbar war [1,7,8]. Das funktionelle Ergebnis wurde anhand des Disabilities of the Arm, Shoulder and Hand Scores (DASH) ermittelt [9]. Hinsichtlich der Komplikationsrate zeigten sich jedoch deutli- …”

Section: Hintergrundunclassified

Distale Radiusfraktur

Kalbitz

Gebhard

2016

Trauma Berufskrankh

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Die distale Radiusfraktur ist mit bis zu 20 % die häufigste Fraktur des älteren Menschen, in Deutschland sind dies insgesamt über 100.000 Fälle pro Jahr. Bei der distalen Radiusfraktur gibt es 2 Altersgipfel, der eine liegt im jugendlichen Alter von ca. 9 bis 18 Jahren, der zweite liegt bei > 50 Jahren und betrifft 80 % der Frakturen. Es besteht eine steigen- FragestellungZiel dieses Beitrages ist es, die Vor-und Nachteile der operativen und konservativen Therapie aufzuzeigen. Außerdem sollen verschiedene klinische Beispiele herangezogen werden, um besondere Herausforderungen bei der operativen Therapie zu verdeutlichen.

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Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment

Cited by 69 publications

References 26 publications

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults

Management of Complications of Distal Radius Fractures

Distale Radiusfraktur

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