Treatment of unstable extra-articular distal radius fractures by modified intrafocal Kapandji method

Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis

PURPOSE

This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures.

METHODS

Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation.

RESULTS

Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups.

CONCLUSION

Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.

Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years

Objective

We evaluated hybrid nonbridging external fixation (NBEF) supplemented by K-wires as an effective and safe treatment option for osteoporotic distal radius fractures (DRFs) in a retrospective case series.

Methods

Sixteen extra-articular and one intra-articular DRF were treated by NBEF from 2016 to 2018 (mean patient age, 61.8 years; 15 women, 1 man). Radiographic parameters (volar tilt, radial inclination, and ulnar variance), range of motion, grip power, the visual analog scale score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed at 4 weeks, 6 weeks, 6 months, and 12 months postoperatively.

Results

The volar tilt and radial inclination were restored after surgery and maintained well. The mean visual analog scale score was 4 ± 1 at 4 weeks. Range of motion was restored to 79% to 91% at 6 weeks. The DASH score was good before NBEF device removal. Two superficial pin-tract infections were easily treated with antibiotics.

Conclusions

Hybrid NBEF transfixes DRFs in a multiplanar fashion, and augmentation with percutaneous K-wires provides direct fixation in radial shift and withstands axial loads in fracture fragments. It allows early mobilization with rigid fixation. Hybrid NBEF is reliable for unstable extra-articular and simple intra-articular DRFs in older patients.

Clinical Study registration number

ChiCTR1900021712

The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review

Background Unstable distal radius fractures are a popular research subject. However, to appreciate the findings of studies that enrolled patients with unstable distal radius fractures, it should be clear how the authors defined an unstable distal radius fracture. Questions In what percentage of studies involving patients with unstable distal radius fractures did the authors define unstable distal radius fracture? What are the most common descriptions of an unstable distal radius fracture? And is there one preferred evidence-based definition for future authors? Methods A systematic search of literature was performed to identify any type of study with the term unstable distal radius fracture. We assessed whether a definition was provided and determined the level of evidence for the most common definitions. Results The search yielded 2,489 citations, of which 479 were included. In 149 studies, it was explicitly stated that patients with unstable distal radius fractures were enrolled. In 54% (81/149) of these studies, the authors defined an unstable distal radius fracture. Overall, we found 143 different definitions. The seven most common definitions were: displacement following adequate reduction; Lafontaine's definition; irreducibility; an AO type C2 fracture; a volarly displaced fracture; Poigenfürst's criteria; and Cooney's criteria. Only Lafontaine's definition originated from a clinical study (level IIIb). Conclusion In only half of the studies involving patients with an unstable distal radius fracture did the authors defined what they considered an unstable distal radius fracture. None of the definitions stood out as the preferred choice. A general consensus definition could help to standardize future research.

Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series

At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the "volar Kapandji technique" completed follow-up of at least 12 (12 to 54) months. The mean age was 43 (23 to 53) years. The mean Disability of the Arm, Shoulder, and Hand score was 21.7 (0 to 41) and the mean Patient-Rated Wrist Evaluation score was 12.9 (0 to 25.8). The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.

Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate

We randomized 103 patients over the age of 50 with an unstable closed intra- or extra-articular dorsally displaced distal radius fracture to have either palmar fixed-angle plating (n=50) or 'mixed pinning' (n=53) and compared the clinical and radiological outcomes at 3, 6, 12 and 26 weeks after surgery in a prospective study. Postoperative palmar tilt was significantly better in those stabilized with K-wires, but loss of reduction was statistically less in those stabilized with a plate. At 26 weeks, functional results, assessed by DASH and Herzberg scores, were better in those fixed with a plate.

Distal radius fractures: nonoperative and percutaneous pinning treatment options

Nonoperative treatment of distal radial fractures by reduction and immobilization remains the most common treatment, based on the incidence of appropriate fracture types, as seen in many epidemiological studies in the literature. In this article, the indications, technique, predictors of failure, outcomes, and complications are reviewed. A variety of treatment options have been proposed for distal radial fractures that are predicted, or subsequently identified, to be too unstable for nonoperative management. Percutaneous pinning is an effective option for select fractures. The authors also review the indications, described techniques, complications and outcomes associated with this treatment option.

Distal radius fractures: nonoperative and percutaneous pinning treatment options

Nonoperative treatment of distal radial fractures by reduction and immobilization remains the most common treatment, based on the incidence of appropriate fracture types, as seen in many epidemiological studies in the literature. In this article, the indications, technique, predictors of failure, outcomes, and complications are reviewed. A variety of treatment options have been proposed for distal radial fractures that are predicted, or subsequently identified, to be too unstable for nonoperative management. Percutaneous pinning is an effective option for select fractures. The authors also review the indications, described techniques, complications and outcomes associated with this treatment option.