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de Bruijn MAN, van Ginkel LA, Boersma EZ, van Silfhout L, Tromp TN, van de Krol E, Edwards MJR, Stirler VMA, Hermans E. Cast immobilization duration for distal radius fractures, a systematic review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02494-y. [PMID: 38507086 DOI: 10.1007/s00068-024-02494-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The optimal duration of immobilization for the conservative treatment of non- or minimally displaced and displaced distal radius fractures remains under debate. This research aims to review studies of these treatments to add evidence regarding the optimal immobilization period. METHODS A comprehensive database search was conducted. Studies investigating and comparing short (< 3 weeks) versus long (> 3 weeks) immobilizations for the conservative treatment of distal radius fractures were included. The studies were evaluated for radiological and functional outcomes, including pain, grip strength, and range of motion. Two reviewers independently reviewed all studies and performed the data extraction. RESULTS The initial database search identified 11.981 studies, of which 16 (involving 1.118 patients) were ultimately included. Patient-reported outcome measurements, grip strength, range of motion, and radiological outcomes were often better after shorter immobilization treatments. Radiological outcomes were better with longer immobilization in two studies and shorter immobilization in one study. Fourteen studies concluded that early mobilization is preferred, while the remaining two studies observed better outcomes with longer immobilization. The data were unsuitable for meta-analysis due to their heterogeneous nature. CONCLUSION Shorter immobilization for conservatively treated distal radius fractures often yield equal or better outcomes than longer immobilizations. The immobilization for non- or minimally displaced distal radius fractures could therefore be shortened to 3 weeks or less. Displaced and reduced distal radius fractures cannot be immobilized shorter than 4 weeks due to the risk of complications. Future research with homogeneous groups could elucidate the optimal duration of immobilization.
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Affiliation(s)
- Marcel A N de Bruijn
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Laura A van Ginkel
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
- Faculty of Science and Technology - Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Emily Z Boersma
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lysanne van Silfhout
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Erik van de Krol
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
- Military Health Organisation, Ministry of Defense, Kromhout Kazerne, Utrecht, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Vincent M A Stirler
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
- Military Health Organisation, Ministry of Defense, Kromhout Kazerne, Utrecht, The Netherlands
| | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
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Farzad M, MacDermid J, Hemmati M, Farhoud AR. Occupational Performance 1 Year After a Distal Radius Fracture From the Perspective of the International Classification of Functioning, Disability and Health. Am J Occup Ther 2023; 77:7705205040. [PMID: 37793017 DOI: 10.5014/ajot.2023.050180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
IMPORTANCE Distal radius fractures (DRFs) frequently compromise independent functioning. OBJECTIVE To analyze occupational performance post-DRF using the Canadian Occupational Performance Measure (COPM) and related interviews, guided by the International Classification of Functioning, Disability and Health (ICF). COPM score was compared with standard metrics: Patient-Reported Wrist Evaluation (PRWE) and Participation Behavior Questionnaire (PBQ). METHOD Through a semistructured COPM interview, participants highlighted self-care, productivity, and leisure. They completed the PRWE and PBQ, linking results to ICF sets. DESIGN Prospective cohort. SETTING Outpatient hand surgery clinic at a trauma center. PARTICIPANTS Patients (N = 120), 1 yr post-DRF. OUTCOMES AND MEASURES Incorporated COPM, PRWE, and PBQ, linked to ICF. RESULTS Analysis identified 73 codes, aligning with 30 ICF Hand Conditions codes. Main concerns related to self-care (15.21%), leisure (12.16%), and productivity (16.22%). Major challenges pertained to domestic (67.00%) and civic life (64.53%) within ICF. Occupational performance was positively correlated with participation (r = .62) and inversely with disability (r = -.62). CONCLUSIONS AND RELEVANCE DRFs result in varied occupational challenges that are not always reflected in standard measures. The COPM offers a comprehensive insight into post-DRF patient challenges, emphasizing the value of diverse clinical assessment approaches. What This Article Adds: This study highlights the importance of a holistic approach in occupational therapy for DRF patients, revealing that standard measurements might overlook key challenges that they face. By adopting broader evaluative methods, occupational therapists can better address patient-specific needs and enhance their rehabilitation outcomes.
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Affiliation(s)
- Maryam Farzad
- Maryam Farzad, PhD, MSc, BSc, is Postdoctoral Associate, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada, and Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;
| | - Joy MacDermid
- Joy MacDermid, PhD, MSc, BSc, is Professor, Department of Physical Therapy and Surgery, Western University, London, Ontario, Canada; Codirector, Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; and Professor, Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Motahar Hemmati
- Motahar Hemmati, BSc OT, is Master's Student, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amir Reza Farhoud
- Amir Reza Farhoud, MD, is Assistant Professor, Department of Orthopedic Surgery, Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Tehran, Iran
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Fan Y, Bai D, Cheng C, Tian G. The effectiveness and safety of blood flow restriction training for the post-operation treatment of distal radius fracture. Ann Med 2023; 55:2240329. [PMID: 37505919 PMCID: PMC10392265 DOI: 10.1080/07853890.2023.2240329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Distal radius fracture (DRF) is a common injury in the upper extremities. Blood flow restriction (BFR) has been proven to be effective in improving function in low-load training, which is suitable for post-op rehabilitation. We explored the effectiveness and safety of BFR therapy in DRF patients who underwent surgery. MATERIALS AND METHODS Thirty-five patients were randomly assigned to either the BFR or the regular training (RT; no BFR therapy) groups. All patients completed the same 4-week postoperative rehabilitation program, including anti-inflammatory treatments, strengthening and range of motion (ROM) training. In the BFR group, the pressure was 120 mmHg in strengthening training course. Pain, circumferences of wrists and forearms, ROM, muscle strength, and D-dimer levels were evaluated at weeks 0, 2, and 4. Radius union scoring system (RUSS) was measured at weeks 4 and 12. Finally, wrist functionality (Cooney modification) was evaluated at week 12. RESULTS The BFR group had significantly decreased pain levels compared with the RT group (p < 0.01, effect size= 2.33, -2.44 at weeks 2 and 4). Swelling was effectively relieved in both groups. The wrist swelling was less in the BFR group (p < 0.01, effect size = -2.17 at week 4). The isometric strength of wrist extension (p < 0.01, effect size = 1.5, 3.02 at weeks 2 and 4), flexion (p < 0.01, effect size = 1.33, 2.53 at weeks 2 and 4), and functionality significantly increased in the BFR group (p < 0.01, effect size = 2.80 at week 12). No risk of VT in the BFR group was found. BFR did not threaten bone healing. CONCLUSIONS In patients with DRF who underwent corrective surgery, BFR therapy effectively relieved pain and swelling, increased muscle strength and wrist function, and had no additional risks for bone healing and VT.
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Affiliation(s)
- Yi Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chongyuan Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guihua Tian
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Asmara AAGY, Karna MB, Meregawa PF, Deslivia MF. Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials. Rev Bras Ortop 2022; 57:899-910. [PMID: 36540735 PMCID: PMC9757966 DOI: 10.1055/s-0042-1754379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH ( p = 0.18) and PRWE ( p = 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of Evidence Level I.
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Affiliation(s)
- Anak Agung Gede Yuda Asmara
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia,Endereço para correspondência Anak Agung Gede Yuda Asmara Orthopedics and Traumatology Department, Faculty of Medicine, Udayana University, Sanglah General HospitalJl, Kesehatan no.1, BaliIndonesia
| | - Made Bramantya Karna
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Putu Feryawan Meregawa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Maria Florencia Deslivia
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
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Mohamed MA, Abdel-Wanis ME, Said E, Abdel-Aziz IA, Ahmed AM, Addosooki A. Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures. Injury 2022; 53:3344-3351. [PMID: 35999066 DOI: 10.1016/j.injury.2022.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/27/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal radius fractures are the most frequent upper limb injuries encountered by orthopedic surgeons. Surgical treatment of distal radius fractures is preserved for unstable and displaced fractures. A randomized controlled trial was conducted to compare the radiological and functional outcomes of bridge plating (BP) to external fixation (EF) in comminuted intra-articular distal radius fractures. METHODS Sixty patients with distal radius fractures were eligible for treatment by means of ligamentotaxis using either a dorsal bridge plate (30 patients) or an external fixator (30 patients) with or without supplementary Kirschner wires (K-wires). Radiological evaluation was done using the radial inclination angle, radial length, and the volar tilt. Clinical evaluation was performed using ranges of wrist motion, grip strength, Visual Analogue Scale (VAS), and a validated Arabic version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire RESULTS: Patients were followed up for 12 months. No significant difference was found in terms of radiographic parameters or ranges of wrist motion. At 3-months follow-up, bridge plating group had stronger grip strength, lower Disability of the Arm, Shoulder, and Hand scores, and lower Visual Analogue Scale. However, both groups had similar functional outcomes at last follow-up. External fixation group had a higher rate of postoperative complications. CONCLUSION In comparison to external fixation, bridge plating may provide earlier functional recovery with lower complication rates. However, no functional or radiological superiority were demonstrated at 12-months follow-up.
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Affiliation(s)
- Mohamed A Mohamed
- Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed E Abdel-Wanis
- Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Elsayed Said
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Islam A Abdel-Aziz
- Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed M Ahmed
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
| | - Ahmad Addosooki
- Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference? INTERNATIONAL ORTHOPAEDICS 2022; 46:2165-2176. [PMID: 35690670 PMCID: PMC9372011 DOI: 10.1007/s00264-022-05469-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Purpose Two different locking plate designs are now being used for volar plating of the distal radius fractures based on the freedom of screw direction; the fixed-angle, and the variable-angle (polyaxial) plates. We investigated the clinical and radiographic outcomes of both designs. Methods We reviewed 96 patients with 113 unstable distal radius fractures that were operated on with volar locking plates. The patients’ mean age was 41 years. Fixed-angle volar locking plates were utilized in 65 fractures and variable-angle volar locking plates in 48 fractures through modified Henry approach or extended carpal tunnel approach. Full clinical and radiographic evaluation was done for all patients with a mean follow-up of 14 months. Results All patients had acceptable clinical and radiographic parameters. The overall functional results (Mayo score, Quick Disability of Arm, Shoulder, and Hand (Q-DASH) score, Range of motion (ROM), and grip strength) were in favor of the variable-angle plate. The radiographic parameters were better with the variable-angle group. The variable-angle group recorded less operative time but more mean image intensifier exposure time. There were two cases of flexor tendon rupture with the fixed-angle group. Fixation with the fixed-angle system needed K-wire augmentation more than the variable-angle group. There was a positive correlation between hand dominance and the final score. Conclusion Distal radius volar locking plates yield satisfactory results comparable among different designs. In our series, the variable-angle system showed slightly better function and radiographic outcomes. Supplementary K-wires were needed more frequently with the fixed-angle system.
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Michael G, George K, Canjirathinkal MA, Ratna P, Francis J. Functional Outcome of Joshi’s External Stabilization System Fixation in Distal Radius Fractures. Cureus 2022; 14:e24215. [PMID: 35602785 PMCID: PMC9117850 DOI: 10.7759/cureus.24215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Distal radius fractures account for almost one-sixth of all fractures in a casualty setting. The usual aim of distal radius fracture treatment is to restore the function of the wrist joint, of which the distal radius is an important part. There seems to be no consensus regarding which mode of treatment is optimal for managing distal radius fracture, particularly when it is associated with distal radioulnar joint instability. Objective To describe the functional outcome in patients presenting with displaced distal radius fractures who undergo Joshi’s external stabilization system (JESS) fixation. Methods An observational study was done among 32 working-age (18 to 55 years) patients presenting with unilateral displaced distal radius fractures (excluding volar displaced) and subsequently treated with JESS fixation. The outcomes of the patients were assessed using the Green and O’Brien Scoring System modified by Cooney et al. at six months and one year following the surgery. Radiographs were also taken postoperatively and during follow-up. The data were analyzed (using IBM SPSS software version 22 and Microsoft Excel) in terms of the proportion of patients with acceptable clinical and radiological outcomes. Results Acceptable functional outcomes (good and excellent scores in the Green and O’Brien Scoring System) were observed in 78.1% of the study population. Though the functional outcome scores were higher among the younger age group, a statistically significant difference was not obtained. 96.9% of the patients had acceptable radiological reductions, and infection of the pin tracts complicated 9.4% of the cases. A significant improvement in outcome scores (p-value 0.0001) was observed between the outcome scores at six months and one year after surgery. Conclusions JESS fixation is an easy and effective method for treating displaced distal radius fractures to achieve good to excellent clinical outcomes. The functional outcome scores were better in the younger age group and male patients, but no statistically significant difference was observed.
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Aladraj TH, Keshta AS, Mukhtar I, Zeidan AA, Abousaleh MA, Ali N. A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children. Cureus 2022; 14:e22544. [PMID: 35345722 PMCID: PMC8956498 DOI: 10.7759/cureus.22544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Distal radius fractures are common pediatric orthopedic injuries accounting for 25% of all fractures with a significant incidence in the age group 10-14 years. This study aims to evaluate the operative and non-operative methods of treating distal radius fractures in children. Methods This is a retrospective cohort study conducted on 176 children with distal radius fracture. We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022. The inclusion criteria were as follows: age of 17 years or younger, distal radius fracture with or without complete displacement and skeletal immaturity managed as of non-operative or operative groups. Patients who did not have follow-up data after the date of surgery were excluded. The statistical analysis was performed using the software SPSS version 23.0 (IBM Corp., Armonk, NY). Continuous data expressed as mean, standard deviation and discrete variables were expressed as frequency and percentages. One-way Analysis of Variance (ANOVA) was used to compare the continuous variables between groups. The Student’s t-test was used for the two-group comparison. For the comparison of discrete variables, a Chi-Square test or Fisher’s exact test was used. Results Seventy-seven patients were conservatively managed with cast immobilization (“non-operative” group) in comparison to 99 patients who were surgically managed (“operative” group) with either percutaneous pinning (n=56) or flexinail (n=43). Fewer patients underwent physiotherapy in the operative group with 14 (25.0%) patients for percutaneous pinning and seven (16.3%) patients for flexinail versus 31 (40.3%) patients in the non-operative group (p<0.015). There were statistically significant differences in radial inclination (p<0.001) between conservative and percutaneous pinning (22.22±2.86 vs 18.76±3.33 degrees) and percutaneous pinning and flexinail (18.76±3.33 vs 22.37±3.44 degrees). Likewise, there was a significant difference found in ulnar variance between conservative and percutaneous pinning (-0.45±2.14 mm vs -1.47±1.93 mm, p=0.012) and conservative and flexinail (-0.45±2.14 mm vs -1.59±1.90 mm, p=0.009). There were a total of 25 documented complications. Nineteen (19.8%) complications occurred in the non-operative group versus five (7.2%) and one (2.3%) complications in percutaneous pinning and flexinail groups, respectively (p=0.003). The most common complication in the non-operative group was loss of reduction while in cast and subsequent need for surgical intervention. Ten of these patients underwent percutaneous pinning whereas nine were fixed by flexinail. Conclusion This study illustrated an overall similar success between the surgical and the conservative treatments of distal radius fractures in children. Due to the higher complication rate reported in the conservative group, the conservative treatment cannot be considered safer than the surgical treatment.
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Al-Faily HOHA, Nasir HA, Mohammed TR, Al-Edanni M. Prospective Descriptive Study of Radiological and Functional Outcomes of Volar Barton’s Fracture Fixed by Volar Locked Plate. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Volar Barton’s fracture is a shearing mechanism of injury that results in fracture and subluxation of distal end radius in which volar rim of the distal radius is displaced with hand and carpus. Open reduction and volar plate fixation ensure more stable change of displacement, preservation of reduction, and early mobilization.
AIM: This study aims to assess the functional and radiological outcome results of volar Barton’s fracture treated by volar buttress plate using the demerit points system of Gartland and Werley.
PATIENTS AND METHODS: This study is a prospective descriptive observational study on 32 patients who were treated with ORIF by volar buttress plate for isolated volar Barton’s fractures between February 2018 and June 2020 in Alkindy teaching hospital/Baghdad/Iraq. All volar Barton’s fracture cases satisfying the inclusion criteria which included patient over 18 years, isolated fracture, medically fit, and <5 days old injuries, while fractures extend to radius shaft, compound fractures, and associated with other injuries were excluded from the study. All fractures are fixed by volar locked plate followed up for 12 week’s duration for functional and radiological assessment using the Demerit points system of Gartland and Werley.
RESULTS: Most cases were in the age group below 40 years, average age 38 years (range 19–64 years), male patient was 69%, side of involvement was right wrist in 75% of cases, falling on an outstretched hand account 50%, while roads traffic accidents in 37.5%, fall from a height in 6.25%, and direct trauma in 6.25%. The final sequel of the results was average volar tilt was 11.1°, the radial shortening average was 4 mm, the radial inclination average was 19.9°, and the ulnar variance was 0.3 mm. Functional outcomes depending on Gartland and Werley’s score were 50% as excellent results, 43.75% as good results, 6.25% as fair results, and no poor results in this study.
CONCLUSIONS: Volar locking buttress plate provides fracture stability and early mobilization, therefore, recovery of daily live activity in a short time.
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Development and Trial of a Prototype Device for Sensorimotor Therapy in Patients with Distal Radius Fractures. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the clinical feasibility of a prototype device (development name: Ghost) for facilitating range of motion (RoM) recovery in the acute phase in patients with distal radius fractures (DRF). The Ghost device involves the administration of a combination of vibratory and visual stimuli. We divided the patients into the Ghost (n = 10) and control group (n = 4; tendon vibration only) groups. The experimental interventions were administered between the day after surgery and day 7 postoperatively. Traditional hand therapy was provided to both groups once daily from day 7 until day 84 postoperatively and once a week from day 84 until the end of the intervention period. Because vibratory stimulation makes the patient focus on wrist flexion, the primary outcome was the arc of wrist flexion-extension on the injured side, which was measured on days 7, 14, 28, 42, 56, 70, and 84. Analysis of covariance was applied using a bootstrap method to evaluate changes over time and compare them between the groups. Analyses was performed after stratification by age and body mass index. Both interventions improved RoM over time in patients with DRF. Results showed that Ghost has greater efficacy for improving wrist RoM in DRF patients than vibration alone. Treatment with Ghost can result in good RoM improvement during the acute phase of DRF in young patients and those with and normal or low body mass index. Further study is needed to verify our findings and assess the extent of RoM recovery.
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Schwartz DA, Schofield KA. Utilization of 3D printed orthoses for musculoskeletal conditions of the upper extremity: A systematic review. J Hand Ther 2021; 36:166-178. [PMID: 34819255 DOI: 10.1016/j.jht.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/02/2021] [Accepted: 10/02/2021] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Systematic Review INTRODUCTION: 3D printed orthoses are emerging as a possible option in the field of hand therapy to fabricate conventional casts and orthoses. It is unknown how this technology is currently being used to treat upper extremity musculoskeletal conditions, and if 3D orthoses are comparable to custom- made low temperature thermoplastic orthoses fabricated by hand therapists. PURPOSE OF THE STUDY The primary aim of this review was to investigate the utilization, effectiveness and feasibility of 3D printed technology to manufacture custom orthoses for musculoskeletal conditions of the upper extremity. METHODS Studies describing 3D printed orthoses or casts used in treatment with patients were included following a comprehensive literature search using CINAHL, PubMed, Medline, ProQuest, and EBSCO databases. The selected studies had to address musculoskeletal conditions of the elbow, wrist, hand and/or digits that would typically be immobilized with a cast or brace or orthotic or orthosis. RESULTS Ten studies met the inclusion criteria. Study designs included case studies, case series, and 1 randomized clinical trial. 3D printed orthoses/casts appear to be comfortable, provide adequate immobilization, and have pleasing aesthetics. However, expensive equipment, lack of appropriate software and scanning tools and lack of highly skilled clinicians are all factors preventing the implementation of 3D printed orthoses into current clinical practice. DISCUSSION 3D printed orthoses appear to be effective at immobilization of a limb, aesthetically pleasing, and utilize lightweight and well -ventilated materials. However, the feasibility of implementing 3D printing technology in hand therapy settings remains challenging in part due to the resources required. CONCLUSIONS While 3D printing shows promise, the high cost of equipment, lack of training and skill of clinicians and the long time required for production are all factors that need to be improved to make 3D printing a viable option in the hand therapy setting.
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Affiliation(s)
- Deborah A Schwartz
- Orfit Industries America, Leonia, NJ, USA; Touro University, Yeshiva University, USA.
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Fang C, Fang E, Yee DK, Kwan K, Leung G, Leung F. A comparison of six outcome measures across the recovery period after distal radius fixation-Which to use and when? J Orthop Surg (Hong Kong) 2021; 29:2309499020971866. [PMID: 33509054 DOI: 10.1177/2309499020971866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Many standardized outcome measures exist to measure recovery after surgical fixation of distal radius fractures, however, choosing the optimal instrument is difficult. We evaluated responsiveness, ceiling/floor effects, and criterion validity over multiple time intervals across a 2-year follow-up period for six commonly used instruments. METHODS A total of 259 patients who received open reduction and internal fixation for distal radius fractures between 2012 and 2015 were recruited. Patients were administered the Patient-Rated Wrist Evaluation (PRWE), Shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), Green and O'Brien score (Cooney modification) (CGNO), Gartland and Werley score (Sarmiento modification) (SGNW), flexion-extension arc (FEArc), and grip fraction test (GripFrac) at 1.5, 3, 6, 12, and 24 months postoperatively. Responsiveness was evaluated by calculating standardized response means (SRM) and Cohen's d effect sizes (ES), and by correlating each instrument's change scores against those of QuickDASH and PRWE, which were also used as external comparators to assess criterion validity. Ceiling/floor effects were calculated for all measures at each time point. RESULTS SRM (1.5-24 months) were 1.81, 1.77, 1.43, 1.16, 2.23, 2.45 and ES (1.5-24 months) were 1.81, 1.82, 1.95, 1.31, 1.99 and 2.90 for QuickDASH, PRWE, CGNO, SGNW, FEArc, and GripFrac respectively. Spearman correlation coefficients against QuickDASH at 24 months were: 0.809, 0.248, 0.563, 0.285, and 0.318 for PRWE, CGNO, SGNW, FEArc, and GripFrac respectively. Significant (>15% of patients reaching maximum score) ceiling effects were observed before 6 months for PRWE and SGNW. CONCLUSIONS Our evidence supports the use of QuickDASH, PRWE, FEArc and GripFrac up to 6 months postsurgery, and QuickDASH and PRWE after 6 months. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Christian Fang
- Department of Orthopedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Evan Fang
- Department of Orthopedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Dennis Kh Yee
- Department of Orthopedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kenny Kwan
- Department of Orthopedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Gladys Leung
- Occupational Therapy Unit, David Trench Rehabilitation Centre, Hong Kong, China
| | - Frankie Leung
- Department of Orthopedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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13
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Abstract
Distal radius fractures are common in the elderly population, second only to hip fractures in frequency. Historically, these injuries were treated almost exclusively without surgery, but an increase in operative management has occurred with development of volar locked plating in the early 2000s. Functional outcomes are similar between conservative and surgical treatment, but most studies assume low functional demands in older patients. Many elderly individuals today are active and independent. Decision-making in this higher-demand population is difficult. This article provides current evidence to facilitate informed, individualized decision-making when treating distal radius fractures in geriatric patients.
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14
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Coughlin T, Norrish AR, Scammell BE, Matthews PA, Nightingale J, Ollivere BJ. Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures: a randomized controlled trial of effectiveness. Bone Joint J 2021; 103-B:1033-1039. [PMID: 33926211 DOI: 10.1302/0301-620x.103b.bjj-2020-2026.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. METHODS Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. RESULTS A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). CONCLUSION Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy. Cite this article: Bone Joint J 2021;103-B(6):1033-1039.
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Affiliation(s)
| | - Alan R Norrish
- Queen Elizabeth Hospital, King's Lynn, UK.,Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | | | - Jessica Nightingale
- Nottingham University Hospitals, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Ben J Ollivere
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
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15
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Application of 3D-Printed Orthopedic Cast for the Treatment of Forearm Fractures: Finite Element Analysis and Comparative Clinical Assessment. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9569530. [PMID: 32775455 PMCID: PMC7399740 DOI: 10.1155/2020/9569530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/21/2020] [Accepted: 06/23/2020] [Indexed: 01/01/2023]
Abstract
Objective This pilot study is aimed at investigating the mechanical characteristics of a cast-wrapped fractured forearm and performing a clinical comparative study of our own developed 3D-printed orthopedic cast. Methods An integrated finite element (FE) model including a forearm and a 3D-printed cast wrapping the forearm was created. The distal radial ulna in this model was cut through to mimic the bone fracture. A 400 N force and 1 Nm rotation moment, which were much larger than the loading conditions encountered in daily life for a human being, were applied on the palm. We conducted a comparative clinical study by using statistical assessment. 60 patients with forearm fractures were selected and treated with manual reduction and external fixation cast. All patients were divided into three groups with equal members (20): (a) 3D-printed external cast group, (b) traditional plaster external fixation group, and (c) splint external fixation group. The clinical efficacy, wrist function, and patient satisfaction were scored and compared. Results In the condition of 400 N loading, the fracture displacements in anterior-posterior (AP), posterior-anterior (PA), medial to lateral (ML), and lateral to medial (LM) compression directions were 1.2648, 1.3253, 0.8503, and 0.8957 (mm), respectively, and the corresponding fracture stresses were 4.5986, 3.9129, and 5.0334, 7.9197 (MPa), respectively. In the inward (IR) and outward (OR) rotations, the fracture displacements were both 0.02628 (mm), and the corresponding fracture surface stresses were 0.1733 and 0.1723 (MPa), respectively. In the clinical efficacy, wrist function, and patient comfort evaluation, the total scores of group A were both higher than those in groups B and C (P < 0.05). Conclusion A 3D-printed orthopedic cast was capable of exerting appropriate mechanical correction loads on specific areas to maintain optimal alignment of a fractured forearm and thus could achieve the favorable clinical efficacy and patient comfort.
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16
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Delft EAV, Gelder TGV, Vries RD, Vermeulen J, Bloemers FW. Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review. J Wrist Surg 2019; 8:430-438. [PMID: 31579555 PMCID: PMC6773589 DOI: 10.1055/s-0039-1683433] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/28/2019] [Indexed: 01/07/2023]
Abstract
Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.
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Affiliation(s)
- Eva A.K. van Delft
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tamara G. van Gelder
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jefrey Vermeulen
- Department of Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Frank W. Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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17
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Gouk C, Ng SK, Knight M, Bindra R, Thomas M. Long term outcomes of open reduction internal fixation versus external fixation of distal radius fractures: A meta-analysis. Orthop Rev (Pavia) 2019; 11:7809. [PMID: 31579208 PMCID: PMC6769357 DOI: 10.4081/or.2019.7809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 05/02/2019] [Indexed: 11/23/2022] Open
Abstract
Distal radius fractures are among the most common fractures encountered in the clinical setting. Of these common fractures, it has been said that up to 60% are intraarticular in nature. Intra-articular or unstable and comminuted fractures represent severe and high energy injuries. Despite a large amount of literature, it is surgeon preference which determines the fixation method employed. There are only a few randomised control trials that report 2-year outcomes. There has yet to be a meta-analysis comparing the long-term outcomes of open reduction internal fixation (ORIF) and external fixation (EF). The aim of this metaanalysis is to identify any difference in the outcomes of either fixation method in the long term. We pooled the data of all the available randomised control trials that followed the patients for a minimum of 2 years and compared outcomes of ORIF against EF of distal radius fractures as per PRISMA guidelines from inception of the databases to December 2016. We then performed our meta-analysis using RevMan 5.3 software. Flexion/extension arcs were significantly improved in ORIF, and 7 of the 10 analysed outcomes supported ORIF, although most not to a significant degree. The meta-analysis indicated that there is no difference in outcomes with either form of treatment. Even though the flexion extension arc was statistically better in the ORIF group, the difference is not clinically meaningful.
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Affiliation(s)
- Conor Gouk
- Gold Coast University Hospital, Queensland.,Griffith University, Gold Coast Campus, Queensland
| | - Shu-Kay Ng
- Griffith University, Menzies Health Institute, Nathan Campus, Queensland, Australia
| | | | - Randy Bindra
- Gold Coast University Hospital, Queensland.,Griffith University, Gold Coast Campus, Queensland
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18
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Yu L, Zhang X, Zhang B, Hu C, Yu K, Tian D, Bai Y. Outcomes of volar locking plate (VLP) fixation for treatment of die-punch fracture of the distal radius: A retrospective single-surgeon study. Medicine (Baltimore) 2019; 98:e16796. [PMID: 31415386 PMCID: PMC6831231 DOI: 10.1097/md.0000000000016796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Distal radius fracture involving the lunate facet is a tough issue for surgeons, but currently there is scarcity of data on these injuries. This study aims to evaluate results of volar locking plate (VLP) for treatment of die-punch fractures of the distal radius.Between January 2013 and June 2017, a total of 37 patients with die-punch fractures of the distal radius were admitted and underwent VLP fixation. Clinical and radiographic data on these patients were extracted from their electronic medical records. Preoperative radiographs, CT scanning and 3D reconstruction were used to definitely diagnose this injury. Radiographs taken at immediate postoperation and at last follow-up were analyzed. Data on radial subsidence, articular step-off status, volar tilt, radial inclination, wrist motion range, grip strength and related complications at the final follow-up were documented for analysis. The overall outcomes of the injured limb were evaluated, based on the Gartland and Werley scoring system.The mean radial subsidence was 0.8 mm (0-3.3 mm), and articular step-off finally occurred in 4 patients (10.8%). The mean volar tilt was 9.5° (6°-15°), radial inclination 21° (12°-27°). The mean wrist was 84.2% in flexion of the contralateral uninjured wrist, 87.0% in extension, 92.2% in pronation and 94.5% in supination, respectively. The mean grip strength was 86% (range 56%-108%) of the contralateral un-injured upper limb. Gartland and Werley score demonstrated the excellent and good rate of 83.8%, with excellent result in 21 patients, good in 10, fair in 4 and poor in 2. Incidence of overall complications was 27.0% (10/37), with one requiring surgical intervention.VLP demonstrated its efficacy and safety for treatment of die-punch fractures. Prospective comparative studies with larger sample are required to compare the outcomes among different fixation methods, with expectation of precise and individualized treatment for every patient.Type of study/level of evidence: Therapeutic III.
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Affiliation(s)
- Lili Yu
- Department of Neurology, the 2nd Hospital of Hebei Medical University
| | - Xiong Zhang
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Bing Zhang
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Chunhe Hu
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Kunlun Yu
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Dehu Tian
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yanbin Bai
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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19
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Gutiérrez-Monclus R, Cavero-Redondo I, Álvarez-Bueno C. The effectiveness of adding a scapular exercise programme to physical therapy treatment in patients with distal radius fracture treated conservatively: a randomized controlled trial. Clin Rehabil 2019; 33:1931-1939. [PMID: 31353941 DOI: 10.1177/0269215519866240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effectiveness of a scapular exercise programme in addition to a physical therapy treatment in patients with distal radius fracture. DESIGN A single-blinded randomized controlled trial was conducted. SETTING Clinical Hospital San Borja Arriaran, Santiago, Chile. PARTICIPANTS A total of 102 patients above 60 years of age with extra-articular distal radius fracture were randomly divided into two groups. INTERVENTIONS The control group (n = 51) received a six-week physical therapy treatment; the intervention group (n = 51) received the same treatment plus a scapular exercise programme. OUTCOME MEASURES The two groups were assessed at baseline and after the six-week treatment. The arm function was assessed with the disabilities of the arm, shoulder and hand (DASH) questionnaire; secondary outcomes were measured by the patient-rated wrist evaluation (PRWE) questionnaire and visual analogue scale (VAS). RESULTS A total of 102 patients, 51 in the control group (40 women; mean age of 65.3 ± 4.8 years) and 51 in the intervention group (42 women; mean age of 67.2 ± 5.4 years), were analysed. At the end of the treatment, the difference between groups for the DASH was 16.7 points (P < 0.001), 1.5 points (P = 0.541) for the PRWE, 0.2 cm (P = 0.484) for the VAS at rest, and 1.7 cm (P < 0.001) for the VAS at movement. All differences were in favour of the intervention group. CONCLUSION In the short term, adding a scapular exercise programme provides a significant clinical benefit in arm function and pain relief with movement in patients above 60 years of age with extra-articular distal radius fracture treated conservatively.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Faculty of Health, University of the Americas, Santiago, Chile.,Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
| | - Felipe Araya-Quintanilla
- Faculty of Health, University of the Americas, Santiago, Chile.,Faculty of Health, Universidad SEK, Santiago, Chile
| | | | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Centro de Estudios Sociosanitarios, Cuenca, España.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Centro de Estudios Sociosanitarios, Cuenca, España.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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20
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Lameijer CM, ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 2018; 138:1699-1712. [PMID: 30317380 PMCID: PMC6224009 DOI: 10.1007/s00402-018-3046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.
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Affiliation(s)
- C. M. Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - H. J. ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - D. Vroling
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. T. Hartlief
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - C. K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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21
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Lameijer CM, Ten Duis HJ, Dusseldorp IV, Dijkstra PU, van der Sluis CK. Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 2017; 137:1499-1513. [PMID: 28770349 PMCID: PMC5644687 DOI: 10.1007/s00402-017-2765-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The objective of this systematic review was to analyze (1) prevalence of radiological posttraumatic arthritis (PA), (2) associations of PA with outcome measures and (3) predictors of PA following distal radius fractures in non-osteoporotic patients. MATERIALS AND METHODS Nineteen studies were included (10 open source data). RESULTS In total, 733 patients were described with a weighted mean age of 37 years (range 25-54) at the time of the injury. Follow-up ranged from 13 months to 38 years. Overall prevalence of PA was 50% and 37% in the open source data. Radial deviation was significantly worse in patients with PA (N = 49, mean 14°, SD 6° versus N = 55, mean 17°, SD 6°, p = 0.037). No analysis could be performed regarding patient reported outcome measures, because of limited data. Articular incongruence was a significant predictor for PA. CONCLUSIONS A high prevalence of PA was found in non-osteoporotic patients following a distal radius fracture. PA following a distal radial fracture was associated with a limited radial deviation and flexion, but not with grip strength. Articular incongruence predicted PA. Patient reported outcome measures should be investigated more thoroughly to be able to understand the value of using these instruments in interpreting outcome in follow-up of non-osteoporotic patients following a distal radius fracture. LEVEL OF EVIDENCE Level of evidence 3 (Phillips et al. Levels of Evidence-Oxford Centre for Evidence-based Medicine, 1).
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Affiliation(s)
- C M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands.
| | - H J Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands
| | - I van Dusseldorp
- Medical Center Leeuwarden, MCL Academy, Leeuwarden, The Netherlands
| | - P U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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22
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Jain MJ, Mavani KJ. A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures. J Clin Diagn Res 2016; 10:RC14-RC17. [PMID: 28208956 DOI: 10.7860/jcdr/2016/21926.9036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves "bridging" the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. AIM The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. MATERIALS AND METHODS This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. RESULTS At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. CONCLUSION The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of complications associated with them. The current technique represents an alternative that provides union of the comminuted distal radius fracture with anatomical alignment, optimal range of motion and with minimal clinical disability.
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Affiliation(s)
- Mohit J Jain
- Assistant Professor and Consultant Trauma Surgeon, Department of Orthopaedics, Sanjeevani Multispeciality Hospital , Jetpur, District-Rajkot Gujarat, India
| | - Kinjal J Mavani
- Senior Resident and Lecturer, Department of Orthodontics, Maratha Mandal Institute , Belgaum, Karnataka, India
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González N, Antón-Ladislao A, Orive M, Zabala J, García-Gutiérrez S, Las Hayas C, Quintana JM. Factors related to a decline in upper extremity function among patients with a wrist fracture due to a fall. Int J Clin Pract 2016; 70:930-939. [PMID: 27870256 DOI: 10.1111/ijcp.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022] Open
Abstract
AIMS The aim of this study was to identify factors related to a decline in function following a wrist fracture. METHODS Observational, prospective cohort study done in five public hospitals of the Basque Health Service. We recruited adults aged 65 or older with a wrist fracture due to a fall who attended the emergency department (ED) of one of these hospitals. Sociodemographic and clinical data were collected, along with information about health-related quality of life (HRQoL) and functionality. RESULTS A decline in function 6 months after the fracture was more likely among women (OR=3.409; 95% CI=1.920-6.053), patients receiving institutional help before the fracture (OR=5.717; 95% CI=1.644-19.883), patients who developed fracture-related complications within 6 months of the fall (OR=5.015; 95% CI=1.377-18.268), patients who visited an ED within 6 months of the fall (OR=1.646; 95% CI=1.058-2.561), patients with a displaced fracture (OR=1.595; 95% CI=1.106-2.300), and patients who broke the dominant hand (OR=1.464; 95% CI=1.019-2.103). Better baseline HRQoL and function were associated with smaller declines in function 6 months after the fall. Eighteen months after the fall, decline in function was more likely among women (OR=2.172; 95% CI=1.138-4.144) and patients visiting an ED because of fracture-related complications (OR=1.722; 95% CI=1.113-2.663). Better HRQoL and dependency level at baseline were associated with less decline in function 18 months after the fracture. DISCUSSION Two different models identified several parameters related to declines in upper extremity function 6 and 18 months after the fracture. CONCLUSIONS These results can help develop preventive actions needed to avoid or reduce the consequences of these falls.
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Affiliation(s)
- Nerea González
- Research Unit, Hospital Galdakao-Usansolo - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Ane Antón-Ladislao
- Research Unit, Hospital Galdakao-Usansolo - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Miren Orive
- Research Unit, Hospital Galdakao-Usansolo - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Jon Zabala
- Traumatology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Susana García-Gutiérrez
- Research Unit, Hospital Galdakao-Usansolo - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Spain
| | - Carlota Las Hayas
- Deusto University, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Jose Maria Quintana
- Research Unit, Hospital Galdakao-Usansolo - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Spain
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Ezzat A, Baliga S, Carnegie C, Johnstone A. Volar locking plate fixation for distal radius fractures: Does age affect outcome? J Orthop 2016; 13:76-80. [PMID: 27053837 PMCID: PMC4805772 DOI: 10.1016/j.jor.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The AAOS guidelines are unable to recommend for or against operative treatment of distal radius fractures in older patients. AIMS This study compares the outcomes of older patients (≥60 years) against a cohort of younger patients treated with volar locking plate (VLP) fixation. METHODS We assessed 78 patients, comparing range of movement (ROM), grip and pinch strength, subjective Visual Analogue Score (VAS) for pain and function and composite outcome scores. RESULTS There was no difference in clinical outcomes between the two groups at six months. CONCLUSION Open reduction and VLP for distal radius fractures gives comparable outcomes in the older population.
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Affiliation(s)
- Ahmed Ezzat
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Santosh Baliga
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
- Department of Trauma Orthopaedics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Carol Carnegie
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
- Department of Trauma Orthopaedics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Alan Johnstone
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
- Department of Trauma Orthopaedics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
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Barker SL, Rehman H, McCullough AL, Fielding S, Johnstone AJ. Assessment Following Distal Radius Fractures: A Comparison of 4 Scoring Systems, Visual Numerical Scales, and Objective Measurements. J Hand Surg Am 2016; 41:219-224.e1. [PMID: 26684714 DOI: 10.1016/j.jhsa.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare 4 recognized upper-limb scoring systems that are regularly used to assess wrist function after injury. METHODS We reviewed 116 patients 6 months after volar locking plate fixation for distal radius fractures. Two purely subjective and 2 composite scoring systems composed of both subjective and objective components were compared along with visual numerical scores for pain and function and objective measures of function. Each score was standardized into a scale from 0 to 100. RESULTS The distribution of the standardized total scores was statistically significantly different and indicated marked variability between scoring systems and therefore the information provided. Overall, the subjective scoring systems correlated well with each other and with both visual numerical scores for pain and function. However, the composite scores and objective measures of function correlated poorly with the subjective scores including the visual numerical scores. CONCLUSIONS Results from wrist scoring systems should be interpreted with caution. It is important to ensure that the component parts of each score are taken into consideration separately because total scores may be misleading. CLINICAL RELEVANCE Composite scores may be outdated and should be avoided.
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Affiliation(s)
- Scott L Barker
- Trauma and Orthopaedics Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Haroon Rehman
- Trauma and Orthopaedics Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
| | - Anna L McCullough
- Trauma and Orthopaedics Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Shona Fielding
- Trauma and Orthopaedics Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Alan J Johnstone
- Trauma and Orthopaedics Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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Shah H, Chavali V, Daveshwar R. Adolescent Volar Barton Fracture with Open Physis treated with Volar Plating using Buttressing Principle. Malays Orthop J 2015; 9:47-50. [PMID: 28435610 PMCID: PMC5333669 DOI: 10.5704/moj.1507.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The objective of the study was to assess the outcome of Salter- Harris type III distal radius fracture fixed using the principle of buttressing and avoiding screw insertion through the physis. Materials and Method: Eight school going children in the age group of 11-16 years with volar Barton fractures were treated with a volar plate using the buttress principle without inserting screws in the distal fragment. Patients were evaluated over a period of 18 months. Clinical evaluation was done using the Green O’Brien criteria and radiological evaluation using the Sarmiento criteria. Results: The average union time was two months. All the patients had good to excellent functional outcome with full extension and flexion. Conclusion: Buttress plating of volar Barton fractures in the adolescent age group is an excellent technique to achieve satisfactory outcome without violation of the physis.
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Affiliation(s)
- H Shah
- Department of Orthopaedics, Government Medical College, Baroda, India
| | - V Chavali
- Department of Orthopaedics, Government Medical College, Baroda, India
| | - R Daveshwar
- Department of Orthopaedics, Government Medical College, Baroda, India
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27
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Reynolds PJ. The correlation of radiographic outcome to functional outcome following fracture of the distal radius in elderly patients: A literature review. HAND THERAPY 2014. [DOI: 10.1177/1758998314527069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Fractures of the distal radius are common in the elderly population. Elderly patients have been considered to be functionally low-demand, but as the population becomes more active, expectations of outcomes may be increasing. The aim of this review was to determine whether there is any correlation between radiographic and functional outcome for elderly patients following fracture of the distal radius. Methods Medline, PubMed, CINAHL, Embase and AMED were searched for studies including elderly patients managed conservatively or surgically following distal radius fracture, either alone or in combination with younger patients. Results Eleven studies were selected for review. A wide variety of outcome measures and radiological parameters were found to be used. Of the 11 studies, 6 found no correlation between functional outcome and radiological outcome. Discussion The literature reviewed suggests functional outcome for elderly patients following distal radius fracture is not dependant on radiological outcome. This may give therapists better insight into potential outcomes for their patients, however further studies may be required to determine the most effective therapeutic management of these patients.
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