Patterns of injury and treatment for distal radius fractures at a major trauma centre

Predictors of limited forearm rotation following conservative treatment of distal radius fractures: a retrospective comparative study

BACKGROUND

Limitations in forearm rotation resulting from distal radius fracture are often neglected in clinical practice. We aimed to explore possible influencing factors of forearm rotation limitation following conservative treatment of these fractures.

METHODS

A series of patients with distal radius fractures who underwent conservative treatment in the Third Hospital of Hebei Medical University were retrospectively enrolled. Basic patient information and data on post-reduction imaging parameters and specific treatment strategies were collected. Ranges of forearm pronation and supination motion were recorded at 6-month and 12-month follow-ups. Univariate and multivariate logistic regression analyses were used to identify factors associated with forearm rotation limitation.

RESULTS

A total of 118 enrolled patients, 49 patients (41.5%) had limited forearm rotation function at the 6-month follow-up. Analysis of the fracture and cast fixation characteristics revealed that involvement of the sigmoid notch (odds ratio [OR], 7.010; 95% confidence interval [CI], 1.572-31.249), immobilization > 6 weeks (OR, 2.524; 95% CI, 1.044-6.099), and pronation fixation (OR, 1.797; 95% CI, 1.082-2.985) were associated with limited forearm rotation. Among patients with sigmoid notch fractures, there were no significant differences in forearm pronation or supination motion between the 6-month and 12-month follow-ups. At the 12-month follow-up, there was less supination function in patients with > 6 weeks of immobilization than in those with < 6 weeks of immobilization (P = 0.012), with no significant difference in pronation function (P = 0.131). At the 6-month follow-up, the degree of forearm supination was significantly lower in the fixed pronation position than in the neutral (P = 0.001) or supination (P < 0.001) positions, with no significant differences in the degree of forearm pronation among the three groups (P = 0.166). At the 12-month follow-up, no significant differences in pronation (P = 0.257) or supination (P = 0.164) were found among the three groups.

CONCLUSIONS

Sigmoid notch involvement, immobilization > 6 weeks, and pronation fixation were influencing factors of post-fracture limitation in forearm rotation. The effects of these factors on pronation and supination were not completely consistent and exhibited varying duration.

Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center

OBJECTIVES

The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

METHODS

A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III. Patients were either managed conservatively, i.e. 100 patients out of 150 and surgical management was done in 50 cases. For surgical management, implants used were K-wires, Schanz pins, and Ellis Plate. The functional outcomes were noted in terms of pain and range of motion, in the follow up of six months. Union was noted clinically and radiologically.

RESULTS

The mean age of the study patients was 42.32 ± 15.77 years. Out of 150 patients, there were 100 (66.67%) male patients. Compared to conservative management, surgical management had significantly lesser time of union (12 vs. 20 weeks, P<0.0001); significantly more excellent results (44% vs. 30%), more good results (32% vs. 15%) (P=0.003); comparable pain score (P=0.236); and comparable functional score (P=0.661). Regarding radiological outcomes, surgical management had significantly more volar tilt (9.6±2.5° vs. 8±5°, P=0.035); lesser Ulnar variance (3±2 vs. 4±2 mm, P=0.004), lesser grip strength <50% (26% vs. 65%, P<0.0001); comparable radial inclination (21±4° vs. 20±5°, P=0.661); and comparable radial height (11±3 vs. 10±5 mm, P=0.195) Conclusion: To conclude, surgery for distal radius fractures promotes faster healing, lesser pain, lesser malunion, and better functional outcomes. However, it is not without potential risks. Non-surgical treatment is still a suitable option, for patients with contraindications to surgery or having lower need for functional improvement.

Three-Dimensional Morphometric Analysis of the Volar Cortical Shape of the Lunate Facet of the Distal Radius

In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.

Locked Wire Fixator for a Distal Radius Fracture With Malunion: A Case Report

Surgical treatment for a distal radius fracture using a volar locking plate is difficult if the distal radius malunion remains. Therefore, a different surgical method from volar locking plate fixation should be required. We report the case of an 83-year-old woman with a left dorsal displaced distal radius fracture. However, the deformity of the volar cortex of the radius was recognized because of a previous distal radius fracture. Therefore, osteosynthesis with a locked wire fixator was performed. At 12 months after surgery, the patient has returned to daily activities without difficulty. A locked wire fixator can be useful for treating a distal radius fracture with malunion of the volar cortex of the distal radius.

Four weeks versus six weeks of immobilization in a cast following closed reduction for displaced distal radial fractures in adult patients: a multicentre randomized controlled trial

Aims

There is no level I evidence dealing with the optimal period of immobilization for patients with a displaced distal radial fracture following closed reduction. A shorter period might lead to a better functional outcome due to less stiffness and pain. The aim of this study was to investigate whether this period could be safely reduced from six to four weeks.

Methods

This multicentre randomized controlled trial (RCT) included adult patients with a displaced distal radial fracture, who were randomized to be treated with immobilization in a cast for four or six weeks following closed reduction. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after follow-up at one year. Secondary outcomes were the abbreviated version of the Disability of Arm, Shoulder and Hand (QuickDASH) score after one year, the functional outcome at six weeks, 12 weeks, and six months, range of motion (ROM), the level of pain after removal of the cast, and complications.

Results

A total of 100 patients (15 male, 85 female) were randomized, with 49 being treated with four weeks of immobilization in a cast. A total of 93 completed follow-up. The mean PRWE score after one year was 6.9 (SD 8.3) in the four-week group compared with 11.6 (SD 14.3) in the six-week group. However, this difference of -4.7 (95% confidence interval -9.29 to 0.14) was not clinically relevant as the minimal clinically important difference of 11.5 was not reached. There was no significant difference in the ROM, radiological outcome, level of pain, or complications.

Conclusion

In adult patients with a displaced and adequately reduced distal radial fracture, immobilization in a cast for four weeks is safe, and the results are similar to those after a period of immobilization of six weeks.

Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis

AIM

This network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.

METHODS

We searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.

RESULTS

Fourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.

CONCLUSION

Evidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.