1
|
Raudasoja L, Vastamäki H, Aspinen S, Ryhänen J, Hulkkonen S. Distal radial fractures: a nationwide register study on corrective osteotomies after malunion. J Hand Surg Eur Vol 2024; 49:329-333. [PMID: 37694946 PMCID: PMC10882945 DOI: 10.1177/17531934231193849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023]
Abstract
The aim of the present study was to explore the incidence of corrective osteotomies after conservatively treated distal radial fracture and the risk for late correction depending on the patient's age. Based on data from the Finnish National Care Register of Health Care, Specialist Care, on all corrective osteotomies carried out in Finland during 2015-2019 in adults aged ≥20 years, we calculated the mean annual incidence rates per 100,000 person-years, standardized with the European Standard Population 2013. Using multivariable logistic regression, we calculated the risk of corrective osteotomies in various age groups. In total, 41,418 distal radial fractures were identified. Of those, 10,577 received surgical treatment in the acute phase. The incidence rate of primary operations for distal radial fractures was 47.9 per 100, 000 person-years. A total of 321 conservatively treated fractures needed corrective osteoteomy, with a surprisingly low mean annual incidence rate of 1.5 per 100,000 person-years. The risk for this was highest in patients in their fourth or fifth decade.Level of evidence: III.
Collapse
Affiliation(s)
- Leena Raudasoja
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| | - Heidi Vastamäki
- Sports Trauma Research Unit, Hospital Mehilainen Neo, Turku, Finland
| | - Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| | - Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, HUS, Finland
| |
Collapse
|
2
|
Tai TH, Chu PJ, Lu KY, Wu JJ, Wong CC. Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures-An Updated Narrative Review. J Clin Med 2023; 12:6801. [PMID: 37959267 PMCID: PMC10648218 DOI: 10.3390/jcm12216801] [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: 09/09/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues.
Collapse
Affiliation(s)
- Ting-Han Tai
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
| | - Po-Jui Chu
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
- Department of Primary Care Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Kuan-Yu Lu
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
| | - Jeffrey J. Wu
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
| | - Chin-Chean Wong
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Research Center of Biomedical Devices, Taipei Medical University, Taipei 110301, Taiwan
- International PhD Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| |
Collapse
|
3
|
Aniel-Quiroga M, Fruner G, Monge-Baeza A, García-Toledo A, Liñán-Padilla A, Jiménez I. The hematoma block is not enough as method of anesthesia in reduction of displaced distal radius fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:371-377. [PMID: 36898432 DOI: 10.1016/j.recot.2023.03.004] [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: 11/27/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Two out of three wrist fractures seen in the emergency are displaced but most can be treated conservatively after closed reduction. Patient-reported pain during closed reduction of distal radius fractures varies widely and the best method to decrease the perceived pain has not been well established. The purpose of this study was to assess the pain during closed reduction of distal radius fractures after using the hematoma block as method of anaesthesia. PATIENTS AND METHODS Cross-sectional clinical study including all patients who presented an acute fracture of the distal radius requiring closed reduction and immobilization during a six-month period in two University Hospitals. Demographic data, fracture classification, perceived pain using a visual analog scale at different times of reduction and complications were registered. RESULTS Ninety-four consecutive patients were included. Mean age was 61 years. Mean pain score at initial assessment was 6 points. After the hematoma block, the perceived pain during the reduction manoeuvre improved to 5.1 points at the wrist, but increased to 7.3 points at the fingers. Pain decreased to 4.9 points during cast placement and reached 1.4 point after sling placement. The reported pain was higher in women at all times. There were no significant differences according to the according to the type of fracture. No neurological or skin complications were observed. CONCLUSIONS The hematoma block is only a mild effective method to reduce the wrist pain during closed reduction of distal radius fractures. This technique decreases slightly the perceived pain in the wrist and does not reduce the pain in the fingers. Other reduction methods or other analgesic techniques may be more effective options. LEVEL OF EVIDENCE Therapeutic study. Cross-sectional study - Level IV.
Collapse
Affiliation(s)
- M Aniel-Quiroga
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - G Fruner
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - A Monge-Baeza
- Servicio de Cirugía Ortopédica y Traumatología, Hospital San Juan de Dios del Aljarafe, Sevilla, España
| | - A García-Toledo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - A Liñán-Padilla
- Servicio de Cirugía Ortopédica y Traumatología, Hospital San Juan de Dios del Aljarafe, Sevilla, España
| | - I Jiménez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| |
Collapse
|
4
|
Aniel-Quiroga M, Fruner G, Monge-Baeza A, García-Toledo A, Liñán-Padilla A, Jiménez I. [Translated article] The haematoma block is not enough as method of anaesthesia in reduction of displaced distal radius fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T371-T377. [PMID: 37311480 DOI: 10.1016/j.recot.2023.06.004] [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: 11/27/2022] [Accepted: 03/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Two out of three wrist fractures seen in an emergency department are displaced but most can be treated conservatively after closed reduction. Patient-reported pain during closed reduction of distal radius fractures varies widely and the best method to decrease the perceived pain has not been well established. The purpose of this study was to assess pain during closed reduction of distal radius fractures after using haematoma block as method of anaesthesia. PATIENTS AND METHODS Cross-sectional clinical study including all patients who presented an acute fracture of the distal radius requiring closed reduction and immobilisation during a six-month period in two University Hospitals. Demographic data, fracture classification, perceived pain using a visual analogue scale at different times of reduction and complications were registered. RESULTS Ninety-four consecutive patients were included. Mean age was 61 years. Mean pain score at initial assessment was 6 points. After the haematoma block, the perceived pain during the reduction manoeuvre improved to 5.1 points at the wrist, but increased to 7.3 points at the fingers. Pain decreased to 4.9 points during cast placement and reached 1.4 point after sling placement. The reported pain was higher in women at all times. There were no significant differences according to the according to the type of fracture. No neurological or skin complications were observed. CONCLUSIONS Haematoma block is only a mildly effective method to reduce wrist pain during closed reduction of distal radius fractures. This technique slightly decreases the perceived pain in the wrist and does not reduce the pain in the fingers. Other reduction methods or other analgesic techniques may be more effective options. LEVEL OF EVIDENCE Therapeutic study. Cross-sectional study - Level IV.
Collapse
Affiliation(s)
- M Aniel-Quiroga
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - G Fruner
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Monge-Baeza
- Servicio de Cirugía Ortopédica y Traumatología, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
| | - A García-Toledo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Liñán-Padilla
- Servicio de Cirugía Ortopédica y Traumatología, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
| | - I Jiménez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| |
Collapse
|
5
|
Jayaram M, Wood SM, Kane RL, Yang LY, Chung KC. Association of Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults: A Network Meta-analysis. JAMA Netw Open 2023; 6:e2318715. [PMID: 37326988 PMCID: PMC10276304 DOI: 10.1001/jamanetworkopen.2023.18715] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Randomized clinical trials (RCTs) and meta-analyses have reported inconsistent conclusions regarding optimal distal radius fracture (DRF) treatment in older adults and are limited due to the inclusion of cohort studies with small sample sizes. A network meta-analysis (NMA) addresses these limitations by only synthesizing direct and indirect evidence from RCTs and may clarify optimal DRF treatment in older adults. Objective To examine DRF treatment results in optimal short-term and intermediate-term patient-reported outcomes. Data Sources Searches of MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes in older adults between January 1, 2000, and January 1, 2022. Study Selection Randomized clinical trials including patients with a mean age of 50 years or older that compared the following DRF treatments were eligible for inclusion: casting, open reduction and internal fixation with volar lock plating (ORIF), external fixation, percutaneous pinning, and nail fixation. Data Extraction and Synthesis Two reviewers independently completed all data extraction. An NMA aggregated all direct and indirect evidence among DRF treatments. Treatments were ranked by surface under the cumulative ranking curve score. Data are reported as standard mean differences (SMDs) and 95% CIs. Main Outcomes and Measures The primary outcome was short-term (≤3 months) and intermediate-term (>3 months to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1-year complication rates. Results In this NMA, 23 RCTs consisting of 3054 participants (2495 women [81.7%]) with a mean (SD) age of 66 (7.8) years were included. At 3 months, DASH scores were significantly lower for nail fixation (SMD, -18.28; 95% CI, -29.93 to -6.63) and ORIF (SMD, -9.28; 95% CI, -13.90 to -4.66) compared with casting. The PRWE scores were also significantly lower for ORIF (SMD, -9.55; 95% CI, -15.31 to -3.79) at 3 months. In the intermediate term, ORIF was associated with lowered DASH (SMD, -3.35; 95% CI, -5.90 to -0.80) and PRWE (SMD, -2.90; 95% CI, -4.86 to -0.94) scores. One-year complication rates were comparable among all treatments. Conclusions and Relevance The findings of this NMA suggest that ORIF may be associated with clinically significant improvements in short-term recovery compared with casting for multiple patient-reported outcomes measures with no increase in 1-year complication rates. Shared decision-making with patients may be useful to identify patient preferences regarding recovery to determine optimal treatment.
Collapse
Affiliation(s)
- Mayank Jayaram
- Medical Student, University of Michigan Medical School, Ann Arbor
| | - Shannon M. Wood
- Master’s Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert L. Kane
- Division of Plastic Surgery, Department of Surgery, The Medical University of South Carolina, Charleston
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kevin C. Chung
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor
| |
Collapse
|
6
|
Hoffer AJ, St George SA, Banaszek DK, Roffey DM, Broekhuyse HM, Potter JM. If at first you don't succeed, should you try again? The efficacy of repeated closed reductions of distal radius fractures. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04904-z. [PMID: 37178164 DOI: 10.1007/s00402-023-04904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION A repeated closed reduction ("re-reduction") of a displaced distal radius fracture is a common procedure performed to obtain satisfactory alignment and avoid surgery when the initial reduction is deemed unsatisfactory. However, the efficacy of re-reduction is unclear. Compared to a single closed reduction, does a re-reduction of a displaced distal radius fracture: (1) improve radiographic alignment at the time of fracture union and, (2) decrease the rate of operative intervention? MATERIALS AND METHODS Retrospective cohort analysis of 99 adults aged 20-99 years with extra-articular or minimally displaced intra-articular, dorsally angulated, displaced distal radius fracture with or without an associated ulnar styloid fracture who underwent a re-reduction, compared against 99 adults matched for age and sex who were managed with a single reduction. Exclusion criteria were skeletal immaturity, fracture-dislocation and articular displacement greater than 2 mm. Outcome measures included radiographic alignment at fracture union and rate of surgical intervention. RESULTS At 6-8 weeks follow-up, the single reduction group had greater radial height (p = 0.045, CI 0.04 to 3.57), and less ulnar variance (p < 0.001, CI - 3.08 to - 1.00) compared to the re-reduction group. Immediately following re-reduction, 49.5% of patients met radiographic non-operative criteria, but by 6-8 weeks follow-up, only 17.5% of patients continued to meet these criteria. Patients in the re-reduction group were treated with surgery 34.3% of the time, compared to 14.1% of the time for patients in the single reduction group (p = 0.001). In patients aged under 65 years, 49.0% of those who underwent a re-reduction were managed with surgery, compared to 21.0% of those who had a single reduction (p = 0.004). CONCLUSION A re-reduction performed to improve radiographic alignment and avoid surgical management in this subset of distal radius fractures had minimal value. Alternative treatment options should be considered before attempting a re-reduction.
Collapse
Affiliation(s)
- Alexander J Hoffer
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Stefan A St George
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Daniel K Banaszek
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| |
Collapse
|
7
|
Lawson A, Naylor J, Mittal R, Kale M, Xuan W, Harris IA. Does Radiographic Alignment Correlate With Patient-Reported Functional Outcomes and Posttreatment Complications in Older Patients Treated for Wrist Fractures? J Hand Surg Am 2023:S0363-5023(23)00115-6. [PMID: 37115143 DOI: 10.1016/j.jhsa.2023.02.012] [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: 04/09/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Surgical treatment of distal radius fractures provides better fracture alignment than closed reduction; however, surgical treatment does not lead to better patient-reported function at 12 months. The aims of this study were to report the radiographic outcomes from the Combined Randomized and Observational Study of Surgery for Fractures In the distal Radius in the Elderly trial, investigate the association between radiographic outcomes and patient-reported function, and explore whether this association was affected by posttreatment complications and direction of malalignment. METHODS This study used the outcomes of the Combined Randomized and Observational Study of Surgery for Fractures In the distal Radius in the Elderly trial, which is a combined randomized and observational trial that compared volar-locking plate fixation with closed reduction and cast immobilization, to treat distal radius fractures in patients aged ≥60 years. Four radiographic outcomes (dorsal angulation, radial inclination, ulnar variance, and articular step) were reported at the following three time frames: (1) baseline, (2) after treatment, and (3) ≥6 weeks by treatment group. Secondary analysis was correlation of 12-month patient-reported function scores with 6-week radiographic measures for each of four radiographic parameters, and a subgroup analysis was conducted to investigate if this was affected by posttreatment complications. Tertiary analysis investigated if direction of malalignment affected the secondary analysis. RESULTS We recruited 300 participants (166 randomized and 134 observational); 113 had volar-locking plate fixation, and 187 had closed reduction. There were no between-group differences for each of the four pretreatment radiographic parameters, but there were between-treatment group differences for all four radiographic parameters apart from articular step. We found no association between patient-reported function at 12 months and each of the four radiographic parameters at 6 weeks. This lack of association was unaffected by posttreatment complications and the direction of malalignment. CONCLUSIONS For patients with wrist fractures aged ≥60 years, final radiographic alignment did not correlate with patient-reported function at 12 months. These findings were not affected by treatment type, and there was no association between radiographic alignment and posttreatment complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia; South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia.
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia; South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | - Michael Kale
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia; South Western Sydney Clinical School, UNSW Sydney, Sydney, Australia
| |
Collapse
|
8
|
Hwang LK, Greige N, Wang F, Yi JK, Treiser MD, Ricci JA. Use of Plain Radiography of Uninjured Wrists as Patient-Specific Markers of Successful Reduction of Unilateral Distal Radius Fractures. Hand (N Y) 2022; 17:129S-134S. [PMID: 35502541 PMCID: PMC9793610 DOI: 10.1177/15589447221092057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The standard of care of distal radius fractures requiring operative intervention involves restoration of anatomical alignment radiologically by comparing preoperative films and intraoperative fluoroscopy with established values based on population norms. The objective of this study is to evaluate the use of plain radiographs obtained from the uninjured wrist of patients who present with unilateral displaced distal radius fractures as a measure of successful achievement of anatomical realignment. METHODS A retrospective review was performed on 133 consecutive patients who presented from August 2020 to August 2021 with a diagnosis of unilateral distal radius fracture as confirmed on 3-view plain radiography. Patients who had bilateral radiographs and underwent open reduction and internal fixation were included. The primary outcome measure was comparison of radial inclination, radial height, tilt, and ulnar variance measured by 3 observers on preoperative, 1-week postoperative, and uninjured contralateral wrist films. RESULTS Twenty-one patients were included for analysis. Comparison of postoperative radiologic parameters with the contralateral uninjured extremity revealed a mean radial inclination difference of 3.8°, radial height difference of 2.0 mm, volar tilt difference of 6.3°, and ulnar variance difference of 0.9 mm. The average postreduction radial height was found to deviate from contralateral radial height significantly more than from the historic radial height parameter (2.0 vs 0.6 mm, P < .001). CONCLUSION Attempts at achieving distal radius fracture reduction to within historical normal limits may result in an increased deviation from patient-specific anatomical parameters, especially with respect to radial height.
Collapse
Affiliation(s)
| | | | - Fei Wang
- Montefiore Medical Center, Bronx, NY,
USA
| | | | | | | |
Collapse
|
9
|
Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh ZJ, Smith P, Xuan W, Howard K, Vafa A, Perriman D, Mittal R, Yates P, Rieger B, Smith G, Adie S, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Beattie S, Mulford J, Incoll I, Kale M, Schick B, Li T, Higgs A, Oppy A, Harris IA. Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Secondary Analysis of a Randomized Clinical Trial. JAMA Surg 2022; 157:563-571. [PMID: 35476128 PMCID: PMC9047748 DOI: 10.1001/jamasurg.2022.0809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Distal radius fractures are common and are managed with or without surgery. Current evidence indicates surgical treatment is not superior to nonsurgical treatment at 12 months. Objective Does surgical treatment for displaced distal radius fractures in patients 60 years or older provide better patient-reported wrist pain and function outcomes than nonsurgical treatment at 24 months? Design, Setting, and Participants In this secondary analysis of a combined multicenter randomized clinical trial (RCT) and a parallel observational study, 300 patients were screened from 19 centers in Australia and New Zealand. Of these, 166 participants were randomized to surgical or nonsurgical treatment. Participants who declined randomization (n = 134) were included in the parallel observational group with the same treatment options and follow-up. Participants were followed up at 3, 12, and 24 months by a blinded assessor. The 24-month outcomes are reported herein. Data were collected from December 1, 2016, to December 31, 2020, and analyzed from February 4 to October 21, 2021. Interventions Surgical treatment consisting of open reduction and internal fixation using a volar-locking plate (VLP group) and nonsurgical treatment consisting of closed reduction and cast immobilization (CR group). Main Outcomes and Measures The primary outcome was patient-reported function using the Patient-Rated Wrist Evaluation (PRWE) questionnaire. Secondary outcomes included health-related quality of life, wrist pain, patient-reported treatment success, patient-rated bother with appearance, and posttreatment complications. Results Among the 166 randomized and 134 observational participants (300 participants; mean [SD] age, 71.2 [7.5] years; 269 women [89.7%]), 151 (91.0%) randomized and 118 (88.1%) observational participants were followed up at 24 months. In the RCT, no clinically important difference occurred in mean PRWE scores at 24 months (13.6 [95% CI, 9.1-18.1] points for VLP fixation vs 15.8 [95% CI, 11.3-20.2] points for CR; mean difference, 2.1 [95% CI, -4.2 to 8.5]; P = .50). There were no between-group differences in all other outcomes except for patient-reported treatment success, which favored VLP fixation (33 of 74 [44.6%] in the CR group vs 54 of 72 [75.0%] in the VLP fixation group reported very successful treatment; P = .002). Rates of posttreatment complications were generally low and similar between treatment groups, including deep infection (1 of 76 [1.3%] in the CR group vs 0 of 75 in the VLP fixation group) and complex regional pain syndrome (2 of 76 [2.6%] in the CR group vs 1 of 75 [1.3%] in the VLP fixation group). The 24-month trial outcomes were consistent with 12-month outcomes and with outcomes from the observational group. Conclusions and Relevance Consistent with previous reports, these findings suggest that VLP fixation may not be superior to CR for displaced distal radius fractures for patient-rated wrist function in persons 60 years or older during a 2-year period. Significantly higher patient-reported treatment success at 2 years in the VLP group may be attributable to other treatment outcomes not captured in this study. Trial Registration ANZCTR.org Identifier: ACTRN12616000969460.
Collapse
Affiliation(s)
| | - Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Zsolt J Balogh
- Department of Orthopedics, John Hunter Hospital, Newcastle, Australia.,Department of Orthopedics, University of Newcastle, Newcastle, Australia
| | - Paul Smith
- Department of Orthopedics, Canberra Hospital, Canberra, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Arezoo Vafa
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Diana Perriman
- Department of Orthopedics, Canberra Hospital, Canberra, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Piers Yates
- Department of Orthopedics, Fiona Stanley Hospital, Perth, Australia
| | - Bertram Rieger
- Department of Orthopedics, Fiona Stanley Hospital, Perth, Australia
| | - Geoff Smith
- Department of Orthopedics, St George and Sutherland Hospitals, Sydney, Australia
| | - Sam Adie
- Department of Orthopedics, St George and Sutherland Hospitals, Sydney, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Ilia Elkinson
- Department of Orthopedics, Wellington Hospital, Wellington, New Zealand
| | - Woosung Kim
- Department of Orthopedics, Wellington Hospital, Wellington, New Zealand
| | - Jai Sungaran
- Department of Orthopedics, Concord Hospital, Sydney, Australia
| | - Kim Latendresse
- Department of Orthopedics, Nambour Hospital and Sunshine Coast University Hospital, Nambour, Australia
| | - James Wong
- Department of Orthopedics, Westmead Hospital, Sydney, Australia
| | | | - Keith Landale
- Department of Orthopedics, Campbelltown Hospital, Sydney, Australia
| | - Herwig Drobetz
- Department of Orthopedics, Mackay Base Hospital, Mackay, Australia
| | - Phong Tran
- Department of Orthopedics, Western Health, Melbourne, Australia
| | - Richard Page
- Department of Orthopedics, University Hospital Geelong, Barwon Health, Geelong, Australia.,Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University, Geelong, Australia
| | - Sally Beattie
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University, Geelong, Australia
| | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, Australia
| | | | | | - Trent Li
- Prince of Wales Hospital, Sydney, Australia
| | | | - Andrew Oppy
- Royal Melbourne Hospital, Melbourne, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| |
Collapse
|
10
|
Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
Collapse
Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| |
Collapse
|
11
|
An Analysis of the Impact of Timing and Technique on Outcomes after Surgery for Distal Radius Fractures: The Wrist and Radius Injury Surgical Trial Collaborative Study. Plast Reconstr Surg 2021; 148:1053-1062. [PMID: 34546187 DOI: 10.1097/prs.0000000000008416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical treatment of closed distal radius fractures varies based on treatment, surgeon schedule, and patient preferences. The authors examined how timing and technique impact surgeon-perceived procedural difficulty and quality of reduction, outcomes, and complications. METHODS This was a retrospective study of participants in the randomized, multicenter Wrist and Radius Injury Surgical Trial with isolated unstable distal radius fractures. Participants were randomized to treatment with a volar locking plate system, closed reduction and percutaneous pinning, or external fixation. The authors analyzed surgeon-perceived procedural difficulty and reduction quality based on time to operation. RESULTS Of 184 participants, 88 underwent surgery less than 7 days after fracture (mean, 4.6 days) and 96 underwent surgery at more than 7 days after fracture (mean, 12.3 days). Surgery performed at more than 7 days was rated more difficult versus surgery at less than 7 days [4.6 versus 3.8 of 10 (1 = easiest); p = 0.05]. When the volar locking plate technique was performed, there was no difference in surgeon-perceived difficulty or reduction quality between the groups; however, surgeons performing closed reduction and percutaneous pinning more than 7 days after injury reported greater procedure difficulty (4.1 versus 2.9; p = 0.05) and poorer reduction quality compared to less than 7 days (7.2 versus 8.1; p = 0.03). Participants who underwent surgery at less than 7 days scored 8 and 7 points greater on the Michigan Hand Outcomes Questionnaire Satisfaction (p = 0.05) and Activities of Daily Living (p = 0.03) domains, respectively. CONCLUSIONS Surgery performed less than 7 days after fracture leads to better surgeon-perceived reduction quality and less procedural difficulty. If surgery cannot be performed before 7 days, the authors recommend patients undergo treatment with the volar locking plate system, given the comparable level of surgeon-perceived procedural difficulty and reduction quality when surgery was performed less than 7 days after injury. CLINICAL QUERSTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
|
12
|
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.
Collapse
|
13
|
Stephens AR, Presson AP, McFarland MM, Zhang C, Sirniö K, Mulders MA, Schep NW, Tyser AR, Kazmers NH. Volar Locked Plating Versus Closed Reduction and Casting for Acute, Displaced Distal Radial Fractures in the Elderly: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Bone Joint Surg Am 2020; 102:1280-1288. [PMID: 32675679 PMCID: PMC7431141 DOI: 10.2106/jbjs.19.01442] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It remains unclear whether volar locked plating (VLP) yields a better functional outcome than closed reduction and casting (CRC) for elderly patients with an acute, displaced distal radial fracture. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials comparing outcomes of VLP and CRC for elderly patients (age, ≥60 years). METHODS Multiple databases, including MEDLINE, were searched for randomized controlled trials evaluating outcomes following distal radial fracture treatment. Raw data were obtained for studies that included patients of all ages, and the elderly subgroup was included for analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at ≥1 year of follow-up. Secondary outcomes included the 3-month DASH score, range of motion, final radiographic alignment, and complications. Effect sizes for the comparison of each outcome between groups were pooled across studies using random-effects models with the inverse variance weighting method. Changes in DASH score were compared with a minimal clinically important difference (MCID) estimate of 10 to assess clinical relevance. RESULTS Of 2,152 screened articles, 6 were included. Demographics were similar for the 274 VLP and 287 CRC patients. DASH scores were significantly better following VLP than CRC at the time of final follow-up (12 to 24 months postoperatively; score difference, -5.9; 95% confidence interval [CI], -8.7 to -3.1) and at 3 months (-8.9; 95% CI, -13.0 to -4.8). VLP yielded significantly better palmar tilt, radial inclination, and supination, with no differences in ulnar variance, flexion-extension, pronation, or total complication rates. CONCLUSIONS Functional outcome was significantly better following VLP than CRC 3 months into the treatment of acute, displaced distal radial fractures in an elderly population and up to 2 years after injury. However, the observed differences in the final DASH score did not exceed published estimates of the MCID, suggesting that clinical outcomes are similar for both treatment options. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Andrew R. Stephens
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Mary M. McFarland
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Kai Sirniö
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Andrew R. Tyser
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Nikolas H. Kazmers
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| |
Collapse
|
14
|
Lameijer CM, Ten Duis HJ, Haag CMSC, El Moumni M, van der Sluis CK. The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant? Disabil Rehabil 2020; 43:3777-3788. [PMID: 32356451 DOI: 10.1080/09638288.2020.1753247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Following distal radius fractures in young non-osteoporotic patients, clinical relevancy of outcome has been scarcely reported. Outcome can be put in perspective by using measurement errors of radiological measurements and Minimal Important Change when reporting on clinician and patient reported outcome. Aim of this study was to assess the clinical relevance of radiological measurements, clinician and patient reported outcomes following distal radius fractures in young non-osteoporotic patients.Methods: Retrospective cohort study. Non-osteoporotic patients following a distal radius fracture were selected. Radiographs of both wrists were obtained at baseline, 6 weeks and at follow-up. Active range of motion and grip strength measurements were obtained at the follow-up visit and 4 questionnaires were answered to assess pain, upper extremity functioning, and health status.Results: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years at the time of injury were included. Median follow up was 62 months (IQR 53.0-84.5). Several radiological measurements evolved statistically significantly over time, however none exceeded measurement errors. Flexion/extension difference of injured compared to uninjured wrist (mean difference 11.2°, t = -7.5, df = 72, p < 0.001), exceeded Minimal Important Change, while grip strength differences did not. When comparing patients with DRFs to healthy controls, only the differences on Patient Reported Wrist Evaluation subscales "pain", "function" and total scores exceeded minimal important change (8, 10 and 13 points, respectively). Multivariable regression analysis revealed statistically significant relationships between residual step-off and respectively diminished flexion/extension (B = -36.8, 95% CI -62; -11.1, p = 0.006), diminished radial/ulnar deviation (B = -17.9, 95% CI -32.0; -3.9, p = 0.013) and worse ShortForm-36 "mental component score" (B = -15.4, 95% CI -26.6; -4.2, p < 0.001).Conclusion: Radiological measurements following distal radius fractures seem to evolve over time, but differences were small and were probably not clinically relevant. Range of motion, in particular flexion/extension, was impaired to such extend that it was noticeable for a patient, whereas grip strength was not impaired. The Patient Reported Wrist Evaluation was clinically relevantly diminished. Residual articular incongruency seems to influence range of motion.Implications for rehabilitationReporting Minimal Important Change regarding clinician and patient reported outcome following distal radius fractures is of more clinical value than reporting on statistical significance.Following distal radius fractures, the changes in radiological measurements do not seem to reflect a clinical relevant change.Range of motion, in particular flexion/extension, should be measured following distal radius fractures, as this might be impaired in a clinically relevant way.Measuring grip strength is of less importance following distal radius fractures, because grip strength does not seem to be affected.Residual articular incongruency seems to influence range of motion and therefore should be reduced to a minimum when treating non-osteoporotic patients.
Collapse
Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Jan Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients. Orthop Traumatol Surg Res 2020; 106:319-323. [PMID: 32044260 DOI: 10.1016/j.otsr.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/18/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of the distal radius fracture in elderly remains controversial. The objective was to assess the outcomes of volar locking plate for displaced complete intra-articular distal radius fractures in elderly as compared to younger patients. HYPOTHESIS The outcomes in elderly patients would be comparable with those in younger patients with a low rate of complications. MATERIAL AND METHODS Non-randomised prospective comparative study between 70 patients older than 65 years and 46 younger patients with AO type-C fractures. The main outcome was Disabilities Arm, Shoulder and Hand (DASH) score. Secondary variables were Patient-Rated Wrist Evaluation (PRWE) score, range of motion, Visual Analogue Scale (VAS) for pain, and grip strength. Radiological measurements were also performed. RESULTS The mean follow-up was 30.9 (range, 24-53) months. There were no significant differences in mean DASH, PRWE, VAS-pain, wrist motion or radiological parameters at final follow-up. Multivariate analysis showed that the functional outcomes were significantly influenced by baseline ulnar positivity greater than 3mm at baseline but not by age. DISCUSSION The study hypothesis was confirmed. Surgical treatment with volar locking plate for displaced complete intra-articular fractures of the distal radius in elderly patients represents a safe and effective treatment alternative with similar early complication rate than in younger. LEVEL OF EVIDENCE III, cohort study.
Collapse
|
16
|
Ochen Y, Peek J, van der Velde D, Beeres FJP, van Heijl M, Groenwold RHH, Houwert RM, Heng M. Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e203497. [PMID: 32324239 PMCID: PMC7180423 DOI: 10.1001/jamanetworkopen.2020.3497] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE No consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift. OBJECTIVES To compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults. DATA SOURCES The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures. STUDY SELECTION Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019. MAIN OUTCOMES AND MEASURES The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment. RESULTS A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (≤1 year) DASH score after operative treatment compared with nonoperative treatment (MD, -5.22 [95% CI, -8.87 to -1.57]; P = .005; I2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI, 0.15-5.32]; P = .04; I2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI, 2.26-14.15]; P = .007; I2 = 76%). No improvement in medium-term DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, -0.98 [95% CI, -3.52 to 1.57]; P = .45; I2 = 34%]), compared with a larger improvement in medium-term DASH score after operative treatment in the other studies that included patients 18 years or older (MD, -7.50 [95% CI, -12.40 to -2.60]; P = .003; I2 = 77%); the difference between these subgroups was statically significant (test for subgroup differences, P = .02). CONCLUSIONS AND RELEVANCE This meta-analysis suggests that operative treatment of distal radius fractures improves the medium-term DASH score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate. The findings suggest that operative treatment might be more effective and have a greater effect on the health and well-being of younger, nonelderly patients.
Collapse
Affiliation(s)
- Yassine Ochen
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jesse Peek
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Mark van Heijl
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - R. Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston
| |
Collapse
|
17
|
Austine J, Kotian P, Mirza K, Annappa R, Sujir P. Functional and radiological outcomes in 2.7-mm volar locking compression plating in distal radius fractures. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joasp.joasp_2_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
18
|
International Survey: Factors Associated With Operative Treatment of Distal Radius Fractures and Implications for the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria. J Orthop Trauma 2019; 33:e394-e402. [PMID: 31188260 DOI: 10.1097/bot.0000000000001517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Through an international survey, we assessed whether deciding to operatively treat an intra-articular distal radius fracture (DRF) is guided by identifiable patient and surgeon factors. In addition, we compared surgeons' treatment decisions with the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria (AUC) treatment recommendations. METHODS This cross-sectional survey asked 224 surgeons to operatively or nonoperatively treat 28 hypothetical patients with radiographs of an intra-articular DRF. We randomized patient age (50/70 years), gender, mechanism of injury, activity level, and OTA/AO fracture type. We classified 6 fractures as "nonclinically significant displacement" and 22 as "potentially clinically significant displacement." Multilevel logistic regression analysis was performed. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Statistical significance was P < 0.05. RESULTS Patient factors independently associated with surgery included younger age (OR 6.7, P = 0.003), clinically significant fracture displacement (type B: OR 122, CI, 20-739, P < 0.001; type C: OR 59, CI, 12-300, P < 0.001), normal activity level (OR 5.0, P < 0.001), and high-energy mechanisms (OR 1.3, P = 0.002). Surgeon factors associated with recommending surgery included practicing outside the United States (Europe: OR 2.6, P < 0.001; "other": OR 4.8, P < 0.001). Hand surgeons most often selected surgery, as compared to orthopaedic trauma surgeons (OR 2.3, P = 0.001) and "other orthopaedists" (OR 2.2, P = 0.022). Thirty-seven percent of treatment decisions for patients with normal activity levels were rated by AUC recommendations as "rarely appropriate," which included 91% disagreement for 70-year-olds with nonclinically significant displacement. CONCLUSIONS Surgeons use patient age and fracture displacement to make treatment recommendations for intra-articular DRF. We recommend that the AUC be updated to include these clinical factors as essential components in its algorithm. LEVEL OF EVIDENCE Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
19
|
Meek R, Sundaralingam A, Shen M, Sundaralingam A, Sorace L. Functional outcome and management pathways for adult patients presenting to an Australian health service with distal radius fracture. Emerg Med Australas 2019; 32:105-111. [PMID: 31418525 DOI: 10.1111/1742-6723.13375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primarily to determine mid-term functional outcome for patients with distal radius fracture (DRF) and to compare this between operative and conservatively managed patients. Secondarily to examine for differences in age, gender and number of instability factors between management groups. METHODS Eligible patients (age 18 years or more, closed DRF managed to completion of care within Monash Health), presenting between 1 January and 31 December 2016. Completion of the patient-rated wrist evaluation (PRWE) questionnaire was sought at 6-12 months post-injury. Management was noted (operative or conservative). Age, sex and number of defined instability factors present (dorsal angulation >20°, intra-articular fracture, associated ulna fracture, dorsal comminution, radial shortening >2 mm) are reported and compared between management groups. RESULTS Of 369 eligible patients, 199 (54%) completed a PRWE. Median age was 60 years (interquartile range [IQR] 45-71), 150 (75%) were women, median number of instability factors present was 2 (IQR 1-4) and 45 (23%) underwent operative management. Difference in PRWE scores between operative and conservatively managed patients was not significant (20 [IQR 7-36] vs 16 [IQR 5-35]). Differences in age and gender between management groups were not significant. Significantly more in the operative group had presence of four or more instability factors (44% [95% confidence interval 30-60] vs 20% [14-27]). CONCLUSION The mid-term median PRWE score was 18 (IQR 5-36). This was not significantly different between operative and conservatively managed patients. Operation was more likely when four or more instability factors were present.
Collapse
Affiliation(s)
- Robert Meek
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Ananth Sundaralingam
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Matthew Shen
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Aravinthan Sundaralingam
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Laurence Sorace
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Mosenthal WP, Boyajian HH, Ham SA, Conti Mica MA. Treatment Trends, Complications, and Effects of Comorbidities on Distal Radius Fractures. Hand (N Y) 2019; 14:534-539. [PMID: 29388485 PMCID: PMC6760081 DOI: 10.1177/1558944717751194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Distal radius fractures (DRFs) are the most common upper extremity fractures in adults. This study seeks to elucidate the impact age, fracture type, and patient comorbidities have on the current treatment of DRFs and risk of complications. We hypothesized that comorbidities rather than age would relate to the risk of complications in the treatment of DRFs. Methods: A retrospective review of data was performed for patients treated between 2007 and 2014 using Truven Health MarketScan Research Databases. Patients who sustained a DRF were separated into "closed" versus "open" treatment groups, and the association between patient demographics, treatment type, and comorbidities with complication rates was analyzed, along with the trend of treatment modalities throughout the study time interval. Results: In total, 155 353 DRFs were identified; closed treatment predominated in all age groups with the highest percentage of open treatment occurring in the 50- to 59-year age group. Between 2007 and 2014, there was an increase in the rate of open reduction and internal fixation (ORIF) in all age groups <90 with the largest increase (11%) occurring in the 70- to 79-year age group. Higher complication rates were observed in the open treatment group in all ages <90 years with a trend toward decreasing complication rates as age increased. Comorbidities were more strongly associated with the risk of developing complications than age. Conclusions: Closed treatment of DRFs remains the predominant treatment method among all age groups, but DRFs are increasingly being treated with ORIF. Emphasis on the patients' comorbidities rather than chronological age should be considered in the treatment decision-making process of elderly patients with DRFs.
Collapse
|
21
|
Yan B, Chen Y, Yin W. Influence of distal radius fractures involving the intermediate column on forearm rotation. J Orthop Surg Res 2019; 14:111. [PMID: 31018858 PMCID: PMC6480890 DOI: 10.1186/s13018-019-1155-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to compare the radiologic and clinical outcome of patients with distal radius fractures involving the intermediate column and distal radial metaphyseal fractures treated conservatively. METHODS Two cohorts of 52 matched patients with distal radius fractures treated conservatively, one with a fracture involving the intermediate column and the other with no intermediate column fracture, were retrospectively analyzed by examining the data. Patients were matched for age, sex, fracture side, and AO fracture type. The two groups were analyzed for differences in wrist motion; grip strength; Gartland and Werley score; Disabilities of the Arm, Shoulder and Hand (DASH) score; and visual analogue scale (VAS) score at 12 months. The differences in continuous variables were compared using the paired t test. Linear regression analyses or Pearson correlation analyses were used to evaluate the associations of radiological parameters with clinical outcomes. RESULTS The analysis showed significant differences in the range of motion (ROM) for pronation (p = 0.000) and supination (p = 0.008) in the paired groups. There was a significant difference in DASH scores (p = 0.024) in the paired groups. Using Pearson correlation analysis, negative correlations (r = - 0.360, p = 0.000) were observed between articular step-off and ROM for pronation. Linear regression analyses also indicated that ROM for pronation had negative relationships (β = - 6.327, p = 0.001) with articular step-off. CONCLUSIONS Distal radius fractures involving the intermediate column had an adverse effect on forearm rotation after distal radius fractures treated conservatively.
Collapse
Affiliation(s)
- Bingshan Yan
- Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, 201508, People's Republic of China
| | - Yanchao Chen
- Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, 201508, People's Republic of China
| | - Wangping Yin
- Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, 201508, People's Republic of China.
| |
Collapse
|
22
|
Drobetz H, Black A, Davies J, Buttner P, Heal C. Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates. World J Orthop 2018; 9:203-209. [PMID: 30364833 PMCID: PMC6198296 DOI: 10.5312/wjo.v9.i10.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.
METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.
RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.
CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.
Collapse
Affiliation(s)
- Herwig Drobetz
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Alyce Black
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
| | - Jonathan Davies
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Petra Buttner
- Tropical Health Solutions PTY Ltd, Townsville 4810, Queensland, Australia
- Centre for Chronic Disease Prevention, James Cook University, Cairns 4878, Queensland, Australia
| | - Clare Heal
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, Townsville 4810, Queensland, Australia
| |
Collapse
|
23
|
Mulders MAM, Detering R, Rikli DA, Rosenwasser MP, Goslings JC, Schep NWL. Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis. J Hand Surg Am 2018; 43:710-719.e5. [PMID: 29908929 DOI: 10.1016/j.jhsa.2018.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the association between alignment, as determined by plain radiographs, and patient-reported outcome in adults with a displaced distal radius fracture. We also determined which specific radiological parameters are associated with patient-reported outcomes. METHODS We performed a systematic literature search to identify studies that evaluated the association between radiological and patient-reported outcome in adults with a displaced distal radius fracture and who had an average follow-up of at least 12 months. Radiological outcome was determined as acceptable or unacceptable reduction, defined by radiological parameters. Patient-reported outcome was assessed with the Disability of the Arm, Shoulder, and Hand, the Quick-Disability of the Arm, Shoulder, and Hand, and the Patient-Rated Wrist Evaluation questionnaires. RESULTS Sixteen articles were included, comprising 1,961 patients with a distal radius fracture. A significant mean difference of 4.15 points in patient-reported outcomes (95% confidence interval [CI], 0.26-8.04) was found in favor of an acceptable radiological reduction. Moreover, a significant mean difference of 5.38 points in patient-reported outcomes (95% CI, 1.69-9.07) was found in favor of an acceptable dorsal angulation, and 6.72 points (95% CI, 2.16-11.29) in favor of an acceptable ulnar variance. CONCLUSIONS An unacceptable radiological reduction is significantly associated with worse patient-reported outcomes in adults with a displaced distal radius fracture. Dorsal angulation and ulnar variance are the most important radiological parameters. Despite the statistical significance, the mean difference of each association did not meet the threshold of the minimally clinically important difference and therefore were unlikely to be clinically important. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
| | - Robin Detering
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam
| | - Daniel A Rikli
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Melvin P Rosenwasser
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Raudasoja L, Vastamäki H, Raatikainen T. The importance of radiological results in distal radius fracture operations: Functional outcome after long-term (6.5 years) follow-up. SAGE Open Med 2018. [PMID: 29854401 DOI: 10.1177/2050312118776578.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Whether or not radiological results correlate with functional outcome after operative treatment of distal radius fractures still remains controversial. We carried out a retrospective study to analyse the long-term (6.5 year) outcome of radius fractures treated by means of surgery in our hospital. The aim of the study was to explore whether step-off on radius joint surface, shortening of the radius versus ulnar height and dorsal or volar tilt of the radius correlate with long-term Patient-Rated Wrist Evaluation or Quick Disability of the Arm, Shoulder and Hand scores among 100 consecutive patients after surgical treatment. Materials and Methods Of these, 60 patients (63 wrists) participated. They were examined radiologically, clinically and by means of a questionnaire. Results Shortening of the radius correlated significantly with both Patient-Rated Wrist Evaluation and Quick Disability of the Arm, Shoulder and Hand scores. Step-off on the radius joint surface correlated significantly with worse PRWE scores, with no difference in Quick Disability of the Arm, Shoulder and Hand evaluation. Dorsal or volar tilt showed no statistical correlation (though it was mild in this group). The age of the patients (below 60 years vs 60 years or above) did not affect the PRWE or Quick Disability of the Arm, Shoulder and Hand results. Conclusion Our results indicate that when it comes to conserving the radial height and congruence of the joint surface, the more precise the reduction of the fracture achieved by surgical means, the better the functional outcome.
Collapse
Affiliation(s)
- L Raudasoja
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Vastamäki
- Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - T Raatikainen
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
25
|
Raudasoja L, Vastamäki H, Raatikainen T. The importance of radiological results in distal radius fracture operations: Functional outcome after long-term (6.5 years) follow-up. SAGE Open Med 2018; 6:2050312118776578. [PMID: 29854401 PMCID: PMC5968661 DOI: 10.1177/2050312118776578] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/18/2018] [Indexed: 01/30/2023] Open
Abstract
Background and Aims: Whether or not radiological results correlate with functional outcome after operative treatment of distal radius fractures still remains controversial. We carried out a retrospective study to analyse the long-term (6.5 year) outcome of radius fractures treated by means of surgery in our hospital. The aim of the study was to explore whether step-off on radius joint surface, shortening of the radius versus ulnar height and dorsal or volar tilt of the radius correlate with long-term Patient-Rated Wrist Evaluation or Quick Disability of the Arm, Shoulder and Hand scores among 100 consecutive patients after surgical treatment. Materials and Methods: Of these, 60 patients (63 wrists) participated. They were examined radiologically, clinically and by means of a questionnaire. Results: Shortening of the radius correlated significantly with both Patient-Rated Wrist Evaluation and Quick Disability of the Arm, Shoulder and Hand scores. Step-off on the radius joint surface correlated significantly with worse PRWE scores, with no difference in Quick Disability of the Arm, Shoulder and Hand evaluation. Dorsal or volar tilt showed no statistical correlation (though it was mild in this group). The age of the patients (below 60 years vs 60 years or above) did not affect the PRWE or Quick Disability of the Arm, Shoulder and Hand results. Conclusion: Our results indicate that when it comes to conserving the radial height and congruence of the joint surface, the more precise the reduction of the fracture achieved by surgical means, the better the functional outcome.
Collapse
Affiliation(s)
- L Raudasoja
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Vastamäki
- Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - T Raatikainen
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
26
|
Kyriakedes JC, Tsai EY, Weinberg DS, Yu CC, Hoyen HA, Malone K, Bafus BT. Distal Radius Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Level I Trauma Center. Hand (N Y) 2018; 13:209-214. [PMID: 28720040 PMCID: PMC5950960 DOI: 10.1177/1558944717691133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to determine whether the American Academy of Orthopaedic Surgeons' (AAOS) Appropriate Use Criteria (AUC) for distal radius fractures correlates with actual treatment by orthopedic hand surgeons at a level I trauma center. METHODS ICD-9 codes were used to retrospectively identify patients who presented with wrist fractures over 1 year. Patients with isolated distal radius fractures were evaluated using the AAOS AUC application for distal radius fractures. Actual treatment was then compared with treatment recommended by the AUC. RESULTS Of the 112 patients, 64 (57%) received treatment that matched the AAOS AUC recommendation as an "appropriate treatment." Actual management matched the AUC recommendation 100%, 7%, and 50% of the time, for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type A, B, and C fractures, respectively. Surgery was performed for type A, B, and C fractures 30%, 7%, and 50% of the time, respectively. For type B fractures, only the 2 cases that were managed operatively were in agreement with the AUC. For type C fractures, increased patient age (57 years and older) was significantly associated with nonoperative treatment decisions. Surgeon decisions for nonoperative treatment were in agreement with the AUC recommendations 40% of the time, whereas surgeon decisions for surgery matched the AUC recommendations 97% of the time. CONCLUSIONS We found low agreement between actual treatment decisions and the AUC-recommended "appropriate" treatments, especially for the type B and C fractures that were managed nonoperatively. The AUC favors surgery for all intra-articular fractures, while we emphasized age and fracture displacement in our decision-making process.
Collapse
Affiliation(s)
- James C. Kyriakedes
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Eugene Y. Tsai
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas S. Weinberg
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Charles C. Yu
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Harry A. Hoyen
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Kevin Malone
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Blaine T. Bafus
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
27
|
Conservative treatment of distal fractures after the age of 65: a review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1469-1475. [PMID: 29423866 DOI: 10.1007/s00590-018-2150-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
The goal of this study was to evaluate the role of conservative treatment of distal radius fractures in the elderly since 2000. Our series included 22 articles, of which 3 reviews, 2 meta-analyses, 6 descriptive series of conservative treatment, 10 series comparing surgical and conservative treatments and 1 series comparing different types of conservative treatments. The reduction was performed by closed reduction in 7 cases and by traction in 3 cases. A short-arm cast was used in 8 cases and a long-arm cast in 4 cases for an average length of 6 weeks. The indications of conservative treatment were varied: AO type A fractures in 2 cases, type C fractures in 1 case, types A and C in 8 cases and types A, B and C in 3 cases. No article reported any significant difference between surgical and conservative treatments in terms of DASH or PRWE, whereas strength was sometimes improved when surgical treatment was used. Radiological results were always better after surgical treatment. The rate of complications varied greatly, greater, equally or lower compared to conservative treatment depending on the series. All in all, there is no consensus to assert that a conservative treatment is more justified than a surgical treatment to treat distal radius fractures after the age of 65. Most authors consider that the long-term clinical outcome is identical and that the radiological result is better after surgical treatment. The fact that the fixation of a distal radius fracture by a volar locking plate after 65 years speeds up the recovery remains to be proven.
Collapse
|