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PubMed2006

Current concepts in volar fixed-angle fixation of unstable distal radius fractures.

UNLABELLED: We present new developments in the volar treatment of unstable distal radius fractures in adults. New perspectives on the anatomy of the wrist, the watershed line on the volar radius and the usefulness of the pronator fossa are presented and these help to avoid flexor and extensor tendon disturbance when using a volar approach. Other new insights on the bony anatomy of the distal end of the radius are discussed, which are important in improving the quality of fracture fixation, including the benefits of constructing a precise fixed-angle scaffold underneath the articular surface in order to stabilize it. A volar fixed-angle plate must support the dorsal, central and volar aspects of the subchondral bone in order to stabilize the most complex fractures. Awareness of the anatomy of blood supply to the distal radius: the dorsal retinaculum that feeds the distal fragments and the blood supply to the diaphysis through branches of the anterior interosseous artery is necessary to maximize healing potential and avoid complications. Volar fixed-angle plates need to withstand very high forces during rehabilitation, the magnitude of these forces are up to five times the loads applied on the hand. LEVEL OF EVIDENCE: Level V (expert opinion).

Biomechanical Phenomena↗
PubMed1998

Minimally displaced distal radius fractures: do they need plaster treatment?

In a prospective, randomized trial, minimally displaced distal radius fractures were divided into two groups: those treated with plaster immobilization for 1 week compared with 3 weeks. Functional Cooney scores were determined at 6 weeks, 3 months, 6 months, and 1 year. No statistical differences could be found in functional outcome between the groups at any time during the evaluation. Although patients did not allow immediate functional treatment in the presence of a fracture, we could not find any differences between 1 week or 3 weeks of plaster treatment. No further dislocation occurred, and all patients experienced eventful healing with good and excellent results in 92% of the cases. We believe, therefore, that only minimal immobilization is required in these fractures and that they should be mobilized as soon as comfort allows.

Activities of Daily Living↗
PubMed1994

[Treatment results after surgical therapy of distal radius fractures].

Fractures of the distal radius are being surgically treated with increasing frequency, because of the poor results yielded by cast treatment. Using the AO fracture classification as a basis, we present a treatment regimen for these fractures. For surgical interventions we prefer closed reduction and osteosynthesis with, for ex percutaneous K-wire fixation, intrafocal (Kapandji) pinning, minimal open screw osteosynthesis, fixateur externe and combined methods; only fractures of type B2 and B3 will be treated by open reduction and application of an internal plate. In addition, we present the results of a follow-up examination in 100 patients (85 female, 15 male) with radius fractures treated operatively: their average age was 59 years (range 18-91) and the average follow-up period was 21 months (range 12-36). According to the AO classification we found mostly fractures were of type A3.2 (n = 40) and type C2.2 (n = 23). We selected the method of osteosynthesis in dependence on the AO classification. The functional result was judged according to Sarmiento's modification of the Gartland and Werley score. The overall results were excellent or good in 80% of the patients, only 7% had a moderate result; none of the patients had a poor result. The radiological result was measured by the Lidström score: 97%, grade I and II; only 2%, grade III; 1% grade IV. Our results have shown that anatomical reduction of the fracture is essential if a good functional result is to be obtained.

Adolescent↗
PubMed1997

Dynamic external fixation for distal radius fractures.

Thirty adult patients with closed comminuted and mostly intraarticular fractures of the distal radius were treated by closed reduction and immobilization with a dynamic external wrist fixator during a 2-year period. In 13 patients with severely comminuted and unstable fractures, additional Kirschner wires were used. After 10 to 14 days of rigid fixation in neutral position, the motion element was unlocked to allow up to 30 degrees flexion. Six weeks later, the fixator was removed. The patients then were observed for an average of 24 weeks. An excellent functional outcome was seen in 6 patients (20%), a good outcome in 20 patients (67%), and a fair outcome in 4 patients (13%). Anatomically, 15 patients (50%) had an excellent result, 14 (47%) a good outcome, and 1 (3%) a fair outcome. Only minimal loss of reduction averaging 1 degree palmar tilt was seen during mobilization. There were 2 major complications: 1 deep Kirschner wire tract infection and 1 index metacarpal fracture. Minor complications such as sensory disturbances and pin tenderness were present but recovered completely after removal of the fixator. This study provides promising data and offers an alternative method in the treatment of distal radius fractures with severe comminution. In cases with postreductive unstable fragments, additional Kirschner wires should be used to allow early mobilization of the wrist.

Adult↗
PubMed2000

Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years.

Twenty-five sedentary, low-demand patients older than 60 years were retrospectively evaluated for function and radiographic results following nonoperative treatment of displaced distal radius fractures. The mean age was 72 years and the average follow-up period was 34 months. All patients had radiographic and functional evaluations. The radiographic assessment included a scoring system based on measurements of the final dorsal angle, loss of radial length, and the final radial inclination. The development of radiocarpal and distal radioulnar joint arthrosis was also investigated. The functional assessment included subjective and objective criteria. Overall satisfaction, ability to return to previous activity level or occupation, concern over wrist appearance, and a functional task questionnaire were part of the subjective assessment. Objective assessment included neuromuscular evaluation and measurements of range of motion and grip strength. The final radiographic scores revealed that 6 patients (24%) had excellent results, 11 (44%) had good results, 2 (8%) had fair results, and 6 (24%) had poor results. Six of 10 patients with intra-articular fractures developed progressive wrist arthrosis. Two of 6 patients with radiographic arthrosis had unsatisfactory functional outcome. Five of 8 patients with intra-articular fractures that healed with a residual stepoff >/=2 mm had satisfactory functional outcome; 3 of these 8 patients had unsatisfactory functional outcome. The functional assessment revealed that 22 patients (88%) had excellent or good results and 3 (12%) had fair or poor results. The radiographic outcome did not correlate with the functional outcome. Twenty-three of 25 patients (92%) were satisfied with the overall outcome of the treatment and 22 (88%) were able to return to their previous activity level or occupation. Despite an obvious clinical deformity in over half of the patients, none were unhappy with the clinical appearance of the wrist. According to the functional task questionnaire, jar opening was by far the most difficult task to perform after fracture healing. Functional outcome was satisfactory in most cases; a high level of personal satisfaction and return to previous activity level was observed, regardless of the radiographic result. Nonoperative treatment of distal radius fractures yields satisfactory outcome, especially in those with low functional demands. It also is indicated in poor operative candidates. (J Hand Surg 2000; 25A:19-28.

Activities of Daily Living↗
PubMed1989

[Distal radius fracture; fixation using Kirschner wire or only a cast? A retrospective comparative study].

56 distal radius fractures were followed for a median period of 54 months (31-88 months) following the accident. Conservative treatment (immobilisation in a plaster alone) was compared to percutaneous K-wire fixation. The two groups of patients were matched in regard to type of fracture, age (+/- 5 years) and sex. The functional end result was assessed according to the scoring system of Gartland/Werley, which was modified by Solgaard. The operative treatment modality showed better functional end results, especially for intraarticular fractures, when compared to the conservatively treated fractures.

Aged↗
PubMed2005

Distal radius fracture fixation with an intramedullary nail.

The purpose of this article is to describe a novel technique and implant system for fixation of unstable (Arbeitsgemeinschat fur Osteosynthesesfragen Types A and B) distal radius fractures. Currently the most common complications directly related to distal radius plate fixation includes tenosynovitis, tendon attrition, and rupture, often necessitating hardware removal. With the advent of this new device, a decrease in soft tissue complication is expected. The implant utilizes the principles of load sharing, subchondral screw divergence, and locked fixed-angle fixation. It is inserted through a small skin incision at the radial styloid and does not further devascularize the fracture fragments. The limited surgical dissection and rigid fracture fixation allow for minimal postoperative immobilization and an early return of function. The authors believe that this system is a valuable addition to the arsenal of distal radius fracture treatment options and can quickly get patients back on the road of recovery.

Aged↗
PubMed1995

[Radius fractures in typical sites in young patients--is it early osteoporosis?].

Fractures of the radius in premenopausal women caused by a slow speed trauma are often associated with osteoporosis. Out of 156 patients we were able to screen 26 for osteoporosis. Bone mineral density (BMD) of the lumbar spine and the femoral neck was compared with the age related control group. At the lumbar spine the mean decrease of BMD was 13.1% (CI 95% 8.78 to 17.4%; SEM = 2.1). The patients showed a BMD between Z = -1 and Z = -2 and 4 patients lessen than Z = -2. At the femoral neck the mean decrease of BMD was 15.8% (CI 95% 11.3 to 20.3%; SEM = 2.17). Z was between -1 and -2 in 10 patients and smaller -2 in 6 patients. There was no correlation between the number of risk factors and bone mineral decrease. All evaluated laboratory tests were within normal range. As a result of our investigation we suggest looking for osteoporosis in premenopausal women with fractures following slow speed trauma as a routine procedure to offer adequate therapy.

Adult↗
PubMed1991

[Secondary arthrosis of the wrist joint in malposition of healed and uncorrected distal radius fracture].

The authors report on long-term results of thirty-five unreduced distal radius fractures with malunion. The mean observation period was 11.5 years (5 to 45 years). It was found malalignment of the carpal articular surface of the radius with a resulting decrease in range of motion of the wrist, well tolerated by the patients and apparently not very painful. Much more evident was pain and decreased motion in the distal radio-ulnar joint for pronation and supination, which paralleled the extent of osteoarthrosis of this joint. This reduced forearm rotation was due to shortening of the radius, leading to incongruency and even dislocation of the distal radio-ulnar joint.

Adult↗
PubMed2000

Principles of external fixation and supplementary techniques in distal radius fractures.

External fixation for fractures of the distal radius has been used for almost 80 years. The main objective is to gain reduction and maintain the reduction throughout the treatment period. Several fixator concepts are available and selection is based on the complexity of the injury to be treated as well as the surgeon's experience. Periarticular application of the fixator with immediate use of the wrist joint is recommended whenever possible. For intra-articular fractures, transarticular application is advisable. External fixtion in complex fractures has to be supplemented by bone grafting, fixation wires and stabilization of the radioulnar joint. Associated injuries in distal radius fractures need to be identified and treated. The possible complications of external fixation and the means to prevent them are discussed. External fixation of the distal radius has found its place as an established method in treating certain types of this common fracture.

Adolescent↗
PubMed1991

[Variable treatment of distal radius fractures. Results of a prospective study].

The paper presents a new strategy for treatment of distal radius fractures. The strategy is based on a prognosis-related classification model from which an appropriate treatment strategy is derived. Between 1 January 1987 and 31 December 1988, a series of 205 patients with a total of 207 fractures were treated. An average of 12 months after the accidents 198 persons (96.6%) with 200 fractures were re-examined. Wrist function was good or excellent in 83.5%, fair in 15.5% and poor in 1% of the patients studied.

Adolescent↗
PubMed1999

Midterm results of arthroscopic treatment of scapholunate ligament lesions associated with intra-articular distal radius fractures.

Since 1993, we have treated 30 patients with acute intra-articular distal radius fractures using arthroscopic assistance. Concomitant lesions of the intrinsic scapholunate (SL) ligaments were diagnosed in 12 patients (40%). Using the grading system of Geissler et al. [13], the identified lesions included a single grade I tear, three grade II, six grade III, and two grade IV. The grade III and IV lesions were accompanied by intraoperative findings of marked instability. Therefore operative stabilization was performed by temporary scapholunate and scaphocapitate arthrodesis. Seven patients in this group (87.5%) were followed up clinically and radiologically for an average of 3 years postoperatively. Clinical examination included range of motion and a subjective questionnaire concerning pain and ability to work. Objective grip strength was measured using a Jamar-tester and compared to the contralateral wrist. Radiological evaluation consisted of posteroanterior and lateral views and of stress views in radial and ulnar deviation. Data were evaluated by the scoring systems of Jakim et al. [21], Cooney et al. [5] and by the demerit point system of Gartland and Werley [12], as modified by Sarmiento et al. [36]. An excellent result was present in 100% of our patients by the Gartland and Werley system, in 86% by that of Jakim et al., and in 60% by that of Cooney et al. Based on a subjective questionnaire, all of the patients had an excellent or good result.

Adult↗