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PubMed1976

[A new technic for the correction of malunited distal radius fractures].

After malunited fractures of the distal radius the original anatomy of the wrist joint can be restored only by osteotomy of the radius and interposition of a cortico-cancellous bone block. This procedure has been shown to be much easier using a new bone plate for internal fixation. The plate is applied to the radius volarly through a radio-volar approach. The correcting angles can be adjusted easily. The stable osteosynthesis allows early postoperative motion. In cases of osteoarthritic changes the procedure may be combined with a denervation of the wrist joint (A. WILHELM).

Bone Plates↗
PubMed1990

[Indications, technique and preventable errors in conservative therapy of distal radius fracture].

The guidelines for conservative or operative treatment of fractures of the distal radius have been standardized for years. To decide whether conservative treatment is indicated the following factors are important: 1. the amount of metaphyseal impaction, 2. the presence of a joint surface, and 3. the remaining bony buttress. Conservative treatment is indicated in cases in which there is a chance to ensure retention. The difficulty of conservative treatment does not lie in special sophisticated steps of procedure. It is more important to consider the standardized technical procedures of reduction, adequate immobilization and surgical control.

Casts, Surgical↗
PubMed1989

[CT diagnosis of malalignment following distal radius fracture].

Examination of 29 cases of fracture of the distal radius with restricted motion or persistent pain in 22 patients showed that most had been caused by incongruity of the distal radioulnar joint or by rotational malalignment in supination or pronation. Imaging of the distal radioulnar joint without superimposition enables us to detect whether disorders of the joint facets are impeding movement. Exact knowledge of the malalignment aids in the planning of osteoplastic surgery.

Adult↗
PubMed1989

[Conservative treatment of distal radius fractures. Results of a retrospective study].

Between 1 January 1984 and 31 December 1986, 175 patients with a total of 178 distal radius fractures were treated conservatively in our department. An average of 25 months after the accidents, 124 patients with 126 fractures (71%) were re-examined. Wrist function was good or excellent in 52.4%, fair in 41.3% and bad in 6.3% of the patients studied. Anatomical results were slightly better, with the patients' subjective evaluation markedly better. The results are analysed and the causes of the unsatisfactory results pointed out. Thereafter, the indications for conservative treatment are discussed and a regimen presented. Conservative treatment alone is not justifiable.

Adolescent↗
PubMedDate not supplied

Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age.

OBJECTIVE: To evaluate the clinical, radiographic, and functional outcomes of patients aged 60 and older treated with open reduction and internal fixation using plates and screws for displaced and comminuted fractures of the distal radius. DESIGN: Retrospective, clinical research. SETTING: Tertiary care center (Level 1 trauma center) located in a large urban area. PATIENTS: Eighteen patients with an average age of 71 years (range 60-86) form the basis of this study. Patients were obtained from a surgical database of 2 hand surgeons in a tertiary care center. INTERVENTION: Open reduction and internal fixation of fractures of the distal radius using metal plates and screws designed for treatment of these injuries. MAIN OUTCOME MEASUREMENTS: Clinical (history and physical examination), plain radiographic, and functional assessments were performed at an average follow-up of 26 months (range 12-40 months). Functional outcomes were assessed using the Gartland and Werley and Disabilities of the Arm, Shoulder, and Hand scoring systems. RESULTS: Satisfactory reduction was achieved in all 18 fractures at the time of operative fixation with no instances of loss of fracture reduction during the study period. There were no cases of malunion, nonunion, or instances of device failure. We identified 4 minor complications. No patients required reoperation. Fifteen patients had an excellent (83%) and 3 had a good (17%) result according to the Gartland and Werley scoring system. The mean Disabilities of the Arm, Shoulder, and Hand score was 4.4 (range 0-14) out of a maximum 100. CONCLUSION: Our findings suggest that open reduction and internal fixation with plates and screws in patients 60 years and older with displaced and comminuted fractures of the distal radius represents a safe and effective treatment alternative.

Adult↗
PubMed2003

Acute volar and dorsal compartment syndrome after a distal radius fracture: a case report.

We present a case of an acute volar and dorsal compartment syndrome of the forearm secondary to a distal radius fracture. The patient sustained a low-energy injury (fall) and presented within 12 hours with signs and symptoms of a compartment syndrome prior to any treatment. Emergent volar and dorsal fasciotomies were performed, and the fracture was reduced and pinned. The fracture and fasciotomies healed without complication, and the patient was doing well on the last follow-up examination. To our knowledge, this is the first report in the literature of a volar and dorsal compartment syndrome after a low-energy fall prior to a patient receiving any treatment.

Accidental Falls↗
PubMed1990

Displaced distal radius fractures. A comparative study of early results following external fixation, functional bracing in supination, or dorsal plaster immobilization.

A comparison of the radiographical and functional results after displaced distal radius fractures in 41 patients treated by external fixation (EF), 36 patients treated by functional bracing in supination (FUSU), and 49 patients treated by dorsal plaster immobilization (DPI) was performed. The rate of initial complications after EF was 53%, compared with 22% after FUSU and 14% after DPI. The radiographical result after EF was significantly better than after nonoperative treatment, but the functional result after 3 and 6 months demonstrated no significant difference between the three series. Consequently, EF and FUSU do not restore wrist function faster than conventional plaster treatment (DPI), but EF improves the radiographical result, though the rate of complications is higher.

Adult↗
PubMed1996

X-ray film measurements for healed distal radius fractures.

In order to understand the effect of malunion on functional outcome, it is essential that deformity be measured in a consistent manner. A standardized method of measuring eight anatomic parameters at the distal radius was developed. By this method, six x-ray films of healed distal radius fractures were subsequently measured by 16 raters. Rater agreement was quantified by using the intraclass correlation coefficient. Tolerance limits were developed in order to estimate the expected margin of error for each parameter. Parameters measured with high rater agreement include ulnar variance, palmar tilt, and radial shift; however, even experienced clinicians did not readily agree on the size of step and gap deformity. Using the method of tolerance limits, one would expect that two randomly chosen clinicians measuring step and gap deformity on a random x-ray film will differ by more than 3 mm at least 10% of the time. Similarly, repeat step or gap measurements by the same observer are expected to differ by more than 2 mm at least 10% of the time. In view of our inability to measure deformity more accurately, the concept of a specific relationship between a given degree of deformity and outcome must be questioned. Prospective research is needed in order to improve our understanding of the precise relationship between malunion and functional outcome.

Fracture Healing↗
PubMed2007

Predictors of functional outcomes after surgical treatment of distal radius fractures.

PURPOSE: Identifying predictors of outcomes is important in anticipating and treating patients with underlying factors that may affect recovery. The predictors of functional outcomes after distal radius fracture (DRF) treatment have not been well defined in the past. METHODS: This was a prospective cohort study designed to identify predictors of hand outcomes after DRF treatment. The study included consecutive patients with inadequately reduced DRFs who had open reduction and internal fixation with volar plating. Demographic and socioeconomic data were collected at the time of the initial treatment. Outcome data were collected 3, 6, and 12 months after surgery. Outcome evaluation consisted of radiographic measurements and the Michigan Hand Outcomes Questionnaire (MHQ). We hypothesized that the following factors are important predictors of functional outcomes: (1) age, (2) socioeconomic status, (3) severity of fracture pattern, and (4) postsurgical radiographic measurements. Regression models were developed using the overall MHQ score as the outcome variable at 3 months and 1 year after surgery. RESULTS: Sixty-six patients had data available at 3 months and 49 patients had data available at 1 year. At 3 months after surgery, radiographic incongruity (step + gap) was a significant predictor after controlling for age, fracture type, dorsal-volar tilt angulation, and income. Patients with increased incongruity reported lower MHQ scores (worse functional outcomes). At 1 year after surgery, however, only age and income were significant predictors after controlling for fracture type. Increased age and decreased income were associated with lower MHQ scores. CONCLUSIONS: After successful surgery and hand therapy, only age and income were significantly associated with long-term outcomes 1 year after surgery. Precise anatomic reduction enhances short-term functional outcomes in DRF treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level I.

Age Factors↗
PubMed2005

Use of bio-resorbable implants for stabilisation of distal radius fractures: the United Kingdom patients' perspective.

Bio-resorbable implants have been, recently, introduced in the United Kingdom. To our knowledge there have been no randomised studies to assess perception of today's well-informed patients about this new method of fracture stabilisation. In order to assess the patients' perception a prospective study was performed on 100 consecutive adult patients with distal radius fractures. Following detailed verbal and written information about both resorbable and metal implants, the patients were asked to complete a specifically designed questionnaire. Ninety-five percent of the patients appreciated the 'resorbable' feature and responded that they would prefer to have their fracture stabilised with a resorbable implant. Conversely, 91% of the participants considered removal as the most negative aspect of the metal implant (p<0.0001). While 56% of the patients felt that it was relatively a new and evolving technology, 29% of them had apprehension about the relative strength of the resorbable implant. Eighty percent of the patients stated that they would be happy to participate in clinical trials to compare the use of bio-resorbable implants versus metal ones (p=0.0001). This study sets the foundation for the implementation of prospective randomised trials to assess the efficacy of the new generation of bio-resorbable implants.

Absorbable Implants↗
PubMed1999

The evaluation of tension in an experimental model of external fixation of distal radius fractures.

A cadavaric model was used to evaluate the previously reported methods of determining excessive tension when applying an external fixator across the wrist. An osteotomy of the distal radius was performed and tension was applied incrementally across the joint in 9 cadaveric specimens. The fingers of each specimen could fully flex to the palm at all levels of tension tested. Although the radiocarpal and midcarpal joint spaces did lengthen with incremental changes in the amount of tension, there was no statistically significant correlation that could be made about the difference between the radiocarpal and midcarpal spaces and tension applied across the wrist. Although the carpal height ratio increased significantly from 0 to 10 lb of traction, the carpal height ratio appeared to plateau after further increases in tension. In conclusion, surgeons need to be careful when using any of these previously reported techniques for determining the optimal tension to be applied with an external fixator across the wrist. These techniques may not reproducibly allow the surgeon to detect whether there is excessive distraction across the distal radius fracture.

External Fixators↗
PubMedDate not supplied

The management of isolated distal radius fractures in children.

In a consecutive series of 175 forearm fractures requiring manipulation in children who presented to the John Radcliffe Hospital between 1 January 1991 and 30 June 1992, 23 had isolated distal radius fractures, all of which required manipulation for unacceptable angulation or displacement. We had previously noted that these fractures had a high incidence of loss of position leading to malunion. The 23 patients were randomly allocated to one of two treatment groups: either manipulation and cast alone, or manipulation and percutaneous Kirschner wiring with cast. These two groups were followed up clinically and radiographically until union occurred. Those fractures treated by percutaneous wiring had no significant complications, and all had a satisfactory result. The fractures treated by manipulation and casting alone required further manipulation in 10 cases (91%). We conclude that these problematic fractures should be treated by stabilisation with percutaneous wiring.

Adolescent↗
PubMed2005

Nonbridging external fixation of intra-articular distal radius fractures.

New solutions to difficult problems are always welcome, but nonbridging external fixation of intra-articular fractures is still in its infancy. Multicenter clinical trials are necessary to deter-mine whether the superior results obtained with nonbridging fixation of extra-articular fractures can be duplicated. With further study and new fixator designs, it is anticipated that nonbridging external fixation of intra-articular distal radius fractures will become another viable treatment option.

Biomechanical Phenomena↗
PubMed1999

Augmentation of distal radius fracture fixation with coralline hydroxyapatite bone graft substitute.

We implanted coralline hydroxyapatite bone graft as a substitute for autogenous bone graft to support the reduced articular surface of 21 consecutive patients with distal radius fractures treated with external fixation and K-wires. The purpose of this single-cohort retrospective study was to report the outcomes of treatment with this material, complications associated with its use, and its efficacy in supporting the articular surface reduction. Eighteen patients were available for independent evaluation of motion, subjective outcome analysis, and final radiographic analysis at an average of 35 months after surgery. Wrist motion averaged 90% of the uninjured wrist and grip strength measured 75% of the uninjured side. Results in 17 of the 18 cases were rated as good or excellent by the criteria of Gartland and Werley; 12 by the criteria of Green and O'Brien. Seventeen had good or excellent radiographic results by the modified Lidstrom radiographic scoring system. The average DASH functional/symptom score was 90.3 (maximum, 100). Radiographic parameters were restored to an average of 12 mm radial length, 4 degrees volar tilt, 23 degrees radial inclination, and 0.6 mm positive ulnar variance. Articular reduction was maintained in all patients. A complication related to the use of coral was a 0.5 mm prominence of coralline hydroxyapatite beyond the subchondral line at the radiocarpal joint in 1 patient, which was not present on final radiographs. Coralline hydroxyapatite was effective at maintaining articular surface reduction when used in combination with external fixation and K-wires and had a safety profile comparable to other forms of treatment.

Bone Substitutes↗
PubMed2003

Remodeling capacity and functional outcome of palmarly versus dorsally displaced pediatric radius fractures in the distal one-third.

INTRODUCTION: The purpose of this retrospective study was to compare the remodeling capacity and functional outcome of palmarly and dorsally displaced pediatric radius fractures in the distal one-third. MATERIALS AND METHODS: Fifty-three children with a residual dorsal angulation of 15 degrees (range 10 degrees -28 degrees, +/-SD 5.32) and 31 children with a residual palmar angulation of 15 degrees (range 10 degrees -30 degrees, +/-SD 4.88) at fracture healing were re-examined clinically and radiologically with a median follow-up time of 10 years (range 5-15 years). RESULTS: There was no difference in the remodeling capacity, palmar tilt, radial inclination, and ulnar variance between both groups at follow-up. Pain as well as flexion/extension of the wrist and pronation showed no difference in both groups. Palmarly displaced fractures showed a significantly higher restriction of supination ( p=0.01). CONCLUSION: We conclude that remodeling of residual palmar angulation occurs to the same extent as it does in dorsal angulation. Functional outcome differs in forearm supination.

Adolescent↗
PubMed2002

Volar neutralization plate fixation of dorsally displaced distal radius fractures.

Open reduction and volar neutralization plate fixation avoids problems associated with dorsal plate fixation (eg, extensor tenosynovitis and tendon rupture) and minimizes the necessity for secondary plate removal. Volar plating is a useful technique for treating dorsally displaced distal radius fractures with minimal scarring, infrequent bone grafting, and safe early wrist mobilization.

Adult↗
PubMed1996

[Treatment of unstable distal radius fractures with a small AO-fixateur externe not bridging the joint].

This retrospective study investigated the stability of the small AO external fixator in a radioradial configuration used in the treatment of 42 mostly unstable distal radius fractures (types A-3.2, C-1.2 and C-2.1 according to the AO classification). No bone grafting was performed. All cases were documented with antero-posterior and lateral X-rays preoperatively, 0, 2 and 6 weeks postoperatively and after consolidation. Early functional aftertreatment was started one week after surgery. Thirty-six fractures showed a dorsal comminution, combined with osteopenia in 18 cases. The mean preoperative radial angle of 17 degrees was normalized to 25 degrees postoperatively. The mean preoperative volar angle of minus 30 degrees was reduced to 12 degrees postoperatively. None of these mean angles changed until consolidation. The external fixator was removed on average after 7 weeks (range 6-10 weeks) depending on the radiological fracture healing. The small AO external fixator in a radioradial configuration proved to be stable enough for early functional aftertreatment of the wrist. Its stability is related to a proper operative technique and correct indication (unstable Colles type with one or two distal fragments). Bone grafting is unnecessary if the external fixator is left in situ until bony consolidation.

Adolescent↗
PubMed1996

Can cast immobilization successfully treat scapholunate dissociation associated with distal radius fractures?

During a 3.5-year period, 20 of 424 consecutive patients with fractures of the distal radius presented with evidence of scapholunate dissociation upon x-ray films and traction view fluoroscopy. The sequential changes of x-ray abnormalities of the scapholunate joint were consistently observed over a 1-year period, and wrist functions were evaluated 1 year after injury. The scapholunate gaps were 3.5 +/- 0.5 mm at the time of injury, 3.2 +/- 0.4 mm immediately after closed reduction of the fracture, 3.4 +/- 0.5 mm at the time after removal of fixation, and 3.8 +/- 0.4 mm 1 year after injury. By the modified clinical scoring system of Green and O'Brien, of these 20 patients, none had excellent, 2 had good, 14 had fair, and 4 had poor wrist function 1 year after injury. The wrists with scapholunate dissociation had significantly worse function as compared to a selected subgroup of 228 wrists with no signs of intercarpal ligament disruption. All 20 patients with signs of scapholunate dissociation on x-ray examination at the time of injury had clinical signs in the scapholunate joint and positive x-rays findings of dissociation 1 year later. After 1 year, 8 of the 20 patients underwent surgery for relief of symptoms and to stabilize the joint. Arthrography in the patients with persistent symptoms showed disruption in scapholunate interosseous ligaments. This study indicates that scapholunate dissociation with concomitant fractures of the distal radius cannot be cured by cast immobilization of the fracture. Early operative treatment should be instituted for the concomitant scapholunate dissociation.

Adult↗