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PubMed2001

[Distal radius fractures--retrospective quality control after conservative and operative therapy].

BACKGROUND: The distal radius fracture is the most frequent fracture in the adult patient. The wide spectrum of different types of fracture and the coexisting factors make the choice for the optimal treatment difficult. As an interne quality control we retrospectively evaluated all patients with distal radius fractures treated in 1995 at our institution. METHODS: The study included 69 adult patients with 71 distal radius fractures. After on average 26 months 58 patients with 59 fractures were clinically and radiologically evaluated. The patients were asked to give supplementary information about their follow-up treatment as well as any remaining physical difficulties and limitations in the daily life. All x-rays of the broken radius were carefully analysed and compared with the opposite side. The final results were evaluated according to the "Demerit Point System". RESULTS: Patients were treated with five different therapeutical methods. 76.3% of the patients showed a very good/good final result. In 56.7% of the cases secondary fracture dislocation occurred; the dislocation-rate of fractures treated with percutaneous k-wires was 93.3%! A clear correlation between secondary displacement and final results was found. CONCLUSION: A main factor for an optimal outcome is the anatomic restoration of length and axis of the distal radius as well as of joint congruency, also moderate angular deformities are well tolerated. Our collective showed an unexpected high rate of secondary displacement, especially in the k-wire group. The reasons for this unsatisfactory event are manifold: too optimistic indication, insufficient follow-up examination in the first four to six weeks, inconsequent change to a more stable fixation method in case of a secondary dislocation. The results of this retrospective evaluation had a major impact on our concept of treatment. The dorso-radial double-plate technique combined with bone graft will be more used in the future especially in younger patients. The new standardised concept is the base of a present prospective study.

Adolescent↗
PubMed2005

External fixation and bone grafting for collapsed and comminuted distal radius fracture.

OBJECTIVE: To study the therapeutic effect of collapsed and comminuted distal radius fracture. METHODS: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. RESULTS: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient's radius. The average volar tilt was 6 to 15 degrees and the average ulnar tilt was 18 to 25 degrees. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. CONCLUSIONS: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.

Adult↗
PubMed1990

[Treatment of distal radius fracture. Surgical technique: bore wire osteosynthesis].

The Kirschner wire fixation is mainly indicated in unstable types of Colles' and children's fractures of the distal radius. Out of 2760 distal radius fractures (1975-1989) 626 (20.7%) were treated operatively including 326 (11.8%) with K-wires. Primary operation was performed in 53.5% immediately after trauma. Exposing the sensitive radial nerval paths, 3-4 K-wires were inserted from the radial and the dorsoulnar aspect. The K-wire ends were covered subcutaneously. The clinical evaluation of a series of 226 patients according to the score of Lidström presented 79% excellent and good, 16% fair and 5% poor results. The clinical results correlate to the radiocarpal angle and radial shortening. Because of additional injuries to the ulnar complex give worse results in reposition, the ulnar styloid should be fixed.

Bone Plates↗
PubMed1990

[Treatment of distal radius fracture--diagnosis and therapy of local concomitant injuries].

In a high percentage the accompanying local injuries in Colles' type fractures of the distal radius are related to lesions of the triangular fibrocartilage complex (TFCC) and the distal radioulnar joint (DRUG). Frequency and importance of these local injuries concerning the long-term result after distal radius fractures are described and diagnostic and therapeutical proceedings are presented.

Fracture Fixation, Internal↗
PubMed2000

Self-reported disability following distal radius fractures: the influence of hand dominance.

The purpose of this study was to record the spectrum of self-reported disability following distal radius fractures and to gauge for differences in hand dominance in the use of subjective outcome data. Items were generated through patient interviews, literature review, and peer consultation. Fifty-three items were evaluated by a group of 55 patients recovering from a fracture of the distal radius, which established the prevalence, mean severity score, and overall severity score (or impact) of each item as it related to physical function and social/emotional impact. Hand dominance, age, and gender were also recorded. The results confirm that many patients who sustain distal radius fractures experience substantial impairment across a spectrum of quality of life domains. Because patients who sustain a dominant wrist injury are likely to report greater functional impairment across a wider range of activities, they also possess a greater potential for improvement. The practical implication is that outcome studies for the treatment of distal radius fractures should take hand dominance into account.

Activities of Daily Living↗
PubMed2002

The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures.

Sixty-nine cases of distal radius fracture were studied retrospectively for various factors that might affect the functional outcome. Patients were treated with various techniques including plaster immobilization, external fixation, open reduction and internal fixation and percutaneous pinning. Functional assessment was made at 1 year after the injury. The most important factor affecting the functional outcome was radial length, followed by volar tilt. Carpal instability was an indicator of poor functional results. The relative movement of the lunate with respect to the distal radial articular surface, when defined as an effective radio lunate flexion of more than 25 degrees, was also associated with poor functional results.

Adult↗
PubMed2002

Digital radiographs in the assessment of distal radius fracture parameters.

The purpose of the current study was to assess the reliability of measurement of distal radius fracture parameters using digital radiographs. Digital radiographs and corresponding plain radiographs of the wrists of 20 patients with intraarticular distal radius fractures were used to measure radial inclination, palmar tilt, radial height, and articular step-off. The plain radiographs and digital images were evaluated independently by three examiners in two sessions. The plain radiographs were assessed using a standard goniometer (manual measurements) whereas the digitized radiographs were evaluated using imaging software to do the computer-assisted measurements. The interobserver and intraobserver reliability were measured using repeated measures analysis of variance and weighted kappa statistics. Measurement of the digital images improved the interobserver reliability of measurement of palmar tilt from substantial to excellent, radial height from moderate to substantial, and articular step-off from fair to moderate. Similarly, intraobserver reliability increased from moderate to substantial when measuring radial height. In no instance (between or within observers) did the level of reliability decrease when using digital images for fracture evaluation. The current data suggest that the reliability of measurements of angular and linear fracture parameters of distal radius fractures is similar between plain and digital radiographs.

Humans↗
PubMed2003

[Distal radius fractures. 2.4 mm locking compression plates. Are they worth the effort?].

Fracture of the distal radius has a second peak of incidence in the second half of life. Because complex injuries are seen frequently, there is a need for differentiated treatment to achieve good results. The aim of our study was to evaluate the treatment of distal radius fractures with 2.4-mm locking compression (LC) plates in patients older than 65 years suffering from osteoporosis to determine the complications and compare costs of treatment with different interventions. Thirty-seven patients were included in this prospective study. The distribution of fractures according to AO classification was: nine type A, one type B, and 27 type C. The mean age was 76 years. Twenty-six volar plates, seven dorsal and four "sandwich" procedures were applied. The mean follow-up for 33 patients was 11.1 months. Using the functional Lidström score, we found 13 very good results, 15 good, four fair, and one poor, the radiologic Lidström scores were: 15 very good, 13 good, four fair, and one poor results. With the application of 2.4-mm LC plates, findings were good or very good in over 80%of osteoporotic distal radial fractures. Compared to other treatments, the real costs of intervention for LC plates is much higher.

Age Factors↗
PubMed2003

Kinematic and torque-related effects of dorsally angulated distal radius fractures and the distal radial ulnar joint.

PURPOSE: The purpose of this study was to examine the torque required to achieve a full range of motion of the distal radioulnar joint (DRUJ) as a result of increasing dorsal angulation from simulated fractures of the distal radius. Based on this study the accepted amount of dorsal angulation of the distal radius can be determined. METHODS: In 9 fresh cadaver limbs motion of the DRUJ was simulated by a custom motion and loading forearm device. The malunion model of the distal radius was controlled by a specially designed external fixation frame that provided control in 6 degrees of dorsal angulations (N, 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees ). The study included an intact and nonintact triangular fibrocartilage complex. RESULTS: This study showed that torque across the DRUJ was affected by the degree of simulated malunion of the distal radius. With more than 30 degrees dorsal angulation the torque across the DRUJ was increased in both muscle loading and unloading conditions. Although significance was not noted, with resistive loading this study showed torque changes with as little as 10 degrees malunion of the distal radius. CONCLUSIONS: We conclude that reduction of distal radius fractures to within 10 degrees of dorsal angulation is needed to allow patients to maintain full forearm and wrist rotation.

Aged↗
PubMed2006

Cancellous allograft versus autologous bone grafting for repair of comminuted distal radius fractures: a prospective, randomized trial.

BACKGROUND: Distal radius fractures with a large metaphyseal defect often need defect filling. We assessed the reliability of a new allogenic transplant as a bone-graft substitute in comparison to autologous iliac crest bone-grafting. METHODS: This prospective, randomized study included 90 patients. Fracture-osteosynthesis was done with 2.7 mm quarter-tube plates. Tutoplast-cancellous-chips were used as allografts. Clinical and radiologic parameters were determined at three and 12 months after surgery. RESULTS: Overall outcomes were assessed according to the Demerit Point System: There were 71% good-to-excellent results in the "Tutoplast"; group and 75% good-to-excellent in the "iliac crest" group. Radiologic parameters were comparable and within normal range. Complications deriving from iliac bone harvesting were notably more frequent in the iliac crest group. Operation time was significantly shorter in the Tutoplast group. CONCLUSION: By the use of the investigated allograft no adverse effects were detected on the outcome of the treated radius fractures. Therefore, this new allograft could be a desirable alternative to autologous bone grafting from the iliac crest, as operating and anesthetics times are shortened and complications of iliac crest bone grafting avoided.

Adult↗
PubMed2006

[Treatment of dorsally displaced distal radius fractures with a double dorsal plate: a study of 12 patients].

BACKGROUND: Distal radius fractures with dorsal displacement and comminution are unstable and difficult to treat. Several surgical techniques have been suggested. Dorsal plates may have some advantages because of the failure of external fixation and pinning. The biomechanical superiority of radius reconstruction using two dorsal plates in both radial columns has been demonstrated in comparison to other techniques. METHODS: A prospective study was made on 12 patients with distal radius fractures with dorsal displacement, operated with double Mathys plates used in neutralization, and seven cases were grafted with Endobon. RESULTS: We have a follow-up of ten months. According to the Herzberg score, one case was rated as excellent, seven as good, three as medium and one as bad. The average flexion was 48.3 degrees, extension 49.8 degrees, pronation 75 degrees and supination 80 degrees. We found two cases of algodystrophy, and one of malunion. DISCUSSION: The best indication to apply the double dorsal plates on distal radius fractures is for metaphyso-diaphyseal fractures with dorsal displacement, comminution and articular involvement. Among its advantages, plating allows good control of the articular surface and of the "posterior-middle" fragment. A stable and solid ostheosynthesis allows rapid re-education and mobilization.

Adolescent↗
PubMed2001

Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture.

A classification system for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures has not been established. Using plain x-rays and corresponding computed tomography (CT) scans we characterized and quantified the types of sigmoid notch involvement in 20 consecutive distal radius fractures with radiocarpal joint extension. Plain radiographs revealed fracture extension into the sigmoid notch in only 7 cases (35%) and the CT scans demonstrated fracture extension into the sigmoid notch in 13 cases (65%). Of the 13 fractures with sigmoid notch involvement, 9 (69%) were displaced and 4 (31%) were nondisplaced. Sigmoid notch articular step-off (n = 7) and gapping (n = 9) were detectable on the CT scans but not on the x-rays. Plain x-rays appear to underestimate sigmoid notch involvement following distal radius fractures. In addition, CT appears to be a superior diagnostic modality for quantifying sigmoid notch fracture step-off and articular gapping.

Adult↗
PubMed1990

[Treatment of distal radius fracture with plate osteosynthesis].

The indications for osteosynthesis of distal radius fractures with a T-plate have been precisely defined. They include Smith's fractures, Barton's fractures, reversed Barton's fractures and the fracture types A3, C1 and C2 according to the A0 classification. The surgical approach is dorsal for the extension type fractures and palmar for those of the flexion type A. Correct diagnosis and accurate operative technique make it possible to achieve favourable results in the treatment of these often compound fractures. Results are presented for 105 patients who underwent osteosynthesis of distal radius fractures with a T-plate.

Bone Plates↗
PubMed2006

External fixation in patients with age over 65 years with distal radius fracture.

AIM: This study evaluates the final outcome of the treatment of the distal radius fractures with external fixation in patients older than 65 years. PATIENTS AND METHODS: Thirteen patients over the age of 65 years with a distal radius fracture were treated with external fixation. The fracture type was determined according the Frykman classification. For evaluation of the outcome six months after the operation were used: Stewart Score System; Gartland and Werley; and PRWE (Patient-rated wrist evaluation). RESULTS: According to the Stewart score system one patient has excellent; nine good; and tree have fair result. Gartland and Werley score showed that four patients have excellent; six good; and three have fair result. According to the PRWE two patients have no pain and no functional disability; five have minimal; five have mild pain and functional disability; and one has moderate degree and frequency of pain and moderate functional disability. Statistically there is strong correlation between Gartland and Werley score and PRWE score (r=0.657) and weak correlation between Stewart score and PRWE score (r=0.431). CONCLUSION: The external fixation of the distal radius fractures in the patients with advanced age enables high degree of functioning of the injured wrist and high level of daily activity. Judging from the benefit of enabling an "independence" of these persons, the risk for the operative treatment is sustained.

Aged↗
PubMed2005

Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study.

PURPOSE: To see if locking volar plates approach the strength of dorsal plates on a dorsally comminuted distal radius fracture model. Volar plates have been associated with fewer tendon complications than dorsal plates but are thought to have mechanical disadvantages in dorsally comminuted distal radius fractures. Locking plates may increase construct strength and stiffness. This study compares dorsal and volar locking and nonlocking plates in a dorsally comminuted distal radius fracture model. METHODS: Axial loading was used to test 14 pairs of embalmed radii after an osteotomy simulating dorsal comminution and plating in 1 of 4 configurations: a standard nonlocking 3.5-mm compression T-plate or a 3.5-mm locking compression T-plate applied either dorsally or volarly. Failure was defined as the point of initial load reduction caused by bone breakage or substantial plate bending. RESULTS: No significant differences in stiffness or failure strength were found between volar locked and nonlocked constructs. Although not significant, the stiffness of dorsal locked constructs was 51% greater than that of the nonlocked constructs. Locked or nonlocked dorsal constructs were more than 2 times stiffer than volar constructs. The failure strength of dorsal constructs was 53% higher than that of volar constructs. Failure for both volar locked and nonlocked constructs occurred by plate bending through the unfilled hole at the osteotomy site. Failure for both dorsal locked and nonlocked constructs occurred by bone breakage. CONCLUSIONS: Locking plates failed to increase the stiffness or strength of dorsally comminuted distal radius fractures compared with nonlocking plates. Failure strength and stiffness are greater for locked or nonlocked dorsal constructs than for either locked or nonlocked volar constructs. Whether the lower stiffness and failure strength are of clinical significance is unknown. The unfilled hole at the site of comminution or osteotomy is potentially a site of weakness in both volar locked and nonlocked plates.

Biomechanical Phenomena↗
PubMed2006

Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study.

PURPOSE: Controversy exists surrounding the effectiveness and complications associated with dorsal plating for distal radius fractures. This study evaluated the functional outcome of dorsal plating for dorsally angulated distal radius fractures at a single institution. METHODS: Thirty patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. The functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. RESULTS: The median patient age at surgery was 59 years. The median follow-up period was 18 months. According to the AO classification system, there were 4 type A fractures, 5 type B fractures, and 21 type C fractures. The median preoperative dorsal angulation was 30 degrees, and the median postoperative angulation was -4 degrees volar. Sixteen patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points, and 28 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. One patient lost reduction, 1 patient needed a tenolysis of the extensor pollicis longus tendon, and 2 patients required the removal of a single metaphyseal screw. CONCLUSIONS: Results from this study show that patients can expect to have 80% of their range of motion and strength after dorsal plating for distal radius fractures. Moreover, 93% of the patients will have good to excellent functional outcomes. Complications from dorsal plating may be caused by the specific plate used, rather than by the technique itself, supporting a dorsal approach for dorsally angulated distal radius fractures.

Adult↗
PubMed1985

Classification of distal radius fractures.

We analysed retrospectively a series of 269 distal radius fractures in adults in order to determine which of five different classification systems gave the best information about the radiographical prognosis of a fracture. The result after reduction in 195 cases was influenced mainly by the primary shortening, whereas dorsal angulation, radial displacement, and the age and sex of the patient were of minor importance. The system described by Older et al. in 1965, was superior to the others. In the analysis of the radiographical result after fracture union, the quality of the reduction, the Older classification system, and the age of the patient were the most important prognostic factors. We conclude that reduction of a distal radius fracture should primarily aim at correcting the shortening.

Adult↗
PubMed2006

Buttressing angle of the double-plating fixation of a distal radius fracture: a finite element study.

Treatment of a distal radius fracture should consider principles including stable fixation and early motion. The aim of this study was to investigate the biomechanical interactions of plate-fixation angles in the internal double-plating method coupled with various load conditions using non-linear finite element analysis (FEA). A 3D finite element distal radius fracture model with three separation angles (50, 70, and 90 degrees ) between the buttressed L- and straight plates was generated based on computed tomography data. After model verification and validation, frictional (contact) elements were used to simulate the interface condition between the fixation plates and the bony surface. The stress/strain distributions and displacements at the radius end were observed under axial, bending, and torsion load conditions. The simulated results indicated that the bending and torsion increased the stress values more than the axial load. The radius and straight plate stress values decreased significantly with increasing fixation angles for all load conditions. However, the L-plate stress values increased slightly under the bending buckling effect. The displacements at the radius end and strains at the fracture healing interface decreased with increasing fixation angles for axial and torsion conditions but displayed a slight difference for the bending condition. The findings using FEA provide quantitative evidence to identify that much larger plate fixation angles could provide better mechanical strength to establish favorable stress-transmission and prevent distal fragment dislocation.

Biomechanical Phenomena↗