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PubMed2004

Assessment of articular displacement of distal radius fractures.

Intraarticular step and gap displacements represent the most common indication for surgical treatment of distal radius fractures. Most often, treatment decision making relies only on good-quality plain radiographs taken before and after reduction with measurement accuracy maximized by using the longitudinal axis method. When plain radiographs alone prove insufficient, CT scans or tomograms will significantly improve interobserver and intraobserver reliability of measurements, especially when evaluated using the arc method. Tomography is an effective method for postoperative evaluation of fractures immobilized in splints or casts. The role of MRI in assessing intraarticular distal radius fractures is limited to confirming injuries to carpal ligaments or the triangular fibrocartilage complex. Intraoperatively, we use fluoroscopy to obtain 30 degrees cephalad posteroanterior views and as 22 degrees lateral views to best observe articular surface reduction. Our current operative indications include fractures with radiocarpal or distal radioulnar joint step or gap deformities greater than 1-2 mm, gross distal radioulnar joint instability, or those with extensive metaphyseal comminution rendering them particularly unstable after closed reduction. In general, we tend to lean toward operative fixation in younger, more active patients.

Arthroscopy↗
PubMed2005

Rehabilitation of distal radius fractures: a biomechanical guide.

Fracture healing and surgical decision making are not always predictable. The suggested protocols are intended to be flexible rather than rigid to be responsive to patient progress and the fracture site stability. A methodologic approach to the rehabilitation following a distal radius fracture, based on a knowledge of the biology of fracture healing and biomechanics of fixation, may preempt some of the pitfalls associated with distal radius fracture healing.

Biomechanical Phenomena↗
PubMed1994

Treatment of complex intra-articular distal radius fractures.

Techniques for reduction and fixation of intra-articular distal radius fractures have improved in recent years such that fractures that were once thought doomed to a poor result may now be successfully treated operatively. This article explores open, semi-open, and arthroscopically assisted techniques for reduction and fixation of complex distal radius fractures. The reader should gain an appreciation of which fractures can benefit from operative treatment and which techniques may be most useful for specific fracture types. A number of fixation techniques are described, and familiarity with diverse methods will aid the surgeon in complex cases.

Arthroplasty↗
PubMed2026

CL16019, A Combination of Cissus quadrangularis and Boswellia serrata Extracts Promotes the Healing of Distal Radius Fractures: A Multicentric, Randomized, Open-Label Study.

OBJECTIVE: Distal radius fracture (DRF) is the most frequent injury to the upper limb. Complications include nonunion, wrist stiffness and instability, local discomfort, and tendon irritation. The purpose of the current open-label clinical study was to evaluate the safety, efficacy, and tolerability of CL16019, an herbal formulation of Cissus quadrangularis and Boswellia serrata extract, in accelerating fracture healing in volunteers with DRFs. METHODS: Fifty participants (both male and female; age: 30-50 years) with type I, IIA, or IIB DRFs (as per Lidstrom classification) were equally randomized and treated with standard treatment (ST) or ST + CL16019 for 60 days. The primary efficacy outcome was the radiographical bone fracture healing rate as scored by the Radius Union Scoring System (RUSS). Pain, swelling, and tenderness were among the clinical characteristics evaluated using the visual analog scale (VAS). Wrist function improvements were assessed using the Patient-Rated Wrist Evaluation Questionnaire (PRWEQ). The intergroup and intragroup results were analyzed using a paired t-test and an analysis of covariance model, respectively. RESULTS: The RUSS scores for the ST and ST + CL16019 groups at the end of the trial were 5.54 &#xb1; 1.77 and 7.96 &#xb1; 0.20, respectively, with a p-value <0.0001. In addition, the CL16019 volunteers showed substantial (p < 0.05) declines in their VAS and PRWEQ scores. The ST + CL16019 group demonstrated higher Physician Global Assessment and Subject Global Assessment scores. CONCLUSIONS: Supplementation of CL16019 along with standard therapy was found to enhance the bone fracture healing rate, possibly by accelerating the callus formation rate and enhancing cortical bridging. These findings imply that CL16019 might be a good adjunctive in addition to ST for the faster healing of DRFs. The trial was registered with the Clinical Trial Registry of India (CTRI) with the registration number CTRI/2021/12/039006, on December 29, 2021.

Humans↗
PubMed2006

Bridge plating of distal radius fractures: the Harborview method.

UNLABELLED: High-energy comminuted distal radius fractures treated at Level 1 trauma centers represent unique treatment challenges. In particular, two groups of patients require special consideration: patients with high-energy injuries that have fracture extension into the radius and ulna diaphysis and patients with multiple injuries that require load bearing through the injured wrist to assist with mobilization. We report our experiences treating these injuries with a bridge plating technique. The bridge plate acts as an "internal fixator" and depends on ligamentotaxis for fracture reduction. The technique has been found to be performed easily and achieves the goals of maintenance of fracture reduction, allows weightbearing through the injured extremity, and is associated with few complications. We describe the technique and review our experience with a retrospective chart review of 62 consecutive patients. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series).

Adult↗
PubMed2000

External fixation for distal radius fractures: effect of distraction on outcome.

Few studies have examined the potential adverse effects of excess distraction and prolonged duration of external fixation for the treatment of distal radius fractures. In this study, 19 patients with distal radius fractures treated with external fixation and supplemental Kirschner wire fixation between August 1991 and November 1997 were studied retrospectively. Patients were evaluated by questionnaire, chart review, radiographs, and clinical examination an average of 161 weeks after injury. Although no significant correlation was found between amount of distraction, as measured by carpal height index, and scores for pain, function, radiographs, motion, grip, strength, and final result, a negative correlation was found of all categories with increasing carpal height index. A significant negative correlation was seen between duration of external fixation and scores for pain, motion, and total score, with motion scores being most affected. New York Orthopaedic Hospital grades of good or excellent were attained by 89% of the patients. The data suggest that external fixation with supplemental pin fixation is a satisfactory method of treating severe fractures of the distal radius. Outcome likely is improved with shorter duration of external fixation.

Adult↗
PubMed2005

Fragment-specific internal fixation of distal radius fractures.

The treatment of complex, intra-articular distal radius fractures can be challenging. Goals of treatment include the restoration of articular congruity and maintenance of a stable reduction to allow for early range-of-motion, prevention of arthrosis, and ultimately return of upper extremity function. Proper understanding of individual fracture patterns is paramount in achieving these goals and avoiding complications. Through the use of limited surgical incisions and low-profile,anatomically contoured implants, fragment-specific internal fixation provides a rational approach to the treatment of these complex injuries.

Biomechanical Phenomena↗
PubMed2000

The treatment of unstable distal radius fractures with volar fixation.

Stable internal fixation and early motion has not been routinely available for distal radius fractures. Difficulties with the dorsal approach discourage surgeons from internally fixing the most common fracture types. The introduction of a new volar plate with subchondral support fixation allows the treatment of most distal radius fractures with stable internal fixation and early motion while avoiding the complications inherent in the dorsal approach.

Adult↗
PubMed2006

[The role of CT in the diagnosis and treatment of distal radius fracture].

OBJECTIVES: To investigate and discuss the role of CT in the diagnosis and treatment of comminutive distal radius fractures. METHODS: One hundred and eleven consecutive patients (118 cases of fractures) who were admitted to Jishuitan hospital from January 2003 to January 2005 were included in this study. These patients all need operative treatment and accepted CT scans for better understandings of these injuries and helping to make operation plans. RESULTS: after comparing the results of X planes and CT scans, considerable differences existing between the two examinations were found in the measurements of articular compression and step-off, gapping, comminution degree and subdislocation. This difference was manifested not only in the alteration of quantity but also in the change of quality. CONCLUSIONS: Computed tomography can provide more vivid and detailed information of fractures for practitioners. Undoubtedly, CT is especially valuable in the evaluation of severity degree and stability of comminutive distal radius fractures, thus it helps us to determine whether operation is obligatory and choose the best method and approach of operation. Moreover, CT can also clearly show the important parts of fractures which need special attention in the process of operation. At the same time, practitioners are required to understand the indications of CT examination completely and know how to choose scan planes properly.

Adolescent↗
PubMed1993

[Measuring pressure in the carpal tunnel in distal radius fracture].

During to the nature of its anatomical locations the median nerve is the nerve most often and most severely affected in compartment syndromes. In our controlled prospective study of 59 patients with distal fractures of the radius, critically high pressure was recorded in the carpal tunnel even in sites of moderate soft tissue swelling. The increase in pressure is directly related to the extent of fracture hematoma, the interval between injury and treatment, and the amount of manipulation during reduction. The average pressure within the carpal tunnel of a normal wrist joint held in the neutral position is 5 mm Hg. In contrast, the average carpal tunnel pressure in the distal radius fracture group in this study was increased to 24 mmHg. During reduction average pressures increase to 44 mmHg, subsequently decrease for a brief period, and finally increase to 34 mmHg 4 h later. At 12 h after reduction average values are still 26 mm Hg. Patients developing Sudeck's dystrophy during treatment (n = 4) exhibit above-average carpal tunnel pressure.

Adolescent↗
PubMed2003

[Occult scaphoid-lunate dissociation in distal radius fractures].

INTRODUCTION: The aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap in pathomechanics. The diagnosis however is frequently missed initially. PATIENTS AND METHODS: We reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients were re-examined clinically and radiographs of both wrists were compared. RESULTS: Four patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2 mm on anterior-posterior radiograph and the scapholunate angle > 60 degrees on lateral radiograph). All patients with SLD showed a poor radioulnar deviation. Three patients reported mild to moderate pain. DISCUSSION: The difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately to scapholunate advanced collapse.

Adolescent↗
PubMed2006

The outcome of intra-articular distal radius fractures treated with fragment-specific fixation.

PURPOSE: To assess the clinical, radiographic, and functional outcome of treating intra-articular distal radius fractures with fragment-specific fixation. METHODS: A retrospective review of 81 patients with 85 intra-articular distal radius fractures who were treated with fragment-specific fixation was performed. Minimum time to follow-up evaluation was 1 year, with a mean time of 32 months. The immediate postoperative films were compared with those taken at the final follow-up evaluation. Radiographs of the uninjured wrist were also obtained at the final follow-up evaluation for comparison. Patients were examined for wrist and finger range of motion, deformity, and grip strength, and they completed a standard Disabilities of the Arm, Shoulder, and Hand outcome survey. RESULTS: According to Gartland and Werley scoring there were 61 excellent and 24 good results. Flexion and extension of the surgically treated wrist at the final follow-up evaluation averaged 85% and 91%, respectively, of the uninjured wrist; grip strength averaged 92% compared with the uninjured side. The average Disabilities of the Arm, Shoulder, and Hand outcome score for the injured wrist was 9. Sixty-two percent of patients achieved a 100 degrees arc of flexion and extension and normal forearm rotation by postoperative week 6. Radiographic alignment was maintained between immediate postoperative and final follow-up films, and there were no cases of symptomatic arthritis at the final follow-up evaluation. CONCLUSIONS: Fragment-specific fixation is a reasonable alternative for treating intra-articular fractures of the distal radius. At final follow-up evaluations, patients had good to excellent results with respect to range of motion, grip strength, radiographic alignment, and satisfaction scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Adolescent↗
PubMed1999

Supplemental pinning improves the stability of external fixation in distal radius fractures during simulated finger and forearm motion.

External fixation is commonly used in the treatment of distal radius fractures. In this in vitro study, we investigated changes in fracture stability when using supplemental radial styloid pinning in combination with external fixation. Eight previously frozen cadaveric upper extremities were mounted in a computer-controlled wrist-loading apparatus. This device was used to generate finger and forearm motions through loading relevant tendons. An unstable extra-articular distal radius fracture was simulated by removing a dorsal wedge from the distal radius metaphysis. An electromagnetic tracking system measured fragment motion following randomized application of a Hoffman external fixator, a Hoffman external fixator with 2 supplemental radial styloid pins, and a dorsal 3.5-mm AO plate. Regardless of the fixation technique used in this unstable fracture model, fragment motion occurred when postoperative finger and forearm motions were simulated. The addition of radial styloid pins to a construct stabilized by an external fixator significantly improved fragment stability, approaching that achieved with the dorsal AO plate.

Biomechanical Phenomena↗
PubMed2000

Increasing incidence of distal radius fractures in Japanese children and adolescents.

To investigate recent trends in the incidence of fractures in children and adolescents, we conducted a survey of distal radius fractures in 1992 and 1995 in Tottori Prefecture, Japan. Seven-hundred and forty-five patients under age 20 years were registered (562 males and 183 females). The age and sex-specific incidences of fractures in patients under 20 years of age were higher in males than in females, showing peaks at age 12-13 years for males and at age 10-11 years for females. The incidences had an obvious monthly variation, with peaks in spring and autumn. The age and sex-specific incidences were compared with those in the period 1986-1988, which we reported previously. The incidence in each year showed a significant increase with time for males but not for females. We conclude that the incidence of distal radius fractures in children and adolescents has a prominent peak matched by the age of the growth spurt, and the incidence of the fracture has increased in males during the past decade in Tottori Prefecture.

Adolescent↗
PubMed2006

A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional percutaneous K-wires.

OBJECTIVES: To compare closed reduction and casting with closed reduction and external fixation with optional K-wire fixation for distal radius fractures with metaphyseal displacement but without joint incongruity. DESIGN: Prospective study. SETTING: Multicenter study at 3 University teaching hospitals. PATIENTS/PARTICIPANTS: A total of 113 skeletally mature patients with distal radius fractures with metaphyseal displacement, but without joint incongruity, were randomized to receive 1 of 2 standardized treatment protocols. Patients were evaluated at 6 weeks, 6 months, 1 year, and 2 years. INTERVENTION: Closed reduction and casting (n = 59) or closed reduction and external fixation (n = 54). MAIN OUTCOME MEASUREMENTS: Upper extremity function was measured using upper extremity MFA domain scores, overall Jebsen Taylor scores, and pinch and grip strength tests. Global function and pain were measured using the SF-36. Radiographic evaluation and range of motion were documented. RESULTS: Upper extremity MFA scores, Jebsen Taylor scores, SF-36 bodily pain scores, and grip strength improved significantly during the first year for all patients. By 2 years, mean Jebsen Taylor scores and SF 36 bodily pain scores for patients in both groups were similar to scores for normal age- and gender-matched population controls. At all points, there was a trend for better function in the external fixation; however, this did not reach statistical significance. There was a trend for better length and palmar tilt restoration with external fixation. CONCLUSIONS: For distal radius fractures with metaphyseal displacement but with a congruous joint, there exists a trend for better functional, clinical, and radiographic outcomes when treated by immediate external fixation and optional K-wire fixation.

Adult↗