Functional outcome of distal radius fractures, an implant based approach - Narrative review (original) (raw)
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Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification
Archives of Trauma Research, 2015
Background: Management of distal radius fractures (DRFs) is still controversial and may be influenced by the initial fracture classification. Even though numerous classification systems have been proposed in this regard, the evaluation and management of this fracture has remained problematic. Objectives: The purpose of this study was to evaluate the functional outcome of DRF managed on the basis of a new classification. This classification named as Barzullah Working Classification represents a modification of Melone classification, which is based on fracture stability. Patients and Methods: A total of 310 DRFs of patients skeletally matured referred to a tertiary care hospital at a period of 18 months were classified as per the new classification system into four types; metaphyseal stable, metaphyseal unstable, radiocarpal stable, and radiocarpal unstable fractures. They were managed and followed over a mean period of 15.10 ± 5.4 months, and the results were recorded at the final follow-up. Results: The mean age of the patients was 51.22 ± 20.58 years. Most of the patients were females (n=189, 64.19%). The minimal follow up was 6 months with a mean of 15.10 ± 5.4 months. Mean mayo wrist scores were 95 ± 4, 80 ± 7.4, 75 ± 7.4, and 70 ± 6.9, for stable metaphyseal fractures, unstable metaphyseal radial, stable radiocarpal fractures and unstable radiocarpal fractures, respectively. The overall mean mayo wrist functional score was 80.58 ± 12.3 (good results) at final follow up. Conclusions: Various modalities of treatment used differentially in different types of DRFs based on the Barzullah Working Classification give good results in spite of conflicting literature.
Evaluation of a treatment protocol in distal radius fractures
Acta Orthopaedica, 2008
Background and purpose Distal radius fractures are most often treated nonoperatively, but sometimes they aretreatedsurgicallywhendeemedunstable.Basedon the literature, a consensus protocol for treatment has beendevelopedinsouthernSwedentoaidcliniciansin theirdecisionmaking.Weevaluatedtheresultsofthis protocolprospectivelyusingavalidatedoutcomeinstrument (DASH) in a large consecutive and populationbasedseriesofunselectedpatients.
Comparison of 24-Month Outcomes After Treatment for Distal Radius Fracture
JAMA Network Open
IMPORTANCE Distal radius fractures (DRFs) are common injuries among older adults and can result in substantial disability. Current evidence regarding long-term outcomes in older adults is scarce. OBJECTIVE To compare outcomes across treatment groups at 24 months among adults with DRFs who participated in the WRIST trial.
The Journal of Hand Surgery, 2018
Purpose Most patients recover well from a distal radius fracture (DRF). However, approximately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time. Methods Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients (445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were women and 57 men and the mean age was 69 years (range, 18e95 years). One-fourth had been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up DASH questionnaire was sent to the 346 of 445 patients still alive. Results Seventy-three patients (27%) had initially been treated surgically and 196 (73%) nonsurgically for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall median DASH score improved from 50 at 1 year to 36 at the 2-to 12-year follow-up, (P < .05). Forty-seven percent had improved to a score below the cutoff 35, but 53% remained at a high suboptimal level. Conclusions The subjective outcome after a DRF improves over time for patients with an inferior result at 1 year, but more than half of the patients continue to have major disability.
Journal of Orthopedic and Spine Trauma, 2016
Background: Calculation of the risk of instability and malunion in patients with distal radius fracture and choosing treatment based on this risk percentage is a new method that can greatly help surgeons in decision-making. In this study, we have tried to make a comparison between treatment decision-making based on prediction of the risk of instability and experience of orthopedic surgeons for management of this fracture. Methods: Recorded information of 69 patients with extra-articular distal radius fracture diagnosis was examined. Radiographs and age of each patient were submitted to two orthopedic surgery professors and they were asked to express their opinion about surgical or non-surgical treatment for each patient based on their own personal habit. The risk of instability was calculated for each patient and surgical or non-surgical treatment for each patient was proposed based on this risk percentage with cutoff point of 70%. Then, the treatment proposed by each surgeon was compared with the treatment proposed based on the calculated risk of instability. Results: The study demonstrated that treatment decision-making for distal radius fracture according to the risk of instability with cutoff point of 70% (this is surgery for fractures with instability risk of more than 70% versus non-surgical intervention for cases with risk of less than 70%) is not significantly and reliably consistent with the opinions of two orthopedic surgeons who had the experience of confronting this fracture. Conclusions: Prediction of the risk of instability for management of distal radius fracture needs to be validated through further studies before being used as the decisive factor for management of this fracture. Colleagues are invited to assess the outcomes of using the risk of instability more accurately with further studies. It is suggested to be more prudent and perform more evaluations when the risk of instability calculation with cutoff point of 70% is used to choose the appropriate treatment.
European Journal of Trauma and Emergency Surgery, 2016
All adults treated conservatively for a DRF between May 2008 and February 2010 in the Leiden University Medical Center were eligible for inclusion in this study. Patients were excluded if they were (1) unwilling or unable to provide informed consent or had (2) systemic diseases such as rheumatoid arthritis and SLE, or had (3) contralateral Abstract Objective The presence of distal radioulnar joint (DRUJ) instability remains often unnoticed initially, but may worsen functional outcome of distal radius fractures (DRF). The aim of this study was to evaluate the influence of concurring clinical DRUJ instability on the outcome of conservatively treated DRF. Methods In a retrospective cohort study, all unilateral, conservatively treated DRF patients were invited for physical examination, CT scan of both wrists and filling out questionnaires. Static and dynamic DRUJ instability were clinically tested. Results Forty-nine DRF patients with a mean follow-up of 4.2 years (SD 0.5) were assessed. Seventeen patients tested positive for DRUJ instability. No differences were found in baseline characteristics between the DRUJ stable and unstable group. Apart from wrist flexion, no statistical significant differences in outcome was found between patients with and without DRUJ instability. Conclusion The presence of clinical DRUJ instability does not seem to affect functional outcome of conservatively treated distal radius fractures at long-term follow-up.
Indian Journal of Orthopaedics Surgery, 2023
Introduction: Fractures of the distal radius (DRF) are the most common orthopedic injuries: one out of every six fractures presented at emergency department is a distal radius fracture. Almost two-thirds of these fractures are displaced and need to be reduced. Epidemiological studies point out that the age rate curve is bimodal and that the highest incidences are found in children and the elderly. DRF constitute 14% of all extremity injuries. They occur as a result of high or low energy trauma resulting in significant injury and impairment of function of the upper extremity. Randomized controlled trial has been attempted to scrutinize the best method for treating DRF, ranging from methods of conservative treatment to advanced strategies of plate osteo-synthesis. Materials and Methods: 124 Patients with 126 intra-articular distal radius fractures were studied, who met with predefined inclusion and exclusion criteria at Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar from 1st October 2017 to 30th September 2019. They underwent different treatment interventions. The cases were followed for 12 months at regular intervals for serial clinical & radiological evaluation. Functional grading and pain scoring was done for different treatment modalities. Radiological grading was made based on union/ non-union of fracture. Results: Majority with wrist fracture were of age 20-40 years followed by the age group 61-80 years. Grip strength was reported better in surgical group(79.2%). Mode of treatment is statistically significant with Palmar flexion (p = 0.015), Supination (p=0.025) and Pronation (p<0 p=0.012).> Conclusion: The impetus for the inclination towards treatment of wrist fracture by surgery, mainly plating method, stands multifactorial and might bring better outcomes in terms of range and degree of movement, expedited recovery, lower chances of malunion and in a way, better prognosis and quality of life in case of DRF. Keywords: Distal radius fracture, Plating, Ellis approach, Unstable fracture, Pain score, Function score.
" Do Radiographic parameters predict Functional Outcome in Distal end Radius Fracture? "
Background: Lower end radius fractures are among the most common fractures of the upper limb and accounts for 15-20% of orthopedic admissions in hospitals. Management these fractures continues to be a therapeutic problem and challenge. Though there are various treatment options described so far; still there is lacunae in the literature, regarding accurate treatment modality, particularly in case of unstable fractures. Various clinical and biomechanical studies have shown the benefits of restoring anatomical reduction. However other studies have demonstrated that restoring normal anatomy does not offer better functional outcomes. While achieving good fracture alignment may be significant, the actual functional importance of anatomical reduction is controversial. The assumption that functional outcome is better by restoration of anatomy is argued. Most orthopaedicians accept the fact that anatomical alignment is preferable, but the threshold for acceptable malunion and the long-term outcome of anatomical reduction on functional outcome and patient related satisfaction remain to be evaluated. The study had been taken up to disclose the correlation between anatomical and functional outcome in these patients with distal radius fracture. Objective: To examine association of radiographic parameters of distal radius fracture and objective (ROM, Grip strength) and subjective (PRWE) functional outcome. Study design and setting: A observational study on management of adult patients with distal radial fractures presenting at Deenanath Mangeshkar Hospital and Research Centre, Pune from October 2013 to December 2015. Patients and methods: This study carried out on the patients with intra-articular and extra-articular fractures of the distal end radius as per selection criteria and after taking a written informed consent. Outcome measures were assessed both objectively and subjectively. Objective assessment included a radiographic score determined by measuring the radial length, radial angle and dorsal angle on wrist radiographs; and the wrist function by measuring the range of motion and hand-grip strength. Subjective assessment was done using wrist pain and disability based on the patient rated wrist evaluation (PRWE) score. Data were analyzed using SPSS v20. Results and analysis: The mean age of our study population (49) was 53 years (20 – 90 years), and 33 patients (67%) were female. Twenty eight fractures (57.1%) were of the dominant hand. Non-operative (14) and operative treatments (35) were used. Majority of patients had a good radiographic score (61%), while 6% had a poor score. Sixty five patients (65%) had a good functional objective score, and 21% had an excellent score. In the subjective assessment of pain and disability, the PRWE score was highest in the 41-60 years age group at 38/100 and least in those at 60 and above years (32/100; p= 0.004). There was a positive correlation (p =0.000) between radiographic assessment and the objective functional assessment in younger age group. There was no correlation between the radiographic score and the subjective assessment (p =0.319). Grip strength was a significant predictor of disability (PRWE score). Conclusion: The majority of the patients had a good radiographic score which correlated positively with the objective functional score, especially in the younger patients; however, a good radiographic score does not seem to positively affect the subjective functional outcome. The patient's age is an important factor in the overall patient satisfaction regardless of the radiographic and the objective functional scores, hence to be considered during planning of treatment options.
Interventions for Distal Radius Fractures
Journal of the American Academy of Orthopaedic Surgeons, 2018
Introduction: The distal radius is the second most commonly fractured bone in the elderly population. Several approaches for management exist including both surgical and nonsurgical treatments. Evidence for alternative approaches remains inconclusive and often conflicting. Methods: Electronic database searches were conducted to identify randomized trials that (1) enrolled adults with a distal radius fracture; (2) compared external fixation, intramedullary nailing, K-wires, plaster casting (PC), or plate fixation (PF) to one of the other treatments listed; and (3) reported on a functional outcome that categorized patients as "excellent" and "good" or reported fracture healing complication (loss of reduction, malunion, delayed union, nonunion, and refracture). Data were synthesized using a Bayesian network meta-analysis. Odds ratios (ORs) with 95% credible intervals (CrIs) using a randomeffects model were calculated. Results: Thirty-eight trials were included. Total sample sizes ranged from 30 to 461 patients. Although no differences were noted between treatments at 3 months, PF was ranked the highest for improving functional outcomes at 6 and 12 months, and it demonstrated a statistically significant difference compared with PC at 12 months (OR = 4.27; 95% CrI, 1.07 to 15.12). For reduction in fracture healing complications, PF was ranked the highest again, showing significantly more favorable results relative to the four other interventions: OR = 0.25 (95% CrI, 0.07 to 0.86) versus external fixation, OR = 0.09 (95% CrI, 0.02 to 0.36) versus K-wire, OR = 0.01 (95% CrI, 0.00 to 0.03) versus PC, and OR = 0.00 (95% CrI, 0.00 to 0.35) versus intramedullary nailing. Conclusions: A network meta-analysis of randomized trials revealed that open reduction and internal fixation with a plate offers the best results for adult patients with a distal radius fracture, in terms of early and sustained functional recovery and a reduction in fracture healing complications. Determining whether one approach to PF or plate design is superior requires further study. T he distal radius is one of the most commonly fractured bones, with approximately 18% of all adult orthopaedic fractures occurring in this region. 1 Furthermore, annualized estimates in the United States alone suggest an incidence of approximately 640,000 cases, and rising, per year. 1 With the high costs associated with the surgical management of