Common Myths and Evidence in the Management of Distal Radius Fractures

Diaz-Garcia, Rafael J.; Chung, Kevin C.

doi:10.1016/j.hcl.2012.02.005

Cited by 30 publications

(22 citation statements)

References 57 publications

(51 reference statements)

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“…In terms of long-term outcomes, an articular step-off of 2 mm has been shown to result in radiographic signs of arthritis. However, this has not consistently translated into poorer clinical outcomes [6,11]. Therefore, small differences in radiographic outcomes are likely not clinically important.…”

Section: Discussionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Distal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior. Questions/purposes We performed a meta-analysis of randomized controlled trials to determine whether patients treated with volar locking plates (1) achieved better function (2) attained better wrist motion, (3) had better radiographic outcomes, and (4) had fewer complications develop than did patients treated with K-wires for dorsally displaced distal radius fractures. Methods We performed a comprehensive search of MEDLINE (inception to 2014, October Week 2), EMBASE (inception to 2014, Week 42), and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials; we supplemented these searches with manual searches. We included studies of extraarticular and intraarticular distal radius fractures. Adjunctive external fixation was acceptable as long as the intent was to use only K-wires where possible and external fixation was used in less than 25% of the procedures. We considered a difference in the DASH scores of 10 as the minimal clinically important difference. We performed quality assessment with the Cochrane Risk of Bias tool and evaluated the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Seven randomized trials with a total of 875 participants were included in the meta-analysis. Results Patients treated with volar locking plates had slightly better function than did patients treated with K-wires as measured by their DASH scores at 3 months (mean difference [MD], 7.5; 95% CI, 4.4-10.6; p \ 0.001) and 12 months (MD, 3.8; 95% CI, 1.2-6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7°[95% CI, 0.3°-7.1°; p = 0.04] and 4.1°[95% CI, 0.6°-7.

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Section: Discussionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…To classify fractures, we used Kapanji's classification [11]. Although there's no perfect classification for DRF [12], this one seems to be clear and reproducible particularly for the stability and the comminution. Moreover, it's a very popular and used classification by orthopedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Life expectancy is always growing [4]. A lot of treatment exists for these fractures but there are only few evidence of the superiority of one on them particularly in old patients [5].…”

Section: Introductionmentioning

confidence: 99%

Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases

Genser¹,

Pourre²

2015

J Osteopor Phys Act

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Patients were identified using the digital medical records of the hospital. We used the CIM-10 classification [7] codes: S52-5 and S52-6. Statistical analyses were conducted using the on-line software of the Jussieu Paris VI University : BiostaTGV [8]. Student's t-test and Fisher's exact F-test were used for that mean. The main outcome was the functional result at the end of the patient's follow up. It was measured objectively with wrist motility and subjectively with the common satisfaction of the patient and the surgeon. Secondary outcomes included hospitalization time, immobilization duration, rate and nature of complications, and the pain at the end of the follow up. Source of Funding There was no external funding source for this study. Results Ninety-four patients were hospitalized in our institution between January 1 st , 2010 and June 30 th 2013. There were 74 surgical treatments and 20 conservatives' treatments. The mean age was 88.7 (85-101).

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“…Although ample literature supports good short-term outcomes, higher-level evidence examining the outcomes of surgical fixation in distal radial fractures stresses the importance of age and socioeconomic status. 52,53 No evidence supports one surgical technique over the other in younger patients, and no consensus exists regarding the best treatment for these fractures in elderly patients. 51 The call for prospective, multicenter outcomes studies in distal radial fractures remains the same as it was years ago.…”

Section: Discussionmentioning

confidence: 99%

Current Concepts in the Treatment of Distal Radial Fractures

Ipaktchi¹,

Livermore²,

Lyons³

et al. 2013

Orthopedics

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Distal radial fractures are among the most commonly encountered traumatic fractures of the upper extremity. Initial trauma mechanism, fracture pattern, associated injuries, and patient age influence treatment and outcome. Although stable fractures are commonly treated conservatively, the past decade has seen changes in surgical practice and techniques. Indications for surgery have been extended and refined based on new insight into the pathophysiology of the distal end of the forearm and technological advances in implant design. Despite the frequency of this fracture, only limited higher-level evidence exists to guide practitioners in decision making for this injury. This article highlights key concepts in the treatment of distal radial fractures and summarizes current evidence.

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Common Myths and Evidence in the Management of Distal Radius Fractures

Cited by 30 publications

References 57 publications

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases

Current Concepts in the Treatment of Distal Radial Fractures

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