Distal radius fractures: an evidence-based approach to assessment and management

Vaghela, Kalpesh R.; Velazquez-Pimentel, Diana; Ahluwalia, Aashish; Choraria, Anika; Hunter, A. R.

doi:10.12968/hmed.2020.0006

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…(1) Combined with fractures in other parts or injuries of blood vessels, nerves, and tendons; (2) people with mental illness and uncontrollable behavior; (3) an open fracture; patients who met any of the exclusion criteria were excluded from the study.…”

Section: Exclusion Criteriamentioning

confidence: 99%

“…Generally, most Colles fractures could be treated nonoperatively and achieve satisfactory therapeutic effects, and the fracture could be reset with manual closed reduction and kept immobilized in good alignment with external fixation, but they have received little attention in the literature [ 3 ]. In the external fixation scheme, the sugar tong gypsum and short arm cast are the most commonly used option after reduction, but the resulting inadequate immobilization is a risk factor for the loss of reduction, requiring either repeat reduction or surgical treatment [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Improvement, Validation, and Analysis of Colles Fracture Treated with an Integrated Retainer Pad Splint

Meng

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To observe the effectiveness and safety of the Colles fracture treated with the integrated retainer pad splint and to compare the clinical and radiological outcomes of the integrated retainer pad splint and the traditional bamboo curtain splint in the treatment of the Colles fracture. Methods. A total of 100 patients with Colles fractures were randomly divided into two groups: the treatment group was fixed with the integrated retainer pad splint (IS), and the control group was fixed with the traditional bamboo curtain splint (TS).The range of wrist motion was measured at follow-up examinations, and volar inclination, ulnar deviation, and radial height were measured on radiographs. Regular follow-up wrist imaging examinations and functional examinations were performed before reduction, after reduction, and at the 1st, 3rd, 5th, and 8th weeks. The two groups were compared in terms of convenience, fracture healing time, X-ray data of volar inclination, ulnar deviation, radial height, and wrist joint function. The relevant data were analyzed with SPSS 25.0 statistical software. Results. There were no notable differences in gender, age, and injured side between IS and TS groups. In terms of operation time, IS was better than the TS group ( P < 0.05 ), and the operation time in the IS group was shorter. On the basis of X-ray data of volar inclination, ulnar deviation, and radial height measured on radiographs, the difference between the IS and TS groups was statistically significant ( P < 0.05 ), which showed that the IS group was more stable in fracture fixation and had less reduction loss during the treatment process. At the 8th week of treatment, the wrist Gartland–Werley score of the two groups showed that the two fixation methods are equivalent in restoring wrist joint function ( P > 0.05 ); however, in terms of the excellent and good rate of wrist joint function, the IS group scored 96% was higher than the TS group (80%). Conclusion. Compared with the traditional bamboo curtain splint, the integrated retainer pad splint is more convenient and stable, and it has less reduction loss during the treatment. Repair of the Colles fracture using the integrated retainer pad splint with external fixation results in nearly normal return of function, which is significantly better than using the traditional bamboo curtain splint.

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Section: Exclusion Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improvement, Validation, and Analysis of Colles Fracture Treated with an Integrated Retainer Pad Splint

Meng

Zhang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…In adults, these fractures often require closed reduction and/or operative repair, depending on fracture configuration and displacement. [1][2][3][4][5] Closed reduction is usually performed by applying traction followed by manual reduction of the fracture, after which a splint or cast is applied and radiography is used to confirm post-reduction alignment. 3 4 The primary goal of closed reduction is to realign the cortices of the distal radius, to minimise the need for operative repair.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial

Haak,

Borgstede,

Stolmeijer

et al. 2023

Emerg Med J

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BackgroundDuring closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts.MethodsThis multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction. The primary outcome was the proportion of patients requiring more than one reduction attempt. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair).ResultsA total of 214 patients were screened, of which 211 patients were included for primary endpoint analysis (87% female, median age 68 years, 94% dorsal angulation, 59% intra-articular and 73% multifragmentary). In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. In the standard treatment group, 13 patients (12%) required more than one reduction attempt, compared with 6 patients (6%) in the PoCUS group (OR 2.35, 95% CI 0.86 to 6.45). The median reduction time was 5 min in the PoCUS group (IQR 3–6) vs 3 min (IQR 2–4) in the standard reduction group (p<0.001). At ED discharge, operative repair was indicated for 17 (16%) patients in the standard group and 21 (20%) patients in the PoCUS group (OR 0.78, 95% CI 0.39 to 1.58).ConclusionThis study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts.Trial registration numberThe Netherlands Trial Register (NTR7934).

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“…Non-operative treatment options include closed reduction and immobilisation in plaster or a splint. Operative treatment options most commonly include open reduction and internal fixation, percutaneous fixation or external fixation [ 5 ]. Decision-making between conservative and operative treatment options will depend on patient and fracture characteristics.…”

Section: Introductionmentioning

confidence: 99%

Reducing Exposure to X-Ray in Patients With Conservatively Managed Distal Radius Fractures: A Closed-Loop Pilot Audit

Kazzam¹,

Clowes²,

Wilson³

et al. 2022

Cureus

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Introduction British Orthopaedic Association Standards for Trauma (BOAST) guidelines state that a radiograph of the wrist at the time of removal of immobilisation is not required in conservatively managed distal radius fracture (DRF) patients unless there is clinical cause for concern. The aim of this pilot audit was to investigate local compliance with these guidelines. Materials and methods The first cycle of a retrospective audit was performed on conservatively managed DRF patients presenting between August and October 2021. An intervention was introduced in the form of education to highlight current guidelines. A second cycle was then performed prospectively on patients presenting between February and April 2022. Data was analysed to assess whether radiographs were taken at the time of cast removal, if the indication for the radiograph was documented and whether it affected the management plan. Results In the first cycle, 20 of 46 patients (43.5%) had repeat radiographs at the time of cast removal compared to 12 of 41 patients (29.3%) in the second cycle (p=0.170). None of the first-cycle patients had any documentation on the indication for radiograph at the time of cast removal and none of the radiographs altered the management plan. In the second cycle documentation on the indication for the radiograph was present for seven of the 12 radiographs and two altered the management plan. Conclusion Through education on adherence to national guidelines, the number of radiographs in patients with conservatively managed DRFs was reduced.

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Distal radius fractures: an evidence-based approach to assessment and management

Cited by 6 publications

References 23 publications

Improvement, Validation, and Analysis of Colles Fracture Treated with an Integrated Retainer Pad Splint

Improvement, Validation, and Analysis of Colles Fracture Treated with an Integrated Retainer Pad Splint

Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial

Reducing Exposure to X-Ray in Patients With Conservatively Managed Distal Radius Fractures: A Closed-Loop Pilot Audit

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