Distal Radius Fractures: Approaches, Indications, and Techniques

Alluri, Ram K.; Hill, J. Ryan; Ghiassi, Alidad

doi:10.1016/j.jhsa.2016.05.015

Cited by 56 publications

(58 citation statements)

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“…11,33,34 Inconclusive clinical practice guidelines in addition to advances to internal fixation including lower profile designs, proximal/distal fit plates, polyaxial capabilities, periarticular hook plates/extensions, and fragment-specific fixation could be considered to play a role in the continued increasing trend of internal fixation. 14,17 The change toward more fracture fixation seen in the elderly population could in part be attributed to the increased risk of loss of reduction and malunion due to the inherent instability associated with osteopenia and osteoporosis. 15,16,28 Several authors have postulated that the stability offered by internal fixation allows for an earlier ability to perform activities of daily living and thereby preserving independence, while Koval et al eluded to an "intrinsic attraction newer technology" and pressures to offer new techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Other indications cited in the literature include unstable fractures as defined by Lafontaine et al and Mackenney et al, open fractures, polytrauma patients, and concomitant carpal fractures. [14][15][16] Although fixation-specific recommendations remain vague, the past several decades have seen an evolution in fixation options with dorsal plating in the 1990s, followed by volar plating in 2000, and the subsequent advent of fragment-specific fixation in 2014. 14,17,18 The influence of these innovations on distal radius fracture treatment trends remains unclear.…”

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confidence: 99%

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Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups

et al. 2019

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Background The purpose of this study is to assess the epidemiology, population-specific treatment trends, and complications of distal radius fractures in the United States. Methods The PearlDiver database (Humana [2007–2014], Medicare [2005–2014]) was used to access US inpatient and outpatient data for all patients who had undergone operative and nonoperative treatment for a distal radius fracture in the United States. Epidemiologic analysis was performed followed by age-based stratification, to assess prevalence, treatment trends, and rates of complications. Results A total of 1,124,060 distal radius treatment claims were captured. The incidence of distal radius fractures follows a bimodal distribution with distinct peaks in the pediatric and elderly population. Fractures in the pediatric population occurred predominately in males, whereas fractures in the elderly population occurred more frequently in females. The most commonly used modality of treatment was nonoperative; however, the use of internal fixation increased significantly during the study period, from 8.75 to 20.02%, with a corresponding decrease in percutaneous fixation. The overall complication rate was 8.3%, with mechanical symptoms most frequently reported. Conclusions The last decade has seen a significant increase in the use of internal fixation as treatment modality for distal radius fractures. The impetus for this change is likely multifactorial and partly related to recent innovations including volar locking plates and an increasingly active elderly population. The implicated financial cost must be weighed against the productivity cost of maintaining independent living to determine the true burden to the healthcare system.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups

et al. 2019

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“…This has led to identification and discussion of shortcomings and complications of many modalities [17]. For example, for a VLP system, a) its shortcomings include high possibility for prominence if applied distally and possibility for irritation of tendon(s) [14]; and b) among its complications are carpal tunnel syndrome, peripheral nerve palsy, extensor tenosynovitis, and rupture of tendon(s) [17] [19]. Thus, there is scope for modifications to current modalities and/or introduction of new ones.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Zysk¹,

Lewis²,

Taxier³

et al. 2017

WJET

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Background: There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the "surgical modality of choice". While outcomes with each modality are usually good to excellent, each has its share of shortcomings and complications. Thus, there is scope for improvements to existing modalities and/or introduction of new ones. Study Purpose: We introduce a novel modality, namely, the prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system, and investigated its plausibility. Experimental Procedures: The biomechanical performance of a construct comprising a synthetic distal radius (fourth-generation Sawbones ® ) on which a simulated fracture was created (4-mm wide osteotomy positioned 25 mm from the most distal end of the radius) and fixated with a placement of the IPBO system (SIPBO Construct) was compared to that when the fixation was with an approved Ti-6Al-4V alloy VLP system (SVLP Construct), under a clinically-relevant compressive loading protocol. Performance involved determination of quantitative parameters of the construct (initial longitudinal stiffness (ICLS), final longitudinal stiffness (FCLS), and load-to-failure (P f )) and observation and recording of features of the construct at the fracture point. We also determined the quantitative parameters for the intact synthetic distal radius (control). Results: For each of the quantitative parameters, the range of values for SIPBO Construct was within that for SVLP Construct, suggesting that the IPBO System is a plausible modality. Also, for SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Con- 310struct, some failure features were fracture of the cortical wall and of the dorsal proximal fragments. Conclusion: The findings suggest that the IPBO system is plausible. As such, it merits further study; for example, determination of the influence of fracture gap fill ratio (defined as the proportion of the fracture gap that is filled by the expanding balloon as the polymer is injected into the balloon) on a large collection of quantitative biomechanical parameters.

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“…Distal radius fracture treatment has evolved over the past decade. 24 The goal of treatment remains restoration of anatomic alignment to allow for optimized hand and wrist function. Volar plate fixation has become an increasingly popular approach for the treatment of these fractures; however, it has limited utility in the setting of significant comminution, a large zone of injury, fracture dislocations, and osteopenic bone.…”

Section: Discussionmentioning

confidence: 99%

Carpal Translocation Following Dorsal Bridge Plate Fixation of Distal Radius Fractures: A Cadaveric Study

et al. 2019

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Background Dorsal bridge plate fixation is an effective technique for stabilization of highly comminuted, complex distal radius fractures. However, it is unknown whether fixation to the second or third metacarpal is optimal. Given dorsal bridge plating spans the radiocarpal joint, it is unclear if the dorsal spanning plate affects carpal position. This study investigates differences in carpal translocation resulting from bridge plate distal fixation to either the second or third metacarpal. Methods Ten paired cadaveric upper extremities without evidence of gross deformity or prior surgery distal to the elbow were evaluated with three-view wrist fluoroscopic images for baseline radiographic measurements. An unstable distal radius fracture model was created via a volar approach using a 1-cm osteotomy. Following fracture creation, a dorsal bridge plate was applied with random to the second metacarpal on one limb, and the third metacarpal on the contralateral limb. Laterality for distal fixation was chosen randomly. Fluoroscopic images were repeated and radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, radial rotation index, and carpal translocation were measured. Results Radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, and radioscaphoid angle were not statistically different before and after fixation, or when comparing the second or third metacarpal fixation. Additionally, there was no difference in Taleisnik's ulnar translocation index, Chamay's ulnar translation index, or McMurtry's carpal translation index based on which metacarpal was used for distal fixation. Conclusions Dorsal bridge plate fixation of distal radius fractures restores preoperative physiologic measures of the radius, ulna, and carpus. Carpal translocation was similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a bridge plate. Level of Evidence This is a Level V, therapeutic study.

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Distal Radius Fractures: Approaches, Indications, and Techniques

Cited by 56 publications

References 50 publications

Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups

Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Carpal Translocation Following Dorsal Bridge Plate Fixation of Distal Radius Fractures: A Cadaveric Study

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