Management of Distal Radius Fractures: Comparison of Three Methods

Abstract

Introduction Distal radius fractures are the most common type of all extremity fractures. It is generally accepted that fractures with more than 2 mm step-off in the radiocarpal joint and greater than 10 degrees dorsal tilt should be treated surgically. However, the ideal technique for surgical management is still a point of debate. We performed cross-sectional data analysis to compare the results of three treatments methods-volar locking plate (VLP), external fixation (EF), Kirschner wire (K-wire)-in patients with distal radius fractures, and compared the clinical, functional, and radiological results Materials and methods Forty-four patients with distal radius fractures who underwent fixation with VLP, K-wire or EF between 2011 and 2013 were included in the study. All fractures were classified according to the Müller's Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Frykman's classifications. Routine radiographs were taken at the postoperative three weeks, six weeks, and three months. Radial inclination, volar tilt, radial length and ulnar variance were assessed on the follow-up visits and additionally at the follow-up for the study. The patient-based Disabilities of the Arm, Shoulder and Hand (DASH) score system and the physician-based MAYO scale were used to evaluate functional outcomes. Radiological and functional outcomes between three surgical modalities were compared and statistically analyzed. Results The average age at the time of surgery was 52 years (range = 35-69 years). Of a total of 44 patients, 28 were operated with VLP, 11 were with K-wire and five with EF. Satisfactory reduction was achieved in all fractures, and all of the fractures healed. DASH and MAYO scores were similar in all groups. Regarding radiographic parameters, there was no significant difference in radial inclination, volar tilt, radial length and ulnar variance between the treatment modality groups. When evaluated based on fracture geometry, the DASH score was significantly higher in the patients with AO23A type fracture compared to the patients with AO23B and AO23C type fractures. As for MAYO score, all AO23 groups had similar outcomes. Conclusions Surgical treatment options VLP, EF, and K-wire provide adequate fixation, satisfactory radiological, and functional results for the management of distal radius fractures of various 1 2 3 4 5 6

Comparação de características sociodemográficas e radiográficas no tratamento de fratura de rádio distal: Cirurgiões de mão versus não especialistas

“…The literature shows that DRF mainly affects women, 3 4 5 6 7 8 9 10 11 12 13 14 15 17 which is consistent with this study. The average age was 50.7 years, lower than that in most studies, 2 3 4 5 6 7 9 12 13 15 18 and few reported average values lower than that. 8 10…”

“…[2][3][4][5][7][8][9]11,14 O método de fixação pode ser um dos responsáveis pela diferença constatada, embora os estudos tenham demonstrado não existir dife-rença dos resultados radiográficos relacionados com o método de fixação. 1,2 Ademais, há contradição na relação entre os resultados radiográficos e a função, principalmente em idosos cuja demanda é menor. [3][4][5][6][7]11,13 Entretanto, diversos fatores influenciam o resultado do tratamento, dentre eles a redução da fratura que o ortopedista pode interferir.…”

“…[11][12][13][14][15] It has a bimodal distribution and is associated with high-energy trauma in young people and lowenergy trauma in elderly patients. 2,4,7 The incidence of DRF is growing due to increased life expectancy and osteoporosis. 4,6,7,9 Distal radial fracture is the second most common fracture in elderly subjects, 16 compromising their functionality and causing disability.…”

Gamification for Distal Radius Fracture Rehabilitation: A Randomized Controlled Pilot Study

“…Post-DRF patients usually experience pain, restricted ROM, reduced grip strength, and limited functional independence due to immobilization under a plaster cast for four-six weeks immediately after the fracture [9]. Therefore, the study aimed to compare the impact of gamification in post-DRF rehabilitation.…”

Do We Really Need to Repair the Pronator Quadratus in Volar Plating of Distal Radius Fracture？A Protocol for Systematic Review and Meta Analysis

“…Distal radius fractures are responsible for high incidence worldwide, mostly due to the anatomy of distal radius,which is located between cortical and cancellous bone [1,2] .According to relevant research statistics, distal radius fractures are the most common upper limb fractures [3] . Currently, open reduction and volar plate internal xation of distal radius fractures is the best treatment option [4][5][6] .To better place on the deep surface of the PQ muscle, it is necessary to be dissected during the operation [7][8][9] .However, whether to repair the PQ muscle remains controversial.83% (608/753) members of the American Society of Hand Surgery of a previous study recommended that they tried to repair the PQ muscle [10] . The main reason is that it is more bene cial to the recovery of the PQ strength, the stability of the distal radioulnar joint, and avoid the damage caused by the long-term friction between the volar exor tendon and the plate.…”