Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case

Abstract

The Clinical Practice Guideline Management of Distal Radius Fractures released by the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand is a summary of the available evidence designed to guide surgeons and other qualified physicians in the management of distal radius fractures. According to this guideline, age of 65 is used as a proxy for functional activity and can serve as a threshold under which patients are likely to benefit from surgical fixation and over which patients are less likely to benefit from surgical fixation when compared with nonsurgical treatment. Supervised therapy and arthroscopic assistance should be used sparingly and on a case-by-case basis. Routine radiographs should also be used on a case-by-case basis. As strong evidence suggests no difference observed in clinical or radiographic outcomes by fixation technique used after 3 months, fixation technique should be driven by fracture pattern. These guidelines serve to guide physicians in the care of patients with distal radius fractures.

Topology-Optimized Splints vs Casts for Distal Radius Fractures

“…However, follow-up studies found no significant differences in pain or functional improvement between these approaches, sparking debate on the best strategy . British guidelines recommend closed reduction and cast immobilization as primary treatments . However, drawbacks of the conventional cast, such as bulkiness, have spurred treatment innovations .…”

“… 16 British guidelines recommend closed reduction and cast immobilization as primary treatments. 17 However, drawbacks of the conventional cast, such as bulkiness, have spurred treatment innovations. 18 , 19 , 20 , 21 The rise of 3-dimensional (3D) printing in orthopedics has led to bespoke splints with superior clinical efficacy, lightweight design, and better ventilation.…”

“…RESULTS A total of 110 patients (mean [SD] age, 64.1 [12.7] years; 89 women [81%]) enrolled in the clinical trial, and complete outcome measurements were obtained for 101 patients (92%). Median G-W scores at 6 weeks were 15 (IQR,(13)(14)(15)(16)(17)(18) for the splint group and 17 (IQR,(13)(14)(15)(16)(17)(18) for the cast group (mean difference, −2.0 [95% CI, −3.4 to −0.6]; P = .03), indicating a statistically significant advantage for the splint group. At 12 weeks, no clinically significant differences in G-W scores between the 2 groups were observed.…”

Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials

“…Recent joint guidelines issued by the American Academy of Orthopedic Surgeons and American Society for Surgery of the Hand have suggested that both techniques are valid for fixation, but the question of best surgical technique still remains controversial. 21…”

“…Recent joint guidelines issued by the American Academy of Orthopedic Surgeons and American Society for Surgery of the Hand have suggested that both techniques are valid for fixation, but the question of best surgical technique still remains controversial. 21 Therefore, we conducted a literature search to identify RCTs comparing K-wire and VLP techniques for unstable DRFs and performed a meta-analysis with the intent of evaluating and comparing the evidence in terms of clinical functional outcomes, radiographic outcomes, joint range of motion (ROM), and postoperative complications to determine the preferred technique in the operative management of unstable DRF.…”