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PubMed1999

[The MR tomographic imaging of uncomplicated secondary fracture healing exemplified by the distal radius fracture].

PURPOSE: To investigate the normal sequential MR-pattern of uncomplicated fracture healing within the first 6 weeks. METHODS: In 8 patients with distal radius fracture, 4 by 4 with and without intraarticular fracture, MR examinations were performed 3-4 days after the onset of fracture and after 1, 2, 3, 4, 5 and 6 weeks using the following techniques: T1-weighted spin echo, T2-weighted spin echo, T2 proton density weighted, STIR (short inversion time inversion recovery), T2-weighted turbo spin-echo and fast field echo (FFE, gradient echo). Sequential examinations were analysed regarding 1) the appearance of fracture line, 2) development of bone marrow signal, and 3) signal changes in surrounding soft tissue. Maximum contrast of bone marrow and soft tissue was measured. RESULTS: The fracture line in bone marrow was best detectable in FFE- and T2-weighted spin ech images during the first week and in T2-weighted fast spin echo and proton density-weighted images from the 2nd to 4th week. Beginning in the 5th-6th week an increase of signal intensity in the fracture gap was typical in all sequences except for T1-weighted spin echo. The contrast maximum of bone marrow and soft tissue, best detectable in STIR- and T2-weighted spin echo images, occurred in the 1st-2nd week. CONCLUSIONS: MRI shows a typical time-depending pattern of the fracture line, surrounding bone marrow and soft tissue in normal fracture healing. The degree of injury influences the development of signal changes.

Adult↗

PubMed1995

Decision making in distal radius fractures.

In distal radius fractures, function follows restoration of preinjury anatomic landmarks. The allowable deviation from these measurements is relatively small if optimal results are to be achieved, particularly in younger individuals. A hierarchy of treatment options--characterized by increasing invasiveness--exists for treating these injuries. As this hierarchy is ascended, treatment-related complications increase. It appears reasonable to select the least invasive treatment option capable of achieving satisfactory anatomic alignment. Hand and extremity function must be addressed early, and a conscientious effort must be exerted to avoid residual stiffness or the development of reflex sympathetic dystrophy.

Colles' Fracture↗

PubMed2003

Pain and disability reported in the year following a distal radius fracture: a cohort study.

BACKGROUND: Distal radius fractures are a common injury that cause pain and disability. The purpose of this study was to describe the pain and disabilities experienced by patients with a distal radius fracture in the first year following fracture. METHODS: A prospective cohort study of 129 patients with a fracture of the distal radius was conducted. Patients completed a Patient-rated Wrist Evaluation at their baseline clinic visit and at 2, 3, 6 and 12 months following their fracture. The frequency/severity of pain and disabilities reported was described at each time point. RESULTS: The majority of patients experienced mild pain at rest and (very) severe high levels of pain with movement during the first two-months following distal radius fracture. This time is also associated with (very) severe difficulty in performing specific functional activities and moderate to severe difficulty in four domains of usual activity. The majority of recovery occurred within six-months, but symptoms persisted for a small minority of patients at one-year following fracture. Patients had the most difficulty with carrying ten pounds and pushing up from a chair. Resumption of usual personal care and household work preceded, and was more complete, than work and recreational participation. CONCLUSIONS: This study demonstrated that the normal course of recovery following a distal radius fracture is one where severe symptoms subside within the first two-months and the majority of patients can be expected to have minimal pain and disability by six-months following fracture. This information can be used when planning interventions and assessing whether the progress of a patient is typical of other patients.

Activities of Daily Living↗

PubMed1991

[Hypersupination dislocation of the distal radio-ulnar joint after distal radius fracture].

Following an intraarticular distal radius fracture of the scaphoid, scapholunate dissociation and fracture of the ulnar styloid process without dislocation, the distal radius fracture healed with rotational deformity. In the course of conservative treatment, a dislocation of the distal radioulnar joint in locked hypersupination developed. Due to the locked rotational deformity, standard X-rays were difficult to assess. Only with the help of a CAT-scan, were the authors able to visualize the distal radioulnar joint dislocation and later control the postoperative result.

Adult↗

PubMed2002

Intrafocal pinning of distal radius fractures: a simplified approach.

Distal radius fractures are not often treated by plastic surgeons. At the authors' institution, plastic surgery manages half of all traumas below the elbow, including distal radius and forearm fractures. This opportunity gives the residents a unique perspective for comprehensive training in treating upper extremity injuries. Because a distal radius fracture is the most common fracture of the upper extremity, the authors describe the use of intrafocal pinning as a simple and effective approach in the treatment of extra-articular distal radius fractures (Colles' fractures). They conducted a prospective study of 18 patients with Colles' fractures treated sequentially at their institution from 1998 to 2001 using this technique. They measured ulnar variance and palmar tilt of the distal radius at the time of injury, after closed reduction, immediately postoperatively, and 11 weeks postoperatively. Acceptable distal radius reduction aims to achieve at least neutral ulnar variance and 0-deg palmar tilt. Compared with closed reduction, they achieved superior anatomic reduction with intrafocal pinning: ulnar variance, +2.6 mm vs. -1.4 mm; palmar tilt, -13.3 deg vs. +2.1 deg). These results were stable at the 11-week follow-up. Intrafocal pinning is a valuable tool in the management of Colles' fractures. It is simple to perform and to teach, and it produces results that are superior to closed reduction alone.

Adolescent↗

PubMed1993

Imaging techniques for distal radius fractures and related injuries.

In patients with distal radius fractures, routine roentgenographic examination in at least two or three planes should be performed first and is usually sufficient for correct diagnosis and adequate treatment. A careful examination of the soft tissues of the forearm and wrist on conventional roentgenograms may be key for correct diagnoses. Routine roentgenographic examination of the wrist, preferable in four views, should be performed in every patient with a distal radius fracture acutely as well as at follow-up. The technique is easy to perform, universally available, and inexpensive. Advanced imaging techniques such as radionuclide bone imaging, CT, or MR imaging should not be first choice modalities in patients with distal radius fractures and should be used only when conventional roentgenograms are inconclusive. Scintigraphy can be helpful for diagnosing occult fractures, for documenting fracture healing and ligamentous or cartilaginous post-traumatic disorders, as well as for diagnosis and follow-up of reflex sympathetic dystrophy. A disadvantage of scintigraphy is its poor specificity. Indications for CT include the confirmation of occult fractures suspected on the basis of the findings of physical examination and focally hot bone scintigrams when plain films are normal or inconclusive. In comparison with conventional radiography, CT is superior for the preoperative evaluation of complex comminuted distal radius fractures, depicting the distal radial articular surface and size and position of fracture fragments, as well as for the assessment of fracture healing. Additionally, CT is the imaging technique of choice for the correct diagnosis of subluxations of the distal radioulnar joint. Magnetic resonance imaging is an important diagnostic technique for the evaluation of suspected injuries of soft tissues related to distal radius fractures, such as to the flexor and extensor tendons or the median nerve, and for the early diagnosis of necrosis of the scaphoid or lunate. Other indications include identification of triangular fibrocartilage complex perforations, ruptures of carpal ligaments, and demonstration of contents of the carpal tunnel.

Follow-Up Studies↗

PubMed2002

Calcium phosphate bone cement for treatment of distal radius fractures: a preliminary report.

Distal radius fractures in osteoporotic patients are often complicated with a residual deformity and a subsequent stiff and painful wrist. The aim of this study was to evaluate the usefulness of calcium phosphate bone cement (CPC95) in the treatment of these fractures. Seven Colles type fractures in seven patients (all female; average age, 58 years) were treated. After a closed reduction, the fractures were fixed either by percutaneous pinning or by external skeletal fixation. The CPC95 was then injected into the cancellous bone defect through a small dorsal incision. The functional and radiological results were evaluated for up to 1 year. All patients were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 3.5 weeks. The overall shortening of the radius was 2.3 mm. In one patient, CPC95 extruded into the extensor tendon sheath and was surgically removed. Injection of CPC95 is a promising augmentation of osteosynthesis for distal radius fractures, although a prospective control study is mandatory to prove the usefulness of this material. The equipment and surgical technique should be refined to avoid the extrusion of CPC95.

Biocompatible Materials↗

PubMed2005

The International Classification of Functioning as an explanatory model of health after distal radius fracture: a cohort study.

BACKGROUND: Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. METHODS: This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. RESULTS: Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. CONCLUSION: The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.

Activities of Daily Living↗

PubMed1996

Distal radius fractures: concepts and complications.

Distal radius fractures are one of the most common types of injuries treated by an orthopedic surgeon. The overall results may not be as favorable as once thought. As a distinct subgroup, the young adult deserves special consideration. Management of distal radius fractures in these patients is difficult due to the higher energy involved, amount of comminution, and associated soft tissue damage. Functional outcome has been best when an anatomical reduction has been achieved. Many surgical options are available: external fixation, percutaneous pin fixation and open reduction are the mainstays. The complications may be minimized with careful attention to and knowledge of the techniques used and early intervention when closed treatment fails.

Adult↗

PubMedDate not supplied

Early active rehabilitation for operatively stabilized distal radius fractures.

From the young to the elderly, distal radius fractures are very common. Extensive literature has been written regarding surgical management of distal radius fractures, but the same degree of attention has not been given to the critical rehabilitation that follows. Successful functional outcomes for distal radius fractures are a result of appropriate surgical treatment as well as timely and specific rehabilitation. Surgical treatment strategies available for unstable distal radius fractures include percutaneous pinning, external fixation, dorsal plating, and volar fixed-angle plating. Arthroscopically assisted as well as other minimally invasive techniques are now gaining acceptance. The ideal surgical treatment would provide stable fixed-angle fragment-specific support with minimal soft tissue disturbance and allow safe, early active wrist rehabilitation. This article reviews the normal anatomy of the region, the pathoanatomy created by the different stabilization strategies, and specific therapy techniques, including static and static progressive splints, that correlate with each of the surgical procedures.

Arthroscopy↗

PubMed2003

Fixation of distal radius fractures using AO titanium volar distal radius plate.

This study is to assess the effectiveness and outcome of the AO titanium volar distal radius plate (Synthes) in the treatment of peri-articular volar rim fractures of the distal radius. It was conducted on 22 patients with distal radius fractures who underwent open reduction, internal fixation using the AO titanium volar distal radius plate between July 1998 and December 1999 at the Changi General Hospital. The radiographs of the patients were analysed upon fracture union and assessment of wrist function was done using Gartland and Werley criteria. There were four extra-articular AO Type A2(1) and A3(3): the remaining 18 intra-articular fractures consisted of AO B3(2), AO C1(11), AO C2(2) and AO C3(3). The average follow-up period was 12.6 months (range 7-23). Radiological review showed bone healing in 21 patients (95.5%) and good articular congruity for all intra-articular fractures with less than 2 mm step-off. Three patients defaulted follow-up. Complications were few with one wound infection, one tendon rupture and three neuropraxia of the superficial radial nerve. Wrist function was excellent in three patients, good in 12 and fair in four. The AO titanium plate with its distal buttressing ability is an effective treatment modality in patients with distal radius fractures involving the peri-articular volar rim.

Adult↗

PubMedDate not supplied

Functional limitation immediately after cast immobilization and closed reduction of distal radius fractures: preliminary report.

The majority of research on distal radius fractures consists of retrospective, descriptive studies of patients with unstable fractures requiring fixation. The purpose of this investigation was to report on impairments in flexibility, grip strength, and motor control and on the presence of swelling and atrophy immediately after cast immobilization of closed reductions of simple distal radius fractures. Sixteen adult subjects from Kaiser Permanente Medical Center, San Francisco, entered the study, and 13 completed it. At the initial evaluation, upper extremity ranges of motion, grip strength, forearm circumferences, two-point discrimination, and motor reaction times were measured on the uninvolved side. The same measurements were taken on the affected side within 48 hours after cast removal. All but one subject worked throughout the casting period. There were significant postcasting impairments in forearm rotation (40% deficit in pronation and supination); wrist flexion, extension, and radial and ulnar deviation (50% reduction in all motions); grip strength (-32 kg, or approximately 24% of the strength of the unaffected side); and forearm circumference (-1.1 cm) and wrist circumference (+1.5 cm). Patients complained of awkwardness of the involved hand. These measured impairments immediately after immobilization of simple radius fractures were greater than the reported impairments in patients after reduction of radius fractures with fixation 6 to 27 months after injury. To prevent long-term disability and recover flexibility, strength, and function, patients with simple distal radius fractures should be referred to a hand, occupational, or physical therapist for evaluation, education, and treatment after immobilization. Longitudinal studies are needed to quantify long-term functional recovery with regard to the type of fracture and the degree of impairment measured immediately after casting.

Adult↗

PubMed2005

[Frequency of acute and chronic scapholunate dissociation in distal radius fractures. Different treatment plans].

BACKGROUND: Early diagnosis and appropriate treatment of acute scapholunate dissociation (SLD) is crucial for obtaining a favorable result in fractures of the distal radius. The aim of this study was to determine the incidence of acute SLD in a prospective study and to differentiate this entity from chronic SLD. PATIENTS AND METHODS: A total of 120 patients with unilateral distal radius fractures were prospectively evaluated for SLD. Stress radiographs were obtained for all patients on the injured side after fixation of the distal radius fractures. In cases of SLD the unaffected side was examined to rule out chronic, bilateral SLD. RESULTS: Acute SLD was detected in 13 patients (11%), 11 (9.1%) of whom had stage 3 injury. Chronic SLD with bilateral asymptomatic instability was seen in three patients (2.5%). CONCLUSION: When treating fractures of the distal radius, acute SLD has to be ruled out and to be discriminated from chronic SLD. While acute SLD requires appropriate treatment, immediate treatment of chronic SLD is not indicated.

Acute Disease↗

PubMed1999

[Reflex sympathetic dystrophy (Sudeck's disease). An unavoidable complication of distal radius fracture?].

OBJECTIVE: Reflex sympathetic dystrophy after a distal radius fracture is judged as a complication, which cannot be avoided in every case. The aim of the present study is to find out whether this assumption also holds with respect to the actual technique of treatment of the radius fracture. METHODS: 50 cases are analyzed, in which (between 1975 and 1996) an expert opinion was given about the question of malpractice. RESULTS: In 3 of 50 cases malpractice due to healing of fracture in malposition was proven. Only in one case malpractice was seen in development of reflex sympathetic dystrophy itself. Although two thirds of the fractures were classified as instabile, 47 of them were treated conservatively. 30 of 40 repositions were incomplete from the beginning. In ten cases a second reposition was necessary, in 19 cases a secondary dislocation happened, 24 of 40 repositions were done without a sufficient analgesia. Most of the treatments would not follow the latest treatment principles of distal radius fracture. CONCLUSION: The estimation of development of reflex sympathetic dystrophy has to be changed: This complication is to be regarded as inevitable only if the two most important triggers (instability and pain) are avoided by following the actual rules of treatments of the distal radius fracture.

Female↗

PubMed2002

Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures.

OBJECTIVES: To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors. DESIGN: Prospective cohort study, mean follow-up of 9.8 years. SETTING: Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon. PARTICIPANTS: Nine thousand seven hundred four white women aged 65 and older, enrolled in the multicenter Study of Osteoporotic Fractures. METHODS: Five hundred twenty-seven distal radius fractures were confirmed by physician review of radiology reports; characteristics of the fractures were noted. Information was also collected on lifestyle, demographics, bone mineral density (BMD), and clinical and performance measures. RESULTS: The overall incidence of fracture was 7.3/1,000 person-years. Twenty-seven percent of the fractures were intra-articular; 73% were extra-articular. The independent predictors of fracture were decreased BMD (per 0.1 g/cm(2)) at the distal radius ( relative risk ( RR)=1.8, 95% confidence interval ( CI)=1.6-2.1), a history of recurrent falls ( RR=1.6, 95% CI=1.2-2.0), and having had a previous fracture since age 50 ( RR=1.3, 95% CI=1.1-1.6). Current use of oral estrogen was protective ( RR=0.6, 95% CI=0.4-0.8). For women aged 75 and older, poor cognitive status was also a predictor of wrist fracture. Intra-articular fractures occurred more than twice as frequently in women with diabetes mellitus. CONCLUSIONS: This is the first large long-term comprehensive study of distal radius fractures in older people. The results indicate that factors predictive of distal radius fractures can easily be assessed in routine clinical practice and can identify women at high risk for fracture. Selected preventive strategies could be designed to reduce the incidence of these fractures.

Aged↗

PubMed2005

Essential radiographic evaluation for distal radius fractures.

Fractures of the distal radius can be complex injuries, often generating multiple fragments with distortion of the normal anatomy in all three dimensions. Superficial assessment of the injury on the standard PA and lateral radiographs often can result in incomplete recognition of the injury pattern and a misdirected approach to treatment. In addition, failure to recognize subtle radiographic findings may result in the acceptance of a reduction that has significant residual incongruency and articular surface disruption. Standard radiographs of the distal radius can provide a wealth of information about the topography of the bone if the surgeon knows what to look for. The ability to recognize detailed landmarks and parameters on the radiographic images and convert this information into a three-dimensional visual image is a skill that requires education and training. As more aggressive treatments have emerged for anatomic restoration of the bony and articular anatomy, accurate identification of the pattern of injury has become essential. Parameters such as the tear drop angle, AP distance, and articular separation have been recognized only recently. Because these parameters reflect the congruency of the articular surface,it would be natural to assume that postreduction films in which these parameters are abnormal would compromise clinical outcome. Because nearly all historical studies do not include routine evaluation of these parameters, knowledge of radiographic correlation with clinical outcome is still incomplete. At the same time, previous studies to assess outcome of distal radius fractures may be compromised by the failure to recognize residual deformity and articular incongruency that would have been evident with measurement of these parameters. With careful understanding of the radiographic landmarks, radiographic parameters, and patterns of injury, the surgeon can visualize a more accurate picture of the fracture itself and the reduction. As a result, treatment decisions for distal radius fractures can be based on a more thorough understanding of the anatomy of the injury, and future grading of radiographic results may reflect more accurately the precision of the articular restoration.

Humans↗

PubMed2006

[Intraarticular distal radius fractures--arthroscopic assessment of injuries].

Intraarticular distal radius fractures affect predominantly young people by contrary to "loco typico" fractures concerning old patients with osteoporosis. They are usually caused by high energy trauma and their treatment needs anatomic reposition. Between August and December 2004 there were performed 10 wrist arthroscopies in distal intraarticular radius fractures: 3 women and 7 men, age from 20 to 63 years, average 41. In all cases arthroscopy revealed larger displacement than assessed by standard radiographs and multiple associated soft tissue injuries were detected: lesions of TFCC in 5 patients, cartilage lesions of carpal bones in 6 and I degree SL interosseous ligament lesion in 4 patients. Arthroscopy in distal radius fractures allows detailed articular surface displacement assessment and reposition under "eye control". Additionally associated soft tissue injuries, which are not visible in standard X-ray examination are detected and treated.

Adult↗

PubMed2006

External fixation techniques for distal radius fractures.

UNLABELLED: Fractures of the distal radius are common injuries. Low-energy or high-energy mechanisms may be involved. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. External fixation is a valuable instrument for fracture reduction and stabilization. Limited open incisions, early range of motion, and treatment of complex wounds are a few of the benefits of external fixation. Fixators may be spanning or nonbridging and may be used alone or in combination with other stabilization methods to obtain and maintain distal radius fracture reduction. Augmentation with percutaneous wires allows for optimal fracture stabilization with physiologic alignment of the wrist. Moderate distraction at the carpus does not induce postoperative stiffness. The distal radioulnar joint must be assessed and may need to be stabilized. Complications of external fixation are usually minor, but must be anticipated and treated early. LEVEL OF EVIDENCE: Level V (expert opinion).

Aftercare↗