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Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction:Results of the SLA-VER noninferiority trial

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World Journal of Orthopedics 2022年第9期13卷 802-811页

作者： Giovanni Dib Tommaso Maluta Matteo Cengarle Alice Bernasconi Giulia Marconato Massimo Corain Bruno Magnan Department of Orthopaedics and Trauma Surgery University of Verona Medical SchoolAOUI Borgo TrentoVerona 37126Italy MsC Biostatistics Evaluative Epidemiology UnitDepartment of ResearchNational Cancer Institute Foundation IRCSSMilano 20133Italy Department of Hand Surgery University of Verona Medical SchoolAOUI Borgo RomaVerona 37134Italy

BACKGROUND distal radius fractures(DRFs)are a common challenge in orthopaedic trauma care,yet for those fractures that are treated nonoperatively,strong evidence to guide cast treatment is still lacking.AIM To compare the efficacy of below elbow cast(BEC)and above elbow cast(AEC)in maintaining reduction of manipulated DRFs.METHODS We conducted a prospective,monocentric,randomized,parallel-group,open label,blinded,noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs.Two hundred and eighty patients>18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period.Noninferiority thresholds were defined as a 2 mm difference for radial length(RL),a 3°difference for radial inclination(RI),and volar tilt(VT).The trial is registered at Clinicaltrials.gov(NCT03468023).RESULTS One hundred and forty-three patients were treated with BEC,and 137 were treated with AEC.The mean time of immobilization was 33 d.The mean loss of RL,RI,and VT was 1.59 mm,2.83°,and 4.11°for BEC and 1.63 mm,2.54°,and VT loss were respectively 0.04 mm(95%CI:-0.36-0.44),-0.29°(95%CI:-1.03-0.45),and 0.59°(95%CI:-1.39-2.57),and they were all below the prefixed noninferiority thresholds.The rate of loss of reduction was similar.CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF.Being more comfortable to patients,BEC may be preferable for nonoperative treatment of DRFs.

关键词： distal radius fracture Immobilization Below elbow cast Above elbow cast Short arm cast Long arm cast

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distal radius fracture: What Does the Patient Want?

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Open Journal of Orthopedics 2022年第6期12卷 288-296页

作者： Christian Blough Stuart Harvey Kuschner Cedars-Sinai Medical Center Los Angeles USA

distal radius fractures are common and while historically most have been treated nonoperatively the frequency with which distal radius fractures are treated surgically is increasing. Criteria for considering surgical treatment are often based on radiographic appearance of the fracture. Less often discussed is patient preference: what do patients want. We investigated responses of a general population when presented with various treatment options following a hypothetical distal radius fracture. Many respondents chose nonoperative treatment even when told that surgery might result in a better outcome. This information can help during the shared decision-making process when discussing treatment options with a patient who presents with a distal radius fracture.

关键词： distal radius fracture Colles fracture Wrist Surgery Open Reduction and Internal Fixation Wrist Radiographs

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Ulnar nerve injury associated with displaced distal radius fracture:Two case reports

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World Journal of Clinical Cases 2021年第23期9卷 6956-6963页

作者： Jing-Jing Yang Wei Qu Yu-Xuan Wu Hua-Jun Jiang Department of Neurology The First Affiliated Hospital of Dalian Medical UniversityDalian 116011Liaoning ProvinceChina Department of Orthopaedics The First Affiliated Hospital of Dalian Medical UniversityDalian 116011Liaoning ProvinceChina

BACKGROUND Ulnar nerve injury subsequent to a fracture of the distal radius is extremely rare compared to median nerve injury.Treatment of ulnar nerve injury after closed distal radial fracture is controversial.Reasonable surgical planning and careful postoperative management can improve the prognosis of patients.CASE SUMMARY We report two cases of ulnar nerve injury subsequent to fracture of the distal radius.Both patients were admitted to hospital.Both patients had persistent ulnar nerve compression syndromes.The first patient achieved rapid recovery by early nerve decompression surgery,while the second patient had no recovery at 2-3 mo after injury and had more severe symptoms.At 10 wk after injury,the second patient agreed to nerve decompression surgery.The second patient finally achieved a successful outcome after nerve decompression and neurolysis,although she still has residual symptoms.CONCLUSION For patients with ulnar nerve compression syndrome related to acute wrist fracture,if symptoms persist and signs of recovery are not observed,early release is necessary to prevent permanent neurological damage.

关键词： Ulnar nerve injury distal radius fracture fracture treatment Early release Case report

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Effect of fixing distal radius fracture with volar locking palmar plates while preserving pronator quadratus

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Chinese Medical Journal 2014年第16期127卷 2929-2933页

作者： Fan Jian Chen Kai Zhu Hui Jiang Bo Yuan Feng Zhu Xiaozhong Mei Jiong Yu Guangrong Department of Orthopedics Tongji Hospital Tongji UniversityShanghai 200065 China

Background L-shaped incision of pronator quadratus （PQ） muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation.Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons.But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ.Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through miniincisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus.The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair.Methods Between September 2010 and April 2012,65 patients （42 males and 23 females; aged 20-68 years and a mean age of 42.5 years） with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates （Depuy or Smith companies）.The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association （OTA） classifications.All surgeries were completed by the same trained team.The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females.We compared the two groups for wrist pain,forearm range of motion,grip strength,pedoperative complications and wrist functional recovery score.Results The minimum follow-up for the whole cohort was one year.The differences between the two groups were significant with regard to wrist pain,forearm range of motion,grip strength and wrist function at 1,2,and 6 weeks postoperatively,but insignificant at 6 a

关键词： distal radius fracture open reduction palmar plate pronator quadratus

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Manual reduction with traditional small splints for distal radius fracture in older patients

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Journal of Acute Disease 2021年第2期10卷 78-82页

作者： Li-You Wei Hong-Wei Zhang De-Hong Dong Jin-Zeng Zuo Liang Li Guo-Qiang Wang Hua Chen Xin Geng Cheng Jiao Li-Jun Chen Hui Guo Yu-Long Zhang Lin Rong Jing Zhang Department of Orthopedics the Second Hospital of Tangshan(Orthopaedic Hospital Affiliated to North China University of Science and Technology)Tangshan 063000China Department of Orthopedics the People's Hospital of TangshanTangshan 063000China

Objective:To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods:Older patients(aged at least 60 years)with distal radius fractures were enrolled in this study.The patients were randomly divided into the treatment group and the control group.The treatment group was treated with manual reduction and small splints fixation.The control group was treated with manual reduction and resin plaster fixation.Before treatment,after reduction,and 3 months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length were recorded.Before treatment and 3 months after treatment,the Cooney wrist joint scores were recorded.The time of fracture healing and related adverse events during the treatment were recorded.Results:Before treatment and after reduction,there were no statistically significant differences between the two groups in palmar tilt angle,ulnar deviation angle,or radial length(P>0.05).Three months after treatment,the palmar tilt angle,ulnar deviation angle,and radial length of the treatment group were better than those of the control group(Pfracture healing of the treatment group was shorter than that of the control group,but the difference was no statistically significant(P>0.05).Conclusions:Compared with resin plaster fixation,traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery.Besides,the method is simple and low cost thus,it needs to be promoted.

关键词： Traditional small splint distal radius fracture Older patients External fixation

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A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

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Chinese Journal of Traumatology 2021年第5期24卷 301-305页

作者： Ratish Kumar Mishra Bhagwati Prasad Sharma Amit Kumar Rohit Sherawat Orthopedic Department Sir Gangaram HospitalNew Delhi 11006India Central Institute of Orthopedics Vardhman Mahavir Medical College and Safdarjung HospitalNew Delhi 110029India Orthopedic Department All India Institute of Medical SciencesRae Bareli 229405India Central Institute of Orthopaedics Vardhman Mahavir Medical College and Safdarjung HospitalNew Delhi 110029India

Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups:volar plate group and external fixator group.These patients aged between 18 and 60 years had unilateral fractures,and agreed to be included in the study.Patients with a history of fracture,bilateral fracture,associated other injuries,delayed injury for more than 2 weeks,open fracture,pre-existing arthrosis or disability,psychiatric illness and pathological fracture were excluded.Patients were followed up at 6 weeks,3 months,6 months and 1 year.The assessment of pain,functional activity,range of motion and grip strength was done at each stage of follow-up.The pain and functional activities were assessed by patient rated wrist evaluation(PRWE)score and disabilities of the arm,shoulder and hand(DASH)score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of followup.At 1 year follow-up,the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group;while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group.They had better flexion and extension range of movement.They also had better pronation and supination range of motion at initial follow-up,however the difference get attenuated by 1 year.Volar plate group had significantly better grip strength than external fixator group.Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization,better range of movement,less pain and disability and early return of function.

关键词： Comminuted distal radius fracture Intraarticular Volar plate External fixator

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Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 distal radius fractures

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Open Journal of Orthopedics 2022年第4期12卷 131-141页

作者： Kinya Nishida Yong Ho Che Hideto Irifune Kazuhiro Uesugi Akane Maeda Koji Miyata Department of Orthopaedic Surgery Teine Keijinkai Hospital Sapporo Japan

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

关键词： distal radius fracture Intra-Articular fracture External Fixator Dynamic External Fixator Volar Locking Plate

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Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of distal radius fractures: A Historical Cohort Study

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Open Journal of Anesthesiology 2020年第12期10卷 422-434页

作者： Noriaki Matsumura Satoki Inoue Hidenobu Iwagami Yumiko Kondo Kazuya Inoue Yasuhito Tanaka Akihiro Okuda Department of Orthopedics Yamato Kashihara Hospital Kashihara Nara Japan Department of Anesthesiology Division of Intensive Care Nara Medical University Kashihara Nara Japan Department of Orthopedics Nara Medical University Kashihara Nara Japan

Background: distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectivel... 详细信息

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.<

关键词： Ultrasound-Guided Brachial Plexus Block (Axillary Approach) General Anesthesia Patient Satisfaction distal radius fracture

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