medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2010, Number 4

<< Back Next >>

Acta Ortop Mex 2010; 24 (4)

Functional result in distal radius fractures. Comparison between the severity of the fracture, the treatment of choice and the baseline X-ray parameters

Farías CE, Gil OF, Trueba DC, Jaspeado RR

Language: Spanish
References: 45
Page: 220-229
PDF size: 451.82 Kb.


ABSTRACT

Background: the AO classification has a prognostic value and assists physicians in the planning of fracture management. The X-ray data and the DASH questionnaire are used to assess the outcome of radial fractures. A trend towards open treatment, opposite to closed or percutaneous approaches, has been observed in the past ten years. Methods: descriptive study evaluating the functional outcome, with a follow-up from 6-months to one year, using the DASH questionnaire and correlating the outcomes with the treatment used, the type of fracture, the AO and Frykman classifications, and the baseline X-ray parameters. The fracture stability and the treatment of choice were recorded. Patients were grouped according to the treatment used. Results: a DASH score ≤ 20 was considered as good, and › 20 as poor. The questionnaires were applied at the 6- and 12-month follow-up visits, the mean score was 14.46. No statistical difference was found between the good or bad outcomes and the type of treatment. A correlation was found between both the type of fracture and the X-ray parameters and the functional outcome. Conclusions: regardless of the treatment of choice of distal radius fractures, the major goal is to restore the normal X-ray parameters to improve the functional outcome and decrease the complications. No difference was found in the functional outcome among the treatment options used to treat the distal radius fractures. The AO classification is valid as a prognostic indicator and useful to make therapeutic decisions.


REFERENCES

  1. Colles A: Historical paper on the fracture of the carpal extremity of the radius [1814] Injury 1970; 2: 48-50.

  2. Putnam MD, Seitz WH: Fracturas distales del radio. Cap 20, en: Bucholz RW. Rokwodds & Green’s. Fracturas en el adulto. Tomo 2. Madrid, 2003.

  3. Anderson R, O’Neil G: Comminuted fractures of the distal end of the radius. Surg Gynecol Obstet 1944; 78: 434-40.

  4. Cole JM, Obletz BE: Comminuted fractures of the distal end of the radius treated by skeletal transfixion in plaster cast. An end-result study of thirty-three cases. J Bone Joint Surg 1966; 48A: 931-45.

  5. Ellis J: Smith’s and Barton’s fractures: a method of treatment. J Bone Joint Surg 1965; 47B: 724-7.

  6. Leung F, Tu Y, Chew WYC, Chow SP: Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures. A Randomized Study. J Bone Joint Surg Am 2008; 90: 16-22.

  7. Orbay JL, Fernandez DL: Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg [Am] 2002; 27: 205-15.

  8. Konrath GA, Bahler S: Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma 2002; 16: 578-85.

  9. Orbay JL, Fernandez DL: Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg [Am] 2004; 29: 96-102.

  10. Jupiter JB: Plate fixation of fractures of the distal aspect of the radius: relative indications. J Orthop Trauma 1999; 13: 559-69.

  11. Simic PM, Robison J, Gardner MJ, Gelberman RH, Weiland AJ, Boyer MI: Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg [Am] 2006; 31: 382-6.

  12. Jupiter JB, Ring D, Weitzel PP: Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg [Am] 2002; 27: 714-23.

  13. Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg [Am] 2005; 30: 289-99. Erratum in: J Hand Surg [Am] 2005; 30: 629.

  14. Rozental TD, Blazar PE: Functional outcome and complications after volar plating for dorsally displaced unstable fractures of the distal radius. J Hand Surg [Am] 2006; 31: 359-65.

  15. Kamath AF, Zurakowski D, Day CS: Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg [Am] 2006; 31: 1061-7.

  16. Ring D, Prommersberger K, Jupiter JB: Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am 2004; 86: 1646-52.

  17. Rikli DA, Regazzoni P: Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996; 78: 588-92.

  18. Drobetz H, Bryant AL, Pokorny T, Spitaler R, Leixnering M, Jupiter JB: Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction-a biomechanic study in a cadaveric model. J Hand Surg [Am] 2006; 31: 615-22.

  19. Grindel SI, Wang M, Gerlach M, McGrady LM, Brown S: Biomechanical comparison of fixed-angle volar plate versus fixed-angle volar plate plus fragment specific fixation in a cadaveric distal radius fracture model. J Hand Surg [Am] 2007; 32: 194-9.

  20. Taylor KF, Parks BG, Segalman KA: Biomechanical stability of a fixed-angle volar plate versus fragment-specific fixation system: cyclic testing in a C2-type distal radius cadaver fracture model. J Hand Surg [Am] 2006; 31: 373-81.

  21. Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM: Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg [Am] 2003; 28: 94-104.

  22. Grewal R, Perey B, Wilmink M, Stothers K: A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation. J Hand Surg [Am] 2005; 30: 764-72.

  23. Kreder HJ, Hanel DP, Agel J, McKee M, Schemitsch EH, Trumble TE, Stephen D: Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomized, controlled trial. J Bone Joint Surg Br 2005; 87: 829-36.

  24. Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC: A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg [Am] 2005; 30: 1185-99.

  25. Handoll HHG, Madhok R: Closed reduction methods for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003: 1: CD003763.

  26. Handoll HHG, Madhok R: Conservative interventions for treating distal radial fractures in adults. Cochrane Database of Syst Rev. 2003: 2: CD000314.

  27. Handoll HHG, Madhok R: Surgical interventions for treating distal radial fractures in adults. Cochrane Database of Syst Rev. 2003: 3: CD003209.

  28. Hudak P, Amadio PC, Bombardier C: and the Upper Extremity Collaborative Group. Development of an Upper Extremity Outcome Measure: The DASH (Disabilities of the Arm, Shoulder, and Hand). Am J Ind Med 1996; 29: 602-8.

  29. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowsi MF: Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br 1996; 78: 726-31.

  30. Gausepohl T, Worner S, Pennig D, Koebke J. Extraarticular external fixation in distal radius fractures pin placement in osteoporotic bone. Injury 2001; 32(suppl 4): SD79-85.

  31. Steinberg BD, Plancher KD: Clinical Anatomy of the Wrist and Elbow in The Athletic Elbow and Wrist: Diagnosis and Conservative Treatment. Clin Sports Med 1995; 14: 299-313.

  32. Fernandez DL: “Distal Radius and Wrist”, AO principles of fracture management, ed. T. P. Ruedi, W. M. Murphy, New York, Thieme, 2000.

  33. Nesbitt KS, Failla JM, Les C: Assessment of instability factors in adult distal radius fractures. J Hand Surg 2004; 29A: 1128-38.

  34. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI: Wrist fractures: What the Clinician Wants to Know. Radiology 2001; 219: 11-28.

  35. Altissimi M, Mancini GB, Azzara A, at al: Early and late displacement of fractures of the distal radius, the prediction of instability. Int Orthop 1994; 18(2): 61-5.

  36. Fernandez DL, Jupiter JB: Fractures of the Distal Radius. Berlin Heidelberg New York: Springer-Verlag. 1995.

  37. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF: X-ray film measurements for healed distal radius fractures. J Hand Surg 1996; 21A: 31-39. Erratum in: J Hand Surg [Am] 1996; 21: 532.

  38. Beaton DE, Davis AM, Hudak P, McConnell S: The DASH (Disabilities of the arm, shoulder, and hand) outcome measure: What do we know about it now? J Hand Ther Br 2001; 6(4): 109-18.

  39. Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM: Treatment of unstable distal radial fractures with volar locking plating system. J Bone Joint Surg Am 2006; 88: 2687-94.

  40. Westphal T, Piatek S, Schubert S, Winckler S: Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF. Arch Orthop Trauma Surg 2005; 125: 507-14.

  41. Arora J, Malik AC: External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient? Arch Orthop Trauma Surg 2005; 125: 536-40.

  42. Kreder HJ, Hanel DP, Agel J, et al: Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomized, controlled trial. J Bone Joint Surg 2005; 87B: 829-36.

  43. Grewal R, Perey B, Wilmink M, Stothers K: A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation and external fixation. J Hand Surg 2005; 30A: 764-72.

  44. Jupiter JB, Marent-Huber M and the LCP Study Group. Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates. A Multicenter Prospective Case Series. Bone Joint Surg Am 2009; 91: 55-65.

  45. Friedman SL. Complicaciones en ortopedia. Fracturas del radio distal. Jeffrey O. Anglen, AAOS. Barcelona, Ars Médica, 2008.




2020     |     www.medigraphic.com