Aims. It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer fracture redisplacements and better one-year outcomes compared to plaster splinting. Methods. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a
Despite the variety of implants or techniques that exist to treat
Objectives. The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a
Distal radial fractures are amongst the most common trauma referrals, however controversy remains regarding their optimum management. We undertook a retrospective review of the management of distal radial fractures in our department. The prospectively maintained trauma database was used to identify patients admitted for operative management of a dorsally
Aims. Displaced distal radius fractures were investigated at a level 1 major trauma centre during the COVID-19 2020 lockdown due to the implementation of temporary changes in practice. The primary aim was to establish if follow-up at one week in place of the 72-hour British Orthopaedic Association Standards for Trauma & Orthopaedics (BOAST) guidance was safe following manipulation under anaesthetic. A parallel adaptation during lockdown was the non-expectation of Bier’s block. The secondary aim was to compare clinical outcomes with respect to block type. Methods. Overall, 90 patients were assessed in a cross-sectional cohort study using a mixed, retrospective-prospective approach. Consecutive sampling of 30 patients pre-lockdown (P1), 30 during lockdown (P2), and 30 during post-lockdown (P3) was applied. Type of block, operative status, follow-up, and complications were extracted. Primary endpoints were early complications (≤ one week). Secondary endpoints were later complications including malunion, delayed union or osteotomy. Results. In P1, 86.6% of patients were seen between days one to three, 26.7% in P2, and 56.7% in P3. There were no documented complications from days one to three. Operative rate was 35.5%, which did not vary significantly (p= 0.712). Primary endpoints occurred between day four to seven, and included one patient each period treated for plaster cast pain. Secondary endpoints in P1 included delayed union (one patient). During P2, this included malunion (one patient), a pressure sore (one patient) and ulnar cutaneous nerve symptoms (two patients). In P3, malunion was identified in one patient. Mean follow-up was six months (4 to 9) with union rate 96%. Change in block practice varied significantly (p =<0.05). The risk ratio of complications using regional block (Bier’s) over haematoma block was 0.65. Conclusion. Follow-up adaptations during lockdown did not adversely affect patient outcomes. Regional anaesthesia is gold standard for manipulation of
Aim: To compare the outcome of open reduction and internal fixation with MUA and k-wire stabilisation of dorsally
Aims: In recent years, volar locking plates have increased in popularity for the treatment of
Aims: The aim of this study was to þnd out if undisplaced
Displaced distal radial fractures in adults are commonplace. Acknowledging that satisfactory radiographic parameters typically will beget satisfactory functional outcomes, management of these fractures includes a reduction followed by either cast/splint immobilisation or internal fixation. While we can generally rely on internal fixation to maintain the reduction the same is not true of cast immobilisation. There are, however, limited data defining the fate of a fracture reduction in those treated in a cast and up to the time of radial union. Traditional practice is to recommend six weeks of immobilisation. Our goal was to detail the radiographic patterns of change in the radiographic parameters of radial inclination (RI), ulnar variance (UV) and radial tilt (RT) over the first twelve weeks in women fifty years old and older who had sustained a
Aim: To assess the ability of volar locking plates to maintain fracture reduction when used to treat dorsally displaced extra and intra-articular distal radial fractures. Methods: This prospective study was conducted over a 12 month period. Consenting patients who had sustained a closed, dorsally
Introduction. Several clinical and radiological studies have confirmed the benefits of using Volar Locking Plates (VLPs) to treat unstable distal radius fractures. The “theoretical” advantage of VLPs compared to standard plate fixation is that VLPs, through their design, intrinsically provide angular stability for most fracture configurations including comminuted fractures and, quite possibly, osteoporotic fractures. However few studies have compared the clinical results of patients of different ages who have been treated using VLPs. Aim. The aim of this study was to compare the clinical outcomes of VLP fixation of displaced distal radius in younger (<59 yrs) and older (>60yrs) patients. Patients & Methods. We reviewed 78 consecutive patients who had undergone ORIF of their
Older fracture patients frequently ask whether their osteoporosis will affect fracture healing. There is only limited previous data about this. We investigated recovery after distal radial fracture, and compared it with BMD of the other distal radius and the lumbar spine (measured using quantitative CT). All 28 patients had sustained a dorsally
Various studies report a correlation between the severity of the primary displacement, carpal malalignment &
an expectant loss of reduction over a given time period when treating distal radius fractures with cast immobilization. Recently, studies have attempted to classify carpal malalignments associated with
Measurement of the rate of fracture healing is a major problem in fracture research. Bone mineral density (BMD) of fracture callus has been used as a measure of healing in diaphyseal fractures. However, metaphyseal fractures (especially in the elderly) are now the commonest type of fracture and are a significant public health problem. This study investigated whether measurement of BMD at the fracture site in the distal radius can be used as a measure of fracture healing. We recruited 28 patients who had sustained a dorsally
Background: Extraarticular distal radius fracture is the second most common osteoporotic fracture seen in the elderly patients. Purpose: To establish relationship between radiological parameters and final functional outcome in conservatively treated
Restoration of normal anatomy following a distal radial fracture is an important factor in determining functional recovery. However, current methods of assessing dorsal tilt and displacement require ‘true’ lateral radiographs, and important reference points are often obscured by metalwork. Aims: to investigate if an easily identifiable and predictable relationship exists in the normal wrist between the distal radius and lunate; and if so,to compare fractured wrists (pre and postoperatively)using conventional and new assessment methods. 22 patients with
Restoration of normal anatomy following a distal radial fracture is an important factor in determining functional recovery. However, current methods of assessing dorsal tilt and displacement require ‘true’ lateral radiographs, and important reference points are often obscured by metalwork. Aims: To investigate if an easily identifiable and predictable relationship exists in the normal wrist between the distal radius and lunate; and if so, to compare fractured wrists (pre and postoperatively)using conventional and new assessment methods. Methods: 22 patients with
The standard of treatment for most fractures of distal radius remains closed reduction and immobilization. It is essential to discern which fracture patterns are more susceptible to failure so that surgical intervention can be considered when an acceptable reduction cannot be achieved or has a risk of secondary displacement. A correlation between the severity of the primary displacement, carpal malalignment &
an expectant loss of reduction over a given time period when treating distal radius fractures with cast immobilization is reported. Recently, studies have attempted to classify carpal malalignments associated with
Aim: A prospective randomised clinical trial was performed to evaluate two forms of immobilisation in the treatment of colles fractures not requiring manipulation. Methods: Patients were randomised to either plaster cast (PC) or a removable splint: wrist splint (FWS) according to date of presentation. Patients who had associated injuries to the same upper limb, previous wrist fracture, and open fractures, below 20 years or impaired cognitive function were excluded. The hospital ethical committee approved the study and informed consent was obtained from patients. Patients were reviewed at one week, two weeks, six weeks and twelve weeks following enrolment into the trial. Radiographs were performed on the first four visits. Subjective data was obtained using a patient questionnaire. Levels of pain, comfort in cast, swelling and any modifications to the cast were documented. Was used at six and twelve weeks to assess Clinical assessment was performed by a qualified physiotherapist using the demerit score of Sarmiento which combines range of motion, grip strength and functional assessment. Results: There were thirty-seven patients in the PC group and thirty-four in the FWS group. They were well matched in terms of age and sex distribution One patient in the PC group required manipulation under anaesthesia due to loss of position at one week. There was no statistical difference between either treatment method in radiological position. Nine patients in the PC group required change of cast due to loosening or discomfort. A further eight patients in the PC group required cast trimming. Visual analogue scores for pain and cast discomfort were lower in the FS group (p<
0.05). Grip strength compared to the opposite side was higher in the FS group (55.9% Vs 47.8% at week six, 71.8% Vs 65% at week twelve). Functional assessment demonstrated a higher score in the FS group at six weeks. However the difference did not reach statistical significance at repeat examination at twelve weeks. Conclusion: In this study there was no difference in either method in maintaining fracture position. However there was greater patient satisfaction and earlier rehabilitation in those patients treated in a futura wrist splint. Patients treated in plaster cast required a greater use of plaster room resources. We feel that the use of a removable wrist splint in suitable patients with either undisplaced or minimally
In 2017, the British Society for Children’s Orthopaedic Surgery engaged the profession and all relevant stakeholders in two formal research prioritization processes. In this editorial, we describe the impact of this prioritization on funding, and how research in children’s orthopaedics, which was until very recently a largely unfunded and under-investigated area, is now flourishing. Establishing research priorities was a crucial step in this process. Cite this article: