Yogesh, Anil Chowdary*, Ambreesh, Arvind JD, Yashwant and Sneha

Department of Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India

*Corresponding Author:Anil Chowdary, PG Scholar, Department of Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.

Received: January 31, 2022; Published: February 25, 2022

Abstract

The fracture of the distal radius is the most common fracture encountered in daily practice. Besides, these fractures are also reported in elderly osteoporotic patients. If these fractures are not assessed properly and not treated on time, angulation, shortening and articular incongruity may lead to permanent deformity and loss of function. The degree of disability is highly correlates with degree of residual deformity in elderly patients. There is no consensus with regards to the optimal management of these fractures and lack of scientific evidence to allow definitive conclusions concerning the main aspects of managing distal radius fractures. In this context of the research gap, the present study was undertaken to compare the functional outcome of treatment fracture distal end radius with various surgical modalities i.e. closed reduction and percutaneous K-wire fixation under C-arm guidance with post op cast immobilization, Ligament taxis and stabilization with external fixator, Open reduction and internal fixation with Dynamic Compression Plates, Locking Compression Plates and Buttress Locking Compression Plate. The Mean age of patients was 37.21 years. 48 (82.75%) males and 6 (10.34%) females were considered for the study. Left side was involved in 28 cases (48.27%), right in 22 cases (37.93%), 4 (6.89%) patients had both wrist fractures. Using AO classification, study shows better outcome with plating or k wiring for A2 type of fractures, K wiring or Ex Fix for type A3, Plating for B1, B2, B3, C1 type, External fixation for C2 type, Plating or Ex fix+ k wiring + Plating is preferred for C3 type. The functional outcome after fixation of distal radius fractures depends on patient's age, fracture anatomy, displacement, reducibility, stability and articular incongruity of fractures. They are related more to the quality of anatomical reduction than to the method of immobilization. Volar locking plates are safe and effective option for unstable fracture types.

Keywords: Distal Radius; Comminuted; Intra Articular; Open Reduction; Internal Fixation; External Fixation

References

1. Belloti JC., et al. “Are distal radius fracture classificationsreproducible; Intra and interobserver agreement”. Sao Paulo Medical Journal – SciELO3 (2008): 180-185.
2. Diaz-Garcia RJ., et al. “A systematic review ofoutcomes and complications of treating unstable distal radius fractures in theelderly”. The Journal of Hand Surgery5 (2011): 824-835.
3. Chung KC., et al. “Trends in the United States in thetreatment of distal radial fractures in the elderly”. Journal of Bone and Joint Surgery American8 (2009): 1868-1873.
4. Lidström A. “Fractures of the distal end of the radius: a clinical and statisticalstudy of end results”. Acta Orthopaedica Scandinavica41 (1959): 1-18.
5. Lafontaine M., et al. “Stability assessment of distal radiusfractures”. Injury4 (1989): 208-210.
6. Colles A. “On the fracture of the carpal extremity of the radius”. Edinburgh Medical and Surgical Journal 10 (1814): 181.
7. Bohler L. “The treatment of fracture”. New York, Grune and Stratton (1932): 90-96.
8. Rajan S., et al. “Radiological and functional outcome in extra-articular fractures oflower end radius treated conservatively with respect to its position ofimmobilization”. The Indian Journal of Orthopaedics2 (2008): 201-207.
9. Anderson R and O'Neil G. “Comminuted fractures of the distal end of the radius”. Surgery, Gynecology and Obstetrics 78 (1944): 434-440.
10. John T Anderson., et al. “Buhr Complications of TreatingDistal Radius Fractures with External Fixation: A Community Experience Iowa”. Journal of Orthopaedics 24 (2004): 53-59.
11. Grana WA and Kopta JA. “The Roger Anderson device in the treatment of fractures ofthe distal end of the radius”. Journal of Bone and Joint Surgery8 (1979): 1234-1238.
12. Gartland JJ Jr and Werley CW. “Evaluation of healed Colles' fractures”. Journal of Bone and Joint Surgery 33-A.4 (1951): 895-907.
13. DePalma AF. “Comminuted fractures of the distal end of the radius treated byulnar pinning”. Journal of Bone and Joint Surgery 24-A-3 (1952): 651-662.
14. Dowling JJ and Sawyer B Jr. “Comminuted Colles' fractures. Evaluation of a methodof treatment”. Journal of Bone and Joint Surgery 43-A (1961): 657-668.
15. Thomas FB. “Reduction of Smith's fracture”. The Journal of Bone and Joint Surgery British 39-B.3 (1957): 463-470.
16. Scheck M. “Long-term follow-up of treatment of comminuted fractures of thedistal end of the radius by transfixation with Kirschner wires and cast”. The Journal of Bone and Joint Surgery American 44-A (1962): 337-351.
17. Ellis J. “Smith's and Barton's fractures. A method of treatment”. The Journal of Bone and Joint Surgery British4 (1965): 724-727.
18. Smaill GB. “Long-term follow-up of Colles's fracture”. The Journal of Bone and Joint Surgery British 47 (1965): 80-85.
19. Frykman G. “Fracture of the distal radius including sequelae--shoulder-hand-fingersyndrome, disturbance in the distal radio-ulnar joint and impairment of nervefunction. A clinical and experimental study”. Acta Orthopaedica Scandinavica 108 (1967): 3.
20. Pool C. “Colles's fracture. A prospective study of treatment”. The Journal of Bone and Joint Surgery. British3 (1973): 540-544.
21. Sarmiento A., et al. “Colles' fractures. Functionalbracing in supination”. The Journal of Bone and Joint Surgery American3 (1975): 311-317.
22. Green DP. “Pins and plaster treatment of comminuted fractures of the distal end ofthe radius”. The Journal of Bone and Joint Surgery American3 (1975): 304-310.
23. Cooney WP., et al. “External pin fixation for unstableColles' fractures”. The Journal of Bone and Joint Surgery American6 (1979): 840-845.
24. Van Der Linden W., et al. “How should its displacement be measured and how should it be immobilized?” The Journal of Bone and Joint Surgery American8 (1981): 1285-1288.
25. Melone CP Jr. “Open treatment for displaced articular fractures of the distal radius”. Clinical Orthopaedics and Related Research 202 (1986): 103-111.
26. Foster DE and Kopta JA. “Update on external fixators in the treatment of wristfractures”. Clinical Orthopaedics and Related Research 204 (1986): 177-183.
27. Altissimi M., et al. “Long-term results ofconservative treatment of fractures of the distal radius”. Clinical Orthopaedics and Related Research 206 (1986): 202-210.
28. Clyburn TA. “Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius”. The Journal of Bone and Joint Surgery American2 (1987): 248-254.
29. Keating JF., et al. “Internal fixation of volar-displaced distal radial fractures”. The Journal of Bone and Joint Surgery British3 (1994): 401-405.
30. Fitoussi F., et al. “Treatment of displaced intra-articular fractures of the distal end of the radius with plates”. The Journal of Bone and Joint Surgery American9 (1997): 1303-1312.
31. Kaempffe FA and Walker KM. “External fixation for distal radius fractures: effect of distraction on outcome”. Clinical Orthopaedics and Related Research 380 (2000): 220-225.
32. Emami A and Mjöberg B. “A safer pin position for external fixation of distal radial fractures”. Injury9 (2000): 749-750.
33. Rogachefsky RA., et al. “Treatment of severely comminuted intra-articular fractures of thedistal end of the radius by open reduction and combined internal and externalfixation”. The Journal of Bone and Joint Surgery American 83-A.4 (2001): 509-519.
34. Murray PM and Trigg SD. “Treatment of distal radius fractures with external fixation: technical considerations for rehabilitation”. Techniques in Hand and Upper Extremity Surgery4 (2002): 213-218.
35. Drobetz H and Kutscha-Lissberg E. “Osteosynthesis of distal radial fractures with avolar locking screw plate system”. International Orthopaedics1 (2003): 1-6.
36. Ring D., et al. “Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius”. The Journal of Bone and Joint Surgery American 86-A.8 (2004): 1646-1652.
37. Kreder HJ., et al. “Indirect reduction and percutaneous fixation versus open reductionand internal fixation for displaced intra-articular fractures of the distal radius: arandomised, controlled trial”. The Journal of Bone and Joint Surgery British6 (2005): 829-836.
38. Kiliç A., et al. “[Volar locking plate fixation of unstable distal radius fractures]”. Acta Orthopaedica et Traumatologica Turcica4 (2009): 303-308.
39. Schmelzer-Schmied N., et al. “Comparison ofexternal fixation, locking and non-locking palmar plating for unstable distalradius fractures in the elderly”. International Orthopaedics3 (2009): 773-778.
40. Xu GG., et al. “Prospective randomised study ofintra-articular fractures of the distal radius: comparison between external fixationand plate fixation”. Annals – Academy of Medicine Singapore7 (2009): 600-606.
41. Gereli A., et al. “Comparison of palmarlocking plate and K-wire augmented external fixation for intra-articular andcomminuted distal radius fractures”. Acta Orthopaedica et Traumatologica Turcica3 (2010): 212-219.
42. Kwan K., et al. “Operative treatment of distal radial fractures withlocking plate system-a prospective study”. International Orthopaedics3 (2011): 389-394.
43. Wilcke MK., et al. “Wrist function recovers morerapidly after volar locked plating than after external fixation but the outcomes aresimilar after 1 year”. Acta Orthopaedica1 (2011): 76-81.
44. Diaz-Garcia RJ., et al. “A systematic review ofoutcomes and complications of treating unstable distal radius fractures in theelderly”. The Journal of Hand Surgery5 (2012): 824-835.
45. Tan V., et al. “Comparative analysis ofintramedullary nail fixation versus casting for treatment of distal radius fractures”. The Journal of Hand Surgery 3 (2012): 460-468.
46. Phadnis J., et al. “Midterm functional outcome after the internal fixation of distal radius fractures”. Journal of Orthopaedic Surgery and Research1 (2012): 126.
47. Isapure W. “Fracture fixation of distal part of the radius: a comparative study ofdifferent method”. IOSR Journals2 (2015): 05-07.
48. Costa M., et al. “Percutaneousfixation with Kirschner wires versus volar locking plate fixation in adults withdorsally displaced fracture of distal radius: randomised controlled trial”. British Medical Journal 2 (2014): g4807-g4807.

Citation

Citation: Anil Chowdary., et al. “Evaluation of Various Modalities of Surgical Treatment of Distal End Radius Fractures in a Tertiary Hospital in Bangalore".Acta Scientific Orthopaedics 5.3 (2022): 67-75.

Copyright

Copyright: © 2022 Anil Chowdary., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.