External fixation with or without ancillary K-wire fixation, once being one of the most popular methods of surgery for unstable distal radius fractures, is now losing its position due to a recent surge in the use of volar locking plates. However, these changes are not firmly grounded on scientific evidence. Recent clinical trials showed that a similar wrist function was achieved when the use of external fixation was compared with that of volar locking plates at 1 year after surgery for the treatment of unstable distal radius fractures, even though the rate of functional recovery was slower in the former. In addition, it is still a question whether additional costs and time paid for volar locking plates can be justified by such a small gain in wrist function. We will review recent studies comparing external fixation with volar locking plates regarding wrist function and costs, and discuss current indication of external fixation for unstable distal radius fractures.
Radius Fractures* ; Wrist

PURPOSE: To evaluate clinical and radiological results using 3.5 mm & 2.4 mm volar locking compression plate (LCP) in distal radius fractures. MATERIALS AND METHODS: This study reviewed the results of 115 cases of distal radius fractures treated with 3.5 mm volar LCP (73 cases) & 2.4 mm volar LCP (42 cases) from September 2003 to June 2009. The radiographic results were evaluated by radiographic assessment, and the clinical results were evaluated by Knirk and Jupiter's criteria, Modified Mayo wrist scoring system and DASH score. RESULTS: Radiological evaluation of the radial length, radial inclination, volar tilt and intraarticular step off were improved both 3.5 mm volar LCP and 2.4 mm volar LCP. Nine cases of arthritis occured in 3.5 mm volar LCP and 7 cases in 2.4 mm volar by using the Knirk and Jupiter's criteria. The mean score evaluated by Modified Mayo was 86.7 in 3.5 mm volar LCP and 84.8 in 2.4 mm volar LCP. DASH score was 11.2 point in 3.5 mm volar LCP, 10.9 point in 2.4 mm volar LCP. All cases showed bone union showing no evidence of malunion, nounion, nor metal failure. CONCLUSION: Distal radius fractures treated with 3.5 mm volar LCP and 2.4 mm volar LCP show satisfying radiological and clinical outcome.
Arthritis ; Radius ; Radius Fractures ; Wrist

PURPOSE: The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding. METHODS: December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification. RESULTS: Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031). CONCLUSION: Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders.
Medical Records ; Radius Fractures ; Skiing ; Wrist ; Wrist Injuries

Wrist arthroscopy has been used as an important adjunct procedure to distal radius fracture management. This procedure allows minimal surgical intervention and provides excellent visualization of the joint for anatomical restoration of articular fracture of the distal radius and early management of associated injuries. To many, it is still technically challenging to adequately perform arthroscopy in the distal radius fractures. With this review, we aimed to provide an updated arthroscopic technique in the management of distal radius fractures and potential pitfalls of this technique.
Arthroscopy ; Joints ; Radius ; Radius Fractures* ; Wrist

PURPOSE: To evaluate the usefulness of locking compression plate (LCP) and volar plating through anterior approach for distal radius fracture. MATERIALS AND METHODS: We retrospectively analysed that 15 distal radius fracture, which would not be reduced by closed reduction or too comminuated to maintain reduction or articular surface inconguency, were treated by open reduction through anterior approach and volar plating using LCP. The results were evaluated by preoperative and postoperative radiographs. Functional results were analysed using the Modified Mayo Wrist Scoring System. RESULTS: All cases achieved anatomical articular surface reduction postoperatively. In terms of radiologic analysis, mean radial length (9.0 mm vs. 11.8 mm), radial inclination (14.7degrees vs. 20.9degrees ), volar tilt (-6.3degrees vs. 8.3degrees ) and articular step-off (1.4 mm vs. 0.3 mm) were improved. The average Modified Wrist Score was 89. Nonunion or malunion was not occurred. CONCLUSION: Open reduction through anterior approach and volar plating using LCP is a useful method that provides excellent results with few complications in the treatment of fracture of the distal radius.
Radius Fractures ; Radius* ; Retrospective Studies ; Wrist

OBJECTIVE: To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture. METHODS: In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus. RESULTS: The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group. CONCLUSION The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.
Fracture Fixation, Internal ; Humans ; Radius Fractures ; Range of Motion, Articular ; Treatment Outcome ; Ulna Fractures ; Wrist ; Wrist Joint

PURPOSE: The goal of this retrospective study is to compare radiologic outcome and clinical outcome between operative and non-operative treatment of unstable distal radius fracture in patients over 65-year-old. METHODS: From December 2006 to December 2011, 114 patients over 65-year-old were enrolled in the present study. 45 patients underwent non-operative treatment, and 69 patients underwent operative treatment. We retrospectively reviewed radiologic results and clinical results and then compared the two groups. Radiologic results include radial inclination (RI), volar tilt angle (VT) and radial shortening (RS) shown on the last radiograph and clinical results including disabilities of the arm, shoulder and hand (DASH) scores, modified Mayo wrist score (MMWS), and range of motion (ROM) of wrist. RESULTS: All cases presented bone-union. Among the patients who received non-operative treatments, average RI of 15.5degrees, average VT of 14.1degrees, average RS of 5.3 mm, The patients who received operative treatments showed average volar tilt of 3.9degrees, average VT of 18.2degrees, and average RS of 1.1 mm. RS showed a significant difference (p<0.05). At Clinical evaluation, DASH score, MMWS score, the ROM of wrist joint did not show significant difference (p>0.05). CONCLUSION: Our results suggest that non-operative treatment is initially recommended in patients over 65 years who have an unstable distal radius fracture in terms of functional results.
Aged* ; Arm ; Hand ; Humans ; Radius Fractures* ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Wrist ; Wrist Joint

PURPOSE: Clinical and radiologic results of operative versus nonoperative treatment were compared in patients 70 years or older who had an unstable distal radius fracture. MATERIALS AND METHODS: From March 2007 to April 2009, 49 patients who had an unstable distal radius fracture treated nonoperatively (22 patients) or operatively (27 patients) were investigated. The radiologic results between the two patient groups were compared based on bone union, dorsal tilt, radial inclination and radial shortening. The clinical results were compared based on disabilities of arm, shoulder & hand (DASH) score, the patient-rated wrist evaluation (PRWE) score, the grip strength and the motion range of the wrist joint. RESULTS: At the last follow-up examination, DASH score, PRWE score, the flexion, supination and radial deviation of wrist joint and the grip strength did not showed significant difference. Among the patients who received non-operative treatments, 18 of 22 showed radiologically recognizable deformation; average dorsal tilt of 11.9degrees, the average radial inclination of 18.9degrees, and average radial shortening of 3.8 mm. The patients who received operative treatments showed average volar tilt of 3.3degrees, radial inclination of 18.8degrees+/-3.7degrees, and radial shortening of 1.5 mm. Three patients showed radiologically recognizable deformation. CONCLUSION: Our results suggest that nonoperative treatment is initially recommended in patients with the age of 70 years or older who have an unstable distal radius fracture in terms of functional results.
Arm ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Radius ; Radius Fractures ; Shoulder ; Supination ; Wrist ; Wrist Joint

OBJECTIVEFracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint (DRUJ) is not a common injury and is inherently unstable. Here we report a case series, with both-bone forearm fractures associated with dislocation of DRUJ, as a Galeazzi-variant type fracture-dislocation, and try to analyze this injury pattern.

METHODSThe study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age (20 to 45 years). All fractures were closed type. Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft. After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.

RESULTSAll cases were followed up for 24 weeks. The maximum incidence occurred in age group between 31 and 40 years. All the fractures of both radius and ulna were united in average time of 12 weeks. Range of motion of wrist and elbow, supination and pronation at final follow-up were normal. There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.

CONCLUSIONGaleazzi variant in adult is a new undescribed pattern of forearm with wrist injury. Stable open reduction and internal fixation of both-bone forearm fractures is mandatory, followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.

Distal radius fractures are commonly associated with intra-articular injuries such as carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries. Such injuries occurring in elderly patients with a low-energy distal radius fracture can be treated successfully with cast immobilization and do not usually lead to clinical problems. However, despite healing of the fracture, some intra-articular injuries, especially in active patients with a high-energy fracture, can result in persistent pain and disability. In addition, the current trend of internal fixation and early use of the wrist may actually increase instability due to inadequate healing of the ligament injuries. Due to a lack of typical symptoms and physical findings in acute fracture settings, detection of these injuries is not easy. Arthroscopic examination, as well as radiographs and intraoperative fluoroscopic findings, are useful in detection of carpal ligament injuries. Complete ruptures of intercarpal interosseous ligaments warrant temporary interosseous fixation using K-wires. In TFCC injuries, distal radioulnar joint (DRUJ) instability should be assessed after anatomical reduction and fixation of a distal radius fracture. Operative treatments such as open or arthroscopic repair of TFCC to the fovea can guarantee greater stability of the DRUJ. For optimal results, early detection and appropriate treatment of intra-articular injuries associated with distal radius fractures is critical.
Aged ; Carpal Joints ; Humans ; Immobilization ; Joints ; Ligaments ; Radius ; Radius Fractures ; Rupture ; Triangular Fibrocartilage ; Wrist ; Wrist Injuries