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Bones and fractures
Published in Henry J. Woodford, Essential Geriatrics, 2022
Distal radius fractures occur when there is an attempt to lessen the impact of a fall by using an outstretched arm. The treatment of this type of fracture is usually by placing the limb in a cast. Occasionally open or closed reduction is necessary for proper alignment. It does not usually necessitate hospital admission. However, normal functioning may be impaired, particularly in frail older people who live alone. A good functional recovery is expected in the longer term following this type of fracture. Five-year survival rates are significantly reduced after either hip or vertebral fractures but appear to be unaffected following distal radius fractures.123
Rehabilitation of the osteoporotic patient
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Theodoros H. Tosounidis, Amy Margot Lindh
Handoll et al. (28) conducted a systematic review of RCTs or quasi-RCTs evaluating rehabilitation as part of the management of fractures of the distal radius sustained by adults and concluded that there is insufficient evidence to evaluate the effectiveness of the various rehabilitation interventions. Nevertheless, it is crucial to realize that the effect of rehabilitation is time dependent. Dewan et al. (11), in a longitudinal cohort study of 94 patients, demonstrated that after a distal radius fracture, most of the improvement related to general health status, fear of falling, and fracture-specific pain/disability takes place within the first 6 months after the injury. In a prospective cohort study, Crockett et al. (31) evaluated the changes in functional status within the first year after a distal radius fracture in women older than 50 years. The authors demonstrated that there was significantly lower functional status (patient-rated wrist evaluation) in the elderly patients across all points in time. Improvement in functional status occurred from 1 week up to 1 year, and the authors underpinned the importance of identification of the recovery pattern in patients with distal radius fractures, which might be helpful for future research and the development of preventive approaches.
Injuries of the wrist
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
David Warwick, Adam Watts, Joanna Thomas
Historically, distal radius fractures have been classified using eponymous terms such as Colles’, Smith’s or Barton’s fracture, but these names can lead to confusion and misunderstanding. There is no classification that completely fulfils the requirement of guiding treatment or informing prognosis.
Distraction plating for bilaterally severely comminuted distal radius fracture: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Yuta Izawa, Hiroko Murakami, Tetsuya Shirakawa, Kazuo Sato, Toshiki Yoshino, Yoshihiko Tsuchida
The goal of treating distal radius fractures is to obtain a stable and movable wrist joint. Various treatment options are available, including conservative treatment, but open reduction and internal fixation are required in cases with severe instability or high disposition. The gold standard for internal fixation is volar locking plate fixation [1,2], and fragment-specific fixation is recommended when the articular surface is severely comminuted [3,4]. However, high-energy trauma may be accompanied by severe comminution and soft tissue damage, which are difficult to treat using a traditional internal fixation strategy. In such cases, external fixation is generally regarded as the next best treatment option [5,6]. External fixation spans the wrist joint continuously to maintain alignment until bone union; however, pin site infection and inconvenience owing to the fixation apparatus that the patient has to wear are common problems with this approach. Distraction plating is a method of bridging fixation from the radial shaft to the third metacarpal bone subcutaneously on the dorsal side and is used as an alternative to external fixation [7–10]. Although there is concern that the limitation of range of motion will remain due to the fixation of the wrist joint until implant removal, it has been reported that an acceptable range of motion of the wrist joint will eventually be obtained. Herein, we report a case in which distraction plating was performed for a bilateral highly comminuted distal radius fracture, with acceptable results obtained in the wrist joint’s range of motion and function.
Life has become troublesome – my wrist bothers me around the clock: an interview study relating to daily life with a malunited distal radius fracture
Published in Disability and Rehabilitation, 2020
Ingrid Andreasson, Gunilla Kjellby-Wendt, Monika Fagevik-Olsén, Jón Karlsson, Gunnel Carlsson
The situation with pain, a restricted ability to perform activities and a perceived lack of information led to anxiety about what went wrong, the prognosis, the ability to work and economic issues. The findings indicate that information to the patients about their condition, and routines to guide the health-care process in the event of malunion, are important. Our clinical experience indicates that the rehabilitation process after a distal radius fracture can differ a great deal between patients. There is no clear time point at which the patient should be re-assessed by a physician in the event of persisting pain and stiffness. This adds to the difficulties involved in creating routines in the health-care system, both at one care facility and also in the transitional process of patients between health-care levels. The experiences of the health-care system that are reflected in this study highlight these difficulties. Since the impact of a malunion on daily life is large in this patient group, a generous attitude towards re-assignment to a physician, and a specialist when needed, is recommended.
Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively
Published in Acta Orthopaedica, 2020
Maria Moloney, Simon Farnebo, Lars Adolfsson
Fractures of the distal ulna may result in incongruence and instability of the distal radioulnar joint (DRUJ), which may result in chronic pain or limited forearm rotation (Kvernmo 2014). Fractures of the distal ulna most often accompany a distal radius fracture and in the majority of cases they affect the ulnar styloid process, while fractures of the ulnar head and/or neck are less common (Ring et al. 2004). Distal radius fractures and concomitant fractures of the distal radius and ulna are commonly caused by a fall from standing height on an outstretched arm with extended wrist. Isolated ulna fractures on the other hand are most often caused by a direct trauma to the ulnar border of the wrist (Richards and Deal 2014). Among patients with a Colles fracture, excluding ulnar styloid fractures, 5.6% have a concomitant fracture of the distal ulna (Biyani et al. 1995). Internal fixation of these fractures is typically difficult (Ring et al. 2004) as the distal fragment in most cases is small, consisting to a large extent of metaphysis and has a 270° articular surface.