A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius
Vol 03 | January 2022 | page: 05-09 | Soumendra Kumar Majhi
Authors: Soumendra Kumar Majhi 
 Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.
Address of Correspondence
Dr. Soumendra Kumar Majhi,
Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.
Background: Fractures of the distal radius remain the most common fractures approximately one-sixth of all fractures treated in emergency departments. There are three main peaks of fracture distribution: the first peak is in children ages 5 to 14, the second is in males under age 50 and the third peak is in females over the age of 40 years. Risk factors are – decreased bone mineral density, female gender, ethnicity, heredity & early menopause have all been shown to be risk factors for this injury. The outcome of these fractures is not uniformly good regardless the treatment instituted. A thorough understanding of the anatomy & biomechanics of the wrist is a prerequisite when treating these lesions. There is a strict relationship between the quality of anatomical reconstruction & the long-term functional outcome. No single treatment is the solution for every type of fracture in every kind of patient. Based on the functional anatomy, we analyze the actual treatment possibilities & try to develop strategies in the choice of treatment for different fracture types in different patient groups.
Materials and Methods: 92 Patients with extra-articular distal radius fractures were studied retrospectively. 30 were treated with conservative management and 62 with surgical management. Out of 62 cases treated surgically, 11 were managed by Plate osteosynthesis, 27 with Ligamentotaxis with External fixator & 24 with K wire fixation using Kapandji method at Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, since July 2018 to November 2020.
Results: The association of individuals anatomical parameters with the functional results was measured by Chi-square test of association and Odds ratio with the criteria of Stewart et al. taken as base line for comparison. This study showed a significant association of dorsal angulation < 10° and loss of radial inclination of < 9° with functional results, P < 0.001 also with loss of radial height < 6 mm, P < 0.001 (0.005). On reviewing literature only few articles were found determining values of individual radiological parameters for better functional outcome specially Smilovic et al. (2003) and few of them noted which parameters affect the function most but not determining the values for them.
Conclusion: There was no significant difference in the functional outcome of conservative treatment in comparison to various surgical modalities namely plate osteosynthesis, ligamentotaxis and k wire reduction with Kapandji method in case of extra articular and partial articular fractures of distal radius. Therefore, we cannot generalize one treatment method for all fracture patterns and treatment should be individualized to a particular fracture.
Keywords: Distal radius fracture, Radiological outcome, Functional outcome
1. Canale & Beaty. Campbell’s Operative Orthopaedics. 13th edn. Vol III: Page 3441- 3453.
2. Bucholz, Robert W, Heckman, James D, Court-Brown, Charles M: Fractures of distal radius & ulna: Rockwood & Green’s Fractures in Adults, 6th edition: Chapter 26: Page 910-962.
3. Gray, Henry( 1825–1861). Anatomy of the human body, by Henry Gray. 40th edn. Section – 6 : chapter – 50 : Page 870 – 876.
4. Maruan Haddad, Guy Rubin, Michael Soudry & Nimrod Rozen. External Fixation for the treatment of intra-articular Fractures of the distal radius: short- term results. IMAJ. July 2010; VOL 12
5. David L Nelson. How to classify distal radial fractures – a report. eRADIUS International Distal Radius Fracture Study Group, IFSSH Bone & Joint Committee. Nov 2006. www.eradius.com.
6. Grahm T J. Surgical correction of mal-united distal radius. Jr. Academic Orthopaedic Surgery.1995; 5: 270-281.
7. Koji Fujii, Tatsuhiko Henmi, Yoshiji Kanematsu, Takuya Mishiro, Toshinori Sakai & Tomoya Terai. Fractures of the distal end of radius in elderly patients: A comparative study of anatomical & functional results. Journal of Orthopaedic Surgery 2002, 10(1): 9–15
8. Joy C Macdermid. The Patient-Rated Wrist Evaluation (PRWE) User Manual. School of Rehabilitation Science. December 2007
9. S. Nijs, P. L. O. Broos. Fractures of the Distal Radius : a Contemporary Approach. Acta chir belg, 2004; 104: 401-412.
10. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986 May; (206):202-10.
11. Frankie Leung, Dokuz Eylul, Shew Ping Chow. Conservative treatment of intra- articular fractures of the distal radius — factors affecting functional outcome. Hand Surgery. December 2000; Volume 05: Issue 02.
12. Carrozzella J, Stern PJ. Treatment of comminuted distal radius fractures with pins & plaster. Hand Clinic. 1988 Aug; 4(3): 391-7.
13. Kongsholm-J, Olerud-C. Plaster cast versus external fixation for unstable intra- articular Colles’ fractures. Clin Orthop Relat Res. April 1989 ; 57-65AB.
14. Jakim I, Pieterse HS, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Bone Joint Surge Br. 1991 Mar; 73(2): 302-6.
15. Fernandez DL, Geissler WB. Treatment of displaced articular fractures of the radius. Journal of Hand Surgery. 1991 May; 16(3):375-84.
16. Arora J, Kapoor H, Malik A, Bansal M. Closed reduction & plaster cast immobilization vs. external fixation in comminuted intra-articular fractures of distal radius. IJO. 2004 ; Vol 38 : Issue : 2 : Page : 113-117.
17. Bartosh-R-A., Saldana. Intra-articular fractures of the distal radius: a cadaveric study to determine if ligamentotaxis restores radio-palmar tilt. J-Hand-Surg- [Am]. 1990 Jan. 15(1). P 18-21.
18. Horesh Z, Volpin G, Hoerer D, Stein H. The surgical treatment of severe comminuted intra-articular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-yr follow-up study. Clin Orthop Relat Res. 1991 Feb; (263):147-53.
19. Helen HG Handoll, James S Huntley, Rajan Madhok. External xation versus conservative treatment for distal radial fractures in adults. Cochrane Database of Systematic Reviews 2007, Issue 3.
20. Clyburn-T-A. Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius. J-Bone-Joint-Surg-[Am]. 1987 Feb; 69(2): P 248-54.
21. Bassett-RL. Displaced intra-articular fractures of the distal radius. Clin-Orthop. 1987 Jan; (214): 148-52
22. Fitoussi F, Chow. S.P: The University of Hong Kong, Hong Kong, The Journal of Bone & Joint Surgery. 1997; 79:1303-12.
23. Charles S. Day, Atul F. Kamath, Eric Makhni, Jerome Jean-Gilles, David Zurakowski. “Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar & Dorsal Metaphyseal Comminution. Hand. 2008 March; 3(1): 47–54.
24. Herdrich S, Bauer J, Pichl J, Hoffmann R. Management of complex intra- articular distal radius fractures with open reduction & internal fixation with double dorsal locking plates. Z Orthop Unfall. 2010 Jan;148(1):72-9.
25. M. Jakob, D. A. Rikli, P. Regazzoni. Fractures of the distal radius treated by internal fixation & early function – a prospective study of 73 consecutive patients. J Bone Joint Surg [Br] 2000; 82-B:340-4.
26. Karl M. Koenig, Garrett C. Davis, Margaret R. Grove, Anna N.A., Tosteson, ScD Kenneth J. Koval. Is Early Internal Fixation Preferred to Cast Treatment for Well-Reduced Unstable Distal Radial Fractures?. J Bone Joint Surg Am. 2009 Sep 01; 91(9):2086-2093.
27. Knirk-JL; Jupiter-JB Intra-articular fractures of the distal end of the radius in young adults. :J-Bone-Joint-Surg-Am; 68(5): 647-59: June 1986.
28. Harish Kapoor, Ashoo Agarwal, B.K Dhaon, Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation & open reduction with internal fixation. International Journal of care of injured. Mar 2000. Volume 31, Issue 2, pages 75 – 79.
29. Chin-En Chen, Rei-Jahn Juhn & Jih-Yang Ko. Treatment of Distal Radius Fractures with Percutaneous Pinning & Pin-in-plaster. Hand. 2008 Sep; 3(3): 245–250.
30. Melone. Open treatment for displaced articular fractures of the distal radius. Jr. Clin-Orthop. 1986 Jan; (202): P 103-11.
31. Szabo-R-M. Weber. Comminuted intra-articular fractures of the distal radius. Clin-Orthop. 1988 May; (230): P 39-48.
32. Rodríguez-Merch`n, Carlos E. Management of Comminuted Fractures of the Distal Radius in the Adult: Conservative or Surgical?. Clinical Orthopaedics & Related Research: August 1998 – Volume 353 – Issue – pp 53-62
33. Jupiter, Jesse B, Lipton, Howard. The Operative Treatment of Intra-articular Fractures of the Distal Radius. Clinical Orthopaedics & Related Research: July 1993 – Volume 292 – Issue
34. Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003: (3)
35. Toshiko Hirashima, Wook-Cheol Kim, Kouei Kawamoto, Takashi Yoshida, Toshikazu Kubo. Evaluating Bone Union of Distal Radius Fractures by Measuring Impedance Values. The Cutting Edge: January 2009 – Volume 32 · Issue 1.
|How to Cite this Article: Majhi SK | A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius | Odisha Journal of Orthopaedics and Trauma | January 2022; 03: 05-09. https://doi.org/10.13107/ojot.2022.v03i01.025|