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      Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

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          Abstract

          A wide range of different classifications exist for distal radius fractures (DRF). Most of them are based on plane X-rays and do not give us any information on how to treat these fractures. A biomechanical understanding of the mechanical forces underlying each fracture type is important to treat each injury specifically and ensure the optimal choice for stabilization. The main cause of DRFs are forces acting on the carpus and the radius as well as the position of the wrist in relation to the radius. Reconstructing the mechanism of the injury gives insight into which structures are involved, such as ruptured ligaments, bone fragments as well as the dislocated osteoligamentous units. This article attempts to define certain key fragments, which seem crucial to reduce and stabilize each type of DRF. Once the definition is established, an ideal implant can be selected to sufficiently maintain reduction of these key fragments. Additionally, the perfect approach is selected. By applying the following principles, the surgeon may be assisted in choosing the ideal form of treatment approach and implant selection.

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          Most cited references41

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          A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.

          As the population in developed countries continues to age, the incidence of osteoporotic distal radius fractures (DRFs) will increase as well. Treatment of DRF in the elderly population is controversial. We systematically reviewed the existing literature for the management of DRFs in patients aged 60 and over with 5 common techniques: the volar locking plate system, nonbridging external fixation, bridging external fixation, percutaneous Kirschner wire fixation, and cast immobilization (CI). We reviewed articles retrieved from MEDLINE, Embase, and CINAHL Plus that met predetermined inclusion and exclusion criteria in 2 literature reviews. Outcomes of interest included wrist arc of motion, grip strength, functional outcome measurements, radiographic parameters, and the number and type of complications. We statistically analyzed the data using weighted means and proportions based on the sample size in each study. We identified 2,039 papers and selected 21 papers fitting the inclusion criteria in the primary review of articles with a mean patient age of 60 and older. Statistically significant differences were detected for wrist arc of motion, grip strength, and Disabilities of the Arm, Shoulder, and Hand score, although these findings may not be clinically meaningful. Volar tilt and ulnar variance revealed significant differences among groups, with CI resulting in the worst radiographic outcomes. The complications were significantly different, with CI having the lowest rate of complications, whereas the volar locking plate system had significantly more major complications requiring additional surgical intervention. This systematic review suggests that despite worse radiographic outcomes associated with CI, functional outcomes were no different from those of surgically treated groups for patients age 60 and over. Prospective comparative outcomes studies are necessary to evaluate the rate of functional recovery, cost, and outcomes associated with these 5 treatment methods. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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            Early Rehabilitation of Distal Radius Fractures Stabilized by Volar Locking Plate: A Prospective Randomized Pilot Study.

            Background Distal radius fractures are very common and an increased incidence of 50% is estimated by 2030. Therefore, both operative and postsurgical treatment remains pertinent. Main aim in treating intra-articular fractures is to restore the articular surface by internal fixation and early mobilization (EM). Questions/Purposes The purpose of this study was to compare functional results between EM immediately after surgery and 5 weeks of immobilization (IM). Patients and Methods In a randomized prospective study, 30 patients with an isolated distal radius fracture were treated by open reduction and internal fixation using a single volar locking plate excluding bone graft. Fifteen patients were randomized in the EM group and 15 in the IM group. At 6 weeks, 9 weeks, 3 months, 6 months, and 1 year postsurgery, range of motion, grip strength and X-rays were evaluated. Additionally, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Patient-Rated Wrist Evaluation (PRWE), modified Green O'Brien (Mayo) score, and pain according to the Visual Analog Scale score were analyzed. Results Patients in the EM group had a significantly better range of motion in the sagittal plane, in grip strength up to 6 months, in the frontal plane up to 9 weeks, and in forearm rotation up to 6 weeks. Also QuickDASH and PRWE scores were better up to 6 weeks postsurgery. The Green O'Brien score differed significantly up to 1 year. At 1 year, 93% "excellent" and "good" results in the Green O'Brien score with a mean QuickDASH of 5.98 ± 10.94 and PRWE score of 4.27 ± 9.23 were observed in the EM group. No differences regarding loss of reduction, pain, duration of physiotherapy, and sick leave were noted. Conclusion EM of surgically treated distal radius fractures (without bone graft) is a safe method for postoperative aftercare and leads to an improved range of motion and grip strength at 6 months postsurgery compared with an IM of 5 weeks. Level of Evidence This is a level Ib clinical study.
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              Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis.

              A meta-analysis to compare complication rates following volar or dorsal surgical fixation of distal radius fracture.
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                Author and article information

                Contributors
                r.rosenauer@gmx.net
                Journal
                Arch Orthop Trauma Surg
                Arch Orthop Trauma Surg
                Archives of Orthopaedic and Trauma Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0936-8051
                1434-3916
                19 March 2020
                19 March 2020
                2020
                : 140
                : 5
                : 595-609
                Affiliations
                [1 ]PK Döbling, Heiligenstädter Strasse 55-63, 1190 Vienna, Austria
                [2 ]GRID grid.420022.6, ISNI 0000 0001 0723 5126, AUVA Trauma Hospital Lorenz Böhler, , European Hand Trauma Center, ; Donaueschingenstrasse 13, 1200 Vienna, Austria
                [3 ]GRID grid.420022.6, ISNI 0000 0001 0723 5126, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, , AUVA Research Center, ; Donaueschingenstrasse 13, 1200 Vienna, Austria
                [4 ]Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
                [5 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department for Orthopedic Surgery and Traumatology, , Paracelsus Medical University, ; Strubergasse 21, 5020 Salzburg, Austria
                [6 ]Hand Center Ravensburg, Elisabethenstraße 19, 88212 Ravensburg, Germany
                Author information
                http://orcid.org/0000-0002-6928-473X
                Article
                3405
                10.1007/s00402-020-03405-7
                7181558
                32193681
                fff6aafb-cb3e-4387-9516-e5f314b2ff4b
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 3 February 2020
                Categories
                Trauma Surgery
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Orthopedics
                distal radius fracture,treatment-oriented classification,key fragment,implant selection,biomechanics of the wrist

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