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J Wrist Surg 2019; 08(04): 335-343
DOI: 10.1055/s-0038-1675792
Survey or Meta-analysis
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Unstable Distal Radius Fractures: A Survey of Hand Surgeons

Ara A. Salibian
1   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Karl C. Bruckman
1   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Jonathan M. Bekisz
1   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Joshua Mirrer
1   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Vishal D. Thanik
1   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Jacques H. Hacquebord
1   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
2   Department of Orthopaedic Surgery, New York University Langone Health, New York, New York
› Author Affiliations Funding None.
Further Information

Publication History

20 May 2018

08 October 2018

Publication Date:
16 November 2018 (online)

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Abstract

Background Length of immobilization after operative fixation of unstable distal radius fractures and management in elderly patients is an area of debate.

Purpose The purpose of this study is to delineate common practices of fellowship-trained hand surgeons and how they compare with current evidence-based protocols.

Methods Surveys were distributed to American Society for Surgery of the Hand members on preferred methods of fixation, postoperative immobilization, and variations in treatment of elderly patients with unstable distal radius fractures. Responses were analyzed in comparison to a literature review. Subgroups were compared with regard to training, practice type, and years in practice.

Results Four-hundred eighty-five surveys were analyzed. Volar fixed-angle plating was the most common choice of fixation (84.7%). Patients are most often immobilized for 1 to 2 weeks (40.0%) with range of motion (ROM) therapy begun most commonly between 1 and 4 weeks (47.2%). The majority of surgeons do not treat fractures differently in patients more than 65 years old. Physicians with more than 20 years of experience were significantly more likely to begin wrist ROM sooner with volar plating versus other fixation techniques compared with physicians with less than 20 years of experience (40.7% vs. 34.2%, respectively). Also, physicians in academic-only practices were more likely to immobilize patients for a shorter time after volar plating compared with those in privademics.

Conclusion Volar fixed-angle plating is the dominant fixation method for unstable distal radius fractures among fellowship-trained hand surgeons. Elderly patients are not treated more conservatively and rigid immobilization after operative fixation remains the treatment of choice despite current evidence-based protocols.

Keywords

distal radius fracture - fracture immobilization - volar plate - hand surgery - early mobilization

Supplementary Material

 

  • References

  • 1 O'Neill TW, Cooper C, Finn JD. , et al; UK Colles' Fracture Study Group. Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001; 12 (07) 555-558
    CrossrefPubMedGoogle Scholar
  • 2 Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 1998; 80 (02) 243-248
    CrossrefPubMedGoogle Scholar
  • 3 McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function?. J Bone Joint Surg Br 1988; 70 (04) 649-651
    PubMedGoogle Scholar
  • 4 Koh S, Morris RP, Patterson RM, Kearney JP, Buford Jr WL, Viegas SF. Volar fixation for dorsally angulated extra-articular fractures of the distal radius: a biomechanical study. J Hand Surg Am 2006; 31 (05) 771-779
    CrossrefPubMedGoogle Scholar
  • 5 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (02) 205-215
    CrossrefPubMedGoogle Scholar
  • 6 Geissler WB. Management distal radius and distal ulnar fractures with fragment specific plate. J Wrist Surg 2013; 2 (02) 190-194
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (07) 1568-1577
    CrossrefPubMedGoogle Scholar
  • 8 Rizzo M, Katt BA, Carothers JT. Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intraarticular distal radius fractures. Hand (NY) 2008; 3 (02) 111-117
    CrossrefPubMedGoogle Scholar
  • 9 Walenkamp MM, Bentohami A, Beerekamp MS. , et al. Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strateg Trauma Limb Reconstr 2013; 8 (02) 67-75
    CrossrefPubMedGoogle Scholar
  • 10 Li-hai Z, Ya-nan W, Zhi M. , et al. Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials. J Surg Res 2015; 193 (01) 324-333
    CrossrefPubMedGoogle Scholar
  • 11 Zong SL, Kan SL, Su LX, Wang B. Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res 2015; 10: 108
    CrossrefPubMedGoogle Scholar
  • 12 Chaudhry H, Kleinlugtenbelt YV, Mundi R, Ristevski B, Goslings JC, Bhandari M. Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A meta-analysis. Clin Orthop Relat Res 2015; 473 (09) 3017-3027
    CrossrefPubMedGoogle Scholar
  • 13 Graafmans WC, Ooms ME, Bezemer PD, Bouter LM, Lips P. Different risk profiles for hip fractures and distal forearm fractures: a prospective study. Osteoporos Int 1996; 6 (06) 427-431
    CrossrefPubMedGoogle Scholar
  • 14 Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93 (23) 2146-2153
    CrossrefPubMedGoogle Scholar
  • 15 Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 2011; 36 (05) 824-835
    CrossrefPubMedGoogle Scholar
  • 16 Colles A. On the fracture of the carpal extremity of the radius. Edinb Med Surg J 1814; 10 (38) 182-186
    PubMedGoogle Scholar
  • 17 Fowler JR, Ilyas AM. Prospective evaluation of distal radius fractures treated with variable-angle volar locking plates. J Hand Surg Am 2013; 38 (11) 2198-2203
    CrossrefPubMedGoogle Scholar
  • 18 Quadlbauer S, Pezzei C, Jurkowitsch J. , et al. Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 2017; 6 (02) 102-112
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Karantana A, Downing ND, Forward DP. , et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (19) 1737-1744
    CrossrefPubMedGoogle Scholar
  • 20 Osti M, Mittler C, Zinnecker R, Westreicher C, Allhoff C, Benedetto KP. Locking versus nonlocking palmar plate fixation of distal radius fractures. Orthopedics 2012; 35 (11) e1613-e1617
    CrossrefPubMedGoogle Scholar
  • 21 Brehmer JL, Husband JB. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study. J Bone Joint Surg Am 2014; 96 (19) 1621-1630
    CrossrefPubMedGoogle Scholar
  • 22 Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D. Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am 2008; 90 (06) 1297-1304
    CrossrefPubMedGoogle Scholar
  • 23 Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable Colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 2009; 23 (04) 237-242
    CrossrefPubMedGoogle Scholar
  • 24 Chan YH, Foo TL, Yeo CJ, Chew WY. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg 2014; 19 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 25 Goldfarb CA, Lee WP, Briskey D, Higgins JP. An American Society for Surgery of the Hand (ASSH) task force report on hand surgery subspecialty certification and ASSH membership. J Hand Surg Am 2014; 39 (02) 330-334
    CrossrefPubMedGoogle Scholar
  • 26 Gaspar MP, Kane PM, Honik GB, Shin EK, Jacoby SM, Osterman AL. Geographic and age-based variations in Medicare reimbursement among ASSH members. Hand (N Y) 2016; 11 (03) 347-352
    CrossrefPubMedGoogle Scholar
  • 27 Shubinets V, Gerety PA, Pannucci CJ. , et al. Attitude of hand surgeons toward Affordable Care Act: a survey of members of American Society for Surgery of the Hand. J Orthop 2016; 14 (01) 38-44
    PubMedGoogle Scholar
  • 28 Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 2006; 88 (12) 2687-2694
    CrossrefPubMedGoogle Scholar
  • 29 Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 2008; 33 (05) 691-700
    CrossrefPubMedGoogle Scholar
  • 30 Smith DW, Brou KE, Henry MH. Early active rehabilitation for operatively stabilized distal radius fractures. J Hand Ther 2004; 17 (01) 43-49
    CrossrefPubMedGoogle Scholar
  • 31 Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 2009; 91 (08) 1868-1873
    CrossrefPubMedGoogle Scholar
  • 32 Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am 2009; 91 (06) 1313-1319
    CrossrefPubMedGoogle Scholar
  • 33 Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am 2010; 92 (09) 1851-1857
    CrossrefPubMedGoogle Scholar
  • 34 Chung KC, Shauver MJ, Yin H. The relationship between ASSH membership and the treatment of distal radius fracture in the United States Medicare population. J Hand Surg Am 2011; 36 (08) 1288-1293
    CrossrefPubMedGoogle Scholar
  • 35 Minegishi H, Dohi O, An S, Sato H. Treatment of unstable distal radius fractures with the volar locking plate. Ups J Med Sci 2011; 116 (04) 280-284
    CrossrefPubMedGoogle Scholar
  • 36 Waljee JF, Zhong L, Shauver MJ, Chung KC. The influence of surgeon age on distal radius fracture treatment in the United States: a population-based study. J Hand Surg Am 2014; 39 (05) 844-851
    CrossrefPubMedGoogle Scholar
  • 37 Neuhaus V, Bot AG, Guitton TG, Ring DC. Influence of surgeon, patient and radiographic factors on distal radius fracture treatment. J Hand Surg Eur Vol 2015; 40 (08) 796-804
    CrossrefPubMedGoogle Scholar