title: Quality of life after volar plate fixation of articular fractures of the distal part of the radius. Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation WHICH QUESTIONNAIRE IS BEST? THE RELIABILITY, VALIDITY AND EASE OF USE OF THE PATIENT EVALUATION MEASURE, THE DISABILITIES OF THE ARM, SHOULDER AND HAND AND THE MICHIGAN HAND OUTCOME MEASURE Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? Does an ulnar styloid fracture interfere with the results of a distal radius fracture? Open Reduction and Internal Fixation of Unstable Distal Radius Fractures: Results Using the Trimed Fixation System Effect of mirror therapy on hand function in patients with hand orthopaedic injuries: a randomized controlled trial [Postoperative CT-controlled results of renewed osteosynthesis using screw fixation for acute scaphoid fractures]. Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year [Plate fixation with locking screw for distal fractures of the radius]. [Distal radius fracture. Correlation between radiological and functional results]. A Comparative Study of Fragment-Specific versus Volar Plate Fixation of Distal Radius Fractures Randomised study of non-bridging external fixation compared with intramedullary fixation of unstable distal radial fractures Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial Norian SRS cement compared with conventional fixation in distal radial fractures. A randomized study. 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 Minimally Displaced Colles’ Fractures: A Prospective Randomized Trial of Treatment With a Wrist Splint or a Plaster Cast A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture.
abstract: BACKGROUND Outcome measurement following surgery is increasingly the focus of attention in current health-care debates because of the rising costs of medical care and the large variety of operative options . The purpose of the present study was to correlate quality of life after volar locked plate fixation of unstable intra-articular distal radial fractures with functional and radiographic results as well as with quality -of-life data from population norms . METHODS Fifty-four consecutive patients with intra-articular distal radial fractures and a mean age of sixty-three years were managed with a volar locked plate system .  Range of motion , grip strength , and radiographs were assessed at a mean of six years postoperatively . The wrist-scoring systems of Gartl and and Werley and Castaing were adopted for the assessment of objective outcomes . The Disabilities of the Arm , Shoulder and H and and Short Form-36 question naires were completed as subjective outcome measures , and the results were compared with United States and Austrian population norms . RESULTS Functional improvement continued for two years postoperatively . At the time of the latest follow-up , > 90 % of all patients had achieved good or excellent results according to the scoring systems of Gartl and and Werley and Castaing . The results of the Short Form-36 question naire were similar to the United States and Austrian population norms . The mean Disabilities of the Arm , Shoulder and H and score was 5 points at two years , and it increased to 13 points at six years . The twenty patients with radiocarpal arthritis had significantly poorer results in the physical component summary measure of the Short Form-36 question naire ( p = 0.012 ) . CONCLUSIONS The results of the present single-center study show that , following distal radial fracture fixation , wrist arthritis may affect the patient 's subjective well-being , as documented with the Short Form-36 , without influencing the functional outcome . Well- design ed longitudinal clinical trials are needed to confirm the findings of the present investigation in terms of quality of life after surgical treatment of intra-articular distal radial fractures Background At present , there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius . This study compared the effectiveness of two methods used in surgical treatment of such fractures : percutaneous pinning and external fixation . Methods We r and omly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation .  Independent but not blinded evaluators administered the DASH quality -of-life question naire at postoperative months 6 and 24 , performed functional assessment of pain , range of motion , and palm grip strength , and radiographic examinations ( volar and radial angle , and height of the radius ) before the operation , immediately afterwards , and at 6 and 24 months postoperative . Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery . Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been r and omised according to the intention-to-treat principle . A significance level of 5 % ( alpha = 0.05 ) . was used for all statistical tests , such that tests presenting a p-value less than 0.05 were considered statistically significant . Results Ninety one ( 58.8 mean age and 66 participants were female ) were included in the final assessment at 24 months . The DASH question naire evaluation showed a statistically significant result favouring the De Palma group ( mean difference = -7.1 p = 0.044 ) after six months , but this was not maintained at 24 months . There were no statistically differences between the groups with respect to palm grip strength . Analysis of the range-of-motion limitation index ( uninjured side minus affected side motion of ) showed a statistical difference ( mean difference = 2.4 p = 0.043 ) favoring the external fixator group with regard to the supination movement 6 months after the operation ; however , this was not maintained at 24 months . The final results of the radiographic evaluation were similar for the two groups . Overall , five patients developed complications : two with De Palma pinning and three with external fixation . Conclusion There was a small statistically significant difference favouring the De Palma method in early functional at 6 months according to the DASH question naire , and for supination movement favouring the fixator group . However , both were not clinical relevant . By 24 months the groups were similar for all outcomes Trial registration Current Controlled Trials IS RCT The  Patient Evaluation Measure ( PEM ) , The  Michigan H and Outcome Question naire ( MHQ )  and the Disabilities of the Arm , Shoulder and H and ( DASH ) score were assessed independent of their originators for reliability , construct and criterion validity and acceptability , using an ease of use question naire . These were administered in r and om order to 100 patients with different h and and wrist disorders and with different impairments of movement , pain , sensation and strength . The internal consistency of all three question naires was very high suggesting redundancy in the questions . All question naires were reproducible and valid for finger and wrist disorders , but less for nerve disorders . All had poor construct validity . The PEM was the easiest to underst and and complete , taking the least time . Correlation between the scales is high and conversion equations were calculated . All three are reliable and reproducible patient completed question naires , but the PEM is the easiest to use . The validity of all is suspected for nerve disorders We performed a prospect i ve , r and omised trial to evaluate the outcome after surgery of displaced , unstable fractures of the distal radius . A total of 280 consecutive patients were enrolled in a prospect i ve data base and 88 identified who met the inclusion criteria for surgery . They were r and omised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws . Both groups were similar in terms of age , gender , h and dominance , fracture pattern , socio-economic status and medical co-morbidities . Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist , this advantage diminished with time and in absolute terms the difference in range of movement was clinical ly unimportant . Radiologically , there were no clinical ly significant differences in the reductions , although more patients with AO/OTA ( Orthopaedic Trauma Association ) type C fractures were allocated to the external fixation group . The function at one year was similar in the two groups . No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted Background and purpose Promising results have been reported after volar locked plating of unstable dorsally displaced distal radius fractures . We investigated whether volar locked plating results in better patient-perceived , objective functional and radiographic outcomes compared to the less invasive external fixation . Patients and methods 63 patients under 70 years of age , with an unstable extra-articular or non-comminuted intra-articular dorsally displaced distal radius fracture , were r and omized to volar locked plating ( n = 33 ) or bridging external fixation .  Patient-perceived outcome was assessed with the Disability of the Arm , Shoulder , and H and ( DASH ) question naire and the Patient-Rated Wrist Evaluation ( PRWE ) question naire . Results At 3 and 6 months , the volar plate group had better DASH and PRWE scores but at 12 months the scores were similar . Objective function , measured as grip strength and range of movement , was superior in the volar plate group but the differences diminished and were small at 12 months . Axial length and volar tilt were retained slightly better in the volar plate group . Interpretation Volar plate fixation is more advantageous than external fixation , in the early rehabilitation period Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position , the treatment of choice is operation . The type of operation and the choice of implant , however , is a matter of discussion . Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation . Methods 50 patients with an unstable or comminute distal radius fracture were r and omized to either closed reduction and bridging external fixation , or open reduction and internal fixation using the TriMed system . The primary outcome parameter was grip strength , but the patients were followed for 1 year with objective clinical assessment , subjective outcome using DASH , and radiographic examination . Results At 1 year postoperatively , grip strength was 90 % ( SD 16 ) of the uninjured side in the internal fixation group and 78 % ( 17 ) in the external fixation group . Pronation/supination was 150 ° ( 15 ) in the internal fixation group and 136 ° ( 20 ) in the external fixation group at 1 year . There were no differences in DASH scores or in radiographic parameters . 5 patients in the external fixation group were reoperated due to malunion , as compared to 1 in the internal fixation group . 7 other cases were classified as radiographic malunion : 5 in the external fixation group and 2 in the internal fixation group . Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year , and tended to have less malunions  than external fixation . No difference could be found regarding subjective outcome In a r and omised prospect i ve study , 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning . Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning . The patients were evaluated clinical ly and radiologically at follow-up of 24 months . The Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire and modified Mayo wrist score were used at 3 , 9 , 12 and 24 months postoperatively . In the arthroscopically- and fluoroscopically-assisted group , triangular fibrocartilage complex tears were found in 12 patients ( 60 % ) , complete or incomplete scapholunate ligament tears in nine ( 45 % ) , and lunotriquetral ligament tears in four ( 20 % ) . They were treated either arthroscopically or by open operation . Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination , extension and flexion at all time points than those who had fluoroscopically-assisted surgery . The mean DASH scores were similar for both groups at 24 months , whereas the difference in the mean modified Mayo wrist scores remained statistically significant . Although the groups are small , it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome . Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome Background The ulnar styloid is a supportive structure for the capsular ligament complex of the distal radioulnar joint . The relation between fractures of the ulna and distal radius is not clear , especially in regard to whether ulnar fractures predict worse outcomes for distal radius fractures . The objective of this study was to analyze the influence of ulnar styloid fractures in patients with reducible and unstable distal radius fractures . Methods A total of 100 patients with unstable and reducible distal radius fractures , with or without an ulnar styloid fracture , were r and omly assigned to treatment with transarticular bridging external fixation or transulnar percutaneous pinning . Follow-up was obtained for 91 patients . For the secondary data analysis , three patient cohorts were created : a no ulnar styloid fracture group with the radius fracture treated by pinning or external fixation ( n = 30 ) ; an ulnar styloid fracture with radius fracture group treated by external fixation ( n = 31 ) ; and an ulnar styloid fracture with radius fracture treated by pinning ( n = 30 ) . Functional and radiological outcomes were measured at 6 and 24 months . Functional outcome measures included wrist pain ( visual analogue scale ) and the Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire . Results At 24 months , patients with both fractures had worse wrist pain and worse scores on the DASH question naire than the patients with an isolated distal radius fracture ; and those treated by pinning had less wrist pain and showed better scores on the DASH question naire than the patients treated by fixation . Conclusions Ulnar styloid fracture may be a predictive factor of worse functional outcome for distal radius fracture . Pinning and above-the-elbow casting , used to treat ulnar styloid fractures , led to better function than fixation Objective The purpose of this study was to evaluate the early results of patients with displaced and unstable distal radius fractures treated with fragment-specific fixation .  Design Prospect i ve and consecutive . Setting Private orthopaedic practice . Patients / Participants Twenty-five patients with 27 fractures with an average follow-up of 29 months ( range 24–36 months ) treated with fragment-specific fixation for unstable radius fractures . Main Outcome Measurements Clinical and radiographic examination . Disabilities of the arm , h and , and shoulder and patient-rated wrist evaluation outcome measures . Results Patients had an average 61 ° of dorsiflexion and 54 ° of palmarflexion at the wrist  . Twenty-five fractures healed in acceptable alignment , with one loss of reduction and one patient death . Mean ± st and ard deviation DASH score was 17 ± 18 , and PRWE score was 19 ± 22 . Conclusion Unstable distal radius fractures can be reliably and anatomically reduced and stabilized using fragment-specific fixation . Fixation of markedly comminuted fractures is secure enough to allow immediate motion and does not require casting or external fixation . Preliminary clinical and radiographic results are excellent , and patient satisfaction is high . Anatomic reduction with early motion can be achieved in a routine fashion on unstable distal radius fractures using the described technique Abstract Purpose : To investigate the effects of mirror therapy ( MT ) in restoring h and function in patients with active range of motion ( AROM ) impairments following orthopaedic injuries . Method : In a r and omized controlled trial ( RCT ) , 30 patients with active ROM impairment ( 8 men and 22 women ; mean age : 38 years ) were measured . Intervention group received MT , 30 min a day , five days a week for three weeks , as well , half an hour conventional rehabilitation after each MT session . Patients in the control group received the same treatment programme , but instead of mirror , they observed directly the affected h and . In addition , both groups performed a 15 min home programme , including MT for intervention group and AROM with direct observation of the affected h and for control group , twice daily . Outcome measures , including total active motion ( TAM ) and Disabilities of Arm , Shoulder and H and ( DASH ) question naire , were administered pre- and post-treatment and three weeks later . This study was registered as an RCT , no. NCT01503762 in http:// clinical trials.gov/. Results : Final analysis was performed on 23 patients . The mean ( SD ) changes at post-test from baseline TAM was 154 ( 32 ) in the MT ( N = 12 ) and 61 ( 24 ) in the control group ( N = 11 ) ; mean difference ( 95 % CI ) 93 ( 68–118 ) , p = 0.001 . The mean ( SD ) change at post-test from baseline DASH was −34 ( 7 ) in the MT ( N = 12 ) and −15 ( 11 ) in the control group ( N = 11 ) ; mean difference ( 95 % CI ) 19 ( −27 to −11 ) , p = 0.001 . Conclusions : Despite significant improvement at post-test in both groups and maintenance of improvement during the follow-up period , MT combined with conventional rehabilitation produced more improvement in h and function than control group . Implication s for Rehabilitation H and orthopaedic injuries can result in disabilities in activities of daily living . Mirror therapy ( MT ) provides perception of two healthy limbs through reflection of the healthy limb as the injured limb . In a r and omized controlled trial , our study shows positive effects of MT combined with a classical rehabilitation programme to improve h and function in patients with orthopaedic injuries BACKGROUND Currently screw fixation of the scaphoid is a well-established method to treat unstable scaphoid fractures . PATIENTS AND METHODS Between June 1995 and December 2000 , 68 patients with an unstable acute scaphoid fracture were treated with screw fixation ; 46 patients were reexamined on an average 35 months postoperatively . Range of motion and grip strength ( Jamar dynamometer ) were measured . The total data rating result ed from the Krimmer wrist score . RESULTS The subjective results were evaluated with the DASH question naire . The average postoperative pain score was documented with a visual analogous pain scale from zero to 100 ( VAS 0 - 100 ) . X-rays as well as computed tomography were performed postoperatively . The average range of motion was 124 degrees for extension/flexion ( 92 % of the opposite site ) , 57 degrees for radial/ulnarduction ( = 90 % ) , and 177 degrees for pronation/supination ( = 98 % ) . Postoperative strength was 47 kg ( = 90 % of the opposite site ) . The postoperative pain score was 13 ( 0 - 100 ) after stress and 2 during resting conditions . Bony consolidation was reached in 44 cases . The Krimmer wrist score demonstrated a very good result in 39 cases , a good result in 5 cases , and a satisfactory result in 3 cases . The average DASH score was 8.3 points . CONCLUSIONS The results demonstrate the reliability of internal screw fixation as treatment for acute scaphoid fractures . Functional results as well as subjective satisfaction of the patients are very good . Postoperative CT scans help to evaluate exact bony consolidation , position of the screw , and postoperative morphology of the scaphoid OBJECTIVE To evaluate the effects of cross-education ( contralateral effect of unilateral strength training ) during recovery from unilateral distal radius fractures on muscle strength , range of motion ( ROM ) , and function . DESIGN R and omized controlled trial ( 26-wk follow-up ) . SETTING Hospital , orthopedic fracture clinic . PARTICIPANTS Women older than 50 years with a unilateral distal radius fracture . Fifty-one participants were r and omized and 39 participants were included in the final data analysis . INTERVENTIONS Participants were r and omized to st and ard rehabilitation ( Control ) or st and ard rehabilitation plus strength training ( Train ) . St and ard rehabilitation included forearm casting for 40.4±6.2 days and h and exercises for the fractured extremity . Nonfractured h and strength training for the training group began immediately postfracture and was conducted at home 3 times/week for 26 weeks . MAIN OUTCOME MEASURES The primary outcome measure was peak force ( h and grip dynamometer ) . Secondary outcomes were ROM ( flexion/extension ; supination/pronation ) via goniometer and the Patient Rated Wrist Evaluation question naire score for the fractured arm . RESULTS For the fractured h and , the training group ( 17.3±7.4 kg ) was significantly stronger than the control group ( 11.8±5.8 kg ) at 12 weeks postfracture ( P<.017 ) . There were no significant strength differences between the training and control groups at 9 ( 12.5±8.2 kg ; 11.3±6.9 kg ) or 26 weeks ( 23.0±7.6 kg ; 19.6±5.5 kg ) postfracture , respectively . Fractured h and ROM showed that the training group had significantly improved wrist flexion/extension ( 100.5 ° ±19.2 ° ) than the control group ( 80.2 ° ±18.7 ° ) at 12 weeks postfracture ( P<.017 ) . There were no significant differences between the training and control groups for flexion/extension ROM at 9 ( 78.0 ° ±20.7 ° ; 81.7 ° ±25.7 ° ) or 26 weeks ( 104.4 ° ±15.5 ° ; 106.0 ° ±26.5 ° ) or supination/pronation ROM at 9 ( 153.9 ° ±23.9 ° ; 151.8 ° ±33.0 ° ) , 12 ( 170.9 ° ±9.3 ° ; 156.7 ° ±20.8 ° ) or 26 weeks ( 169.4 ° ±11.9 ° ; 162.8 ° ±18.1 ° ) , respectively . There were no significant differences in Patient Rated Wrist Evaluation question naire scores between the training and control groups at 9 ( 54.2±39.0 ; 65.2±28.9 ) , 12 ( 36.4±37.2 ; 46.2±35.3 ) , or 26 weeks ( 23.6±25.6 ; 19.4±16.5 ) , respectively . CONCLUSIONS Strength training for the nonfractured limb after a distal radius fracture was associated with improved strength and ROM in the fractured limb at 12 weeks postfracture . These results have important implication s for rehabilitation strategies after unilateral injuries Background Non-bridging external fixation has been introduced to achieve better fracture fixation and functional outcomes in distal radius fractures , but has not been specifically evaluated in a r and omized study in the elderly . The purpose of this trial was to compare wrist-bridging and non-bridging external fixation for displaced distal radius fractures . Method The inclusion criteria were women ≥ 50 or men ≥ 60 years , acute extraarticular or intraarticular fracture , and dorsal angulation of ≥20 ° or ulnar variance ≥ 5 mm . The patients completed the disabilities of the arm , shoulder and h and ( DASH ) question naire before and at 10 , 26 and 52 weeks after surgery . Pain ( visual analog scale ) , range of motion and grip strength were measured by a blinded assessor . Results 38 patients ( mean age 71 years , 31 women ) were r and omized at surgery ( 19 to each group ) . Mean operating time was shorter for wrist-bridging fixation by 10 ( 95 % CI 3–17 ) min . There was no significant difference in DASH scores between the groups . No statistically significant differences in pain score , range of motion , grip strength , or patient satisfaction were found . The non-bridging group had a significantly better radial length at 52 weeks ; mean difference in change in ulnar variance from baseline was 1.4 ( 95 % CI 0.1–2.7 ) mm ( p = 0.04 ) . Volar tilt and radial inclination were similar in both groups . Interpretation For moderately or severely displaced distal radius fractures in the elderly , non-bridging external fixation had no clinical ly relevant advantage over wrist-bridging fixation but was more effective in maintaining radial length PURPOSE OF THE STUDY Fractures of the distal radius are common . No one implant has demonstrated superior efficacy in terms of maintaining the reduction over time . We report our experience with plate fixation using a locking screw . MATERIAL AND METHODS Between September 2003 and June 2004 , 67 displaced fractures of the distal radius were treated by plate fixation using the LCP-DRP 2.4 ( Synthès ) . Three different plates ( anterior , posterior , and external ) were used . The patients wore a removable anatomic brace for three weeks . Self-controlled rehabilitation exercises began directly after surgery with mobilization of the digital chains . The Fern and ez , Castaing and AO classifications were noted . Ulnar variance , anteversion of the radial glenoid , radial slope and the alpha angle were measured intraoperatively and at last follow-up to assess maintenance of reduction over time . The DASH test and Green and O'Brien and PRWE scores were used to assess clinical outcome . RESULTS Mean follow-up was eight months . Mean age was 55.8 years . Eight patients were lost to follow-up . The analysis included 59 patients who could respond to the question naires .  Bone healing was achieved at six weeks . There were no cases of secondary displacement nor loss of reduction . The Green and O'Brien score was good or very good for 85 % . The mean DASH was 20.6 and the mean PRWE 32.8 . DISCUSSION The appropriate fixation method for distal fractures of the radius remains a controversial issue , leading to a variety of material s and fixation methods . Primary stability achieved with the locking screw in a plate enables early mobilization associated with more rapid recovery of function . The absence of secondary displacement , irrespective of the quality of the underlying bone enabled us to achieve equivalent results in young patients and older patients with osteoporotic bone . This study also confirmed the preference for the anterior approach , irrespective of the direction of the displacement . To date , no other material has enabled equivalent results . This is a major achievement in terms of fixation stability BACKGROUND The purpose of the present study was to investigate the influence of the radiological parameters on the functional outcome of patients with a fracture of the distal radius and to find out to which extent a deformity can be tolerated . PATIENTS AND METHODS A total of 344 patients with an isolated fracture of the distal radius were treated during a 3-year period ; 211 of them were evaluated at an average of 16 months after the accident according to the score of Gartl and and Werley as modified by Sarmiento . Furthermore , we developed our own score for evaluating the influence of radiological parameters on the functional outcome . RESULTS According to the AO classification , there were 20 patients with an A2 , 71 an A3 , 11 a B , 35 a C1 , 44 a C2 , and 30 a C3 fracture . Of 211 patients , 28 ( 13 % ) had a step-off in the articular surface of over 1 mm , result ing in a 24 % reduction of the range of motion compared to the non-injured wrist ( p<0.05 ) . Patients with a radial shortening of more than 3 mm ( n=12 ) had a 21 % reduction of pro- and supination compared to the non-injured side ( p<0.05 ) . The radial tilt and the palmar inclination did not have a direct influence on the functional outcome . Patients treated with K-wire pinning and with an initial palmar inclination of less then -15 degrees had a significantly higher secondary loss of palmar inclination of 9 degrees compared to all others ( p<0.05 ) at the final follow-up . CONCLUSION The main radiological factors influencing the functional outcome of fractures of the distal radius are radial shortening and a step-off in the articular surface Background : There are many plating systems available for treating distal radius fractures , and deciding which to use can be difficult . This prospect i ve cohort study compared outcomes of two commonly used fixation systems : fragment-specific fixation and a fixed-angle volar locking plate system . Methods : Consecutive distal radius fractures were prospect ively evaluated in a fragment-specific fixation cohort and a volar locking plate system cohort . Radiographic , functional , and patient-rated outcomes were collected immediately postoperatively and at 6 and 12 months postoperatively . Complications were recorded and grade d by severity . Results : Fourteen distal radius fractures treated with fragment-specific fixation and 85 treated with the volar locking plate system were enrolled . Radial inclination was similar in both cohorts ( 23 degrees versus 25 degrees ) ; however , volar tilt was worse in the fragment-specific fixation cohort ( −10 degrees versus 10 degrees , p < 0.05 ) . The majority ( 63 percent ) of the fragment-specific fixation cohort demonstrated a loss of relative radial length . Grip strength , pinch strength , Michigan H and Outcomes Question naire scores , and most range of motion measurements were superior in the volar locking plate system cohort at 6 months , although not all differences were statistically significant . By 12 months the differences in functional and patient-rated outcomes were smaller , suggesting that the fragment-specific fixation cohort tended to reach the outcomes of the volar locking plate system cohort over time . Complications requiring reoperation were higher in the fragment-specific fixation cohort ( p < 0.05 ) . Conclusions : The volar locking plate system results in more stable fixation and better objective and subjective outcomes early in the postoperative period . It has fewer complications requiring reoperation than fragment-specific fixation Abstract This is a r and omised study to compare two types of osteo synthesis to mobilise wrists after distal fractures of the radius . Inclusion criteria were Older type 2 and 3 fractures .  External fixation was managed with Hoffmann II compact non-bridging . Internal fixation was managed with Micronail . Patients were followed up for 12 weeks . The primary outcome was the results of the disabilities of arm , shoulder and h and ( DASH ) question naire . The secondary outcomes were answers to the patient-rated wrist evaluation ( PRWE ) , grip strength , satisfaction , radial length , and volar tilt .  Thirty patients were r and omised to have external fixation and 31 to have internal fixation .  There were no significant differences in DASH score .  Internal fixation gave significantly better grip strength at five ( p = 0.00 ) and 12 weeks ( p = 0.03 ) . The operating time was significantly shorter ( p = 0.00 ) when non-bridging external fixation was used , and there were minor radiological differences . An activity-based costing analysis showed that external fixation  cost three times more overall Background : Minimally angulated fractures of the distal radius are common in children and have excellent outcomes . We conducted a r and omized controlled trial to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function . Methods : We included 96 children 5 to 12 years of age who were treated for a minimally angulated ( ≤ 15 ° ) greenstick or transverse fracture of the wrist between April 2007 and September 2009 at a tertiary care pediatric hospital . Participants were r and omly assigned to receive either a prefabricated wrist splint or a short arm cast for four weeks . The primary outcome was physical function at six weeks , measured using the performance version of the Activities Scale for Kids . Additional outcomes included the degree of angulation , range of motion , grip strength and complications . Results : Of the 96 children , 46 received a splint and 50 a cast . The mean Activities Scale for Kids score at six weeks was 92.8 in the splint group and 91.4 in the cast group ( difference 1.44 , 95 % confidence interval [ CI ] −1.75 to 4.62 ) . Thus , the null hypothesis that the splint is less effective by at least seven points was rejected . The between-group difference in angulation at four weeks was not statistically significant ( 9.85 ° in the splint group and 8.20 ° in the cast group ; mean difference 1.65 ° , 95 % CI −1.82 ° to 5.11 ° ) , nor was the between-group differences in range of motion , grip strength and complications . Interpretation : In children with minimally angulated fractures of the distal radius , use of a splint was as effective as a cast with respect to the recovery of physical function . In addition , the devices were comparable in terms of the maintenance of fracture stability and the occurrence of complications . ( Clinical Trials.gov trial register no. NCT00610220 . BACKGROUND A prospect i ve , r and omized multicenter study was conducted to evaluate closed reduction and immobilization with and without Norian SRS ( Skeletal Repair System ) cement in the management of distal radial fractures .  Norian SRS is a calcium-phosphate bone cement that is injectable , hardens in situ , and cures by a crystallization reaction to form dahllite , a carbonated apatite equivalent to bone mineral . METHODS A total of 323 patients with a distal radial fracture were r and omized to treatment with or without Norian SRS cement . Stratification factors included fracture type ( intra-articular or extra-articular ) , h and dominance , bone density , and the surgeon 's preferred conventional treatment ( cast or external fixator ) . The subjects receiving Norian SRS underwent a closed reduction followed by injection of the cement percutaneously or through a limited open approach . Wrist motion , beginning two weeks postoperatively , was encouraged . Control subjects , who had not received a Norian SRS injection , underwent closed reduction and application of a cast or external fixator for six to eight weeks . Supplemental Kirschner wires were used in specific instances in both groups . Patients were followed clinical ly and radiographically at one , two , four , and between six and eight weeks and at three , six , and twelve months . Patients rated pain and the function of the h and with use of a visual analog scale . Quality of life was assessed with use of the Short Form-36 ( SF-36 ) health status question naire . Complications were recorded . RESULTS Significant clinical differences were seen at six to eight weeks postoperatively , with better grip strength , wrist range of motion , digital motion , use of the h and , and social and emotional function , and less swelling in the patients treated with Norian SRS than in the control group ( p < 0.05 ) . By three months , these differences had normalized except for digital motion , which remained significantly better in the group treated with Norian SRS ( p = 0.015 ) . At one year , no clinical differences were detected . Radiographically , the average change in ulnar variance was greater in the patients treated with Norian SRS ( + 2.0 mm ) than in the control group ( + 1.4 mm ) ( p < 0.02 ) . No differences were seen in the total number of complications , including loss of reduction . The infection rate , however , was significantly higher ( p < 0.001 ) in the control group ( 16.7 % ) than in the group treated with Norian SRS ( 2.5 % ) and the infections were always related to external fixator pins or Kirschner wires . Four patients with intra-articular extravasation of cement were identified ; no sequelae were observed at twenty-four months . Cement was seen in extraosseous locations in 112 ( 70 % ) of the SRS-treated patients ; loss of reduction was highest in this subgroup ( 37 % ) . The extraosseous material had disappeared in eighty-three of the 112 patients by twelve months . CONCLUSIONS Our results indicate that fixation of a distal radial fracture with Norian SRS cement may allow for accelerated rehabilitation . A limited open approach and supplemental fixation with Kirschner wires are recommended . Additional or alternate fixation is necessary for complex articular fractures Objectives : To compare final functional and radiographic outcomes of closed reduction and casting ( CAST ) with open reduction and internal fixation ( ORIF ) with palmar locking plate for unstable Colles type distal radius fractures ( DRFs ) in low-dem and patients older than 70 years . Design : Retrospective , clinical study . Setting : Level 1 university trauma center . Patients : Over a mean period of 4 years and 7 months , 130 consecutive patients older than 70 years were treated for an unstable dorsally displaced DRF of which 114 or 87 % were followed for 1 year or longer . Intervention : ORIF ( n = 53 ) using volar locking plate or closed reduction and casting ( n = 61 ) . Main Outcome Measurements : Objective and subjective functional results ( active range of motion ; grip strength ; disabilities of the arm , shoulder and h and ( DASH ) score ; patient-rated wrist evaluation ( PRWE ) score ; visual analog scale ; and Green and O'Brien score ) and radiographic assessment ( dorsal tilt , radial inclination , radial shortening , fracture union , and posttraumatic arthritis ) were assessed . Results : At final follow-up , there was no significant difference between the 2 groups for mean ranges of motion , grip strength , DASH score , PRWE score , and Green and O'Brien score . Pain level was significantly less for the patients in the CAST group . An obvious clinical deformity was present in 77 % of cast group and none in the ORIF group . At final follow-up , in the ORIF group , there was a mean loss of dorsal tilt of 1.3 degrees , radial inclination of 0.3 degrees , and radial length of 0.5 mm compared with the postoperative measurements . No primary acceptable reduction was achieved in 44 % of the CAST group . At final follow-up , in the CAST group , dorsal tilt , radial inclination , and radial shortening averaged −24.4 ± 12 degrees , 19.2 ± 6.5 degrees , and + 3.9 ± 2.7 mm , respectively . Malunion occurred in 89 % primarily reduced fractures . Dorsal tilt , radial inclination , and radial shortening were significantly better in the ORIF group . Conclusions : Radiographic results ( dorsal tilt , radial inclination , and radial shortening ) after unstable dorsally displaced DRFs are significantly better in patients treated by ORIF using a volar fixed-angle plate rather than those treated by cast immobilization ( P < 0.05 ) . At a mean follow-up time of 4 years and 7 months , the clinical outcomes of active range of motion , the PRWE , DASH , and Green and O'Brien scores do not differ between the 2 methods of treatment . The pain level was significantly less in the CAST group ( P < 0.05 ) , and this group experienced no complications . There was no difference between the subjective and functional outcomes for the surgical and the nonsurgical treatments in a cohort of patients older than 70 years .  Unsatisfactory radiographic outcome in older patients does not necessarily translate into unsatisfactory functional outcome . Nonoperative treatment may be the preferred method of treatment in this age group Sixty-six adult patients with minimally displaced distal radial fractures were r and omly assigned to treatment with either a plaster cast or a lightweight removable wrist splint . Outcome assessment was by clinical and radiological evaluation and an independent physiotherapy assessment . There were significant differences between the treatments for cast satisfaction , cast problems and the functional assessment score at 6 weeks , with the removable splint scoring better in all cases Introduction : Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures . There is evidence of improvement in impairment with physiotherapy ; however , there is no evidence to support early return of functional activity . Traditional physiotherapy management has focussed on improving impairment ; however , there are no trials with emphasis on skill acquisition via motor re-learning principles . Material s and methods : Forty-one participants with conservatively managed distal radius fractures were studied in a r and omised , single-blinded , prospect i ve trial . Two treatment options were compared : exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks . Results : Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 ( SD 0.4 ) times , while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 ( SD 2.3 ) times . At both 6 and 24 weeks there were no significant differences between the groups for change in impairment ( as measured by grip strength , range of motion of wrist flexion and extension and pain intensity ) , activity limitation and participation restriction , as measured by the Patient-Rated Wrist Evaluation ( PRWE ) .  Exercise and advice given by a physiotherapist were equally as effective as  activity-focussed physiotherapy  in recovery both at 6 and 24 weeks . Conclusion : The results suggest that after removal of cast from fracture of distal radius , patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist We evaluated the responsiveness of  patient question naires and physical testing in the assessment of recovery after distal radius fracture . Patients ( n = 59 ) were assessed at their baseline clinic visit and again 3 and 6 months after injury . At each visit patients completed a short form-36 , Disability of the Arm , Shoulder , and H and question naire , and  patient-rated wrist evaluation  ( PRWE ) . At 3 and 6 months grip strength , range of motion , and dexterity were analyzed . St and ardized response means ( SRM ) and effects sizes were calculated to indicate responsiveness . The PRWE was the most responsive . Both the PRWE ( SRM = 2.27 ) and the Disability of the Arm , Shoulder , and H and ( SRM = 2.01 ) question naire were more responsive than the short form-36 ( SRM = 0.92 ) . The physical component summary score of the short form-36 was similar to that of the physical component subscales . Question naires were highly responsive during the 0- to 3-month time period when physical testing could not be performed . Of the physical tests , grip strength was most responsive , followed by range of motion . Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture
target: Only the DASH and PRWE have evidence of reliability , validity , and responsiveness in patients with traumatic injuries to the h and and wrist ; other measures either have incomplete evidence or evidence gathered in a nontraumatic population .
  Conclusions : The DASH and PRWE both have evidence of reliability , validity , and responsiveness in a h and and wrist trauma population .
  Other PROMs used to assess h and and wrist trauma patients do not .
background: Background : Patient-reported outcome measures ( PROMs ) are important tools for assessing outcomes following injuries to the h and and wrist .
  Many commonly used PROMs have no evidence of reliability , validity , and responsiveness in a h and and wrist trauma population .
  This systematic review examines the PROMs used in the assessment of h and and wrist trauma patients , and the evidence for reliability , validity , and responsiveness of each measure in this population .