Decision Making in the Management of Distal Radius Fractures
Journal Title: Journal of Clinical Orthopaedics - Year 2018, Vol 0, Issue 0
Abstract
Background: Distal radius fractures are one of the commonest orthopaedic injuries, occurring across the lifespan. They follow a bimodal incidence, occurring as low energy fragility fractures in older patients with low bone mineral density (particularly women), and higher energy fractures in younger patients (particularly boys and young men). Skeletally immature patients commonly experience different fracture patterns and may tolerate greater deviations from anatomical alignment due to the remodeling potential. Methods: An electronic search of relevant papers and national guidelines was performed. This review considers the variation in the broad evidence base and consensus guidelines on the presentation, management and rehabilitation of distal radius fractures, providing a practical guide to the management of these common injuries. The focus is on adult fragility fractures, although differences in the management of paediatric injuries are also considered. Results: Pain and disability are the two main concerns among patients following distal radius fractures. Management of distal radius fractures can be both non-operative, comprising casting with or without prior closed manipulation, or operative, commonly with closed reduction and percutaneous Kirschner wire fixation, or open reduction and internal fixation with volar locking plates. Overall goals of treatment are to manage pain, restore and maintain (anatomical) alignment to reduce the risk of arthritis, and to rehabilitate patients to pre-injury function. Conclusions: The evidence base on the management of distal radius fractures is generally limited, with significant heterogeneity, and few high quality studies. Most national guidelines therefore incorporate expert consensus. The evidence challenges common practices such as prolonged immobilisation (with a focus on earlier active patient-led rehabilitation) alongside the rising use of volar locking plates. Reducing cost of care and improving the speed of rehabilitation is relevant as epidemiological studies predict a rise in the global number of distal radius fractures, secondary to a growing and ageing population, resulting in rising costs for healthcare systems and society. In addition, distal radius fractures are often deemed predictive of future fragility fractures, as part of a ‘fracture cascade’ and their management must therefore include proactive assessment and management of bone health and falls risk.
Authors and Affiliations
Kunal Kulkarni, Nick Johnson, Joseph Dias
Keywords
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