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--- md:distal_radius_fractures [2020/07/31 14:06]
admin created
+++ md:distal_radius_fractures [2020/08/31 13:00] (current)
admin [Cast Treatment]
@@ Line 1: / Line 1: @@
 =====Distal Radius Fractures=====
+====Adult DR fx=====
+  * meta: 2017-02-26
+  * importance - absolute number, less known
+> "The incidence of distal radius fracture in the adult population is significantly less than in other age groups. As a result of this lower incidence and apparently random occurrence of fracture in this lower risk group, little data is available on this population regarding epidemiology of these injuries" [[jnl:nellans2012]]
+> "Although the pediatric and elderly population are at the greatest risk for this injury, distal radius fracture still have significant importance on the health and well being of young patients"
+[[jnl:tsai2011]]: while age specific increase important, young adults still make up large proportion of cases.
+====Incidence====
+  * meta: 2017-02-27
+  * [[jnl:nellans2012]] Elderly and paeds increasing
+  * [[jnl:brogren2007]] increasing over time (see also Malmo & Rochester & [[jnl:tsai2011]]); peak 119/10,000
+====Mechanism of Injury====
+  * Elderly
+    * low energy at standing height
+    * more often in cognitive intact -- vs proximal humerus and hip fractures [[jnl:nellans2012]]
+====Gender distribution====
+  * meta: 2017-02-26
+  * variation reported
+  * [[jnl:nellans2012]] quoting [[jnl:brogren2007]]: men & women 19-49 almost identical incidence rates
+    * this is at variance with our own study -- so context is important e.g. rural vs urban, industry mix, transportation
+  * [[jnl:tsai2011]]: up to mid 40s, men more than women
+====Paediatric fractures====
+  * 2017-02-27
+  * [[jnl:nellans2012]]: paediatric male and female peak ages differ -- males are older
+    * activity
+    * physiology: BMD and content (Krabbe, Ryan)
+====Young adults====
+  * see [[jnl:strange1991]]
+> It is known that distal radius fracture in patients of the non-osteoporotic age usually result from high energy trauma and often having intra-articular involvement. Furthermore, they are associated with a higher incidence of cartilage, inter-carpal ligament and TFCC lesions.
+Beumer, Lindau, Adlercreutz
+====Elderly====
+  * are they more likely to fall than average?
+  * if we intervene, can we reduce the fall rate?
+====Displacement====
+  * meta: 2017-02-27
+  * [jnl:brogren2007]], [[jnl:nelllans2012]]: type of fracture/ displacement important for outcome, e.g. ia vs ea
+  * brogren's study provides a ?change? of displacement
+====Cast Treatment====
+===Tang JB 1996===
+  * 3.5 y 20/424 SLD in DR fractures --> cast treatment --> 1 year
+  * SL interval remained, GOB 2 gd, 14 fair, 4 poor @ 1 year
+  * Age 49 (vs 51): 8 m, 12 f vs (151 male, 273 female) p < 0.00001
+  * distribution
+Tang, J. B., Shi, D., Gu, Y. Q., & Zhang, Q. G. (1996). Can cast immobilization successfully treat scapholunate dissociation associated with distal radius fractures? The Journal of Hand Surgery, 21(4), 583–90. https://doi.org/10.1016/S0363-5023(96)80007-4
+=== O'Connor 2003===
+  * Randomization by date
+  * Inc: isolated DR fractures not requiring M&R - cast 6/52 vs Futuro 6/52
+  * Outcome: VAS Sarmiento (no scores given)
+    * Functional assess @ 6 & 12 weeks
+  * Results
+    * Similar pain
+    * better cast satisfaction (2 point difference)
+    * decreased complication in splinting (1-2 point difference)
+    * splint faster mobility
+    * function @ 6/52 (3 point difference)
+  * Cost as a benefit
+  * 1/2 of cast patients needed a change
+O’Connor, D., Mullett, H., Doyle, M., Mofidi,  a, Kutty, S., & O’Sullivan, M. (2003). Minimally displaced Colles’ fractures: A prospective randomized trial of treatment with a wrist splint or a plaster cast. Journal of Hand Surgery (Edinburgh, Scotland), 28(1), 50–53. https://doi.org/10.1054/jhsb.2002.0864
+====Outcomes====
+  * meta: 2017-02-26
+  * Paediatric fractures - good - perfect apposition not needed [[jnl:nellans2012]]
+  * Adult
+    * reduced extra-articular - good BUT
+    * intra-articular outcomes not so good (see Knirk & Jupiter, Catalano)
+====Bilateral=====
+[[jnl:brogren2007]]
+^Position    ^ MOI/laterality ^ Female    ^ Male ^
+|upright position  | moderate |  191      |   35  |
+|others: heights, TA, exercise| severe |   67   |  38  |
+|                  |           |          |     |
+|                  |  bilateral  |  1       |  4  |
+|                  |  Left     |  143     |  38  |
+|                  |  Right    |  116     |   31  |
+====Outcomes Assessment====
+  * [[md:assessment_g&w|Gartland and Werley Score]]
+====Outcomes====
+  * [[jnl:foldhazy2007|Long term outcomes of non-surgical treatment]]
 ====Ideas====
@@ Line 11: / Line 120: @@
   - How can we prevent falls?
   - what is the difference between elderly and young falling?
-  - delay or TCM seeking behaviors in DR fracture
+  - delay or TCM seeking behaviors in DR fracture - hyp: alternative health seeking behaviour is common in elderly DR fx and influences our treatment and outcome.
+====Osteoporosis=====
+  * meta: 2017-02-26
+> distal radius fracture in the active elderly population can be one of the first indication of underlying osteoporosis and the event represents a prime point for intervention
+Ca & Vit D treatment
+=== bisphosphonate treatment ===
+  * meta: 2017-02-26
+  * esophageal irritation
+  * necrosis of the jaw 0.4%
+  * atypical subtrochanteric fracture - dose dependent
-===Dates===
+====History====
-  - 2017-02-26
+  - 2017-02-26 created
+  - 2020-08-09 added outcomes section and foldhazy2007

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