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md:distal_radius_fractures [2020/08/02 04:53]
admin added gender distribution 		md:distal_radius_fractures [2020/08/31 13:00] (current)
admin [Cast Treatment]
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 =====Distal Radius Fractures===== =====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==== ====Incidence====
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   * [[jnl:nellans2012]] Elderly and paeds increasing   * [[jnl:nellans2012]] Elderly and paeds increasing
   * [[jnl:brogren2007]] increasing over time (see also Malmo & Rochester & [[jnl:tsai2011]]); peak 119/10,000   * [[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==== ====Gender distribution====
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     * this is at variance with our own study -- so context is important e.g. rural vs urban, industry mix, transportation     * 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   * [[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==== ====Displacement====
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   * brogren's study provides a ?change? of displacement   * 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==== ====Ideas====
  
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   - How can we prevent falls?   - How can we prevent falls?
   - what is the difference between elderly and young falling?   - 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===== ====Osteoporosis=====
Line 47: Line 138:
  
  
-===Dates===+====History====
  
-  - 2017-02-26+  - 2017-02-26 created 
 +  - 2020-08-09 added outcomes section and foldhazy2007
md/distal_radius_fractures.1596343983.txt.gz · Last modified: 2020/08/02 04:53 by admin

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