=====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====

  - Trends in operative fixation 2008-2017
  - background
  - changing perspective to young DRF
  - are men more prone to be in RTA?
  - how can we better prevent and treat a growing and increasingly active elderly population
  - what is our national incidence of osteoporosis? Is it static or changing?
  - How can we prevent falls?
  - what is the difference between elderly and young falling?
  - 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


====History====

  - 2017-02-26 created
  - 2020-08-09 added outcomes section and foldhazy2007