Alphonsus Chong's Personal Wiki

• 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” 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”

tsai2011: while age specific increase important, young adults still make up large proportion of cases.

• meta: 2017-02-27

• nellans2012 Elderly and paeds increasing
• brogren2007 increasing over time (see also Malmo & Rochester & tsai2011); peak 119/10,000

• Elderly
  • low energy at standing height
  • more often in cognitive intact – vs proximal humerus and hip fractures nellans2012

• meta: 2017-02-26
• variation reported
• nellans2012 quoting 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
• tsai2011: up to mid 40s, men more than women

• 2017-02-27
• nellans2012: paediatric male and female peak ages differ – males are older
  • activity
  • physiology: BMD and content (Krabbe, Ryan)

• see 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

• are they more likely to fall than average?
• if we intervene, can we reduce the fall rate?

• meta: 2017-02-27
• [jnl:brogren2007]], nelllans2012: type of fracture/ displacement important for outcome, e.g. ia vs ea
• brogren's study provides a ?change? of displacement

• 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

• 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

• meta: 2017-02-26
• Paediatric fractures - good - perfect apposition not needed nellans2012
• Adult
  • reduced extra-articular - good BUT
  • intra-articular outcomes not so good (see Knirk & Jupiter, Catalano)

brogren2007

• Gartland and Werley Score

• Long term outcomes of non-surgical treatment

1. Trends in operative fixation 2008-2017
2. background
3. changing perspective to young DRF
4. are men more prone to be in RTA?
5. how can we better prevent and treat a growing and increasingly active elderly population
6. what is our national incidence of osteoporosis? Is it static or changing?
7. How can we prevent falls?
8. what is the difference between elderly and young falling?
9. 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.

• 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

• meta: 2017-02-26
• esophageal irritation
• necrosis of the jaw 0.4%
• atypical subtrochanteric fracture - dose dependent

1. 2017-02-26 created
2. 2020-08-09 added outcomes section and foldhazy2007