Differentiated approach to repair of displaced distal radial metaepiphyseal fractures

Matveev R.P., Bragina S.V., Shneiveis A.M.

Abstract


Introduction
Distal radial metaepiphysis (DRME) with the respecting joints and soft-tissue envelope is responsible for most important motions of orientation and stabilization of radiocarpal joint (RCJ), hand and forearm.
Objective to assess techniques, terms and results of displaced DRME fractures.
Material and methods
Retrospective study included 85 patients more than 18 years of age who were treated for displaced DRME fractures between 2012 and 2015. Surgical treatment was performed for 36 (42.4 %) patients and 49 (57.6 %) patients were treated conservatively.
Results
Conservative treatment was used 1.8 times more for AO/ASIF type A fractures and 2.2 times less for AO/ASIF type C fractures. Complications rates were significantly 1.7 times less with surgical treatment as compared to conservative methods (χ2 = 4.14; df = 1; p = 0.041). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Mayo Wrist Score were used to assess long-term outcomes of 2 to 4 years. According to Mayo Wrist Score there were 52 (61.2 %) excellent (90-100 points), 17 (20 %) good (80-90 points) and 14 (16.5 %) fair (60–80 points) results with mean DASH score of 2.7, 11.9 and 26.1, respectively. Two (2.6 %) patients had poor outcomes (with less than 60 points) with mean DASH score of 44.25.
Conclusions
Radiological signs of fracture instability and differentiated approach to conservative and surgical treatments are essential to prevent complications in repair of DRME.

Keywords


radius, distal metaepiphysis, displaced fracture, conservative treatment, operative treatment

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