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Archives of Orthopaedic and Trauma Surgery

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01-07-2015 | Trauma Surgery

Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density

Authors: Elisabeth Brogren, Michael Petranek, Isam Atroshi

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2015

Abstract

Introduction

We hypothesized that treating distal radius fractures with cast only or closed reduction and cast is associated with high malunion risk and that the risk is higher in patients with low bone mineral density (BMD).

Materials and methods

We prospectively studied 130 patients aged 40 years or older with distal radius fractures treated with cast only (87 patients) or closed reduction and cast (43 patients). Radiographs were obtained before treatment, after reduction (in the closed reduction group), and at 1 year. We measured calcaneal BMD with DXA scanner and calculated T scores. We calculated radiological changes from baseline (initial radiographs in cast only and post-reduction radiographs in closed reduction patients) to 1 year. We assessed the relationship between BMD status (normal, osteopenia or osteoporosis) and baseline-to-1-year worsening in volar tilt, ulnar variance, and radial inclination with analysis of covariance adjusting for baseline radiological values. We used receiver operating characteristic (ROC) analysis to determine the ability of T scores to distinguish patients with severe malunion (dorsal tilt >25° and/or ulnar variance ≥5 mm) from those with less severe or no malunion.

Results

In both treatment groups, baseline radiological variables had deteriorated at 1 year, more in the closed reduction group. Compared to patients with normal BMD, those with osteoporosis had significantly greater worsening in volar tilt and radial inclination but did not differ in ulnar variance worsening. Severe malunion was found in 34 fractures (26 %, 15 in cast only group); T scores had a modest ability in distinguishing severe malunion (area under ROC curve 0.67, 95 % CI 0.56–0.78, p = 0.003).

Conclusions

Closed reduction and cast is not an effective treatment for distal radius fractures if radiological graphic outcomes are considered. There is a higher risk of malunion involving dorsal and radial tilt in patients with osteoporosis. Calcaneal BMD measurement may have some benefit in predicting the risk of severe malunion.

Brogren E, Petranek M, Atroshi I (2007) Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord 8:48PubMedCentralPubMedCrossRef

Mallmin H, Ljunghall S, Persson I, Naessen T, Krusemo UB, Bergstrom R (1993) Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 52:269–272PubMedCrossRef

Earnshaw SA, Cawte SA, Worley A, Hosking DJ (1998) Colles’ fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int 8:53–60PubMedCrossRef

Mallmin H, Ljunghall S (1994) Distal radius fracture is an early sign of general osteoporosis: bone mass measurements in a population-based study. Osteoporos Int 4:357–361PubMedCrossRef

Chung KC, Shauver MJ, Birkmeyer JD (2009) Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Jt Surg Am 91:1868–1873CrossRef

Mackenney PJ, McQueen MM, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Jt Surg Am 88:1944–1951CrossRef

Brogren E, Wagner P, Petranek M (2013) Atroshi I distal radius malunion increases risk of persistent disability 2 years after fracture: a prospective cohort study. Clin Orthop Relat Res 471:1691–1697PubMedCentralPubMedCrossRef

Brogren E, Hofer M, Petranek M, Wagner P, Dahlin LB (2011) Atroshi I relationship between distal radius fracture malunion and arm-related disability: a prospective population-based cohort study with 1-year follow-up. BMC Musculoskelet Disord 12:9PubMedCentralPubMedCrossRef

Abramo A, Kopylov P, Tagil M (2008) Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using DASH as outcome. Acta Orthop 79:376–385PubMedCrossRef

10.

Kullenberg R, Falch JA (2003) Prevalence of osteoporosis using bone mineral measurements at the calcaneus by dual X-ray and laser (DXL). Osteoporos Int 14:823–827PubMedCrossRef

11.

World health organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Tech Rep Ser 843:1–129

12.

Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI (2001) Wrist fractures: what the clinician wants to know. Radiology 219:11–28PubMedCrossRef

13.

Steyers CM, Blair WF (1989) Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 14:607–612PubMedCrossRef

14.

Edwards BJ, Song J, Dunlop DD, Fink HA, Cauley JA (2010) Functional decline after incident wrist fractures—study of osteoporotic fractures: prospective cohort study. BMJ 341:c3324PubMedCentralPubMedCrossRef

15.

Meyer U, de Jong JJ, Bours SG, Keszei AP, Arts JJ, Brink PR, Menheere P, van Geel TA, van Rietbergen B, van den Bergh JP, Geusens PP, Willems PC (2014) Early changes in bone density, microarchitecture, bone resorption, and inflammation predict the clinical outcome 12 weeks after conservatively treated distal radius fractures: an exploratory study. J Bone Miner Res 29:2065–2073PubMedCrossRef

16.

Wadsten MA, Sayed-Noor AS, Englund E, Buttazzoni GG, Sjoden GO (2014) Cortical comminution in distal radial fractures can predict the radiological outcome: a cohort multicentre study. Bone Jt J 96-B:978–983CrossRef

17.

Handoll HH, Huntley JS, Madhok R (2007) External fixation versus conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev CD006194

18.

Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR (2004) Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am 29:1121–1127PubMedCrossRef

19.

Young BT, Rayan GM (2000) Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 25:19–28PubMedCrossRef

20.

Hove LM, Solheim E, Skjeie R, Sorensen FK (1994) Prediction of secondary displacement in Colles’ fracture. J Hand Surg Br 19:731–736PubMedCrossRef

21.

Nesbitt KS, Failla JM, Les C (2004) Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 29:1128–1138PubMedCrossRef

22.

Lafontaine M, Hardy D, Delince P (1989) Stability assessment of distal radius fractures. Injury 20:208–210PubMedCrossRef

23.

Astrand J, Thorngren KG, Tagil M (2006) One fracture is enough! Experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients. Acta Orthop 77:3–8PubMedCrossRef

24.

Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB (2013) Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg 133:595–602PubMedCrossRef

25.

Daniel R, Joerg G, Kurt K, Christine V, Andreas P, Beate H (2015) The effect of local bone mineral density on the rate of mechanical failure after surgical treatment of distal radius fractures: a prospective multicentre cohort study including 249 patients. Arch Orthop Trauma Surg 135:201–207PubMedCrossRef

26.

Itoh S, Ohta T, Samejima H, Shinomiya K (1999) Bone mineral density in the distal radius in a healthy Japanese population and in relation to fractures of the distal radius. J Hand Surg Br 24:334–337PubMedCrossRef

27.

Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM (2009) Association between decreased bone mineral density and severity of distal radial fractures. J Bone Jt Surg Am 91:613–619CrossRef

28.

Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259PubMedCentralPubMedCrossRef

29.

Oyen J, Rohde G, Hochberg M, Johnsen V, Haugeberg G (2011) Low bone mineral density is a significant risk factor for low-energy distal radius fractures in middle-aged and elderly men: a case-control study. BMC Musculoskelet Disord 12:67PubMedCentralPubMedCrossRef

30.

Itoh S, Tomioka H, Tanaka J, Shinomiya K (2004) Relationship between bone mineral density of the distal radius and ulna and fracture characteristics. J Hand Surg Am 29:123–130PubMedCrossRef

31.

Hollevoet N, Verdonk R (2003) Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg 69:510–514PubMed

32.

Zebaze RM, Ghasem-Zadeh A, Bohte A, Iuliano-Burns S, Mirams M, Price RI, Mackie EJ, Seeman E (2010) Intracortical remodelling and porosity in the distal radius and post-mortem femurs of women: a cross-sectional study. Lancet 375:1729–1736PubMedCrossRef

33.

Xie X, Barenholdt O (2001) Bone density and geometric properties of the distal radius in displaced and undisplaced Colles’ fractures: quantitative CT in 70 women. Acta Orthop Scand 72:62–66PubMedCrossRef

34.

Dhainaut A, Daibes K, Odinsson A, Hoff M, Syversen U, Haugeberg G (2014) Exploring the relationship between bone density and severity of distal radius fragility fracture in women. J Orthop Surg Res 9:57PubMedCentralPubMedCrossRef

35.

Salminen H, Saaf M, Ringertz H, Strender LE (2005) Bone mineral density measurement in the calcaneus with DXL: comparison with hip and spine measurements in a cross-sectional study of an elderly female population. Osteoporos Int 16:541–551PubMedCrossRef

Title: Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density
Authors: Elisabeth Brogren
Michael Petranek
Isam Atroshi
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2220-z

At a glance: The STEP trials

Springer Medicine

Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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Erratum to: The effect of local bone mineral density on the rate of mechanical failure after surgical treatment of distal radius fractures: a prospective multicentre cohort study including 249 patients