Outcomes of Open Reduction and Internal Fixation of Bilateral Fractures of the Distal Radius

Abstract

Background Bilateral distal radius fracture (DRF) is an uncommon injury. We described the outcomes of 10 consecutive cases of bilateral DRF treated with open reduction and internal fixation (ORIF) at our institution.

Materials and Methods We retrospectively searched our electronic medical records data for all patients 18 years of age or older treated surgically for bilateral DRF over a 6-year period (2011–2016). Patient demographics, fracture classification, fixation method, postoperative complications, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire scores, wrist range of motion (ROM), and radiographic measurements of X-rays at final follow-up were collected and analyzed.

Results Ten patients (8 women; 2 men; mean age: 63 years) with 20 fractures were assessed. A volar approach for ORIF was used in 90% of cases. Six of 20 (30%) wrists experienced postoperative complications and required hardware removal. Mean QuickDASH score was 24.8 at final follow-up. On average, ROM reached 58-degree extension, 52-degree flexion, 75-degree pronation, and 75-degree supination. Mean measurements of radial shortening, radial inclination, and volar tilt taken from final postoperative radiographs were 1.3 mm, 21.2 degrees, and 7.8 degrees, respectively.

Conclusion In bilateral DRF treated with concomitant ORIF, functional outcomes, recovery of wrist ROM, and restoration of radiographic parameters are comparable to those seen in patients with ipsilateral DRF.

Keywords

distal radius - fracture - bilateral - wrist trauma - fixation - volar plating - outcomes - recovery - complications

• References

• 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37 (08) 691-697
• 2 Liporace FA, Adams MR, Capo JT, Koval KJ. Distal radius fractures. J Orthop Trauma 2009; 23 (10) 739-748
• 3 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (02) 113-125
• 4 Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J 2014; 96-B [phone]
• 5 Gumbs VL, Segal D, Halligan JB, Lower G. Bilateral distal radius and ulnar fractures in adolescent weight lifters. Am J Sports Med 1982; 10 (06) 375-379
• 6 Ozkan K, Ugutmen E, Unay K, Poyanli O, Guven M, Eren A. Fractures of the bilateral distal radius and scaphoid: a case report. J Med Case Reports 2008; 2: 93
• 7 Bjørnsen LP. Bilateral combined fractures of the scaphoid and distal radius in a 13-year-old male. Acta Orthop Belg 2008; 74 (06) 856-859
• 8 Stone III N, Karamitopoulos M, Edelstein D, Hashem J, Tucci J. Bilateral distal radius fractures in a 12-year-old boy after household electrical shock: case report and literature summary. Case Rep Med 2014; 2014: 235756
• 9 Tv R, P. R, Grover A, Samorekar B. Bilateral distal radius fracture in third trimester of pregnancy with accelerated union: a rare case report. J Clin Diagn Res 2015; 9 (04) RD01-RD02
• 10 Ehsan A, Stevanovic M. Skeletally mature patients with bilateral distal radius fractures have more associated injuries. Clin Orthop Relat Res 2010; 468 (01) 238-242
• 11 AO/OTA Fracture and Dislocation Classification: 2014 Leaflet. Accessed January 4, 2018
• 12 Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know?. Radiology 1992; 184 (01) 15-24
• 13 Lichtman DM, Bindra RR, Boyer MI. et al. Treatment of distal radius fractures. J Am Acad Orthop Surg 2010; 18 (03) 180-189
• 14 Matzon JL, Lutsky KF, Maloney M, Beredjiklian PK. Adherence to the AAOS upper-extremity clinical practice guidelines. Orthopedics 2013; 36 (11) e1407-e1411
• 15 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?. J Bone Joint Surg Am 2008; 90 (09) 1855-1861
• 16 Dash.iwh.on.ca. The QuickDASH. Available at: http://dash.iwh.on.ca/quickdash Accessed January 7, 2018
• 17 Tsang P, Walton D, Grewal R, MacDermid J. Validation of the QuickDASH and DASH in patients with distal radius fractures through agreement analysis. Arch Phys Med Rehabil 2017; 98 (06) 1217-1222
• 18 Southam M, Driessens S, Burton C, Pope R, Thurnwald P. A retrospective cohort study of QuickDASH scores for common acute trauma conditions presenting for hand therapy. J Hand Ther 2017; 30 (01) 41-48
• 19 Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006; 31 (03) 359-365
• 20 Williksen JH, Husby T, Hellund JC, Kvernmo HD, Rosales C, Frihagen F. External fixation and adjuvant pins versus volar locking plate fixation in unstable distal radius fractures: a randomized, controlled study with a 5-year follow-up. J Hand Surg Am 2015; 40 (07) 1333-1340
• 21 Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 2007; 21 (05) 316-322
• 22 Mignemi ME, Byram IR, Wolfe CC. et al. Radiographic outcomes of volar locked plating for distal radius fractures. J Hand Surg Am 2013; 38 (01) 40-48
• 23 Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2014; 39 (07) 1280-1286
• 24 Wilcke MK, Abbaszadegan H, Adolphson PY. Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop 2011; 82 (01) 76-81
• 25 Gradl G, Gradl G, Wendt M, Mittlmeier T, Kundt G, Jupiter JB. Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg 2013; 133 (05) 595-602
• 26 Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg Br 2008; 90 (09) 1214-1221
• 27 Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 2003; 27 (01) 1-6
• 28 Lutsky KF, Beredjiklian PK, Hioe S, Bilello J, Kim N, Matzon JL. Incidence of hardware removal following volar plate fixation of distal radius fracture. J Hand Surg Am 2015; 40 (12) 2410-2415