Osteoporotische Indikatorfraktur: Die distale Radiusfraktur

Zusammenfassung

Distale Radiusfrakturen stellen die häufigsten Frakturen des Menschen dar. Bei älteren Patienten sind sie häufig, und die Inzidenz nimmt mit dem demographischen Wandel der Bevölkerung weiter zu. Als Indikatorfraktur für Osteoporose, kommt der distalen Radiusfraktur eine besondere Bedeutung zu. Neben einer adäquaten Therapie der Fraktur, welche individuell an die Frakturmorphologie und Patientenbedürfnisse angepasst werden sollte und operativ oder konservativ erfolgen kann, ist zur Vermeidung weiterer Osteoporose-assoziierter Frakturen die Einleitung einer Osteoporose- Therapie und Diagnostik unabdingbar. Ziel der Behandlung ist es, eine schmerzfreie Extremität mit guter Funktion wiederherzustellen und zu erhalten. Bei der Entscheidung für einen chirurgischen Eingriff sollten die Knochenqualität und die funktionelle Aktivität des Patienten besonders berücksichtigt werden. Wenn eine chirurgische Intervention angebracht ist, wird in der Regel eine winkelstabile palmare Plattenosteosynthese eingesetzt. Die chirurgische Behandlung verbessert oftmals die Frakturstellung und damit die radiologischen Parameter, führt jedoch nicht unbedingt zu besseren klinischen Ergebnissen. Daher sollte sich bei der Behandlung distaler Radiusfrakturen des älteren Menschen individuell und mit Sorgfalt für ein Behandlungsregime entschieden werden.

Abstract

Distal radius fractures are the most common fractures in humans. They often occur in older patients and the incidence continues to increase with demographic changes in the population. As an indicator fracture for osteoporosis, the distal radius fracture is of particular importance. In addition to an adequate treatment of the fracture, which should be individually adapted to the fracture morphology and patient needs and which can be performed surgically or conservatively, the initiation of osteoporosis diagnostics and treatment is essential to prevent further osteoporosis-associated fractures. The aim of treatment is to restore and maintain a pain-free extremity with good function. When deciding in favour of surgical intervention, special consideration should be given to the bone quality and functional activity of the patient. If surgical intervention is appropriate, angular stable palmar plate osteosynthesis is usually used. Surgical treatment often improves the fracture position and thus the radiological parameters, but does not necessarily lead to better clinical results. Therefore, when treating distal radius fractures in the elderly, a treatment regime should be decided upon individually and with care.

Schlüsselwörter

distale Radiusfraktur - Osteoporose - winkelstabile Plattenosteosynthese

Keywords

distal radius fracture - osteoporosis - polyaxial plate osteosynthesis

Publication History

Received: 15 July 2024

Accepted: 11 September 2024

Article published online:
27 November 2024

• Literatur

• 1 Patel DS, Statuta SM, Ahmed N. Common Fractures of the Radius and Ulna. Am Fam Physician 2021; 103: 345-354
• 2 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28: 113-125
• 3 Wu JC, Strickland CD, Chambers JS. Wrist Fractures and Osteoporosis. Orthop Clin North Am 2019; 50: 211-221
• 4 Roh YH, Koh YD, Noh JH, Gong HS, Baek GH. Evaluation of sarcopenia in patients with distal radius fractures. Arch Osteoporos 2017; 12: 5
• 5 Cho YJ, Gong HS, Song CH, Lee YH, Baek GH. Evaluation of physical performance level as a fall risk factor in women with a distal radial fracture. J Bone Joint Surg Am 2014; 96: 361-365
• 6 Rozental TD, Makhni EC, Day CS, Bouxsein ML. Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am 2008; 90: 953-961
• 7 Rikli DA, Babst R, Jupiter JB. Distal radius fractures: new concepts as basis for surgical treatment. Handchir Mikrochir Plast Chir 2007; 39: 2-8
• 8 Jayakumar P, Teunis T, Giménez BB, Verstreken F, Di Mascio L, Jupiter JB. AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement. J Wrist Surg 2017; 6: 46-53
• 9 Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 1997; 22: 792-800
• 10 Catalano LW, Barron OA, Glickel SZ. Assessment of articular displacement of distal radius fractures. Clin Orthop Relat Res 2004; 423: 79-84
• 11 Webber T, Patel SP, Pensak M, Fajolu O, Rozental TD, Wolf JM. Correlation between distal radial cortical thickness and bone mineral density. J Hand Surg Am 2015; 40: 493-499
• 12 Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989; 20: 208-210
• 13 Kapandji A. [Intra-focal pinning of fractures of the distal end of the radius 10 years later]. Ann Chir Main 1987; 6: 57-63
• 14 Willenegger H, Guggenbuhl A. [Operative treatment of certain cases of distal radius fracture]. Helv Chir Acta 1959; 26: 81-94
• 15 Oestern HJ. [Distal radius fractures. II. Surgical therapy]. Chirurg 1999; 70: 1381-1394
• 16 Hozack BA, Tosti RJ. Fragment-Specific Fixation in Distal Radius Fractures. Curr Rev Musculoskelet Med 2019; 12: 190-197
• 17 Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am 2016; 41: 845-854
• 18 McKinlay JB. From ‘promising report’ to ‘standard procedure’: seven stages in the career of a medical innovation. Milbank Mem Fund Q Health Soc 1981; 59: 374-411
• 19 Thelen S, Grassmann JP, Jungbluth P, Windolf J. [Distal radius fractures: Current treatment concepts and controversies]. Chirurg. 2018; 89: 798-812
• 20 The treatment of displaced intra-articular distal radius fractures in elderly patients – PubMed [Internet]. [cited 2024 Jul 7]. Available from: https://pubmed.ncbi.nlm.nih.gov/25491556/
• 21 Ochen Y, Peek J, van der Velde D, Beeres FJP, van Heijl M, Groenwold RHH. et al. Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3: e203497
• 22 Yang Q, Cai G, Liu J, Wang X, Zhu D. Efficacy of cast immobilization versus surgical treatment for distal radius fractures in adults: a systematic review and meta-analysis. Osteoporos Int 2023; 34: 659-669
• 23 Oldrini LM, Feltri P, Albanese J, Lucchina S, Filardo G, Candrian C. Volar locking plate vs cast immobilization for distal radius fractures: a systematic review and meta-analysis. EFORT Open Rev 2022; 7: 644-652
• 24 Lawson A, Naylor JM, Buchbinder R, Ivers R, Balogh ZJ. et al. Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA Surg 2021; 156: 229-237
• 25 CLawson A, Naylor J, Buchbinder R, Ivers R, Balogh ZJ. et al. Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Secondary Analysis of a Randomized Clinical Trial. JAMA Surg 2022; 157: 563-571
• 26 Hassellund SS, Williksen JH, Laane MM, Pripp A, Rosales CP, Karlsen Ø. et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Joint J 2021; 103-B: 247-255
• 27 Dehghani M, Ravanbod H, Piri Ardakani M, Tabatabaei Nodushan MH, Dehghani S, Rahmani M. Surgical versus conservative management of distal radius fracture with coronal shift; a randomized controlled trial. Int J Burns Trauma 2022; 12: 66-72
• 28 Fogel N, Mertz K, Shapiro LM, Roe A, Denduluri S, Kamal RN. Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review. Hand (N Y) 2022; 17: 43S-49S
• 29 DeFazio MW, Godfrey N, Offord E, Budis E, Olson N, Jones M. Distal Radius Fracture Outcomes After Dorsal Spanning Plate Fixation. Hand (N Y). 2023 15589447231163942
• 30 Liechti R, Babst R, Hug U, Link BC, van de Wall BJM, Knobe M. et al. The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study. Eur J Trauma Emerg Surg 2022; 48: 2369-2377
• 31 Beeres FJP, Liechti R, Link BC, Babst R. Role of a spanning plate as an internal fixator in complex distal radius fractures. Oper Orthop Traumatol 2021; 33: 77-88
• 32 Beeres FJP, van de Wall BJM, Hug U, Schep NWL, Babst R, Link BC. et al. Temporary spanning plate wrist fixation of complex distal radius fractures: a systematic review of 353 patients. Eur J Trauma Emerg Surg 2022; 48: 1649-1662
• 33 Luokkala T, Laitinen MK, Hevonkorpi TP, Raittio L, Mattila VM, Launonen AP. Distal radius fractures in the elderly population. EFORT Open Rev 2020; 5: 361-370
• 34 Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000; 25: 19-28
• 35 Levin LS, Rozell JC, Pulos N. Distal Radius Fractures in the Elderly. J Am Acad Orthop Surg 2017; 25: 179-187
• 36 Lawson A, Naylor J, Mittal R, Kale M, Xuan W, Harris IA. Does Radiographic Alignment Correlate With Patient-Reported Functional Outcomes and Posttreatment Complications in Older Patients Treated for Wrist Fractures?. J Hand Surg Am 2023; 48: 533-543