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Background: Closed reduction and a closed cast are common treatments for patients with acute distal radius fractures in the emergency room. Many of the common analgesic techniques such as hematoma block may not be effective, which can hinder the stabilization and reduction of fractures. Case report: An 81-year-old woman who had a Colle's fracture (metaphyseal fracture with dorsal angulation) of the left distal radius arrived at the emergency room. Due to intense pain and need for proper pain management, an ultrasound-guided block of the radial nerve prior to its bifurcation into deep and superficial branches was carried out as an alternative to infiltration of the fracture site. The fracture could be reduced and immobilized with a closed cast as a result of the peripheral nerve block, which caused the patient the least amount of discomfort. Conclusions: The reduction of a distal radius fracture in the emergency room can be accomplished with safe and efficient analgesia using an ultrasound-guided supracondylar radial nerve block close to the beginning of the deep and superficial branches. This is, as far as we are aware, the first report of an ultrasound-guided supracondylar nerve block utilized to treat a distal radius fracture in our nation.

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BACKGROUND: The aim of this study was to describe the presence of pain sensitization (PS) and its association with baseline factors after cast removal in patients older than 60 years with distal radius fracture (DRF) treated conservatively. METHODS: This cross-sectional study included 220 patients older than 60 years with extra-articular DRF who completed the Pain Sensitivity Questionnaire (PSQ). Patients with PSQ score > 7 points were considered positive for PS. In addition, sociodemographic, anthropometrics, clinical, radiological, lifestyle behaviors, pain-related psychological factors, and functional outcomes were analyzed as baseline predictors, all measured were performed 2 weeks after cast removal. RESULTS: A total of 159 patients (72.3%) showed PS. The results showed an association between higher values of PSQ-total with the affected dominant hand (ß = 1.1; P = 0.04), high energy of injury (ß = 3.5; P < .001), extra-articular comminuted metaphyseal DRFs (ß = 1.8; P < .001), lower values of Rapid Assessment of Physical Activity questionnaire (ß = 3.1; P < .001), higher values of Pittsburgh Sleep Quality Index (ß = 2.5; P < .001), higher values of Tampa Scale of Kinesiophobia (ß = 1.9; P < .001), higher values of Pain Catastrophizing Scale (ß = 1.8; P < .001), higher values of Disabilities of the Arm, Shoulder and Hand questionnaire (ß = 1.6; P < .001), lower values of grip strength (ß = 1.4; P < .001) and higher values of Visual analog scale (ß = 4.2; P < .001). CONCLUSIONS: A high percentage of patients older than 60 years with extra-articular DRFs present PS at 2 weeks after cast removal. Our results may help physicians and physiotherapists identify risk and/or prognostic baseline factors for the occurrence of PS after DRF, and the need for a therapeutic approach that incorporates the clinical management of this condition in these patients.

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OBJECTIVE: To determine in the long term whether supervised physiotherapy is more effective than a home exercise program for functional improvement and pain relief in patients with distal radius fracture (DRF). DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital. PARTICIPANTS: A total of 74 patients older than 60 years with extra-articular DRF were randomly allocated into two groups. INTERVENTIONS: The experimental group received 6 weeks of supervised physiotherapy (n = 37) and the control group received 6 weeks of home exercise program (n = 37). MAIN OUTCOME MEASURES: The primary outcome was wrist/hand function assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire; secondary outcomes were the pain visual analogue scale (VAS), grip strength and wrist flexion-extension active range of motion. RESULTS: All patients completed the trial. For the primary outcome, at 6-weeks and 1-year follow-up, the PRWE questionnaire showed a mean difference between groups of 18.6 (95% CI 12.8 to 24.3) and 18.5 points (95% CI 12.7 to 24.2) respectively, these differences are clinically important. Conversely, at 2-year follow-up this effect decreases to 3.3 points (95% CI -2.4 to 9.0). For secondary outcomes, at 6-weeks and 1-year follow-up, in all measurements the effect size range from medium to large. Conversely, at 2-year follow-up only grip strength showed large effect size in favor of supervised physiotherapy, the rest of outcomes did not show difference between groups. CONCLUSION: At the 6-week and 1-year follow-up, supervised physiotherapy was more effective for functional improvement and pain relief compared with a home exercise program in patients older than 60 years with extra-articular DRF. However, this effect decreases over time, at the 2-year follow-up, only grip strength showed a difference in favor of supervised physiotherapy. TRIAL REGISTRATION: Brazilian registry of clinical trials UTN no. U1111- 1249-2492. Registered 17 March 2020. CONTRIBUTION OF THE PAPER.

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Background Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance. Methods Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed. Two authors independently performed the search and data extraction and assessed risk of bias (RoB) using the Cochrane RoB tool. Results A total of 1,780 relevant abstracts and citations were extracted in the preliminary search, which yielded 6 trials that met the eligibility criteria, and 3 studies were included in the quantitative synthesis. The overall pooled mean difference (MD) estimate showed no significant difference in the Disabilities of the Arm, Shoulder, and Hand scores between surgical groups with and without arthroscopic assistance (MD = 0.77 points, 95% confidence interval = -6.58 to 5.03, p = 0.79), with substantial heterogeneity (I 2 = 85%). Conclusion There was low-quality evidence that wrist arthroscopy conveyed not clinically or statistically significant difference to functional outcomes of patients with DRFs. However, our findings are limited by the numbers of studies included and lack of long-term follow-up, although they do provide a good starting point for future quality research.

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Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.

Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.

Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.

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Purpose: To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP). Methods: We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT. Results: A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures. Conclusions: Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs. Level of evidence: Prognostic II.

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PURPOSE: Occupational radiation exposure can have adverse health consequences for surgeons. The purpose of this study was to determine if utilization of an intraoperative, real-time radiograph counter results in decreased radiation exposure events (REEs) during open reduction and internal fixation (ORIF) of distal radius fractures (DRFs). METHODS: We reviewed all cases of isolated ORIF DRFs performed at a single center from January 2021 to February 2023. All cases performed on or after January 1, 2022 used an intraoperative radiograph counter, referred to as a "shot-clock" (SC) group. Cases prior to this date were performed without a SC and served as a control group (NoSC group). Baseline demographics, fracture, and surgical characteristics were recorded. Final intraoperative radiographs were reviewed to record reduction parameters (radial inclination, volar tilt, and ulnar variance). REEs, fluoroscopy exposure times, and total radiation doses milligray (mGy) were compared between groups. RESULTS: A total of 160 ORIF DRF cases were included in the NoSC group, and 135 were included in the SC group. The NoSC group had significantly more extra-articular fractures compared with the SC group. Reduction parameters after ORIF were similar between groups. The mean number of REEs decreased by 48% in the SC group. Cases performed with the SC group had significantly lower total radiation doses (0.8 vs 0.5 mGy) and radiation exposure times (41.9 vs 24.2 seconds). Mean operative times also decreased for the SC group (70 minutes) compared with that for the NoSC group (81 minutes). CONCLUSIONS: A real-time intraoperative radiograph counter was associated with decreased REEs, exposure times, and total radiation doses during ORIF DRFs. Cases performed with a SC had significantly shorter operative times without compromising reduction quality. Using an intraoperative SC counter during cases requiring fluoroscopy may aid in decreasing radiation exposure, which serves as an occupational hazard for hand and upper-extremity surgeons. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

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Background: Distal radius fractures are very frequent fractures in the world, so it is necessary to establish new rehabilitation strategies. Objective: To determine the effectiveness of tele rehabilitation versus supervised treatment in the functional recovery of patients with distal radius fracture. Method: A randomized clinical trial was conducted that included 91 patients with distal radius fractures grades AO23 A and AO23B, which were randomly assigned to a treatment group, the supervised rehabilitation group received for two weeks a program of 10 treatment sessions and the tele rehabilitation group received through the Moodle platform instructions to carry out the rehabilitation program. Outcome measures (functionality, active range of motion, hand grip strength, quality of life and pain) were measured at the time of admission to rehabilitation and at 1, 3 and 6 months. Results: In both treatment groups at 6 months, statistically significant intragroup differences in functionality were demonstrated, with no intergroup differences. Conclusions: At 6 months, both rehabilitation programs increase functionality, range of motion, quality of life and decrease pain, without statistically significant differences intergroup.

Antecedentes: Las fracturas de radio distal son fracturas muy frecuentes en el mundo, por lo que es necesario establecer nuevas estrategias de rehabilitación. Objetivo: Determinar la efectividad de la telerrehabilitación en comparación con el tratamiento supervisado en la recuperación funcional de los pacientes con fractura de radio distal. Método: Se realizó un ensayo clínico aleatorizado que incluyó 91 pacientes con fracturas de radio distal de grados AO23A y AO23B, los cuales se asignaron aleatoriamente a un grupo de rehabilitación supervisado que recibió durante 2 semanas un programa de 10 sesiones de tratamiento o un grupo de telerrehabilitación que mediante la plataforma de Moodle recibió instrucciones para realizar el programa de rehabilitación. Las medidas de resultado (funcionalidad, rango de movimiento activo, fuerza de prensión de la mano, calidad de vida y dolor) se midieron en el momento del ingreso a rehabilitación y a los 1, 3 y 6 meses. Resultados: A los 6 meses, ambos grupos de tratamiento demostraron diferencias estadísticamente significativas intragrupo en la funcionalidad, sin diferencias intergrupo. Conclusiones: A los 6 meses, ambos programas de rehabilitación aumentan la funcionalidad, el rango de movimiento y la calidad de vida, y disminuyen el dolor, sin diferencias estadísticamente significativas intergrupo.

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The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF). METHODS: We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs. RESULTS: Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at -4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications. CONCLUSIONS: Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.

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PURPOSE: Distal radius (DR) fracture repair using the volar locked plating technique typically involves indirect fracture reduction, assessed using fluoroscopy, without direct visualization of the articular surface. This method of fracture repair may be guided by the rationale that volar radiocarpal ligament disruption may cause radiocarpal instability, although direct articular visualization may facilitate improved fracture reduction. This study investigated anatomical feasibility and articular surface visualization using volar ligament-sparing radiocarpal arthrotomy pertinent to DR fracture repair. METHODS: Ten fresh-frozen cadaveric specimens of the upper extremity underwent volar arthrotomy via the standard flexor carpi radialis approach with partial longitudinal sectioning of the long radiolunate and partial transverse sectioning of the short radiolunate ligaments to visualize the articular surface of the DR. Following arthrotomy, the visible surface of the DR was analyzed using digital photography. The wrist was disarticulated, and the fully exposed articular surface was photographed. The visible area of the articular surface was quantified using digital imaging software by calculating the ratio of the surface area visualized using the arthrotomy to the total articular surface area. RESULTS: The percentage of the articular surface area of the DR visualized using the volar arthrotomy was 76% ± 7.6% (range, 69%-90%), including both the scaphoid facet, lunate facet, and scapholunate ridge. CONCLUSIONS: Volar radiocarpal arthrotomy allows clinically relevant visualization of the articular surface of the DR, including the scaphoid and lunate facets. CLINICAL RELEVANCE: Radiocarpal arthrotomy may facilitate improved articular reduction during DR fracture repair via the volar approach.

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RESUMEN Introducción: la fractura del radio distal es una de las entidades traumáticas más frecuentes por la que acuden enfermos a los servicios de urgencia de Traumatología. Aunque su tratamiento es por lo general conservador, existen situaciones en que es necesaria la intervención quirúrgica con la fijación externa. Objetivo: evaluar los resultados de la fijación externa en pacientes con fracturas inestables del radio distal. Materiales y métodos: se realizó un estudio preexperimental en pacientes con fracturas inestables del radio distal, tratados mediante fijación externa en el Hospital Provincial Docente Clínico Quirúrgico Manuel Ascunce Domenech, de Camagüey, entre abril de 2018 y mayo de 2021. La investigación tuvo un nivel de evidencia IV, recomendación D. Resultados: el promedio de edad de los 41 pacientes fue de 40,5 años, con edad mínima de 20 y máxima de 68. Se observó un predominio del sexo femenino (25 pacientes, para un 61 %). La razón sexo femenino-masculino fue de 1,5 a 1, y la de afección de muñeca izquierda-derecha fue de 1,9 a 1. Se encontró significación entre antes y después al emplear los parámetros imagenológicos y las escalas evaluativas, con mejoría en ambos. Conclusiones: la fijación externa en fractura inestable del radio distal resulta eficaz a los doce meses en la mayoría de los enfermos. Las complicaciones son mínimas, y de presentarse responden de forma favorable al tratamiento.

ABSTRACT Introduction: distal radius fracture is one of the most frequent traumatic entities due which patients come to Traumatology emergency services. Although their treatment is usually conservative, there are situations where surgery with external fixation is necessary. Objetive: to evaluate the results of external fixation in patients with unstable distal radius fractures. Materials and methods: a pre-experimental study was carried out in patients with unstable fractures of the distal radius treated by external fixation at the Provincial Clinical Surgical Teaching Hospital Manuel Ascunce Domenech, of Camagüey, between April 2018 and May 2021. The research has IV level of evidence, D recommendation. Results: the average age of the 41 patients was 40.5 years old, with minimum age of 20 and maximum age of 68 years. Female sex prevalence was observed (25 patients, 61%). The female-male sex ratio was 1.5 to 1, and the left-right wrist condition was 1.9 to 1. Significance was found between before and after using the imaging parameters and the evaluative scales, with improvement in both cases. Conclusions: external fixation in unstable distal radius fracture is effective at twelve months in most patients. Complications are minimal and if they are present, they favorably answer to treatment.

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BACKGROUND: No published prospective studies have reported the clinical effects of physiotherapy at 1-year follow-up in patients with complex regional pain syndrome type I (CRPS I) after distal radius fracture (DRF). The purpose of this study was to evaluate at 1-year follow-up the functional effects of physiotherapy program in elderly patients with CRPS I after extra-articular DRF. METHODS: A total of 72 patients with CRPS I after DRF were prospectively recruited. All patients were treated with a 6-week supervised physiotherapy treatment. Three evaluations were performed: at the beginning, at the end of the treatment, and at 1-year follow-up. Wrist function, upper limb function, grip strength, and pain intensity were assessed with the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), Jamar dynamometer, and Visual Analogue Scale (VAS), respectively. RESULTS: At 1-year follow-up, the PRWE showed a decrease of 21.6 points (Cohen's d = 2.8; 95% confidence interval [CI] = 18.6-24.6; P < .05); the DASH showed a decrease of 23.8 points (Cohen's d = 2.9; 95% CI = 20.8-26.7; P < .05); grip strength showed an increase of 40.6% (Cohen's d = 5.0; 95% CI = 43.5-37.6; P < .05); and the VAS showed a decrease of 2.6 cm (Cohen's d = 1.9; 95% CI = 2.11-3.16; P < .05). CONCLUSION: At 1-year follow-up, a physiotherapy program showed clinically and statistically significant results in all functional outcomes in elderly patients with CRPS I after extra-articular DRF.

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PURPOSE: Distal radius (DR) fracture fixation with volar locked plating typically uses indirect fracture reduction without direct visualization of the articular surface in an attempt to preserve the volar radiocarpal ligaments and prevent iatrogenic radiocarpal instability. This study assessed the biomechanical stability after a volar radiocarpal arthrotomy for direct articular visualization for DR fracture repair compared to a standard trans-flexor carpi radialis approach without arthrotomy in a cadaver model. METHODS: Ten fresh-frozen upper extremity matched-pair cadaveric specimens were tested. For each pair, one limb underwent trans-FCR approach with a volar arthrotomy that partially sectioned the long and short radiolunate ligaments to visualize the DR articular surface (Group 1). The contralateral limb underwent standard trans-FCR approach without arthrotomy (Group 2). Following capsular repair (Group 1), all specimens (Groups 1 and 2) underwent biomechanical testing, including axial loading (22.2 N, 44.5 N, 89.0 N, 177.9 N), volar translational, and dorsal translation loading (22.2 N, 44.5 N, 89.0 N) to assess carpal stability using both fluoroscopy and motion capture. Ulnar carpal translation was assessed using the Gilula method, measuring radiographic lunate overhang from the ulnar edge of the lunate fossa relative to the full width of the lunate. Dorsal and volar translation were assessed by measuring lunate overhang with respect to the dorsal or volar radial cortex. To simulate fractures with dorsal radiocarpal ligament disruption, the dorsal capsule was sectioned, and the biomechanical comparisons were repeated. RESULTS: Ulnar translation of the lunate remained below 2 mm for both groups in all testing scenarios. No significant differences were identified in ulnar, volar, or dorsal translation with increasing loads between the groups. CONCLUSIONS: This volar ligament-sparing radiocarpal arthrotomy did not cause biomechanical radiocarpal instability. CLINICAL RELEVANCE: This arthrotomy may provide enhanced visualization of the DR articular surface during fracture fixation without causing iatrogenic wrist instability.

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OBJECTIVE: To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). METHODS: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF. RESULTS: Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was -10.2 points (p = 0.02), the DASH was -9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3-7 days was -14.58 ml (p = 0.03), at 17-21 days -17.96 ml (p = 0.009), at 33-42 days -15.34 ml (p = 0.003), and at 63-68 days -13.97 ml (p = 0.002). CONCLUSION: There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.

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RESUMEN Introducción: Una clasificación es necesaria para la correcta orientación del cirujano ortopédico en cuanto a diferenciar los tipos de fracturas del extremo distal del radio, su pronóstico en base a su complejidad, la importancia de la radiografía, las variables demográficas de cada caso y qué tipo de proceder será el más indicado para el paciente. Objetivo: Actualizar las clasificaciones para fracturas del extremo distal del radio. Desarrollo: Se procedió a la búsqueda en las bases de datos Pubmed/ Medline, SciELO, BVS, Scopus, Ebsco y Cochrane, se emplearon los descriptores "fractura distal del radio", clasificación de fractura del extremo distal del radio, fractura de la muñeca, consenso sobre fractura del extremo distal del radio, radiología en la fractura de muñeca, guías terapéuticas actuales para el tratamiento de las fracturas distales del radio, solo y con las siguientes cadenas "clasificación", "radiología". Fueron incluidos 19 artículos originales, 10 de revisión, 4 guías terapéuticas, 2 de investigación y 2 libros de la especialidad. Se examinaron los sistemas de clasificación de las fracturas del extremo distal del radio. Conclusiones: No existe consenso en el sistema de clasificación. Se comprueba el pobre aporte al ortopédico de la clasificación de Frykman y que el sistema AO demuestra ser más fácil de interpretar. Se evidencia la utilidad de la radiografía con tracción esquelética para un diagnóstico útil y de ayuda al cirujano en la toma de decisiones para el tratamiento del paciente.

ABSTRACT Introduction: A classification is necessary for the correct orientation of the orthopedic surgeon in terms of differentiating the types of fractures at the distal end of the radius, their prognosis based on their complexity, the importance of radiography, the demographic variables of each case and what type of procedure will be the most suitable for the patient. Objective: To evaluate the current classifications for fractures of the distal end of the radius and to propose on the existing evidence which classification systems have better reliability and reproducibility. Development: The Pubmed / MEDLINE, SciELO, BVS, Scopus, Ebsco and Cochrane databases were searched; the descriptors "distal radius fracture", distal radius fracture classification, wrist fracture were used. , consensus on fracture of the distal end of the radius, radiology in the fracture of the wrist, current therapeutic guidelines for the treatment of distal fractures of the radius, alone and with the following chains "classification", "radiology". 19 original articles, 10 review articles, 4 therapeutic guidelines, 2 research guides, and 2 specialty books were included. Classification systems for distal radius fractures were examined. Conclusions: There is no consensus on the classification system. The poor contribution to the orthopedic of the Frykman classification is verified and that the AO system proves to be easier to interpret. The usefulness of skeletal traction radiography is evidenced for a useful diagnosis and to help the surgeon in making decisions for the treatment of the patient.

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Background: Volar locking plates have provided the capability to repair both simple and complex fractures. However, complications related to the inability to fix or to maintain the fixation of some fracture patterns have been reported with volar locking plates. The purpose of this study was to evaluate the results of dorsal plating treatment for specific pattern of fractures. Methods: Patients with distal radius fractures were retrospectively evaluated. Inclusion criteria for this study were those related to the patient and treatment (adult patients, internal fixation with dorsal plating, a minimum follow-up of 12 months), and those related to the fracture pattern (displaced central articular fragment, volar distal fracture line not enough to allow volar fixation, displaced dorsal-ulnar fragment, dorsal partial fractures, combination of these patterns). Clinical outcome information including active range of motion, radiographs, PRWE and DASH questionnaires were collected. Complications were recorded. Results: During a 6-year period, 679 distal radius fractures were treated with open reduction and internal fixation. Of these, 27 patients fulfilled the inclusion criteria. Patients were examined at a median of 34 months' follow-up. All but pronation, supination, and radial deviation had a statistically significant difference compared to the opposite side. The median score on the DASH was 4.5 and 3.2 on the PRWE. No patient suffered loss of reduction during the follow-up nor were tendon ruptures recorded. Conclusions: Although most of the distal radius fractures can be treated with volar locking plates, almost 5% of them present specific patterns that are amenable to treatment with dorsal fixation, without postoperative loss of reduction. These specific patterns are: (1) displaced central articular fragment, (2) volar distal fracture with less of 1cm distance from the distal volar edge of the radius, (3) displaced dorso-ulnar fragment, (4) Barton's fracture, (5) combination of these patterns.

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Introduction: Comminuted distal radius fracture is one of the fractures that difficult to reduce. This study aimed to compare Patient-Rated Wrist Evaluation (PRWE) score between plating on second and third metacarpal groups. Methods: This study used a retrospective analytic research design with a sample of twenty seven cases of distal radius comminutive fractures that have been treated using dorsal distraction plating. Fifthteen cases with distal fixation in second metacarpal and twelve cases in third metacarpal. Data were then analyzed using the Mann-Whitney test. Results: The mean Pain scores in the second metacarpal and third metacarpal groups, respectively were 5.73 compared to 6.17. While the mean score of Function in the second metacarpal group and the third metacarpal group, respectively 12.67 compared to 13.83. The total PRWE score in the second metacarpal group was 18.40 compared to the third metacarpal group which was 20.0 (p>0.05). Conclusions: Patients with distal radius comminuted fracture treated using dorsal distraction plating with distal fixation in second metacarpal showed higher mean Pain, Function and total PRWE compared to third metacarpal, but there were no significant differences

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Objective: The aim of this study was to analyze the genetic association of five ESR1 single nucleotide polymorphisms (SNPs) (rs3020331, rs851982, rs1999805, rs2234693, rs3020404), four COL1A1 SNPs (rs1800012, rs2075555, rs2412298, rs1107946), and two SNPs on the CCDC170 gene (rs9479055, rs4870044) with distal radius fracture (DRF) in a group of postmenopausal Mexican women.Methods: A case-control study was conducted. Cases (n = 182) were women above the age of 38 years with low-energy DRF, and controls (n = 201) were women without. Analysis was done through real-time polymerase chain reaction. Frequencies and Hardy-Weinberg equilibrium were calculated. A multivariate analysis including bone mass index, age, menarche, and menopause as covariables was carried out. Finally, haplotype and linkage disequilibrium (LD) analyses were performed.Results:COL1A1 rs1107946 was strongly associated with DRF. Both CCDC170 SNPs showed strong association with DRF. For the ESR1 gene, four SNPs (rs2234693, 3020404, rs3020331, and rs851982) showed very strong association with DRF. Additionally, the region between the latter two showed strong LD.Conclusions: A strong association of DRF with variants in these genes was found, including haplotypes and a region with strong LD on ESR1. The results suggest that these SNPs could be useful to detect the population at risk of presenting DRF among Mexican perimenopausal women.

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Purpose: Distal radius fractures (DRFs) are common pediatric injuries typically treated with closed reduction and casting. A substantial number of these fractures fail nonsurgical management, occasionally requiring surgical intervention. Risk factors associated with an unsuccessful initial closed reduction (UIR) attempt or loss of reduction (LOR) after a successful closed reduction remain poorly characterized. Methods: This was a retrospective investigation of pediatric patients with displaced DRFs treated by closed reduction and casting at a single children's hospital from 2013 to 2017. Patient factors (age, sex, and body mass index) and radiographic measurements (fracture type, fracture displacement, associated ulna fracture, and cast index) were evaluated to determine risk factors for UIR and LOR. Results: We identified 159 children (118 boys, mean age, 11 ± 3 years) with DRFs who underwent closed reduction and casting. An initial acceptable reduction was achieved in 81% of patients, and LOR occurred in 21.7%. Higher initial fracture translation in the sagittal or coronal plane and higher initial angulation in the coronal plane were associated with higher fluoroscopy times. Higher initial translation in the sagittal plane was independently associated with UIR. After closed reduction, residual translation in the sagittal plane and cast index were independent predictors for LOR. Fractures that were completely displaced in the sagittal plane were 6.2 times less likely to undergo an acceptable initial reduction, and fractures with any residual postreduction translation in the sagittal plane were 4.7 times more likely to demonstrate LOR. Conclusions: The most important factors predicting failure of nonsurgical management of pediatric DRFs are translation in the sagittal plane and cast index greater than 0.80. To optimize patient outcomes, these variables should be recognized by the treating provider and emphasized during simulation training of orthopedic and plastic surgery residents. Type of study/level of evidence: Prognostic III.

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La asociación entre fractura de radio distal y fractura de escafoides es una asociación infrecuente, en la presentación inicial, pasa inadvertida muchas veces la fractura a nivel de escafoides. El diagnóstico precoz nos permite un correcto tratamiento evitando posibles complicaciones en la evolución. Se presenta el caso de un adolescente de 14 años con dicha asociación lesional. Se le realizó reducción cerrada y fijación percutánea con alambres de Kirschner a nivel del radio distal y se trató la fractura de escafoides, de forma ortopédica, con yeso antebraquipalmar con inclusión del primer dedo. Se obtuvo la consolidación de ambos focos con excelentes resultados clínicos.

The association between distal radius fracture and scaphoid fracture is a rare association, in many cases the scaphoid fracture can be overlooked at the initial presentation. The early diagnosis allows a correct treatment avoiding possible complications in the follow-up. The case of a 14-year-old teenager with this association is presented. Closed reduction and percutaneous fixation was performed with Kirschner Wires at distal radius fracture, the scaphoid fracture was treated orthopedically with short-arm thumb spica cast. Consolidation of both fractures was obtained with excellent clinical results.

A associação entre fratura do rádio distal e fratura do escafoide é uma associação pouco freqüente; na apresentação inicial, a fratura do escafóide geralmente passa despercebida. O diagnóstico precoce nos permite um tratamento correto, evitando possíveis complicações na evolução. É apresentado o caso de um adolescente de 14 anos com essa associação lesional. Ele foi submetido a redução fechada e fixação percutânea com fios de Kirschner no raio distal, e a fratura do escafóide foi tratada ortopedicamente com um molde de antebraço incluindo o primeiro dedo. A consolidação de ambos os focos foi obtida com excelentes resultados clínicos.

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