If at first you don't succeed, should you try again? The efficacy of repeated closed reductions of distal radius fractures.
Closed reduction
Distal radius fracture
Radiographic alignment
Re-reduction
Single reduction
Surgery
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
17
12
2022
accepted:
30
04
2023
medline:
31
7
2023
pubmed:
14
5
2023
entrez:
13
5
2023
Statut:
ppublish
Résumé
A repeated closed reduction ("re-reduction") of a displaced distal radius fracture is a common procedure performed to obtain satisfactory alignment and avoid surgery when the initial reduction is deemed unsatisfactory. However, the efficacy of re-reduction is unclear. Compared to a single closed reduction, does a re-reduction of a displaced distal radius fracture: (1) improve radiographic alignment at the time of fracture union and, (2) decrease the rate of operative intervention? Retrospective cohort analysis of 99 adults aged 20-99 years with extra-articular or minimally displaced intra-articular, dorsally angulated, displaced distal radius fracture with or without an associated ulnar styloid fracture who underwent a re-reduction, compared against 99 adults matched for age and sex who were managed with a single reduction. Exclusion criteria were skeletal immaturity, fracture-dislocation and articular displacement greater than 2 mm. Outcome measures included radiographic alignment at fracture union and rate of surgical intervention. At 6-8 weeks follow-up, the single reduction group had greater radial height (p = 0.045, CI 0.04 to 3.57), and less ulnar variance (p < 0.001, CI - 3.08 to - 1.00) compared to the re-reduction group. Immediately following re-reduction, 49.5% of patients met radiographic non-operative criteria, but by 6-8 weeks follow-up, only 17.5% of patients continued to meet these criteria. Patients in the re-reduction group were treated with surgery 34.3% of the time, compared to 14.1% of the time for patients in the single reduction group (p = 0.001). In patients aged under 65 years, 49.0% of those who underwent a re-reduction were managed with surgery, compared to 21.0% of those who had a single reduction (p = 0.004). A re-reduction performed to improve radiographic alignment and avoid surgical management in this subset of distal radius fractures had minimal value. Alternative treatment options should be considered before attempting a re-reduction.
Identifiants
pubmed: 37178164
doi: 10.1007/s00402-023-04904-z
pii: 10.1007/s00402-023-04904-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5095-5103Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767. https://doi.org/10.1016/s0140-6736(02)08657-9
doi: 10.1016/s0140-6736(02)08657-9
pubmed: 12049882
de Putter CE, Selles RW, Polinder S, Hartholt KA, Looman CW, Panneman MJM et al (2013) Epidemiology and health-care utilisation of wrist fractures in older adults in The Netherlands, 1997–2009. Injury 44:421–426. https://doi.org/10.1016/j.injury.2012.10.025
doi: 10.1016/j.injury.2012.10.025
pubmed: 23199760
Ismail AA, Pye SR, Cockerill WC, Lunt M, Silman AJ, Reeve J et al (2002) Incidence of limb fracture across Europe: results from the European prospective osteoporosis study (EPOS). Osteoporosis Int 13:565–571. https://doi.org/10.1016/S8756-3282(02)00909-2
doi: 10.1016/S8756-3282(02)00909-2
Shauver MJ, Yin H, Banerjee M, Chung K (2011) Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg 36:1282–1287. https://doi.org/10.1016/j.jhsa.2011.05.017
doi: 10.1016/j.jhsa.2011.05.017
Koval K, Haidukewych GJ, Service B, Zirgibel BJ (2014) Controversies in the management of distal radius fractures. J Am Acad Orthop Surg 22:566–575. https://doi.org/10.5435/jaaos-22-09-566
doi: 10.5435/jaaos-22-09-566
pubmed: 25157038
Brogren E, Petranek M, Atroshi I (2015) Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density. Arch Orthop Trauma Surg 135:927–933. https://doi.org/10.1007/s00402-015-2220-z
doi: 10.1007/s00402-015-2220-z
pubmed: 25935132
Moro JK, Dunlop RB, Adili A, McKenzie S, Leone J, Bhandari M (2004) Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg 124:38–41. https://doi.org/10.1007/s00402-003-0597-6
doi: 10.1007/s00402-003-0597-6
pubmed: 14608466
Mulders MAM, van Eerten PV, Goslings JC, Schep NWL (2017) Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries. Orthop Traumatol Surg Res 103:905–909. https://doi.org/10.1016/j.otsr.2017.01.017
doi: 10.1016/j.otsr.2017.01.017
pubmed: 28428037
Mackenney PJ, McQueen MM, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Jt Surg 88:1944–1951. https://doi.org/10.2106/jbjs.d.02520
doi: 10.2106/jbjs.d.02520
Roumen RM, Hesp WL, Bruggink ED (1991) Unstable Colles’ fractures in elderly patients. A randomised trial of external fixation for redisplacement. J Bone Jt Surg Br 73:307–311. https://doi.org/10.1302/0301-620X.73B2.2005162c
doi: 10.1302/0301-620X.73B2.2005162c
Beumer A, McQueen MM (2003) Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop 74:98–100. https://doi.org/10.1080/00016470310013743
doi: 10.1080/00016470310013743
Palmer AK, Glisson RR, Werner FW (1982) Ulnar variance determination. J Hand Surg 7:376–379. https://doi.org/10.1016/S0363-5023(82)80147-0
doi: 10.1016/S0363-5023(82)80147-0
Neidenbach P, Audigé L, Wilhelmi-Mock M, Hanson B, De Boer P (2009) The efficacy of closed reduction in displaced distal radius fractures. Injury 41:592–598. https://doi.org/10.1016/j.injury.2009.10.055
doi: 10.1016/j.injury.2009.10.055
pubmed: 19959165
Case RD (1985) Haematoma block—a safe method of reducing Colles’ fractures. Injury 16:469–470. https://doi.org/10.1016/0020-1383(85)90168-8
doi: 10.1016/0020-1383(85)90168-8
pubmed: 4030071
Kendall JM, Allen P, Younge P, Meek SM, McCabe SE (1997) Haematoma block or Bier’s block for Colles’ fracture reduction in the accident and emergency department–which is best? J Accid Emerg Med 14:352–356. https://doi.org/10.1136/emj.14.6.352
doi: 10.1136/emj.14.6.352
pubmed: 9413772
pmcid: 1342971
Roh YH, Lee BK, Noh JH, Baek JR, Oh JH, Gong HS et al (2014) Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg 134:1775–1781. https://doi.org/10.1007/s00402-014-2094-5
doi: 10.1007/s00402-014-2094-5
pubmed: 25311113
Schermann H, Kadar A, Dolkart O, Atlan F, Rosenblatt Y, Pritsch T (2018) Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg 138:591–596. https://doi.org/10.1007/s00402-018-2904-2
doi: 10.1007/s00402-018-2904-2
pubmed: 29453642
McQueen MM, MacLaren A, Chalmers J (1986) The value of remanipulating Colles’ fractures. J Bone Jt Surg Br 68:232–233. https://doi.org/10.1302/0301-620x.68b2.3958009
doi: 10.1302/0301-620x.68b2.3958009
McQueen MM, Hajducka C, Court-Brown CM (1996) Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Jt Surg Br 78:404. https://doi.org/10.1302/0301-620X.78B3.0780404
doi: 10.1302/0301-620X.78B3.0780404
McQueen MM, Duckworth AD (2014) Closed RE-reduction: is it an alternative. In: Hove LM, Lindau T, Hølmer P (eds) Distal radius fractures: current concepts. Springer, Berlin, Heidelberg, pp 121–128
doi: 10.1007/978-3-642-54604-4_16
Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski M (1996) X-ray film measurements for healed distal radius fractures. J Hand Surg 21:31–39. https://doi.org/10.1016/S0363-5023(96)80151-1
doi: 10.1016/S0363-5023(96)80151-1
Mann FA, Kang SW, Gilula LA (1992) Normal palmar tilt: is dorsal tilting really normal? J Hand Surg 17:315–317. https://doi.org/10.1016/0266-7681(92)90120-Q
doi: 10.1016/0266-7681(92)90120-Q
Lichtman D, Bindra R, Boyer M, Putnam M, Ring D, Slutsky D et al (2010) American academy of orthopaedic surgeons clinical practice guideline on the treatment of distal radius fractures. J Am Acad Orthop Surg 18:180–189. https://doi.org/10.2106/JBJS.938ebo
doi: 10.2106/JBJS.938ebo
pubmed: 20190108
Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N (2010) Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Jt Surg 92:1851–1857. https://doi.org/10.2106/JBJS.I.00968
doi: 10.2106/JBJS.I.00968
Zamzam MM, Khoshhal KI (2005) Displaced fracture of the distal radius in children: factors responsible for redisplacement after closed reduction. J Bone Jt Surg Br 87:841–843. https://doi.org/10.1302/0301-620X.87B6.15648
doi: 10.1302/0301-620X.87B6.15648
Larouche J, Pike J, Slobogean GP et al (2016) Determinants of functional outcome in distal radius fractures in high-functioning patients older than 55 years. J Orthop Trauma 30:445–449. https://doi.org/10.1097/bot.0000000000000566
doi: 10.1097/bot.0000000000000566
pubmed: 26978132