Functional recovery after fractures of the distal forearm. Analysis of radiographic and other factors affecting the outcome.
ABSTRACT Functional recovery of the wrist and hand after a fracture of the distal forearm in 207 consecutive patients was analysed. A good or excellent result was achieved in 77 percent, fair in 22.5 percent and poor in 0.5 percent of cases. The result in 14 unstable fractures treated with external fixation was as good as that of the whole series. Good functional results were associated with extra-articular fractures, good anatomical results, male sex and low age. Comminuted intra-articular fractures of the radiocarpal joint, fracture line into the distal radio-ulnar joint, fracture of the ulnar styloid and a poor anatomical result in addition to high age contributed to a poor result.
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ABSTRACT: Osteoporotic fracture is the main complication of osteoporosis. The current management is to discharge patients as early as possible so they can get back to their daily activities. Once discharged, there are three main issues relating to morbidity, mortality, and risk of a subsequent fracture that need to be addressed and discussed. Therefore, the aim of this systematic review was to summarize and evaluate the evidence from published literature, to determine the outcome of osteoporotic fracture patients after their hospital discharge. The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched, using the terms "osteoporosis", "fracture", "osteoporotic fracture", "hip fracture", and "vertebral fracture". We included only human studies published in English between 2004 and 2014. The reference lists of included studies were thoroughly reviewed in search for other relevant studies. A total of 18 studies met the selection criteria. Most were observational and cohort studies. Out of all the studies, five studies looked into the morbidity, six studies looked into the risk of subsequent fractures, and seven studies looked into mortality. Vertebral fracture caused the greatest health burden, but hip fracture patients were the main users of informal care after hospital discharge. There was an increased risk of a subsequent fracture after a primary fracture compared with the control group, a cohort comparison, or the general population. Osteoporotic fractures, especially hip fractures, are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases. There is strong evidence to show that after hospital discharge, osteoporotic fracture patients are faced with higher morbidity, subsequent fractures, and mortality.Therapeutics and Clinical Risk Management 01/2014; 10:937-948. · 1.34 Impact Factor
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ABSTRACT: Purpose To determine if ulnar styloid fractures (USF) affect clinical outcome following distal radius fracture (DRF) in adults under 65 years of age. Methods This study involved 312 patients (aged 18–64) with surgically and nonsurgically treated DRFs. Patients were followed prospectively at baseline and 3, 6, and 12 months. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE), and secondary outcomes were range of motion and grip strength. The USFs were classified by location (tip, middle, and base) and union status. Results There were 170 patients with isolated DRFs and 142 with associated USF (64 tip, 32 middle, and 46 base fractures). The mean age of the entire cohort was 48 years with 218 (70%) women. All USFs were treated nonoperatively. There was a trend of higher PRWE scores in DRFs associated with USFs compared to isolated DRFs throughout the study. Associated ulnar styloid base fractures had higher but clinically insignificant PRWE scores than isolated DRFs at 6 and 12 months. Patients with an associated USF had a slower recovery of wrist flexion and grip strength compared to isolated DRF, but values were comparable at 12 months. United USFs and nonunited USFs had similar PRWE scores at all time points. Conclusions Adults under 65 years old with DRFs and associated USFs initially have greater pain and disability than those with isolated DRFs; however, this difference dissipated over time and was not significant at 1 year. No long-term differences in measured impairments were observed, but the presence of an associated USF resulted in a slower recovery of grip strength and wrist flexion. Presence of a USF nonunion did not significantly affect outcomes. Type of study/level of evidence Prognostic II.The Journal Of Hand Surgery 08/2014; · 1.66 Impact Factor
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ABSTRACT: There is no consensus on the relation between ulnar styloid process nonunion and outcome in patients with distal radius fractures. The aim of this study was to analyze whether patient-reported outcome is influenced by the nonunion of the accompanying ulnar styloid fracture in distal radius fracture patients.Injury 08/2014; 45(12). · 2.46 Impact Factor