The results in 75 of 105 patients with Older type II/III (AO type A2.2, A3.1, A3.2) Colles' fractures, treated with non-bridging external fixation are presented. The mean age was 67.8 years, and all patients were followed prospectively for 12 months with radiological and functional assessment. No statistically significant loss of radial length, angulation or inclination was seen between the postoperative reduction and the 1-year follow-up examination. The clinical results after 1 year were 66 (88%) excellent/good, nine (12%) fair and 0 (0%) poor according to the modified Gartland and Werley score. Mean visual analogue scale pain score after 1 year was 0.8. In three patients (4%), re-displacement of the fracture occurred and was treated with plating. Non-bridging external fixation offers a reliable method of maintaining radiological reduction of Older type II/III fractures of the distal radius and gives a good functional outcome after 1 year.
[Show abstract][Hide abstract] ABSTRACT: Surgical management of distal radius fractures continues to evolve because of their high incidence in an increasingly active elderly population. Traditional radiocarpal external fixation relies on ligamentotaxis for fracture reduction but has several drawbacks. Nonbridging external fixation has evolved to provide early wrist mobility in the setting of anatomic fracture reduction. Several studies of the nonbridging technique have demonstrated satisfactory results in isolated nonbridging external fixation series and in comparison with traditional spanning external fixation. Nonbridging external fixation for surgical treatment of distal radius fractures can be technically demanding and requires at least 1 cm of intact volar cortex in the distal fracture fragment for successful implementation.
Hand clinics 08/2010; 26(3):381-90, vi-vii. DOI:10.1016/j.hcl.2010.04.006 · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This is a randomised study to compare two types of osteosynthesis to mobilise wrists after distal fractures of the radius. Inclusion criteria were Older type 2 and 3 fractures. External fixation was managed with Hoffmann II compact non-bridging. Internal fixation was managed with Micronail. Patients were followed up for 12 weeks. The primary outcome was the results of the disabilities of arm, shoulder and hand (DASH) questionnaire. The secondary outcomes were answers to the patient-rated wrist evaluation (PRWE), grip strength, satisfaction, radial length, and volar tilt. Thirty patients were randomised to have external fixation and 31 to have internal fixation.There were no significant differences in DASH score. Internal fixation gave significantly better grip strength at five (p = 0.00) and 12 weeks (p = 0.03). The operating time was significantly shorter (p = 0.00) when non-bridging external fixation was used, and there were minor radiological differences. An activity-based costing analysis showed that external fixation cost three times more overall.
[Show abstract][Hide abstract] ABSTRACT: There is a lack of scientific data regarding which treatment provides the best outcome for distal radius fractures (DRFs) in the elderly. Currently, casting is used to treat the majority of these fractures, although open reduction and internal fixation (ORIF) has been used increasingly in recent years. Given the recent emphasis on the wise use of medical resources, we conducted a cost-utility analysis to assess which of 4 common DRF treatments (casting, wire fixation, external fixation, or ORIF) optimizes the cost-to-patient preference ratio.
We created a decision tree to model the process of choosing a DRF treatment and experiencing a final outcome. Fifty adults aged 65 and older were surveyed in a time trade-off, one-on-one interview to obtain utilities for DRF treatments and possible complications. We gathered Medicare reimbursement rates and calculated the incremental cost-utility ratio for each treatment.
Participants rated DRF treatment relatively high, assigning utility values close to perfect health to all treatments. The ORIF was the most preferred treatment (utility, 0.96), followed by casting (utility, 0.94), wire fixation (utility, 0.94), and external fixation (utility, 0.93). The ORIF was the most expensive treatment (reimbursement, $3,516), whereas casting was the least expensive (reimbursement, $564). The incremental cost-utility ratio for ORIF, when compared to casting, was $15,330 per quality-adjusted life years, which is less than $50,000 per quality-adjusted life year, thereby indicating that, from the societal perspective, ORIF is considered a worthwhile alternative to casting.
There is a slight preference for the faster return to minimally restricted activity provided by ORIF. Overall, patients show little preference for one DRF treatment over another. Because Medicare patients pay similar out-of-pocket costs regardless of procedure, they are not particularly concerned with procedure costs. Considering the similar long-term outcomes, this study adds to the uncertainty surrounding the choice of DRF treatment in the elderly, further indicating the need for a high-powered, randomized trial.
The Journal of hand surgery 12/2011; 36(12):1912-8.e1-3. DOI:10.1016/j.jhsa.2011.09.039 · 1.67 Impact Factor
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