Distal end radius fractures： evaluation of results of various treatments and assessment of treatment choice

Objective：The rapid expansion of knowledge regarding the functional anatomy of hand and wrist,increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner.The purpose of our study was to evaluate the difference in patients function among those treated by 1） closed reduction and Plaster of Paris cast,2） distractor application,or 3） open reduction and internal fixation with a volar plate,and to assess the treatment choice for each particular fracture type.Methods：A prospective study was carried out on 60 patients with fractures of the distal end radius.Fractures were classified according to the AO classification into type A （extra-articular）,type B （partial articular） and type C （complete articular）.After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years.Results：Anatomical results were evaluated according to the Sarmiento＇s modification of Lindstrom Criteria,which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique.Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification,which was revealed to relate with the type of treatment techniques.Conclusion：There is no customized solution for all the fractures of the distal radius.The choice of treatment should be based on the fracture type,the patient＇s characteristics,the patient＇s demands and the treating surgeon＇s experience and preference.

Robert Jones bandage versus cast in the treatment of distal radius fracture in children:A randomized controlled trial

Purpose:The present study aimed to treat fractures of the distal end of the radius in children with Robert Jones(RJ)bandage.The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence,child comfortability,and family satisfaction.Methods:The study was a randomized controlled non-inferiority clinical trial including children with recent(less than 5 days)fractures at the distal end of the radius OTA/AO 23-A2,which is usually treated conservatively.Those with open fractures,pathological fracture,severely displaced fracture that needs reduction or multiple injuries were excluded.The participants were divided randomly into 2 groups according to the treatment modalities.Group 1 was treated by plaster of Paris cast(the control group).and Group 2 by modified RJ bandage(the trial group).The difference between the 2 groups was found by the Chi-squared test.The difference was considered statistically significant when the p value was less than 0.05.Results:There were 150 children(aged 2-12 years,any gender)included in the study,75 in each group.The complications occured in 5(3.3%)cases only,pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2.There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment(p=0.649).Children treated by RJ bandages were more comfortable than those treated by the cast(97.3%vs.73.3%,p<0.001)with a statistically significant difference between them.Contrary to that,the families were more satisfied with the cast than RJ bandage(88.0%vs.81.3%),but without a statistically significant difference(p=0.257).Conclusion:RJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.