Treatment of Distal Radial Fractures in Adults [Internet]

Excerpt

The most frequent type of fracture in Norway is the fracture of the distal radius, with an incidence of approximately 15,000 per year. Various treatment alternatives exist, but it remains uncertain which patients should be treated surgically, and which methods are best suited. As a result, there is a relatively large variation in practice in Norway.

In this report, we have summarized the evidence on treatment and rehabilitation of distal radial fractures from the most recent available systematic reviews of high quality. Main findings are as follows:

1. There is not enough evidence to decide which method of reduction is best.

2. There is some evidence to support the use of percutaneous pinning, however the best methods of percutaneous pinning are not established.

3. There is some evidence to support the use of external fixation compared to plaster cast. Though there is insufficient evidence to confirm a better functional outcome, external fixation reduces the incidence of redisplacement, gives better anatomical results, and most of the surgically related complications are minor.

4. There is insufficient evidence to determine the relative effects of the various methods of external fixation.

5. Bone scaffolding (bone transplantation or use of bone substitutes) may improve anatomical outcome compared with plaster cast alone, but there is insufficient evidence to conclude on functional outcome or complications. The same applies for other comparisons between different bone scaffolding methods.

6. There is some evidence that supports the use of rehabilitation interventions for patients with distal radius fractures. However, the evidence did not allow us to calculate the relative effect of different rehabilitation methods.

The evidence base for the management of distal radius fracture is limited. Further research should therefore be preceeded by agreement on the priority questions for the management of these fractures, and to be addressed through large multi-centre trials.

Keywords: Wrist Injuries; Radius Fractures; Adult; Therapeutics; Distal radial fracture; wrist fracture.