[Distal radius fractures : Current treatment concepts and controversies]

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

INTRODUCTION

Palmar plate fixation of the distal radius fracture involves dissecting the pronator quadratus (PQ). This is regardless of whether the approach is radial or ulnar to the flexor carpi radialis (FCR) tendon. It is not yet clear whether and to what extent this dissection leads to a functional loss of pronation or pronation strength. The aim of this study was to investigate the functional recovery of pronation and pronation strength after dissection of the PQ without suturing.

MATERIALS AND METHODS

From October 2010 to November 2011, patients aged over 65 with fracture were prospectively enrolled in this study. Fracture stabilisation was performed via the FCR approach without suturing the PQ. Follow-up examinations took place 8 weeks and 12 months postoperatively, and pronation and supination strength were analysed by means of an especially developed measuring device.

RESULTS

212 patients were initially screened and 107 were enrolled. The range of motion compared to the healthy opposite side was Ext/Flex 75/66% 8 weeks postoperatively. Pronation was 97% with a pronation strength of 59%. After 1 year, the scores improved to Ext/Flex 83/80%. Pronation recovered to 99% and pronation strength to 78%.

CONCLUSION

The present study can show a recovery of pronation as well as pronation strength in a large patient population. At the same time, the pronation strength is still significantly lower 1 year after the operation than on the opposing healthy side. As the pronation strength recovers as the grip strength and is at all times on a par with the supination strength, we believe that we can continue to refrain from re-fixating the pronator quadratus.

The effectiveness and safety of plaster splint and splints for distal radius fractures: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

To assess the efficacy and safety of plaster splint vs splints in the treatment of distal radius fractures (DRFs).

METHODS

For a more comprehensive collection of original study, we mainly searched 9 electronic databases including the PubMed, Web of Science, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials.gov, the Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and VIP Database. The retrieval date of all databases is from the establishment to January 2019. In the aspect of assessing the quality of original research methodology, we mainly rely on the Cochrane risk bias assessment tool and GRADE assessment method. Revman 5.3 is used for statistical analysis.

RESULTS

A total of 8 studies involving 717 participants were included. The results showed that effective rate (RR = 0.99, 95%CI 0.91 to 1.07, P = .83), reduction rate (RR = 1.00, 95%CI 0.93 to 1.07, P = .98), and complication rate of the plaster splint had no significant difference with the splint. In addition, for the excellent rate of treatment, subgroup analysis based on the included studies found that when the intervention period was 4 weeks, the plaster splint was better than the splint, and when the intervention period was more than 4 weeks, there was no significant difference between them.

CONCLUSIONS

There is no sufficient evidence that plaster splint is superior to splint. However, according to current evidence, plaster splint is more effective than splint when the intervention period is shorter (4 weeks), and its advantage disappears when the intervention period is longer (> 4 weeks). It should be noted that the results of this study were influenced by the sample size and the quality of the included studies. More high-quality and well-controlled RCTs are needed to draw better conclusions in further study.