Der Unfallchirurg
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Fractures of the distal radius in elderly patients increasingly contribute to the workload in emergency departments worldwide. There is still no consensus about the best treatment option, e. g. closed reduction and cast stabilization, percutaneous pinning, external fixation or open reduction and internal fixation with volar locking plates (ORIF). In addition, the influence of pharmacological antiosteoporotic treatment (e. g. bisphosphonates) is unclear. ⋯ A clinical or statistical advantage of ORIF over conservative treatment with respect to DASH scores 12 months after the index fracture event could not be demonstrated with a mean difference of 0.25 (95 % confidence interval CI -0.57-1.07). According to current best scientific evidence from preclinical and clinical investigations, antiosteoporotic medication does not have an unfavorable influence on fracture healing and should be continued due to its proven effectiveness in reducing subsequent osteoporotic fractures. Following distal radius fractures in elderly patients with clinical risk factors, an osteoporosis screening should be routine practice and a specific therapy should be initiated if the fracture risk is increased.
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The operative treatment of unstable distal radius fractures primarily aims for the anatomical reduction of the joint while addressing accompanying injuries. Anatomical reduction, stable fixation and early functional movement of the joint are the three cornerstones of modern treatment concepts of distal radius fractures. ⋯ The biomechanical aspects, anatomical findings and clinical evaluation that have influenced current design features and trends in new developments of the latest plates are emphasized. This is an ongoing process that is supported through the investigation and feedback of clinical science.
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The article "Evidence based medicine: what it is and what it isn't" published in the BMJ in 1996, is regarded as the foundation of the evidence-based medicine (EbM) movement. Approximately 5 years later David L. ⋯ Clinical and methodological developments during recent years have, however, overtaken the original principles of EbM. This review highlights the core concepts of EbM which have remained unchanged and valid for the current practice of trauma and orthopedic surgery and where revision is needed.
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The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. ⋯ Among the types of apparatus used for diagnostics, 3‑phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.