Effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mineral density, muscle mass, and exercise capacity for postmenopausal women with distal radius fractures.

BACKGROUND: Distal radius fractures are often the first fractures experienced by adults with osteoporosis, and such fractures provide an opportunity for treatment to prevent a domino effect of future fractures. Most of these fractures result from falls, which may be related to the individual's limb muscle mass, strength, and exercise capacity. Active vitamin D3 positively affects muscle and bone mass. However, the effect of a bone resorption inhibitor is unknown. This study aimed to determine the effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mass, limb muscle mass, and exercise capacity of osteoporotic patients with distal radius fractures and to identify the preventive effects against future fractures. METHODS: Participants were postmenopausal women(n = 99) with distal radius fractures who visited the orthopedics outpatient department in a city general hospital from April 2015 to October 2017. Bone mass, limb muscle mass, skeletal muscle mass index, and muscle strength (grip strength and quadriceps muscle strength), walking speed, 2-step results, and timed up and go tests results were evaluated before and after 1 year of treatment. The instances of fall recurrence and refracture were investigated using a questionnaire. RESULTS: Eighty-five patients completed follow-up assessments for 1 year. After treatment, bone mass and bone mineral density were significantly improved in the lumbar spine and total proximal femur compared to before treatment. Furthermore, skeletal muscle mass index, grip strength on the unaffected side, quadriceps muscle strength, walking speed and 2-step test results after 1 year of treatment were significantly improved. Nineteen and 4 patients experienced fall recurrence and refracture, respectively. CONCLUSIONS: Eldecalcitol alone or a bone resorption inhibitor with eldecalcitol improved bone mass and bone mineral density, and maintained skeletal muscle mass index, muscle strength, and exercise capacity of osteoporotic patients with distal radius fractures.

Comparison of Functional Outcome Between Early and Delayed Internal Fixation Using Volar Locking Plate for Distal Radius Fractures.

The purpose of this study was to assess the effect of timing (Early (E) group vs Delayed (D) group) of internal fixation for distal radius fractures on forearm and wrist function in patients who underwent the surgery. The subjects were one hundred six patients who had extra-articular fractures of the dorsally displaced distal radius and were treated with a volar locking plate. The subjects were divided into two groups: E group (Operation on the day of injury or the next day, n = 76 ; and the D group (Operation at 7 days after injury or later, n = 30). Follow-up examinations conducted at 4, 12, and 48 weeks after surgery included measurements of wrist and forearm ranges of motion (ROM), measurement of grip strength (GS), Disability of the Arm, Shoulder and Hand score (DASH), and complications, retrospectively. The patients in both groups improved significantly with respect to ROM, GS, and DASH. At 4 weeks, the patients in the E group had better forearm motion, At 4 and 12 weeks, those who had undergone early surgery had significantly better wrist motion, GS and DASH. At 48 weeks, there were no differences between the groups in ROM, GS, or DASH. Patients with dorsally displaced extra-articular fractures of the distal radius can expect to have better short-term outcomes with early treatment, open reduction and internal fixation using a volar locking plates.

Extensor pollicis longus tendon ruptures after the use of volar locking plates for distal radius fractures.

Currently, volar locking plates are commonly used to treat distal radius fractures (DRF) because of their stable biomechanical construct and because they cause less soft tissue disturbance and allow early mobilisation of the wrist. Complications such as rupture of tendons have been reported to occur with use of volar locking plates. We describe six cases of rupture of extensor pollicis longus (EPL) tendons after the use of volar locking plates. EPL tendon injuries occurred in 2.1% (6/286) of cases after DRF surgery. The causes of EPL rupture after DRF surgery were protrusion of the head tip and insufficient reduction of the dorsal roof fragment of the distal radius. These were considered iatrogenic problems. The cause of EPL rupture was unknown in three cases. We should be extremely careful when determining optimum screw length and reducing displaced dorsal roof fragments to prevent damaging the EPL tendons.

Treatment with or without internal fixation for ulnar styloid base fractures accompanied by distal radius fractures fixed with volar locking plate.

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis.

OBJECTIVES: The purpose of this study was to compare the postoperative radiologic and clinical outcomes of conventional plate osteosynthesis (C) with minimally invasive plate osteosynthesis (M) using a transverse skin incision without cutting the pronator quadratus muscle for distal radius fractures. DESIGN: Retrospective consecutive cohort with prospective data collection. SETTING: One community teaching hospital. Surgical treatment was performed by a single surgeon. PATIENTS: Sixty-six patients (C group, 36; M group, 30) underwent open reduction and internal fixation of dorsally displaced distal radius fractures with the volar locking plating system from June 2006 to August 2008. Their mean age was 63.5 years and the mean follow-up period was 22.7 months. MAIN OUTCOME MEASURES: Radiologic parameters (volar tilt, radial inclination, ulnar variance), range of motion, grip strength, and Disability of the Arm, Shoulder, and Hand score were evaluated at each examination. The visual analog scale of wrist pain and evaluations of cosmetic problems were assessed at the final follow-up. RESULTS: The groups did not differ significantly in all main outcomes. In the M group, the mean values of the Disability of the Arm, Shoulder, and Hand score at 2 weeks postoperatively (P = 0.06) and visual analog scale (P = 0.07) were lower and the mean value of the patient's satisfaction score of cosmetic problems (P = 0.08) was higher than those in the C group, but no statistically significant differences were apparent in these values. CONCLUSION: No significant differences were found between the minimally invasive plate osteosynthesis and conventional plating for distal radius fractures based on the data from postoperative radiologic and clinical outcomes.

A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating.

PURPOSE: To compare the clinical and radiological outcomes of intrafocal pinning (IFP) and volar locking plating (VLP) of dorsally angulated, unstable distal radius fractures in elderly patients. METHODS: The subjects were 62 consecutive patients over 60 years of age with dorsally angulated, unstable distal radius fractures treated with IFP or VLP. Bone mineral density (BMD) of the lumbar spine was measured by dual-energy x-ray absorptiometry at first examination. The range of motion and grip strength were measured at follow-up examinations, and ulnar variance (UV) was measured on radiographs at baseline and follow-up postoperative examinations. RESULTS: There were no notable differences in gender, age, follow-up period, baseline UV, BMD, and AO classification between IFP and VLP groups. There was no difference between the UV in VLP immediately after surgery and at the final follow-up examination; however, IFP showed a significant loss of reduction as measured by UV. In patients with UV more than 5 mm or BMD less than 70% of young adult mean (YAM) at first examination, UV increased again at the final follow-up examination in IFP, while surgically corrected UV was maintained in VLP, independent of the degree of baseline UV and BMD. VLP resulted in earlier recovery of postoperative range of motion and grip strength compared with IFP. The range of flexion and the grip strength value were significantly larger in VLP at final examination. CONCLUSIONS: VLP, but not IFP, can maintain surgically corrected UV in distal radius fractures, independent of the degrees of initial UV and BMD. VLP enhances earlier recovery in range of motion and grip strength than IFP. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.