Objectives. Patient-reported outcome measures (PROMs) are often used to evaluate the outcome of treatment in patients with distal radial fractures. Which PROM to select is often based on assessment of measurement properties, such as validity and reliability. Measurement properties are assessed in clinimetric studies, and results are often reviewed without considering the methodological quality of these studies. Our aim was to systematically review the methodological quality of clinimetric studies that evaluated measurement properties of PROMs used in patients with distal radial fractures, and to make recommendations for the selection of PROMs based on the level of evidence of each individual measurement property. Methods. A systematic literature search was performed in PubMed, EMbase, CINAHL and PsycINFO databases to identify relevant clinimetric studies. Two reviewers independently assessed the methodological quality of the studies on measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Level of evidence (strong / moderate / limited / lacking) for each measurement property per PROM was determined by combining the methodological quality and the results of the different clinimetric studies. Results. In all, 19 out of 1508 identified unique studies were included, in which 12 PROMs were rated. The Patient-rated wrist evaluation (PRWE) and the Disabilities of Arm, Shoulder and Hand questionnaire (DASH) were evaluated on most measurement properties. The evidence for the PRWE is moderate that its reliability, validity (content and hypothesis testing), and responsiveness are good. The evidence is limited that its internal consistency and cross-cultural validity are good, and its measurement error is acceptable. There is no evidence for its structural and criterion validity. The evidence for the DASH is moderate that its responsiveness is good. The evidence is limited that its reliability and the validity on hypothesis testing are good. There is no evidence for the other measurement properties. Conclusion. According to this systematic review, there is, at best, moderate evidence that the responsiveness of the PRWE and DASH are good, as are the reliability and validity of the PRWE. We recommend these PROMs in clinical studies in patients with distal radial fractures; however, more clinimetric studies of higher methodological quality are needed to adequately determine the other measurement properties. Cite this article: Dr Y. V. Kleinlugtenbelt. Are validated outcome measures used in distal radial fractures truly valid?: A critical assessment using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Bone Joint Res 2016;5:153–161. DOI: 10.1302/2046-3758.54.2000462

Objectives. The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF). Methods. The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach’s α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity. Results. A total of 119 patients (mean age 58 years (. sd. 15)), 74% female, completed PROMs at a mean time of six months (. sd. 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach’s α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires. Conclusion. The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice. Cite this article: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 2018;7:36–45. DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1

Distal radial fractures are amongst the most common trauma referrals, however controversy remains regarding their optimum management. We undertook a retrospective review of the management of distal radial fractures in our department. The prospectively maintained trauma database was used to identify patients admitted for operative management of a dorsally displaced distal radial fracture between June 2008 and June 2009. Only extra-articular or simple intra-articular fractures were included (AO classification A2/A3/C1/C2). Operation notes were reviewed to determine the method of fixation. Patients were contacted by post and asked to complete a functional outcome score - Disabilities of the Arm, Shoulder and Hand (DASH). A further 12 patients with similar fractures who had been managed conservatively were also asked to complete a DASH score to provide a comparison between operative and non-operative management. 98 patients were identified - 67 female, 31 male. Mean age was 51 years, range 15-85 years. All patients were at least 1 year post-op. 26 patients had manipulation under anaesthesia (MUA). 48 patients had MUA and K-wire fixation, which was supplemented with synthetic bone substitute in 16 cases. 3 patients had MUA and bone graft and 21 patients had open reduction and internal fixation (ORIF) with a volar plate. 34 correctly completed DASH scores were returned. A lower score equates to a better functional outcome. Mean DASH scores were: MUA 14.8; MUA+K-wire 13.1; ORIF 13.6; conservative 47.1. This data would indicate that patients with a significantly displaced distal radial fracture have a better functional outcome with operative management to improve the fracture alignment. However, all of the methods of fixation used resulted in similar functional outcomes at one year

Introduction. The distal radius is the most frequently fractured bone in the forearm with an annual fracture incidence in the UK of about 9–37 in 10,000. Restoration of normal anatomy is an important factor that dictates the final functional outcome. A number of operative options are available, including Kirschner wiring, bridging or non-bridging external fixation and open reduction and internal fixation by means of dorsal, radial or volar plates. We designed this study to analyse the clinical and radiological outcome of distal radial fracture fixation using volar plating. Materials/Methods. Thirty-seven patients with distal radius fractures undergoing open reduction and internal fixation using volar plates were included. Tilt of the fractured distal radial fragment was recorded from the initial radiograph and classification of fractures was done using the Orthopaedic Trauma Association system. The QuickDASH questionnaire was used for evaluation of symptomatic and functional outcome six months to one year after surgery. The radiological outcome was assessed using measurements of radial inclination, ulnar variance and volar tilt. Of the thirty-seven patients, 13 were male and 24 were female. The mean age was 55.6 years (range 18–87 years). According to the AO classification, there were 8 cases each of C2 and C3 fractures, 6 cases of C1 fractures and 3 cases each of class A2, A3, B1 and B3 fractures. There were 2 patients with class B2 fracture. Results. Post-operatively, the average restoration of volar tilt was 6.47 degrees (range −12.4 to 20.3 degrees). Mean restoration of radial inclination was 23 degrees (range 12.5 to 30.0 degrees). Ulnar variance on average was 0.09 mm (range −5.0–6.7mm). The mean QuickDASH score was 9.8. Conclusion. The results of this study indicate that fixation of displaced intra- and extra-articular distal radial fractures is achieved satisfactorily with restoration of both normal anatomy and function using volar plates

Older fracture patients frequently ask whether their osteoporosis will affect fracture healing. There is only limited previous data about this. We investigated recovery after distal radial fracture, and compared it with BMD of the other distal radius and the lumbar spine (measured using quantitative CT). All 28 patients had sustained a dorsally displaced distal radial fracture which was deemed to require treatment by intrafocal wire fixation. All patients had acceptable correction of dorsal and radial angle at final x ray (3 months). Wrist function was measured using the Patient Rated Wrist Evaluation (PRWE – a validated outcome measure for use after distal radial fractures), grip strength,and range of motion. All measurements were made at 6, 12 and 26 weeks. BMD was measured in the opposite wrist and the lumbar spine using QCT at 6 weeks after fracture. There was no correlation between recovery of grip strength (% of contralateral grip strength) at 6,12,or 26 weeks with BMD at either site. Similarly, there was no correlation between BMD and either absolute PRWE scores at any time point or improvement in PRWE between time points. The strongest predictor of recovery of grip appeared to be the proportion of grip recovered at 6 weeks (correlation between% grip recovered at 6 weeks and 3 months r = 0.85; at 6 weeks and 6 months r= 0.56; both p < 0.001). This was not affected by age or variations in measured final dorsal or radial angles or length within this group. It was not affected by degree of preoperative fracture displacement. These data suggest that recovery of function after distal radial fractures is not influenced by osteoporosis. The data about the importance of initial recovery of grip suggest that factors other than bone position and bone healing may affect rate of functional recovery after distal radial fracture

Purpose. Distal metaphyseal radial fractures are common in the paediatric population and the management of these fractures is controversial. The incidence of re-displacement in the closed management of these fractures is as much as 30% in some studies. Various methods have been described with the view to predict fracture displacement of distal radial fractures in children. One of these indices is the three point index (TPI). This index seeks to assess the adequacy of 3 point moulding and thus predict fracture displacement. It is a calculated ratio that if above 0.8 states that there is an increased risk of fracture re-displacement. The purpose of this study is to assess the accuracy of this index in predicting displacement of distal radial fractures in children. Methods. This retrospective study included 65 patients of both sexes under the age of 13 for a period of one year from January 2011 to January 2012. All patients with a dorsally displaced fracture of the distal radius were included. 22 patients were excluded because of loss to follow-up or absence of a complete series of x-rays. All patients were taken to theatre for a general anaesthetic and manipulation of their fractures using an image intensifier to confirm reduction. X-rays of initial fracture displacement, post manipulation position and follow-up fracture position at 2 and 6 weeks were assessed. The sensitivity, specificity, negative and positive predictive values of the TPI in screening for fracture re-displacement were calculated. Results. Of the 43 patients included in the study, 93% of patients had an anatomical reduction in theatre with an average TPI of 1. Nineteen patients suffered significant displacement from 2 to 6 weeks postoperatively. We found that the TPI in our study had a sensitivity of 84%, a specificity of 37%, a negative predictive value of 75% and a positive predictive value of 51%. Conclusion. We found the TPI to be a useful screening tool of later displacement for the closed management of distal metaphyseal radius fractures. NO DISCLOSURES

Distal radial fractures represent 17% of fractures in the Italian E.R. In the last years many different techniques accompanied the traditional treatment of closed reduction and cast immobilization such as closed reduction + pinning + cast, “epi-block” fixation, ORIF with dorsal and/or volar plates, screws and external fixation. These techniques are mostly followed by a period of immobilization with cast which is optional in A.O. type A fractures and is usually necessary in type B and C fractures. At the University Hospital “Policlinico Umberto I” of Rome E.R. we have started treating these fractures with a new fixation system which we projected. This system provides a non-bridging external fixation. The synthesis is guaranteed by two or more K-wires which can be intramedullary or x-crossing the cortex and/or inter-fragmentary. These K-wires are connected with two radial pins by an external bar. This radial to radial system gives stability to the fracture and allows the patient to move the wrist immediately. We remove this fixation system after 40 days. From July 2008 to August 2009 we treated 56 distal radial fractures. Clinical assessment was performed every seven days until removal of external fixation system, then at 2, 3, 6 and 12 months. Radiographic assessment was performed at 30 and 40 days, consequently at 2, 3, 6 and 12 months. Outcome was measured on the basis of range of motion, grip and pinch strength, DASH and PRWE scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was carried out. All patients had excellent or good results and were satisfied with the clinical outcome. At 60 days after surgery 90% of patients demonstrated complete clinical and functional recovery. After 3 months 100% of patients demonstrated complete clinical and functional recovery. After 6 months and 12 months no modification of the obtained result was detected

Aims: To detect discriminant features in the cyclic kinematic patterns generated during selected upper limb activities of daily living by a normative and a distal radial fracture group, so as to reduce the multidimensionality of the kinematic analysis. Methods: Cyclic activities of daily living were performed using a protocol that allowed comparison between the resulting kinematic patterns or waveforms. Twop groups were measured:. Group A: 11 subjects with normal hand function (average age: 31.5ys, SD: 8.7ys). Group B: 5 subjects having undergone treatment for distal radial fracture was tested using the same methods (average age: 34.2ys, SD: 16.8ys). Task presented here, (one of 5) performed by turning a key 90 degrees clockwise. Principal component analysis (PCA) was applied to the waveforms of group A, using the procedure illustrated by Deluzio et al.,1997 for use with walking gait patterns. A 90% trace criterion was used to calculate the number of principal components (PCs) to retain. Results: Looking at elbow pronation/supination (PS). Two PCs were retained. The first component consisted of a simple pronation pattern. The opposite signs of Y1 differentiated left-hand users (utmost right), who required pronation to rotate the key, from right-hand ones, who required supination, with the exception of subject 3 group B. The second component consisted of pronation (cycle first half) followed by supination (second half). Subject 3 stood out because of limited elbow supination, which resulted from the combination of pronation (Y1) and supination (Y2) components. Conclusions: Upper limb analysis can employ the statistic tools of gait analysis provided a cyclic and repeatable protocol is used. PCA was applied to elbow PS to identify statistically different movements of the distal radial fracture group and underline their main characteristics. This is particularly important in the presence of a large data group, when the identification and evaluation processes need to be both rapid and accurate. Limited PS was identified as a discriminant feature, supporting the follow-up studies for this injury that measured a reduction of PS by about 80% compared to that of the unaffected side. The cycle stages concerned can be identified on the basis of the contribution given by each component

To ascertain the optimum number, thickness and configuration of K-wires needed to prevent displacement of distal radial fractures. Synthetic and cadaver bones were used. A transverse osteotomy was performed 1. 5 cm proximal to the articular surface of the distal radius. Different numbers and configurations of 1. 1mm or 1. 6mm K-wires were used to hold the bone reduced. Dorsoradial and distraction forces were applied using a tensiometer. The endpoint was a displacement of 3mm at the osteotomy site. We demonstrated a statistically significant increase in the force required to displace the osteotomy site a) when using thicker wires and b) when using three crossed wires compared with two wires either crossed or parallel. When balancing ease of insertion with maximum stability, we would recommend two parallel 1. 6mm wires inserted through the radial styloid process, with 1 wire inserted from the dorsoulnar corner of the radius crossing at approximately 90 degrees. All wires should pass into the opposite cortex. This configuration resisted forces of over 300 Newtons and there was little benefit in using additional wires

Advancements in treating complications of operatively treated distal radius fractures. We will review tips and tricks to avoid complications associated with operative fixation of these complicated injuries. We will cover treatment of the distal radioulnar joint, associated distal ulna fracture, complications of malreduction and implant prominence. During this session, we will review the latest techniques for treating these complex distal radius fractures and how to avoid associated complications.

The aim of this study was to identify psychosocial factors associated with pain intensity and disability following distal radius fracture (DRF).

We prospectively followed up 216 adult patients with DRF for 9 months. Demographics, injury and treatment details and psychological measures (Hospital Anxiety and Depression Score (HADS), Pain Catastrophising Scale (PCS), Post Traumatic Stress Disorder Checklist – Civilian (PCL-C), Tampa Scale for Kinesiophobia (TSK), Illness Perception Questionnaire Brief (IPQB), General Self-efficacy Scale (GSES) and Recovery Locus of Control (RLOC)) were collected at enrolment. Multivariable linear regression was used to identify factors associated with DASH and Likert pain score.

Ten week DASH was associated with age (β-coefficient (β)= 0.3, p < 0.001), deprivation score (β=0.2, p = 0.014), nerve injury (β=0.1, p = 0.014), HADS depression (β=0.2, p = 0.008), IPQB (β=0.2, p = 0.001) and RLOC (β= −0.1, p = 0.031). Nine month DASH was associated with age (β=0.1, p = 0.04), deprivation score (β=0.4, p = 0.014), number of medical comorbidities (β=0.1, p = 0.034), radial shortening (β=0.1, p = 0.035), HADS depression (β=0.2, p = 0.015) and RLOC (β= −0.1, p = 0.027). Ten week pain score was associated with deprivation score (β=0.1, p = 0.049) and IPQB (β=0.3, p < 0.001). Pain score at 9 months was associated with number of medical comorbidities (β=0.1, p = 0.047).

Psychosocial factors are more strongly associated with pain and disability than injury or treatment characteristics after DRF. Identifying and treating these factors could enhance recovery.

Long term outcomes of distal radius fractures have rarely been studied prospectively and do not traditionally extend past 1–2 years following treatment. The purpose of this study was to describe the long term patient-rated pain and disability of patients after a distal radius fracture and to also determine the differences in patient reported pain and disability after one year following injury and at the long term follow-up.

Patients who had previously participated in a prospective study, where baseline and standardised one year follow-up were performed following a distal radius fracture were contact to participate in this long term follow-up (LTFU) study. Eligible cases that consented agreed to evaluation which included being sent a package in the mail contain a letter of information and questionnaire. Baseline demographic data including age and sex, as well as date of fracture, mechanism of fall and attending physician information was obtained for all participating subjects. Patient rated pain and disability was measured at baseline, one year and at long-term follow-up using the Patient Rated Wrist Evaluation (PRWE). Patients were categorised as having had a worse outcome (compared to one year follow-up PRWE scores) if their LTFU PRWE score increased by 5 points, having no change in status (if their score changed by four or less points) or improved if their LTFU PRWE score decreased by 5 or more points.

Sixty-five patients (17 male, 48 female) with an average age of 57 years at the time of injury and 67 years at follow-up were included in the study. The mean length of follow-up was 10.7 (± 5.8) years (range: 3–19 years). Overall, 85% of patients reported having no change or had less patient-reported pain and disability (PRWE) at their long-term follow-up compared to their one year PRWE scores. As well, one year PRWE scores were found to be predictive (20.2%) of the variability in long term PRWE score (p=0.001).

This study provided data on a cohort of prospectively followed patients with a distal radius fracture, approximately 10 years after injury. This data may be useful to clinicians and therapists who are interested in determining the long term effects of this frequently occurring upper extremity fracture. The results of this study indicate that after 10 years following a distal radius fracture, 85% of patients will have good outcomes. The results of this study also indicate that majority of cases, if patients have a low amount of pain and disability at one year, then these outcomes will also be true approximately 10 years later.

Objectives

Current studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons’ agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called ‘spectrum bias’, defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius.

Aims. The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups. Methods. A prospectively registered (ISRCTN95922938) randomized parallel group trial will be conducted. Elderly patients meeting the inclusion criteria with a dorsally displaced distal radius facture will be randomized (1:1 ratio) to either conservative management (cast without further manipulation) or surgery. Patients will be assessed at six, 12, 26 weeks, and 52 weeks post intervention. The primary outcome measure and endpoint will be the Patient-Rated Wrist Evaluation (PRWE) at 52 weeks. In addition, the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH), EuroQol five-dimension questionnaire, pain score (visual analogue scale 1 to 10), complications, grip strength (dynamometer), range of motion (goniometer), and radiological assessments will be undertaken. A cost-utility analysis will be performed to assess the cost-effectiveness of surgery. We aim to recruit 89 subjects per arm (total sample size 178). Discussion. The results of this study will help guide treatment of dorsally displaced distal radial fractures in the elderly and assess whether surgery offers functional benefit to patients. This is an important finding, as the number of elderly distal radial fractures is estimated to increase in the future due to the ageing population. Evidence-based management strategies are therefore required to ensure the best outcome for the patient and to optimize the use of increasingly scarce healthcare resources. Cite this article: Bone Jt Open 2024;5(10):920–928

Aims. It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer fracture redisplacements and better one-year outcomes compared to plaster splinting. Methods. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure. Results. The study included 420 patients. There was no significant difference between the rate of redisplacement of the fracture between the groups: 47% (n = 88) for those treated with a plaster splint and 49% (n = 90) for those treated with a circumferential cast (odds ratio 1.05 (95% confidence interval (CI) 0.65 to 1.70); p = 0.854). Patients treated in a plaster splint reported significantly more pain than those treated with a circumferential cast, during the first week of treatment (estimated mean NRS 4.7 (95% CI 4.3 to 5.1) vs 4.1 (95% CI 3.7 to 4.4); p = 0.014). The rate of complaints relating to the cast, clinical outcomes and PROMs did not differ significantly between the groups (p > 0.05). Compartment syndrome did not occur. Conclusion. Circumferential casting did not result in a significantly different rate of redisplacement of the fracture compared with the use of a plaster splint. There were comparable outcomes in both groups. Cite this article: Bone Joint J 2024;106-B(7):696–704

The relationship between advancing patient age, decreasing bone mineral density and increasing distal radial fracture incidence is well established. Biomechanical and clinical work has shown that the radiographic severity of distal radial fractures is greater in patients with poor bone quality. Between 1991 and 2007, the number of elderly Scots (aged 75 years or more) increased by 18%, and population projections predict a further 82% increase by 2035. This study was conducted to investigate the effect of recent changes in the demographics of our population on the pattern and radiographic severity of distal radial fractures encountered at our institution. The epidemiology of two distinct series of patients (1991–93; 2007–08) suffering distal radial fractures was compared. The patient and radiographic fracture characteristics known to be predictive of fracture instability and severity were compared using the MacKenney formulae, and a subgroup analysis of distal radial fragility fractures was performed. The life expectancy of our catchment population has improved since 1991, and we have encountered a larger number of distal radial fractures occurring in older, more active and functionally independent patients. We identified an increase in the proportion of AO type B fractures, particularly in the oldest patient groups. The radiographic severity of distal radial fractures, especially low energy metaphyseal injuries, has increased. If the current trend in population demographics continues, it seems likely that orthopaedic surgeons will encounter an increasing number of severe distal radial fractures deemed unsuitable for treatment by closed methods

The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized controlled trial (RCT) and to study patterns of change between subspecialties and nationalities. Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year. Of the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, 6 of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle. The majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference

Displaced distal radial fractures in adults are commonplace. Acknowledging that satisfactory radiographic parameters typically will beget satisfactory functional outcomes, management of these fractures includes a reduction followed by either cast/splint immobilisation or internal fixation. While we can generally rely on internal fixation to maintain the reduction the same is not true of cast immobilisation. There are, however, limited data defining the fate of a fracture reduction in those treated in a cast and up to the time of radial union. Traditional practice is to recommend six weeks of immobilisation. Our goal was to detail the radiographic patterns of change in the radiographic parameters of radial inclination (RI), ulnar variance (UV) and radial tilt (RT) over the first twelve weeks in women fifty years old and older who had sustained a displaced distal radial fracture. We examined serial standard PA and lateral distal radius radiographs of 647 women treated by closed reduction and casting for a displaced fracture of the distal radius. Measurements of RI, UV and RT from standardised radiographs were made immediately post-reduction as well as, as often as possible/feasible, at 1,2,3,6,9 and 12 weeks post fracture. All measurements were made by the senior author (accuracy range: 2 degrees for RI, 1 mm for UV and 4 degrees for RT, in 75% of cases). The primary outcome measure was the change in fracture position over time. Secondary outcomes included changes related to age group; known bone density; the relation to associated ulnar fractures; and independence of the variables of RI, UV and RT. The mean immediate post-reduction values for RI, UV and RT were 21 degrees, 1.5 mm, and −6 degrees, respectively. These all changed in the first six weeks, and did not in the second six week period. The mean change in RI was 3 degrees, 60% of the change occurring in the first week post-reduction; only 0.3 degrees of change was noted beyond three weeks. The mean UV increased by 2.2 mm over the first 6 weeks, 23% in the first week post reduction. The mean RT change of 7.7 degrees was also gradual over the first 6 weeks, with no significant change afterwards. The RI changes identified were not influenced by patient age, while UV and RT changes were greater in older groups. Those fractures of the distal radius associated with a distal ulnar shaft or neck fracture did not lose radial inclination over the study period. We have defined patterns of loss of reduction that commonly occur post reduction of a displaced distal radius fracture in women fifty years and older. Such patterns ought to guide our closed management of distal radial fractures, whether by altering the duration or method of casting. Women fifty years old and older, and physicians alike, must be advised that conventional casting post distal radial fracture reduction unreliably maintains fracture reduction

Aims. The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities. Methods. Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year. Results. Of the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, six of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle. Conclusion. The majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference. Cite this article: Bone Joint Open 2020;1-9:549–555

Despite the variety of implants or techniques that exist to treat displaced distal radial fractures, the majority fail to provide sufficient stability to permit early functional recovery. However, locking plates have the advantage over other implants in that locking screws add considerably to the overall stability. The aim of this study was to assess the functional outcome of patients with displaced distal radial fractures treated with a volar distal radial locking plate (Synthes). During a two year period, details of 98 patients admitted to our unit with inherently unstable dorsally displaced distal radial fractures treated with volar locking plates were collected prospectively. For the purpose of this analysis, only those patients (55) with unilateral fracture, able to attend the study clinic at 6 months post-injury were considered. Patients were immobilised in wool and crepe for a 2 week period. The group consisted of 15 males and 40 females with an average age of 54 (28 to 83). At 6 months, patients' perceived functional recovery averaged 80%. Objective assessment was considered in relation to the uninjured side: grip strength 73%; pinch strength 83%; palmarflexion 77%, dorsiflexion 80%; radial deviation 74%; ulnar deviation 74%; pronation 93%, and supination 92%. Seven patients complained of symptoms relating to prominent metalwork. Good/excellent early subjective and objective functional recovery was made following open reduction and internal fixation using volar locking plates of dorsally displaced distal radial fractures. We suggest that objective assessment of grip strength and dorsiflexion can be used as a measure of patient perception of function