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Distal Radius Kırığı Nedeniyle Konservatif Tedavi Edilen Yaşlı Hastalarda Radyolojik Parametrelerin Değerlendirilmesi

Year 2021, Volume , Issue 15, 468 - 481, 31.12.2021
https://doi.org/10.38079/igusabder.1003090

Abstract

Amaç: Radius distal kırıkları yaşlı popülasyonda en sık görülen kırıklardan biridir. Bu çalışmada, radius distal kırıkları nedeniyle konservatif tedavi edilen hastalarda radyolojik parametrelerdeki değişiklikleri kırık tiplerine ve yaş gruplarına göre değerlendirmeyi amaçladık.
Yöntem: 10 Ocak 2015 ile Ocak 2019 tarihleri arasında distal radius kırığı nedeniyle konservatif tedavi alan hastalar geriye dönük olarak tarandı. Hastaların kırıkları Arbeitsgemeinschaft für Osteosynthesefragen (AO) sınıflamasına göre gruplandı ve hastalar 75 yaş altı ve 75 yaş üstü olarak iki gruba ayrıldı. Hastaların kırık redüksiyonu sonrası ve tedavi sonundaki ulnar varyans, radyal eğim ve volar tilt değerleri incelenerek birbirleriyle karşılaştırıldı.
Bulgular: Çalışmada 232 hastanın el bileği radyografileri değerlendirildi. AO sınıflamasına göre 151 hastada tip A (A2:144, A3:7), 46 hastada tip B (B1:6, B2:33, B3:7) ve 35 hastada tip C (C1:21, C2:10, C3:4) kırıklar vardı. 75 yaş altı grupta 134 hasta varken, 75 yaş üstü hasta grubunda 98 hasta vardı. Radyolojik parametreler (AO tip C kırıklarda volar tilt hariç) tedavi sonrası ilk değerlendirmeye göre kırık tipi ve yaştan bağımsız olarak bozuldu.
Sonuç: Radius distal kırıkları nedeniyle konservatif tedavi edilen hastaların redüksiyon kalitesinin bozulabileceği, kabul edilen radyolojik parametrelerin kötüleşebileceği akılda tutulmalıdır. Yaşlı hastalarda bu parametrelerdeki bozulma cinsiyet, ulnar kırık varlığı ve kırık sınıflandırmasından bağımsızdır.

References

  • Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012. doi:10.1016/j.hcl.2012.02.001.
  • MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016. doi:10.1016/j.jht.2016.03.003.
  • Cummings SR, Blacks DM, Rubin SM. Lifetime risks of hip, colles’, or vertebral fracture and coronary heart disease among white postmenopausasl women. Arch Intern Med. 1989. doi:10.1001/archinte.149.11.2445.
  • Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: Nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009. doi:10.1097/BOT.0b013e31819b24e9.
  • Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Jt Surg - Ser A. 2011. doi:10.2106/JBJS.J.01597.
  • Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg Am. 2010. doi:10.1016/j.jhsa.2010.01.028.
  • Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: A prospective randomized controlled trial. J Hand Surg Eur Vol. 2010. doi:10.1177/1753193409339941.
  • Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: Operative compared with nonoperative treatment. J Bone Jt Surg - Ser A. 2010. doi:10.2106/JBJS.I.00968.
  • Lutz K, Yeoh KM, Macdermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am. 2014. doi:10.1016/j.jhsa.2014.04.018.
  • Chan YH, Foo TL, Yeo CJ, Chew WYC. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg. 2014. doi:10.1142/S021881041450004X.
  • Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003. doi:10.1002/14651858.cd000314.
  • Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2009. doi:10.1002/14651858.cd003209.pub2.
  • Chang HC, Tay SC, Chan BK, Low CO. Conservative treatment of redisplaced colles’ fractures in elderly patients older than 60 years old - anatomical and functional outcome. Hand Surg. 2001. doi:10.1142/S0218810401000606.
  • Anzarut A, Johnson JA, Rowe BH, Lambert RGW, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am. 2004. doi:10.1016/j.jhsa.2004.07.002.
  • Cooney WP, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles’ fractures. J Bone Jt Surg - Ser A. 1979. doi:10.2106/00004623-197961060-00006.
  • Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg - Ser A. 1986. doi:10.2106/00004623-198668050-00003.
  • Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. In: Osteoporosis International. 2005. doi:10.1007/s00198-004-1808-x.
  • Abe Y, Doi K, Kuwata N, Yamamoto H, Sunago K, Kawai S. Surgical options for distal radial fractures: Indications and limitations. Arch Orthop Trauma Surg. 1998. doi:10.1007/s004020050227.
  • Markiewitz AD, Gellman H. Five-pin external fixation and early range of motion for distal radius fractures. Orthop Clin North Am. 2001. doi:10.1016/S0030-5898(05)70253-4.
  • Rogachefsky RA, Lipson SR, Applegate B, Ouellette EA, Savenor AM, McAuliffe JA. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Jt Surg - Ser A. 2001. doi:10.2106/00004623-200104000-00005.
  • Blakeney WG. Stabilization and treatment of colles’ fractures in elderly patients. Clin Interv Aging. 2010. doi:10.2147/cia.s10042.
  • Dias JJ, Wray CC, Jones JM, Gregg PJ. The value of early mobilisation in the treatment of colles’ fractures. J Bone Jt Surg - Ser B. 1987;69(3):463-467. doi:10.1302/0301-620x.69b3.3584203.
  • Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208-210. doi:10.1016/0020-1383(89)90113-7.
  • Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of “elderly.” Geriatr Gerontol Int. 2006. doi:10.1111/j.1447-0594.2006.00341.x.
  • Leone J, Bhandari M, Adili A, McKenzie S, Moro JK, Dunlop RB. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg. 2004. doi:10.1007/s00402-003-0597-6.
  • Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury. 2002. doi:10.1016/S0020-1383(01)00174-7.
  • Tsukazaki T, Takagi K, Iwasaki K. Poor correlation between functional results and radiographic findings in colles’ fracture. J Hand Surg Am. 1993. doi:10.1016/0266-7681(93)90010-D.
  • Cai L, Zhu S, Du S, et al. The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients. Orthop Traumatol Surg Res. 2015. doi:10.1016/j.otsr.2015.04.011.
  • Wada T, Tsuji H, Iba K, Aoki M, Yamashita T. Simultaneous radial closing wedge and ulnar shortening osteotomy for distal radius malunion. Tech Hand Up Extrem Surg. 2005. doi:10.1097/01.bth.0000190817.89156.a2.

Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture

Year 2021, Volume , Issue 15, 468 - 481, 31.12.2021
https://doi.org/10.38079/igusabder.1003090

Abstract

Aim: Distal radius fractures are one of the most common fractures in the elderly population. In this study, we aimed to evaluate the changes in radiological parameters in patients treated conservatively for distal radius fractures according to fracture types and age groups.
Methods: Patients who received conservative treatment for distal radius fractures between 10 January 2015 and January 2019 were retrospectively screened. Fractures of the patients were divided according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, and the patients were divided into two groups as under 75 years old and over 75 years old. Ulnar variance, radial inclination, and volar tilt values of the patients after fracture reduction and at the end of the treatment were examined and compared with each other.
Results: Wrist radiographs of 232 patients were evaluated in the study. According to the AO classification, 151 patients had type A (A2:144, A3:7), 46 patients had type B (B1:6, B2:33, B3:7), and 35 patients had type C (C1:21, C2:10, C3:4) fractures. While there were 134 patients in the group under 75 years old, there were 98 patients in the patient group over 75 years old. Radiological parameters (except volar tilt in AO type C fractures) were found to be impaired according to the initial evaluation after treatment, regardless of the fracture type and age.
Conclusion: It should be kept in mind that patients treated conservatively for distal radius fractures may impair the reduction quality of the patients, the accepted radiological parameters may deteriorate. In elderly patients, the deterioration in these parameters was independent of gender, the presence of ulnar fractures, and fracture classification. 

References

  • Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012. doi:10.1016/j.hcl.2012.02.001.
  • MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016. doi:10.1016/j.jht.2016.03.003.
  • Cummings SR, Blacks DM, Rubin SM. Lifetime risks of hip, colles’, or vertebral fracture and coronary heart disease among white postmenopausasl women. Arch Intern Med. 1989. doi:10.1001/archinte.149.11.2445.
  • Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: Nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009. doi:10.1097/BOT.0b013e31819b24e9.
  • Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Jt Surg - Ser A. 2011. doi:10.2106/JBJS.J.01597.
  • Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg Am. 2010. doi:10.1016/j.jhsa.2010.01.028.
  • Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: A prospective randomized controlled trial. J Hand Surg Eur Vol. 2010. doi:10.1177/1753193409339941.
  • Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: Operative compared with nonoperative treatment. J Bone Jt Surg - Ser A. 2010. doi:10.2106/JBJS.I.00968.
  • Lutz K, Yeoh KM, Macdermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am. 2014. doi:10.1016/j.jhsa.2014.04.018.
  • Chan YH, Foo TL, Yeo CJ, Chew WYC. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg. 2014. doi:10.1142/S021881041450004X.
  • Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003. doi:10.1002/14651858.cd000314.
  • Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2009. doi:10.1002/14651858.cd003209.pub2.
  • Chang HC, Tay SC, Chan BK, Low CO. Conservative treatment of redisplaced colles’ fractures in elderly patients older than 60 years old - anatomical and functional outcome. Hand Surg. 2001. doi:10.1142/S0218810401000606.
  • Anzarut A, Johnson JA, Rowe BH, Lambert RGW, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am. 2004. doi:10.1016/j.jhsa.2004.07.002.
  • Cooney WP, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles’ fractures. J Bone Jt Surg - Ser A. 1979. doi:10.2106/00004623-197961060-00006.
  • Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg - Ser A. 1986. doi:10.2106/00004623-198668050-00003.
  • Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. In: Osteoporosis International. 2005. doi:10.1007/s00198-004-1808-x.
  • Abe Y, Doi K, Kuwata N, Yamamoto H, Sunago K, Kawai S. Surgical options for distal radial fractures: Indications and limitations. Arch Orthop Trauma Surg. 1998. doi:10.1007/s004020050227.
  • Markiewitz AD, Gellman H. Five-pin external fixation and early range of motion for distal radius fractures. Orthop Clin North Am. 2001. doi:10.1016/S0030-5898(05)70253-4.
  • Rogachefsky RA, Lipson SR, Applegate B, Ouellette EA, Savenor AM, McAuliffe JA. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation. J Bone Jt Surg - Ser A. 2001. doi:10.2106/00004623-200104000-00005.
  • Blakeney WG. Stabilization and treatment of colles’ fractures in elderly patients. Clin Interv Aging. 2010. doi:10.2147/cia.s10042.
  • Dias JJ, Wray CC, Jones JM, Gregg PJ. The value of early mobilisation in the treatment of colles’ fractures. J Bone Jt Surg - Ser B. 1987;69(3):463-467. doi:10.1302/0301-620x.69b3.3584203.
  • Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208-210. doi:10.1016/0020-1383(89)90113-7.
  • Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of “elderly.” Geriatr Gerontol Int. 2006. doi:10.1111/j.1447-0594.2006.00341.x.
  • Leone J, Bhandari M, Adili A, McKenzie S, Moro JK, Dunlop RB. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg. 2004. doi:10.1007/s00402-003-0597-6.
  • Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury. 2002. doi:10.1016/S0020-1383(01)00174-7.
  • Tsukazaki T, Takagi K, Iwasaki K. Poor correlation between functional results and radiographic findings in colles’ fracture. J Hand Surg Am. 1993. doi:10.1016/0266-7681(93)90010-D.
  • Cai L, Zhu S, Du S, et al. The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients. Orthop Traumatol Surg Res. 2015. doi:10.1016/j.otsr.2015.04.011.
  • Wada T, Tsuji H, Iba K, Aoki M, Yamashita T. Simultaneous radial closing wedge and ulnar shortening osteotomy for distal radius malunion. Tech Hand Up Extrem Surg. 2005. doi:10.1097/01.bth.0000190817.89156.a2.

Details

Primary Language English
Subjects Medicine
Journal Section Articles
Authors

Anıl AGAR (Primary Author)
Saglik Bilimleri University, Kanuni Sultan Suleyman training and research hospital, Orthopaedic and Traumatology Department
0000-0003-2344-7801
Türkiye


Orhan GÜNEŞ
Saglik Bilimleri University, Kanuni Sultan Suleyman training and research hospital, Orthopaedic and Traumatology Department
0000-0001-6166-1118
Türkiye


Adem ŞAHİN
Saglik Bilimleri University, Kanuni Sultan Suleyman training and research hospital, Orthopaedic and Traumatology Department
0000-0002-4020-9488
Türkiye


Bülent KILIÇ
Saglik Bilimleri University, Kanuni Sultan Suleyman training and research hospital, Orthopaedic and Traumatology Department
0000-0001-8101-804X
Türkiye


Cemil ERTÜRK
Saglik Bilimleri University, Kanuni Sultan Suleyman training and research hospital, Orthopaedic and Traumatology Department
0000-0002-9225-917X
Türkiye


Deniz GÜLABİ
Saglik Bilimleri University, Kanuni Sultan Suleyman training and research hospital, Orthopaedic and Traumatology Department
0000-0002-4131-7536
Türkiye

Publication Date December 31, 2021
Published in Issue Year 2021, Volume , Issue 15

Cite

Bibtex @research article { igusabder1003090, journal = {İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi}, issn = {2536-4499}, eissn = {2602-2605}, address = {İstanbul Gelişim Üniversitesi Sağlık Bilimleri Yüksekokulu - Cihangir Mah. Şehit Jandarma Komando Er Hakan Öner Sk. No: 1 Avcılar / İstanbul / Türkiye}, publisher = {İstanbul Gelisim University}, year = {2021}, volume = {}, pages = {468 - 481}, doi = {10.38079/igusabder.1003090}, title = {Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture}, key = {cite}, author = {Agar, Anıl and Güneş, Orhan and Şahin, Adem and Kılıç, Bülent and Ertürk, Cemil and Gülabi, Deniz} }
APA Agar, A. , Güneş, O. , Şahin, A. , Kılıç, B. , Ertürk, C. & Gülabi, D. (2021). Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture . İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi , (15) , 468-481 . DOI: 10.38079/igusabder.1003090
MLA Agar, A. , Güneş, O. , Şahin, A. , Kılıç, B. , Ertürk, C. , Gülabi, D. "Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture" . İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi (2021 ): 468-481 <https://dergipark.org.tr/en/pub/igusabder/issue/66537/1003090>
Chicago Agar, A. , Güneş, O. , Şahin, A. , Kılıç, B. , Ertürk, C. , Gülabi, D. "Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture". İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi (2021 ): 468-481
RIS TY - JOUR T1 - Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture AU - Anıl Agar , Orhan Güneş , Adem Şahin , Bülent Kılıç , Cemil Ertürk , Deniz Gülabi Y1 - 2021 PY - 2021 N1 - doi: 10.38079/igusabder.1003090 DO - 10.38079/igusabder.1003090 T2 - İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi JF - Journal JO - JOR SP - 468 EP - 481 VL - IS - 15 SN - 2536-4499-2602-2605 M3 - doi: 10.38079/igusabder.1003090 UR - https://doi.org/10.38079/igusabder.1003090 Y2 - 2021 ER -
EndNote %0 Istanbul Gelisim University Journal of Health Sciences Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture %A Anıl Agar , Orhan Güneş , Adem Şahin , Bülent Kılıç , Cemil Ertürk , Deniz Gülabi %T Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture %D 2021 %J İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi %P 2536-4499-2602-2605 %V %N 15 %R doi: 10.38079/igusabder.1003090 %U 10.38079/igusabder.1003090
ISNAD Agar, Anıl , Güneş, Orhan , Şahin, Adem , Kılıç, Bülent , Ertürk, Cemil , Gülabi, Deniz . "Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture". İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi / 15 (December 2021): 468-481 . https://doi.org/10.38079/igusabder.1003090
AMA Agar A. , Güneş O. , Şahin A. , Kılıç B. , Ertürk C. , Gülabi D. Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture. IGUSABDER. 2021; (15): 468-481.
Vancouver Agar A. , Güneş O. , Şahin A. , Kılıç B. , Ertürk C. , Gülabi D. Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi. 2021; (15): 468-481.
IEEE A. Agar , O. Güneş , A. Şahin , B. Kılıç , C. Ertürk and D. Gülabi , "Evaluation of Radiological Parameters in Elderly Patients Treated Conservatively for Distal Radius Fracture", İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, no. 15, pp. 468-481, Dec. 2021, doi:10.38079/igusabder.1003090

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