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Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain.

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Objective: This study evaluated sociodemographic and radiographic features of patients with distal radial fractures treated at a trauma hospital in southern Brazil, comparing those treated by hand surgery specialists (group 1) and non-specialists (group 2). Methods: This study consists of a retrospective cohort of 200 patients treated in 2020. After reviewing medical records and radiographs, the following parameters were analyzed: age, gender, trauma mechanism, laterality, associated comorbidities and fractures, fracture classification (AO), radial height, radial inclination, and volar inclination. Comparison of the two groups used the Student t-test, chi-square test, or Fisher exact test. Results: Most subjects were women (54%), sustained low-energy traumas (58%), and were left-handed (53%). Group 1 had a lower mean age (50.2 years); most of their subjects sustained high-energy trauma (54%) and had type C fractures (73%); type A fractures prevailed in group 2 (72%). Radiographs showed a significant difference regarding the mean radial inclination (21.5° in group 1 and 16.5° in group 2 [ p < 0.001] in women, and 21.3° in group 1 and 17° in group 2 [ p < 0.001] in men) and volar inclination (10.1° and 12.8° in groups 1 and 2, respectively [ p < 0.001]). In addition, the absolute number of cases with reestablished anatomical parameters per the three evaluated variables was also significantly different; all parameters were better in group 1. Conclusion: Hand surgeons treated the most severe fractures and had the best radiographic outcomes.

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Abstract Objective: This study evaluated sociodemographic and radiographic features of patients with distal radial fractures treated at a trauma hospital in southern Brazil, comparing those treated by hand surgery specialists (group 1) and non-specialists (group 2). Methods: This study consists of a retrospective cohort of 200 patients treated in 2020. After reviewing medical records and radiographs, the following parameters were analyzed: age, gender, trauma mechanism, laterality, associated comorbidities and fractures, fracture classification (AO), radial height, radial inclination, and volar inclination. Comparison of the two groups used the Student t-test, chi-square test, or Fisher exact test. Results: Most subjects were women (54%), sustained low-energy traumas (58%), and were left-handed (53%). Group 1 had a lower mean age (50.2 years); most of their subjects sustained high-energy trauma (54%) and had type C fractures (73%); type A fractures prevailed in group 2 (72%). Radiographs showed a significant difference regarding the mean radial inclination (21.5° in group 1 and 16.5° in group 2 [p < 0.001] in women, and 21.3° in group 1 and 17° in group 2 [p < 0.001] in men) and volar inclination (10.1° and 12.8° in groups 1 and 2, respectively [p < 0.001]). In addition, the absolute number of cases with reestablished anatomical parameters per the three evaluated variables was also significantly different; all parameters were better in group 1. Conclusion: Hand surgeons treated the most severe fractures and had the best radiographic outcomes.

Resumo Objetivo: Avaliar as características sociodemográficas e radiográficas dos pacientes com fratura de rádio distal tratados em um hospital de trauma no sul do Brasil, comparando os casos tratados pelos especialistas em cirurgia da mão (grupo 1) com aqueles tratados por não especialistas (grupo 2). Métodos: Coorte retrospectiva realizada com 200 pacientes, no ano de 2020. Por meio da revisão de prontuários e radiografias, analisaram-se: idade, sexo, mecanismo de trauma, lateralidade, presença de comorbidades e fraturas associadas, classificação da fratura (AO), altura radial, inclinação radial e, inclinação volar. Comparou-se os dois grupos por meio do teste t de Student, qui-quadrado ou exato de Fisher. Resultados: A maioria era de pacientes do sexo feminino (54%), traumas de baixa energia (58%) e lateralidade esquerda (53%). O grupo 1 apresentou média de idade menor (50,2 anos), traumas de alta energia (54%), e fraturas tipo C (73%), enquanto no grupo 2 fraturas tipo A prevaleceram (72%). As radiografias apresentaram diferença significativa quanto à média de valores de inclinação radial (21,5° no grupo 1 e 16,5° no grupo 2 [p < 0,001] nas mulheres e, 21,3° no grupo 1 e 17° no grupo 2 [p < 0,001] nos homens) e inclinação volar (10,1° e 12,8° no grupo 1 e 2, respectivamente [p < 0,001]), bem como no número absoluto de casos que reestabeleceram os parâmetros anatômicos nas três variáveis avaliadas, sendo todos melhores no grupo 1. Conclusão: Os cirurgiões de mão trataram as fraturas mais graves e apresentaram os melhores resultados radiográficos.

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Abstract Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain.

Resumo Objetivo Avaliar os resultados epidemiológicos e funcionais dos pacientes que apresentaram fraturas concomitantes do rádio distal e do escafoide e foram tratados em um único centro especializado em cirurgia da mão, através de instrumentos validados para analisar os desfechos funcionais desses pacientes. Métodos Foram avaliados os pacientes com diagnóstico de fratura do rádio distal e escafoide tratados de janeiro de 2011 até dezembro de 2021, através dos questionários Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE) e Escala Visual Analógica da dor (EVA); goniometria; consolidação radiográfica; complicações em seis meses de pós-operatório. Resultados Vinte e três pacientes foram incluídos no estudo, sendo 73,9% homens e 26,1% mulheres; 56,5% das fraturas ocorreram à direita e 43,5% à esquerda. A maioria das fraturas do rádio distal foi tratada com placa volar bloqueada, totalizando 56%. Na avaliação funcional pelo PRWE, obteve-se média de 35,9 pontos (variação de 14 a 71 pontos) e pelo DASH média de 37,8 pontos (variação de 12 a 78 pontos). A EVA apresentou uma média de 2,33 durante a atividade (variação de 0,6 a 6,2). Conclusão Verificou-se que as fraturas do rádio distal associadas a fraturas do escafoide foram causadas por traumas de alta energia, com o sexo masculino mais acometido. Houve baixo índice de complicações com tratamento cirúrgico e os pacientes tiveram evolução funcional satisfatória, com baixo índice de dor.

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Introducción: La fractura de radio distal resulta común en la extremidad superior y representa un reto terapéutico. Objetivo: Determinar la concordancia entre radiografía simple y tomografía computarizada con respecto a las clasificaciones AO Foundation y de Fernández, y la elección del tratamiento. Métodos: Se realizó un estudio de concordancia diagnóstica entre radiografía simple y tomografía computarizada. Ortopedistas y cirujanos de mano analizaron 19 imágenes de fracturas de radio distal de acuerdo con las clasificaciones AO Foundation y de Fernández, y las distintas opciones de tratamiento. Para el grado de concordancia se usó el coeficiente Kappa de Fleiss. La prueba de t-Student y Chi cuadrado diferenciaron los grupos para variables cuantitativas y cualitativas, respectivamente. Hubo una significancia estadística de p= 0,05. Resultados: La clasificación de Fernández coincidió mejor que la clasificación AO Foundation entre radiografía y tomografía computarizada. En la elección del tratamiento y la técnica de osteosíntesis la concordancia fue mayor al 90 por ciento, mientras que el abordaje quirúrgico solo alcanzó el 50 por ciento. La clasificación AO Foundation radiográfica se correspondió con fracturas complejas, mientras la de Fernández con las menos complicadas. Las fracturas se subestimaron cuando se clasificaron con radiografía. Conclusiones: La relación de las clasificaciones entre radiografía y tomografía computarizada para fracturas de radio distal no resulta satisfactoria. La tomografía computarizada ofrece información que modifica las decisiones en el tratamiento(AU)

Introduction: Distal radius fracture is common in the upper extremity and represents a therapeutic challenge. Objective: To determine the agreement between simple radiography and computed tomography with respect to AO Foundation and Fernández classifications, and the choice of treatment. Methods: A diagnostic agreement study was carried out between simple radiography and computed tomography. Orthopedists and hand surgeons analyzed 19 images of distal radius fractures according to AO Foundation and Fernández classifications, and the different treatment options. Fleiss Kappa coefficient was used for the degree of agreement. The Student's t-test and chi-square differentiated the groups for quantitative and qualitative variables, respectively. There was a statistical significance of p = 0.05. Results: Fernández classification coincided better than AO Foundation between radiography and computed tomography. In the choice of treatment and osteosynthesis technique, agreement was greater than 90 percent, while the surgical approach only reached 50 percent. The radiographic AO Foundation classification corresponded to complex fractures while Fernández classification corresponded to less complicated ones. Fractures were underestimated when classified with radiography. Conclusions: The relationship of classifications between radiography and computed tomography for distal radius fractures is not satisfactory. Computed tomography provides information that modifies treatment decisions(AU)

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Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

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Objectives: Describe the frequency and types of outcomes in randomized clinical trials (RCT) of intervention for distal radius fractures, analyze how confusing outcome presentations can lead to misinterpretations, and suggest strategies to improve the reader's understanding of the decision-making process. Methods: A retrospective study was conducted through a systematized search on the PubMed® database in the last 10 years, in which only intervention RCT was included for distal radius fractures, and outcomes were analyzed. Results: Of the primary outcomes analyzed in the 75 selected articles, 46.6% were classified as clinical outcomes, 20% as surrogate, 30.6% as composite, 1.3% as complex scales, and 1.3% as safety outcomes. 34.7% of the articles did not report adverse events. Conclusion: The presentation of outcomes with little clinical relevance represented more than half of the sample (53.4%) - such studies can harm the reader since they confuse the interpretation of scientific evidence; the Core Outcome Measures in Effectiveness Trials (COMET) initiative could help health professionals in understanding and selecting the most appropriate therapeutic interventions for patients. Level of Evidence III; Retrospective comparative study .

Objetivos: Descrever a frequência e os tipos de desfechos em ensaios clínicos randomizados (RCT) de intervenção para fraturas distais do rádio, analisar como apresentações confusas de desfechos podem levar a interpretações equivocadas e sugerir estratégias para melhorar a compreensão do leitor sobre o processo de tomada de decisão. Métodos: Foi realizado estudo retrospectivo mediante busca sistematizada na base de dados PubMed® nos últimos 10 anos, na qual foram incluídos apenas RCT de intervenção para fraturas do segmento distal do rádio, cujos desfechos foram analisados. Resultados: Dos desfechos primários analisados nos 75 artigos selecionados, 46,6% foram classificados como desfechos clínicos, 20% como substitutos, 30,6% como compostos, 1,3% como escalas complexas e em 1,3% como desfechos de segurança. 34,7% dos artigos não reportaram eventos adversos. Conclusão: A apresentação de desfechos com pouca relevância clínica representou mais da metade da amostra (53,4%) - tais estudos podem prejudicar o leitor, uma vez que confundem a interpretação das evidências científicas; a iniciativa Core Outcome Measures in Effectiveness Trials (COMET) auxilia os profissionais de saúde na compreensão e seleção das intervenções terapêuticas mais adequadas para os pacientes. Nível de Evidência III; Estudo retrospectivo comparativo .

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Introducción: el músculo pronador cuadrado funciona como un estabilizador dinámico de la articulación radiocubital distal. Su reparación posterior a la fijación interna con placa de bloqueo volar en fracturas distales del radio es controvertida. Objetivo: determinar si la reparación del músculo pronador cuadrado influye en los resultados clínicos y funcionales de pacientes con fractura de radio distal que se sometieron a reducción abierta y fijación interna con placa de bloqueo volar. Materiales y métodos: se realizó una revisión sistemática y metanálisis. Las bases de datos analizadas fueron PubMed/Medline, Embase y Bireme/Lilacs (búsqueda realizada hasta el 20 de febrero del año 2023). Los términos de búsqueda fueron: distal radius fracture AND volar plate AND pronator quadratus. Se determinó la calidad metodológica según el manual de revisiones Cochrane. Resultados: en total se incluyeron 4 ensayos clínicos aleatorizados de adecuada calidad metodológica, lo cual corresponde al análisis de 213 participantes. Existen mejores resultados en la puntuación DASH a los 12 meses de seguimiento en el grupo de no reparación del músculo pronador cuadrado DM 2,8 [IC 95%: 0,51;5,10]. No hubo diferencias significativas al año de seguimiento en las puntuaciones de dolor, rangos de movilidad de la muñeca, fuerza de agarre e incidencia de complicaciones. Conclusión: no existe evidencia que sustente la reparación rutinaria del músculo pronador cuadrado posterior a la fijación interna con placa de bloqueo volar en las fracturas de radio distal. (AU)

Introduction: the pronator quadratus muscle functions as a dynamic stabilizer of the distal radioulnar joint, and its repair after internal fixation with volar locking plate in distal radius fractures is controversial. Objective: to determine whether the repair of the pronator quadratus muscle influences the clinical and functional outcomes of patients with distal radius fracture who underwent open reduction and internal fixation with volar locking plate. Materials and methods: a systematic review and meta-analysis were conducted. The analyzed databases were Pubmed/Medline, Embase, and Bireme/Lilacs (search performed until February 20th, 2023). The search terms were distal radius fracture AND volar plate AND pronator quadratus. Methodological quality was determined according to the Cochrane Reviewer's Handbook. Results: a total of 4 randomized clinical trials of adequate methodological quality, corresponding to the analysis of 213 participants, were included. Better DASH scores were observed at 12 months of follow-up in the non-repair group of the pronator quadratus muscle, with a mean difference of 2.8 [95% CI 0.51; 5.10]. There were no significant differences at one-year follow-up in pain scores, wrist mobility ranges, grip strength, and incidence of complications. Conclusion: there is no evidence to support routine repair of the pronator quadratus muscle after internal fixation with volar locking plate in distal radius fractures. (AU)

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Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

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PURPOSE: This study aimed to analyze baseline predictors of functional outcomes six weeks and at one year follow-up in patients older than 60 years with complex regional pain syndrome type 1 (CRPS I) after distal radius fracture (DRF). METHODS: A total of 120 patients with CRPS I after DRF were prospectively recruited. Presumptive relevant factors were collected and analyzed as potential baseline predictors. Additionally, functional outcomes were assessed at the beginning of physiotherapy treatment, at six weeks after finishing physiotherapy treatment, and at one year follow-up. Patient-Rated Wrist Evaluation; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; Jamar dynamometer; and visual analog scale (VAS) were assessed. RESULTS: All participants completed the study. At 6 weeks, the main results showed an association of lower values of grip strength with female sex (p = 0.010), intra-articular DRFs (p = 0.030), longer immobilization time (p = 0.040), lower levels of physical activity (p < 0.001), higher levels of kinesiophobia (p = 0.010), and anxiety (p = 0.020). At 1-year follow-up, the results showed an association of lower values of DASH with higher BMI (p < 0.001) and longer immobilization time (p < 0.001); and higher values of VAS showed an association with older age (p = 0.010), higher BMI (p = 0.010), and lower levels of physical activity (p = 0.040). CONCLUSION: At six weeks, factors such as BMI, immobilization time, physical activity, and kinesiophobia are associated with lower functional outcomes. Additionally, at one year follow-up, BMI, immobilization time, and physical activity continue to be associated with lower functional outcomes in patients with CRPS I after DRF treated conservatively.

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