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Distal radius fractures (DRFs) are among the most commonly encountered types of fractures in clinical practice. Conventional treatment methods include surgical intervention and traditional small splint fixation following manual reduction based on Traditional Chinese Medicine (TCM). However, these conventional small splints do not adequately meet the current demands for personalized and precision medicine. To address this issue, this study proposes a novel personalized distal radius fixation splint utilizing 3D printing technology. Firstly, a customized splint model that conforms to the patient’s fracture surface is established through three-dimensional scanning of the fracture site. Subsequently, the Tyson polygon structure and Grasshopper software are employed to parameterize the hollowing-out process of the splint, resulting in a personalized splint with a three-dimensional hollow-out structure. During the static analysis of the 3D hollow splint model, forces of 100 N and 150 N were applied. Under a force of 100 N, the maximum deformation of the splint was measured at 0.52 mm with a maximum strain value of 0.02 mm/mm and a maximum equivalent stress level of 19.415 MPa. However, when subjected to a force of 150 N, the maximum deformation increased to 0.78 mm with a corresponding increase in maximum strain value to 0.03 mm/mm and an elevated maximum equivalent stress level measuring 29.122 MPa. Additionally, this study also examined the flexural strength and weight of the 3D-printed splint in comparison to the conventional small splint. The test results demonstrate that, under pressure of 150 N, the radial offset of the 3D printed splint is reduced by 1.7 mm compared to that of the traditional small splint, with a corresponding decrease in stress by 0.01 MPa as well. In terms of weight, a set of 3D printed splints weighs 89 g while a set of conventional splints weighs 102 g, resulting in a significant reduction of 13 g for the 3D printed splints compared to their traditional counterparts. These findings indicate clear advantages associated with utilizing 3D-printed splints in terms of minimizing offset and reducing overall weight.

Background Limited reference is available regarding surgical management in symptomatic ulnar styloid fractures with small bony avulsion. The study goal is to report the surgical outcomes using anchor suture fixation with comparison to traditional tension band wire fixation. Methods We retrospectively reviewed the medical records in patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2017. A total of 31 patients were enrolled including two kinds of fixation methods. Anchor suture fixation plus distal radioulnar joint pinning was performed in ten patients with tiny avulsion bony fragments (group A); tension band wire fixation was performed in 21 patients with big styloid fracture fragments (group B). Patient characteristics and 2-year treatment outcomes were compared between two groups based on Mayo Modified Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); visual analog scale (VAS), and surgical complication. Descriptive statistics were used for calculation of key variables; a p value of < 0.05 was considered statistically significant. Results Based on Gaulke classification, there were five subtypes in group A and three subtypes in group B. Incidence of concomitant distal radius fractures was significantly higher in group B; other patient characteristics including age, sex, injury side, and time to surgery showed no significant difference. Outcome assessment regarding MMWS, QuickDASH, and VAS was comparable between two groups. Bone-related complications including nonunion, DRUJ subluxation, and styloid resorption were analyzed; the difference was not significant. Incidence of implant-related complications including migration and secondary removal surgery was significantly higher in group B ( p = 0.021). Conclusion Surgical fixation in symptomatic ulnar styloid fractures yields comparable treatment outcomes in both fracture patterns. Implant-related complication with secondary removal surgery is more common in tension band wire group. Anchor suture fixation is a feasible option for tiny styloid avulsion fragments with limited surgical complication.

Background Rupture of extensor pollicis longus tendon (EPL) is a known complication following a distal radius fracture (DRF). Although the precise mechanisms behind these ruptures remain unclear, vascular impairment is thought to play a significant role. Additionally, the impact of an EPL rupture on microstructure of the tendon and muscle is not well understood, but such information could be important in guiding treatment strategies. This study aims to explore the histopathological changes in the EPL tendon and muscle in patients who have experienced an EPL rupture following a DRF. Methods Consecutive patients with an EPL rupture following a DRF were included and treated with an Extensor Indicis Proprius to EPL tendon transfer. Samples were taken from the distal part of EPL muscle and the proximal tendon from the musculotendinous junction to the rupture site as well as from the tendon distal to the rupture. The tendon specimens were analysed by standard histopathological techniques including immunohistochemistry. In cases of sufficient amount of muscle, fresh frozen specimens were analysed by enzyme- and immuno-histochemistry on cryostat sections. Results Thirteen patients (12 females, 1 male; median age 61, range 18–72 years) were included in the study. The EPL muscle in all participants showed extensive inflammatory changes, muscle fiber necrosis and regeneration, structural changes in the muscle fibers and slight interstitial fibrosis. The EPL tendon showed profound degenerative changes mainly in the central part of the tendon whereas there were regenerative changes in the periphery of the tendon. The pathological changes were present in all samples regardless of time between the DRF and the EPL rupture or the time between the diagnosis of the rupture and surgery. Conclusions The extensive inflammatory changes in the EPL muscle indicate that immune mediated mechanisms are involved in muscle degeneration following tendon rupture. The EPL tendon showed characteristic degenerative changes at the myotendinous junction, as well as proximally and distally to the rupture site. The reversibility and the clinical significance of the severe pathological changes seen in the EPL muscle alongside the healing potential of the tendon need further investigation. Trial registration Retrospectively registered the 2024–03-15 at Clinicaltrials.gov, ID: NCT06313489.

Purpose Ulnar styloid process (USP) fractures are present in 40–65% of all distal radius fractures (DRFs). USP base fractures can be associated with distal radioulnar joint (DRUJ) instability and ulnar sided wrist pain and are treated by conservative management and surgical fixation, without consensus. This systematic review and meta-analysis compares operative to non-operative treatment of concomitant ulnar styloid base fractures in patients with distal radius fractures. Methods PubMed/Medline/Embase/CENTRAL databases were searched identifying RCTs and comparative observational studies. Effect estimates were extracted and pooled using random effect models to account for heterogeneity across studies. Results were presented as (standardized) mean differences (SMD or MD) or odds ratios (OR) and corresponding 95% confidence intervals (95%CI). Results Two RCTs (161 patients) and three observational studies (175 patients) were included. Tension band wiring was used for surgically treated USP fractures. Results were comparable across the different study designs and hence pooled across studies. Non-surgically treated patients had better wrist function at 6 months (SMD 0.57, 95%CI 0.30; 0.90, I 2  = 0%). After 12 months there was no observed difference (MD 2.31, 95%CI −2.57; 7.19, I 2  = 91%). Fewer patients had USP non-unions in the operative group (OR 0.08, 95%CI 0.04; 0.18, I 2  = 0%). More patients suffered complications in the operative group (OR 14.3; 95%CI 1.08; 188, I 2  = 89%). Conclusion Routinely fixating USP base fractures as standard of care is not indicated. Surgery may be considered in selective cases (e.g. persistent DRUJ instability during ballottement test after fixation of the radius).

IntroductionThe aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters. Materials and methodsDorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up.Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients. OutcomeCharacteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27–212.86), p = 0.008], total [OR 0.16 (95% CI 0.04–0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05–0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02–0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures.ConclusionsIn conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.

SummaryIndividual trabecular segmentation was utilized to identify differences in trabecular bone structure in premenopausal women with wrist fractures and non-fracture controls. Fracture subjects had reduced trabecular plate volume, number, thickness, and connectivity. Identifying altered trabecular microarchitecture in young women offers opportunities for counseling and lifestyle modifications to reduce fracture risk.IntroductionPremenopausal women with distal radius fractures (DRF) have worse trabecular bone microarchitecture than non-fracture controls (CONT), yet the characteristics of their trabecular bone structure are unknown.MethodsPremenopausal women with DRF (n = 40) and CONT (n = 80) were recruited. Primary outcome variables included trabecular structure at the distal radius and tibia, assessed by volumetric decomposition of individual trabecular plates and rods from high-resolution peripheral quantitative CT images. Trabecular morphology included plate and rod number, volume, thickness, and connectivity. Areal bone mineral density (aBMD) of the femoral neck (FN aBMD), and ultradistal radius (UDR aBMD) were measured by DXA.ResultsTrabecular morphology differed between DRF and CONT at the radius and tibia (OR per SD decline 1.58–2.7). At the radius, associations remained significant when adjusting for age and FN aBMD (ORs = 1.76–3.26) and age and UDR aBMD (ORs = 1.72–3.97). Plate volume fraction, number and axially aligned trabeculae remained associated with DRF after adjustment for trabecular density (ORs = 2.55–2.85). Area under the curve (AUC) for discriminating DRF was 0.74 for the proportion of axially aligned trabeculae, compared with 0.60 for FN aBMD, 0.65 for UDR aBMD, and 0.69 for trabecular density. Plate number, plate-plate junction, and axial bone volume fraction remained associated with DRF at the tibia (ORs = 2.14–2.77) after adjusting for age, FN aBMD, or UDR aBMD. AUCP.P.Junc.D was 0.72 versus 0.61 for FNaBMD, 0.66 for UDRaBMD, and 0.70 for trabecular density.ConclusionPremenopausal women with DRF have lower trabecular plate volume, number, thickness, and connectivity than CONT. Identification of young women with altered microarchitecture offers opportunities for lifestyle modifications to reduce fracture risk.

Background : Distal radius fractures (DRFs) are a common orthopedic injury, with open reduction internal fixation (ORIF) and closed reduction percutaneous pinning (CRPP) being the two most frequently used methods for treating unstable DRFs. The optimal treatment approach for DRFs is still a matter of debate. Therefore, this retrospective analysis aimed to compare the functional and radiological outcomes of ORIF and CRPP to determine the most effective approach for treating unstable DRFs. Material and Methods : A total of 89 patients were included in this retrospective study; 34 underwent CRPP and 55 underwent ORIF (61 males and 28 females, mean age: 35.5). Radiographic measurements of radial inclination, radial height, and volar tilt, as well as patient-rated wrist evaluation (PRWE) scores for pain and function, were used to evaluate the functional and radiological outcomes during the final follow-up period, ranging from 1 to 4 years. Results : There were significant improvements in the radiographic measurements for both groups, indicating a good reduction. However, the two fixation methods had no significant difference in radiographic measurements during the entire follow-up period. Regarding PRWE scores, there was a significant difference between the two groups, with patients in the CRPP group reporting better wrist function and less pain. Conclusions : Both CRPP and ORIF are effective methods for treating unstable DRFs. Achieving an acceptable reduction did not correlate with better pain management, function, or the ability to carry out day-to-day activities. However, patients treated with CRPP had better wrist function and less pain during follow-up. Radiographic measurements did not differ significantly between the two groups. Clinicians should consider closed-reduction percutaneous pinning as a viable and effective treatment option for distal radius fractures, particularly when optimal wrist function and pain management are important considerations.

Background The role of surgical fixation of ulnar styloid fractures remains a subject of debate. The purpose of this study was to compare the surgical outcomes following early and late intervention. Methods We retrospectively reviewed 28 patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2014. Surgical fixation was performed within 3 months of injury in 13 patients (group A) and beyond 3 months in 15 patients (group B). Patient characteristics and functional outcomes were compared between the two groups. The outcome survey consisted of QuickDASH score, grip strength, range of motion, pain score based on the visual analog scale, and surgical complications. Descriptive statistics were calculated for key variables. A p value of < 0.01 was considered statistically significant. Results Patient characteristics including age, sex, injured side, dominant side injury, and concomitant distal radius fracture showed no significant differences between the two groups. Time to surgery averaged 1.1 months in group A and 12.3 months in group B. Significantly better outcomes were found in group A than in group B, including QuickDASH scores (4.4 ± 5.9 vs. 12.9 ± 9.9) and grip strength (37.4 ± 5.1 vs. 29.1 ± 5.9 kg). Significantly better range of motion was found in group A than in group B with respect to supination (81.9° ± 4.3° vs. 75° ± 8.5°), extension (84.6 ± 4.3 vs. 76.7 ± 6.5), and flexion (80.4° ± 3.8° vs. 72° ± 4.1°). The difference was not significant in case of pronation (78.8° ± 3° vs. 74.3° ± 5.9°) and with respect to pain scores (0.6 ± 0.7 vs. 1.3 ± 1). Conclusion Both osseous and soft tissue lesions need to be fully addressed in ulnar styloid fractures. Early detection and surgical repair yielded better outcomes. Higher complication rates in late-treated fractures show that surgeons should select surgical candidates and modalities properly.

This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field.

Background/Objectives: The treatment of periarticular distal radius fractures remains challenging. Different surgical treatment options have been proposed as alternatives to conservative treatment. This systematic review aims to compare the functional outcomes, radiological outcomes, and complications among volar locking plates (VLPs), Kirschner-wire fixations, and external fixations (EFs) for distal radius fractures in patients aged 60 years and older. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Science Direct databases assessing the effects of VLP, EF, and K-wire treatments for distal radius fractures in patients aged 60 years and over. The primary outcome was the evaluation of the range of motion (ROM) degrees after three surgical procedures, trying to assess the best treatment option. The secondary outcome included evaluation of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, quick-DASH score, Patient-Rated Wrist Evaluation (PRWE) score, Visual Analog Scale (VAS) score, grip strength, radiographic assessment, and complications comparing VLPs, EFs and K-wires. Results: A total of 23 studies were included, comparing VLP, EF, and K-wire fixation. The overall population comprised 5618 patients, with 4690 females and 1015 males, of which 4468 patients were treated with VLP, 503 with EF, and 647 with K-wire. The most common complications among the VLP group were complex regional pain syndrome (7.5%) and carpal tunnel syndrome (6.8%); for the EF group, infections (9.8%) and carpal tunnel syndrome (6.8%); and for the K-wire group, carpal tunnel syndrome (7.5%) and infections (6.9%). Conclusions: VLP showed better clinical outcomes in the first few months after treatment. However, these differences decreased over time and became similar after one year. EF and K-wire fixations remain easier to manage during surgery.