Blue Book on the Management of Distal Radial Fractures

British Society for Surgery of the Hand publishes its Blue Book on the Management of Distal Radial Fractures


UHCW Consultant Orthopaedic Surgeon Helen Hedley and Electronic Systems & Resources Librarian Helga Perry contributed to this publication.


Obtain the full document at: http://www.bssh.ac.uk/_userfiles/pages/files/professionals/Radius/Blue%20Book%20DRF%20Final%20Document.pdf

Distal Humeral Fractures-Current Concepts

The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M3) 1353-1363

Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.

This review discusses the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we discuss controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.

UHCW Research: James C. Beazley, Njalalle Baraza, Robert Jordan and Chetan S. Modi

Common Paediatric Elbow Injuries

The Open Orthopaedics Journal, 11(Sup 8, M6) p1380-1393. DOI: 10.2174/1874325001711011380

Paediatric elbow injuries account for a large proportion of childrens’ fractures. Knowledge of common injuries is essential to understanding their assessment and correct management. Understanding of the ossification centres around the paediatric elbow is essential to correctly assessing and managing the common injuries that we have discussed in the review. Outcomes after these injuries are usually favourable with restoration of normal anatomy.

UHCW Research: Christopher E. Hill, Stephen Cooke

Diagnosis of displaced scaphoid fractures

Chapter in book Scaphoid fractures: evidence-based management.

UHCW Research: Kanai Garala

Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial.

JAMA. 2017 Nov 14;318(18):1767-1776. doi: 10.1001/jama.2017.16429

Among patients 16 years or older with an acute, displaced, extra-articular fracture of the distal tibia, neither nail fixation nor locking plate fixation resulted in superior disability status at 6 months. Other factors may need to be considered in deciding the optimal approach.

UHCW Research: Costa, M. L.

Complications in Distal Radius Fracture Fixation: A Comparative Case Series

Medical Case Reports, 3(3:21) 2017 DOI: 10.21767/2471-8041.100056

Aim was to compare the complication rate for 471 distal radius fracture treated with either the synthes two column plate or the DePuy distal volar radius plate (DVR) for fixation of distal radius fractures.

UHCW Research: Rory Norris and Andrew Mahon

NHS RightCare pathway: falls and fragility fractures

The latest NHS RightCare pathway on falls and fragility fractures pathway has been developed in collaboration with the national clinical director for musculoskeletal services, Public Health England (PHE), National Osteoporosis Society and a range of other stakeholders from across the health and care system. The pathway defines the key interlocking components for an optimal system for prevention and management, and the priority higher value interventions that systems should focus on to address variation, improve outcomes, reduce cost and contribute toward a sustainable NHS.

Hip fracture care still improving, but two in five patients still not receiving best practice care

The National Hip Fracture Database's (NHFD's) ninth annual report shows that while more patients are receiving early surgery and surviving a hip fracture, two in five are not receiving all of the recommended elements of a hip fracture programme that represent ‘best practice’.

The NHFD report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. It reports much good practice within inpatient care, with the majority of patients getting prompt surgery, specialist geriatric assessment and consideration of their nutritional status.

Hipsprint reaches 5,000 hip fracture records

Hipsprint, the CSP’s national audit of hip fracture rehabilitation, is designed to provide invaluable insight into the rehabilitation of people after fracturing their hips. It was launched on 1 May and will be running to 31 October. The first phase will remain open for members to enter data on new patients until 31 July.

The research aims to map each patient's rehab journey over a 120-day period. It will now move into the community phase, tracking patients' experiences after leaving hospital.

Hip fracture: management

This guideline covering managing hip fracture in adults. It aims to improve care from the time people aged 18 and over are admitted to hospital through to when they return to the community, has been updated.

Do radiological and functional outcomes correlate for fractures of the distal radius?

Bone Joint J 2017;99-B:376–82. DOI: 10.1302/0301-620X.99B3.35819 Published 1 March 2017 

We conducted a study to determine whether radiological parameters correlate with patient reported functional outcome, health-related quality of life and physical measures of function in patients with a fracture of the distal radius.

This study raises concerns about the use of radiological parameters to determine management, and to act as a surrogates for successful treatment, in patients with a fracture of the distal radius. Restoration of ‘normal’ radiographic parameters may not be necessary to achieve a satisfactory functional outcome for the patient.

This trial was co-sponsored by the University of Warwick and University Hospitals Coventry and Warwickshire NHS Trust.

A protocol for a feasibility randomised controlled trial to assess the difference between functional bracing and plaster cast for the treatment of ankle fractures

Pilot and Feasibility Studies20173:11 DOI: 10.1186/s40814-017-0125-z

UK Hospital Episode Statistics 2013–2014 recorded 57,286 fractures of the lower limb including the ankle. This figure is expected to continue to increase due to a greater population of older adults. Following an ankle fracture, patients usually have their ankle immobilised with a plaster cast. This provides maximum support for the healing ankle but is associated with stiffness and muscle wasting. A Cochrane Review has concluded that functional bracing may reduce muscle wasting and speed recovery of ankle movement.

The aim of this study is to determine the feasibility of conducting a full randomised controlled trial in adults with an ankle fracture followed by functional bracing and exercises versus standard plaster cast care.

UHCW Research: Jonathan Young

Specialist hip fracture services linked to fewer deaths in South Central region

Following a hip fracture, nurse-led fracture liaison services or specialist consultant (orthogeriatrician) input both reduce deaths. They did not reduce the small number of people having a second hip fracture within two years of the first. Both models of care were cost effective, although the orthogeriatric model was favoured.

From the NIHR Dissemination Centre

Guideline 142:Management of osteoporosis and the prevention of fragility fractures

Quick reference guide from SIGN for their guideline on the management of osteoporosis and the prevention of fragility fractures.

Tibial plateau fractures – review of current concepts in management

Orthopaedics and Trauma ePub ahead of print. http://dx.doi.org/10.1016/j.mporth.2016.10.005

Tibial plateau fractures represent a wide spectrum of injury patterns and encompass degrees of severity that are challenging to treat by even experienced orthopaedic trauma surgeons. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture.

UHCW Research: Mateen H. Arastu

Hip fracture in adults

NICE's quality standard on hip fracture has been updated:

• Statement 1 Adults with hip fracture are cared for within a Hip Fracture Programme at every stage of the care pathway. [2012, updated 2016]
• Statement 2 Adults with hip fracture have surgery on a planned trauma list on the day of, or the day after, admission. [2012, updated 2016]
• Statement 3 Adults with displaced intracapsular hip fracture receive cemented hemiarthroplasty or, if they are assessed as clinically eligible, a total hip replacement. [2012, updated 2016]
• Statement 4 Adults with trochanteric fractures above and including the lesser trochanter receive extramedullary implants. [2012, updated 2016]
• Statement 5 Adults with subtrochanteric fracture are treated with an intramedullary nail. [new 2016]
• Statement 6 Adults with hip fracture start rehabilitation at least once a day, no later than the day after surgery.[2012, updated 2016]

Percutaneous insertion of craniocaudal expandable implants for vertebral compression fracture

New NICE intervantional procedure guidance on percutaneous insertion of craniocaudal expandable implants for vertebral compression fracture in adults. This involves inserting an implant into the spine to restore the vertebral height.

Fracture risk associated with melatonin and other hypnotics

New Medicines Evidence Commentary from NICE:

An observational cohort study has found that in people aged 45 years and over receiving 3 or more melatonin prescriptions was associated with an increased risk of fracture compared with no use of any hypnotic drugs. The study found that in a matched cohort receiving 2 or more prescriptions for ‘Z drug’ hypnotics was also associated with a similarly increased fracture risk.

Effects of calcium intake on bone mineral density and fracture risk

New Eyes on Evidence from NICE:

Two meta-analyses have found that increasing calcium intake, either through diet or using supplements, did not have a consistent effect on bone mineral density and incidence of fracture in people aged over 50 years