OTA 2008 Posters

Scientific Poster #132 Upper Extremity OTA-2008

Concomitant Distal Radius Fracture and Hip Fracture: A Relative Indication for Fixation of the Distal Radius

Mohammad A. Khoshnevisan (n); David C. Ring, MD, PhD (a,e-Acumed, LLC, Biomet;
a-Joint Active Systems, a,b-Small Bone Innovations; a,b,e- Smith + Nephew, Wright Medical
Technology, Inc.; c-Hand Innovations; d-Illuminos, Inc., Mimedex, Inc.; e-Tornier);
Timothy Bhattacharyya, MD (e-Stryker);
Massachusetts General Hospital, Boston, Massachusetts, USA

Purpose: Elderly patients occasionally present with concomitant hip and distal radius fractures after falls. We hypothesized that the distal radius fractures that occur in patients with hip fractures represent a group with significantly higher amounts of osteoporosis, and tend to fail nonoperative treatment because they use the arms to mobilize after hip fracture repair. We compared the results of operative and nonoperative treatment of distal radius fractures in patients with hip fractures.

Method: From our trauma registry of 1941 patients with hip fractures, we identified 14 patients with simultaneous presentation of hip (intertrochanteric or femoral neck) and distal radius fractures. 6 of 14 were treated with casting, and 8 patients were treated with open reduction and internal fixation (ORIF) of the distal radius. We retrospectively collected data on the initial and final displacement, ulnar variance, palmar tilt, and radial inclination. All patients were followed to radiographic union (mean 6 months). The operative and nonoperative groups did not differ significantly in terms of AO-OTA fracture type distribution or initial displacement.

Results: Five of the six nonoperatively treated distal radius fractures displaced despite adequate closed reduction. None of the eight patients who were treated with ORIF displaced at follow-up, despite weight bearing on a forearm crutch (P <0.003). Patients who underwent ORIF had significantly more mean maintenance of length (P <0.019) and more palmar tilt (P <0.05) than patients with nonoperatively treated distal radius fractures.

Conclusion: Patients with concomitant distal radius fractures and hip fractures benefit from fixation of the distal radius fracture. Fixation results in significantly better radiographic outcomes and patients can be safely allowed to bear weight with a forearm crutch.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.