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Evolution Of Treatment Procedures For Distal Radius Fractures

By Takako Kanatani, MD

The evolution and incorporation of modern technology to continually improve or replace Gold Standard procedures is an important facet of today’s practice. I would like to illustrate my views by an example that has occurred across my 28 years of practice, namely the evolution of the treatment procedures for a distal radius fracture.

A patient presenting with a distal radius fracture two decades ago would most likely have been treated by closed reduction and cast immobilization or possibly percutaneous pinning or external fixation if this was called for to obtain satisfactory radial reduction. Barton’s fractures may have been addressed with plate fixation mainly. The gradual move to plate fixation technology has been driven not just by the technology improvements and expanded choice of systems but also the improved functional outcomes due to proper and ridged reduction and lower risk of the radial length shortening which results in pain and impaired rotation. Advances in surgical intervention techniques may also have contributed.

I relate to my residents the day gone process of percutaneous pinning or external fixation and the resultant complications that arose due to imperfect reduction and alignment. My advice is now to reduce the fracture appropriately and perform plate fixation.

In summary today, for residents, plate fixation is the procedure of first choice, which it is natural for them, like reaching for a mobile phone. They still have the problem of which type of plate system they should choose. I don’t like to tell them “We used XXX,” which is sort of an old people’s cliché, but I enjoy telling them about the evolution of the treatment for distal radius fractures that I experienced in my clinical operating career.

 

Dept. of Orthopedics Kobe Rosai Hospital, Kobe, Japan

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