Journal of Indonesian Orthopaedic, Volume 40, Number 2, August 2012

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Clinical and Radiological Evaluation in Intra-Articular Distal Radial Fracture: Operative Treatment with Open Reduction Internal Fixation using -!ire and "one #ra$t Compared with %on-operative Treatment using Casting in !omen A&ove '( )ears Old in *oeharso Orthopaedic +ospital *ura,arta
osa Omi !"astiastuti, #ang$as !ibarani
%epartement of Orthopaedic & #raumatolog', (acult' of )edicine, !ebelas )aret *ni+ersit',!oeharso -ospital, !olo

A"*TRACT Introduction- #he incidence of distal radius fractures is increasing together "ith the a+erage age of population. Intra,articular incongruit' is the most probable cause of unsatisfactor' outcome of distal radius fractures. #here is much debate regarding the optimal treatment of displaced, unstable distal radius fractures in the elderl'. #he purpose of this retrospecti+e stud' "as to compare outcome for elderl' patients "ith intra,articular distal radial fracture "ho "ere treated "ith or "ithout surgical inter+ention. .aterials and methods. #his cross sectional stud' e/amined patients o+er the age of fift' 'ears old "ho "ere treated "ith or "ithout surger' for intra,articular distal radial fracture. 0atients "ho under"ent non,operati+e treat, ment "ere treated "ith closed reduction and belo" elbo" cast for si/ "ee$s. 0atients "ho under"ent surger' "ere treated "ith criss,cross 1,"ire and bone graft. 2aseline radiographs "ith !chec$3s score and functional scores "ith )a'o "rist score "ere obtained prior to treatment. Outcomes at fi/ed time points "ere compared bet"een groups "ith standard statistical methods. Results- #here are 24 patients intra,articular distal radial fracture bet"een Januar' to Jul' 2011. 14 patients "ere treated conser+ati+el' "ith closed reduction and belo" elbo" cast and 10 patients "ere treated operati+el' "ith criss,cross $,"ire and bone graft. #here is no significance differences bet"een t"o groups in term of !chec$3s score and )a'o "rist score. Conclusions- 2oth non,operati+e treatment "ith closed reduction and belo" elbo" cast and operati+e treatment using criss,cross 1,"ire and bone graft pro+ides good results in terms of radiological dan functional outcome in "omen patients older than 50 'ears old "ith intra,articular distal radius fracture. e/words: intra,articular distal radial fracture, non operati+e and operati+e treatment, clinical outcome, radiological outcome

Outcome of distal radius fracture

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Evaluasi linis dan Radiologis Fra,tur Distal Radius Intra-arti,uler: 0engo&atan Operati$ dan %on-operati$ pada !anita 1sia di atas '( Tahun di Rumah *a,it Orthopaedi *oeharso2 *ura,arta
A"*TRA 3atar "ela,ang- Ang$a $e6adian fra$tur radius distal mening$at dengan bertambahn'a usia. In$ongruen permu, $aan intra arti$ular merupa$an pen'ebab hasil terapi 'ang tida$ memuas$an. #erapi terbai$ untu$ penatala$sanaan fra$tur radius distal intraarti$ular pada usia tua masih diperdebat$an. 0enelitian ini bertu6uan membanding$an hasil terapi fra$tur radius distal intraarti$ular pada pasien usia tua 'ang dila$u$an tinda$an operatif dengan tinda$an non, operatif. "ahan dan cara ,er4a- %ila$u$an penelitian terhadap pasien "anita usia di atas 50 tahun dengan fra$tur radius distal intraarti$ular 'ang dila$u$an tinda$an operasi dengan K-wire dan cang$o$ tulang atau tinda$an non,operatif dengan redu$si tertutup dan below elbow cast selama 5 minggu. -asil radiologis dinilai dengan mengguna$an Schecks score dan hasil $linis dinilai dengan mengguna$an Mayo wrist score. -asil $edua $elompo$ dibanding$an dan diu6i secara statisti$. +asil- %idapat$an 24 pasien fra$tur radius distal intraarti$ular antara bulan Januari higga Juli 2011. #u6uh belas pasien dila$u$an tinda$an non operatif dengan redu$si tertutup dan below elbow cast sedang$an 10 pasien dila$u$an tinda$an operatif dengan criss-cross K-wire dan cang$o$ tulang. #ida$ didapat$an perbedaan berma$na antara $edua $elompo$ bai$ pada hasil e+aluasi radiologis dengan mengguna$an Schecks score maupun hasil e+aluasi $linis mengguna$an Mayo wrist score. *impulan- #erapi non,operatif maupun operatif sama bai$n'a dalam penatala$sanaan fra$tur radius distal intraarti, $ular pada "anita di atas usia 50 tahun. ata ,unci7 fra$tur radius distal intraarti$ular, tinda$an operatif dan non,operatif, hasil radiologis, hasil $linis Introduction %istal radius fracture is a $ind of fracture that often oc, curs in appro/imatel' one,si/th of the "hole fracture incidents.1,2 Ne+ertheless, there has been no agree, ment on the best procedures for the distal radius fracture. A stud' in 1895 in America and Northern :urope had sho"n that females "ith age more than 50 'ears ha+e a 15; increasing ris$ of getting distal ra, dius fracture compared to males on the same age.2 In the past, most of distal radius fractures on the elderl' "ere treated conser+ati+el' b' plaster cast onl' due to the consideration of of lo" function, al demand. -o"e+er, some studies suggested more aggressi+e fi/ation, "ith result in achie+ing anatomic position, and minimi<ing functional disturbance, "ith an e/pectation that it could fasten reco+er' time so that the patients could return to their pre+ious acti+it' le+el. .aterials and methods =e carried out a research to female patients aged abo+e 50 'ears old, "ho +isited the emergenc' unit of 0rof. %r. . !oeharso Orthopaedic -ospital bet"een Januar' and Jul' 2011 "ith intra,articular distal radius fracture. #he' recei+ed either 1,"ire surger' and bone graft or non,operati+e care b' closed reduction and belo" elbo" cast for 5 "ee$s. #he results of the therap' "ere measured b' radiological !chec$3s score, "hereas the clinical results "ere measured b' using )a'o "rist score. #he radiological result measured in !chec$3s scor, ing s'stem included radial inclination, radial length, and +olar tilt, "hich are measured b' the assigned score. #he criteria of the radiologic result according to

the !chec$3s scoring s'stem "ere e/cellent >0 to 1 point?, good >2 to @ points?, and poor >abo+e than @ points?. #he criteria in )a'o "rist score included pain inten, sit' >25 points?, functional status >25 points?, range of motion >25 points?, and grip strength >25 points?. #he results of the t"o groups "ere compared and tested statisticall' using independent t,test. Results (rom 24 intra,articular distal radius fracture patients, 14 patients recei+ed non,operati+e therap' b' closed reduc, tion and belo" elbo" cast, "hereas 10 patients recei+ed operati+e therap' b' open reduction, criss,cross 1,"ire, and bone graft. #he ages of the patients ranged from 50 'ears to 91 'ears old. #he fractures occurred most freAuentl' in pa, tients aged 50 to 55 'ears old. #he a+erage age of the patients "ho recei+ed non,operati+e treatment "as 51.41 'ears and 55.5 'ears for those treated operati+el'. #he age distribution of the patients "as sho"n in figure 1. #he !chec$3s scores from 14 patients in non,opera, ti+e group "ere good in 4 patients and e/cellent in 10 patients "hile those of 10 patients in operati+e group "ere good in 4 patients and e/cellent in @ patients. #he detailed score "as sho"n in table 1. !tatisticall', there "as no significant difference be, t"een non,operati+e and operati+e group. >p B 0.05? #he )a'o "rist scores of non,operati+e group "ere e/cellent in 10 patients, good in @ patients, fair in 2 patients, and poor in 2 patients. #he )a'o "rist scores in the operati+e group "ere e/cellent in 4 patients, fair in 2 patients, and poor in 1 patient. #he detailed score "as
#able 1. adiological and functional outcomes in each group Outcome Radiologica l outcome adial length adial inclination Volar tilt Functional outcome 0ain Intensit' (unctional !tatus ange of motion Crip !trength Non,operati+ e group Value 8.41 21.12 4.44 !core 1 0 1 21 22 25 15 Operati+e group Value 9.@0 18.40 5.@0 !core 1 0 1 22 22 25 15

(igure 1. Age distribution of the patient sho"n in table 1. Discussions Intra,articular distal radius fracture in patients "ho re, cei+ed either non,operati+e or operati+e therap' sho"ed good radiological and functional outcome. #he measurement of functional outcome might in, +ol+e +arious methods, such as )a'o "rist score, %is, abilities of the Arm, !houlder and -and >%A!-? score, and Cartland and =erle' point s'stem. In this stud', the functional outcome "as performed using )a'o "rist score. =e found similar result "ith :gol, et al., and 1han, et al. "ho concluded no difference in %A!- score e/, isted bet"een group treated "ith conser+ati+e and op, erati+e treatment.@,4 Conclusions =e concluded that either non,operati+e or operati+e therap' of intra,articular distal radius fracture had simi, lar result in patients aged abo+e 50 'ears old.

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Re$erences
1. uch %!. (racture of the distal radius and ulna. In 7 2uchol<, obert =,-ec$man, James %, Dourt,2ro"n, Dharles ), editors. oc$"ood & =il$ins3 fractures in adult. 5th ed. Eippincott =illiams&=il$ins.2005. p.810,

3. :gol 1A, =alsh ), omo,Dardoso !, %ors$' ! , 0a$sima N. %istal radius fracture in elderl' 7 operati+e compared "ith non,operati+e treatment. J 2one Joint !urg>Am?. 20107 8271951,1954. 4. 1han JA, )ahara %0. )anagement of Dolles3 fracture b' conser+ati+e +s open reduction bone grafting and internal fi/ation "ith 1,"ire. J Nepal -ealth es Dounc. 2009 F 5>12? 7 15,21.

851. 2. Danale !#, 2eat' J-. Dampbell3s operati+e orthopaedics. 11th ed. )osb' :lse+ier 0hiladelphia,0enns'l+ania, 2009.