Distal Radius Fractures, Poor Bone Quality, Treatment Complications
Conditions
Keywords
Radius fracture, Adverse effects, Wrist, Postoperative complications, Colles' fracture, Intraoperative complications, Osteoporosis, Dual-energy x-ray absorptiometry (DXA), Bone Density
Brief summary
The purpose of this study is to evaluate if poor bone quality increases the risk of specific types of treatment complications in patients with distal radius fractures treated with open reduction and Locking Compression Plates(LCP).
Detailed description
Despite fractures of the wrist being widely regarded as fragility fractures, there is good evidence that they are caused by diminished Bone Mineral Density (BMD) and that a low BMD value predicts a higher fracture risk at the distal radius. Both measurements of areal BMD with DXA and volumetric BMD with peripheral Quantitative Computer Tomography (pQCT)showed a lower BMD in women with Colles' fractures. Thus, Colles' fractures can be recognized as a good indication of underlying osteoporosis. High resolution peripheral Quantitative Computer Tomography at the distal radius will be evaluated in a subset of patients. Clinical experts are concerned that osteoporosis increases the risk for poor outcomes and complication rates in surgical patients with osteoporosis. However, this has not yet been confirmed in clinical studies. It is important to investigate this question in order to correctly advise clinicians and patients and possibly develop tailored approaches for treatment of osteoporotic patients with distal radius fractures.
Interventions
None listed
Sponsors
AO Clinical Investigation and Publishing Documentation
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
50 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Radiologically confirmed closed fracture (within 7 days) of the distal radius * Primary fracture treatment with a volar LCP 2.4 mm * Age equal greater 50 and equal younger 90 years * Willing and able to give written informed consent to participate in the study * Willing and able to participate in the study follow-ups according to the CIP * Willing and able to comply with the post-operative management program * Able to understand and read country national language at an elementary level
Exclusion criteria
* Fracture of ulna (except an associated fracture of the ulnar styloid process) * Open distal radius fracture * Concomitant contralateral radius fracture * Previous distal radius fracture on either side after the age of 25 years * Time to operation \> 7 days * Polytrauma * Regular systemic therapy with corticosteroids due to chronic disease * Legal incompetence * Patient received radio- or chemotherapy prior to, during, or within the last year * Currently active cancer * Recent history of substance abuse (i.e recreational drugs, alcohol) * Prisoner * Currently involved in a pharmaceutical study * Has a disease process that would preclude accurate evaluation (e.g. neuromuscular or rheumatic disease, significant psychiatric or metabolic disorders)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Local bone quality-related complication | From enrollment to 12 months postoperative | The qualifying events are those involving either directly the local bone and fracture or the implant and its surgical application whether they are anticipated or not. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Grip strength | 6 weeks | For the grip strength, the average value of three successive measurements with a Jamar dynamometer will be calculated as percentage of the contralateral, healthy side. |
| Bone mineral density at contralateral distal radius by DXA | until 6 weeks postoperative | Local bone status will comprise BMD and BMC of the contralateral side. The absolute values for BMD and BMC will be provided as well as the deviations to the T-score according to the manufacturer's reference collective. |
| Occurence of any complication | Baseline | To capture any complication that occured. A complication is defined as any occurrence or deviation from the normal treatment or outcome, regardless of whether it has any relationship with the treatment or product under investigation. |
| Patient self-assessment of wrist function questionnaire (PRWE) | Baseline | PRWE was developed to rate wrist-related pain and disability in functional activities. This provides a score from 0-100, where higher scores indicate greater pain and disability. |
| Range of motion | 6 weeks | The bilateral range of motion will be measured by clinical examination as follows: * Dorsal extension / palmar flexion * Wrist ulnar abduction / radial abduction * Forearm supination / pronation |
| Disabilities of the arm, shoulder and hand questionnaire (DASH) | Baseline | The disability of the arm, shoulder and hand (DASH) questionnaire is an upper extremity specific outcome measure. The main part of the DASH is a 30-item disability/symptom scale concerning the patient's health status during the preceding week. The scores for all items are then used to calculate a scale score ranging from 0 (no disability) to 100 (most severe disability). |
| Health-related quality of life (EQ-5D) | Baseline | EQ-5D is a standardised instrument for use as a measure of health outcome.It has five items with a three-point categorical response scale (no problems, some/moderate problems, extreme problems. A unique EQ-5D health state is defined by combining 1 level from each of the 5 dimensions. |
| High resolution pQCT of contralateral distal radius | within 6 weeks after surgery | High-resolution pQCT of the contralateral side with an XTremeCT will be performed in a subset of patients in Zürich. To obtain the bone mineral content the CT values will be calibrated with the help of a phantom in hydoxyapatite (HA) densities in mg HA/cm3. The relation of bone volume to tissue volume will be calculated as BV/TV. These values will be analyzed separately. |
| Patient self-assessment of hand function with the PRWE | 6 weeks | PRWE was developed to rate wrist-related pain and disability in functional activities. This provides a score from 0-100, where higher scores indicate greater pain and disability. |
Countries
Austria, Germany, Italy, Singapore, Switzerland, United States
Outcome results
None listed