Nayyer Qayyum, Nadeem Kashmiri.
Outcome of surgical versus consertaive treatment of fracture distal radius in osteoporotic bones.
J Pak Orthop Assoc Jan ;24(1):32-8.

Objective: To evaluate the results in terms of functional outcome of fracture distal radius in osteoporotic bones. Study Design: Comparative study. Place And Duration Of Study: This study was conducted at Department of Orthopaedics, District Headquarters Teaching Hospital,affiliated with Rawalpindi Medical College Rawalpindi from January 2009 to December 2010. Patient And Methods: 120 patients with male :female 4:6 , age between 45 to 65 years were included having fracture distal radius. Duration of injury was less than one week and follow up duration of each patient was more than 1 year. All the patients were radiographed and were classified in different groups according to Frykman's classification. Immediate post reduction X-rays were also taken and each patient was followed up after every two weeks for first three months and then monthly up to 1 year.Osteoporosis was confirmed by X-ray, DEXA scan, Bone Mass Density and serum calcium and Alkaline phosphatase levels. Final outcome was observed in terms of union, range of motion and pain. Anatomic reduction was assessed by radial length and radial inclination angle. Range of motion was measured clinically and pain was measured by using Pakistan Coin Scale and visual analogue. Two groups were made, in group A 45% of the patients were treated surgically by percutaneous pinning and ligamentotaxis and group B 65% of patients were treated conservatively by plaster of paris cast and reduction under haematoma block or general anaesthesia. Results: Mean age of the patients was 45 years and average follow up was up to 9 months. In group A 88.5 % were having excellent results, 10.5% good and 1 % had poor results. In group B 70.5% had excellent results 18% had good and 10.5% had poor results. In group A 92.5% had union, 17% had superficial pin track infection, 3% had malunion and 7.5% had nonunion required bone grafting later. In group B 79% had union, no infection was observed and 21% had nonunion required ORIF with or without bone grafting, 18% of the patients had malunion in which 60% required the surgical correction. All the data was analyzed by using SPSS version 13 data analysis system. Conclusion: In osteoporotic fracture distal radius the surgical treatment by percutaneous pinning and ligamentotaxis is better option of treatment than conservative management by closed reduction and cast application.

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