| What should be done for a majority of pediatric distal radius fractures? | treated with a short period of immobilization with a cast or splint | Open fracture Simple fracture Simple fracture Intra-articular distal radius fracture Extra-articular distal radius fracture Open fracture A majority of pediatric distal radius fractures are inherently stable and can be treated with a short period of immobilization with a cast or splint Essential: Radiographs of wrist AP, lateral and oblique views Desirable (In patients with trivial trauma): Distal radial fractures may be the first opportunity to evaluate and treat osteoporosis to reduce the risk of future fragility fractures ∙ Serum calcium, Serum phosphorous, Serum alkaline phosphates ∙ Serum vitamin D levels, Serum Parathyroid Hormone (PTH) ∙ BMD all three sites Optional: CT scan for comminuted fractures and for planning surgery Undisplaced Emergent referral: Open fractures Neurovascular Deficit Concomitant trauma requiring immediate admission July/ 2024 This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. | 219 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | Open fracture Simple fracture Simple fracture Intra-articular distal radius fracture Extra-articular distal radius fracture Open fracture A majority of pediatric distal radius fractures are inherently stable and can be treated with a short period of immobilization with a cast or splint Essential: Radiographs of wrist AP, lateral and oblique views Desirable (In patients with trivial trauma): Distal radial fractures may be the first opportunity to evaluate and treat osteoporosis to reduce the risk of future fragility fractures ∙ Serum calcium, Serum phosphorous, Serum alkaline phosphates ∙ | 1 | page=1,block=53 | 0.700 | valid |
| What diagnostic imaging is essential for distal radius fractures? | Radiographs of wrist AP, lateral and oblique views | Open fracture Simple fracture Simple fracture Intra-articular distal radius fracture Extra-articular distal radius fracture Open fracture A majority of pediatric distal radius fractures are inherently stable and can be treated with a short period of immobilization with a cast or splint Essential: Radiographs of wrist AP, lateral and oblique views Desirable (In patients with trivial trauma): Distal radial fractures may be the first opportunity to evaluate and treat osteoporosis to reduce the risk of future fragility fractures ∙ Serum calcium, Serum phosphorous, Serum alkaline phosphates ∙ Serum vitamin D levels, Serum Parathyroid Hormone (PTH) ∙ BMD all three sites Optional: CT scan for comminuted fractures and for planning surgery Undisplaced Emergent referral: Open fractures Neurovascular Deficit Concomitant trauma requiring immediate admission July/ 2024 This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. | 298 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | Open fracture Simple fracture Simple fracture Intra-articular distal radius fracture Extra-articular distal radius fracture Open fracture A majority of pediatric distal radius fractures are inherently stable and can be treated with a short period of immobilization with a cast or splint Essential: Radiographs of wrist AP, lateral and oblique views Desirable (In patients with trivial trauma): Distal radial fractures may be the first opportunity to evaluate and treat osteoporosis to reduce the risk of future fragility fractures ∙ Serum calcium, Serum phosphorous, Serum alkaline phosphates ∙ |
| What exercises should be initiated during cast application for conservatively treated fractures? | Shoulder, elbow and finger ROM during cast application | ∙ Conservatively treated fractures are managed for 4-6 weeks in cast ∙ To check for fracture displacement, angulation subsidence and fracture healing, serial images are necessary at 1 week and 2 weeks follow up ∙ If fracture displaces in follow up, may require re-reduction/surgery ∙ Exercises should be initiated early (Shoulder, elbow and finger ROM during cast application and wrist ROM after removal of plaster) 1. Wu JC, Strickland CD, Chambers JS. Wrist Fractures and Osteoporosis. Orthop Clin North Am. 2019 Apr;50(2):211-221. doi: 10.1016/j.ocl.2018.10.004. PMID: 30850079. 2. Shapiro LM, Kamal RN; Management of Distal Radius Fractures Work Group; Nonvoting Clinical Contributor; Nonvoting Oversight Chairs; Staff of the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand. | 321 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | ∙ Conservatively treated fractures are managed for 4-6 weeks in cast ∙ To check for fracture displacement, angulation subsidence and fracture healing, serial images are necessary at 1 week and 2 weeks follow up ∙ If fracture displaces in follow up, may require re-reduction/surgery ∙ Exercises should be initiated early (Shoulder, elbow and finger ROM during cast application and wrist ROM after removal of plaster) 1. |
| What is the guideline for operative intervention based on dorsal tilt? | Dorsal tilt of >10 [degrees] | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical management of osteoporosis AP: Antero-posterior ORIF: Open Reduction and Internal Fixation CT: Computed Tomography ROM: Range of Motion | 472 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical |
| What is the guideline for operative intervention based on radial shortening? | Radial shortening of >3 mm | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical management of osteoporosis AP: Antero-posterior ORIF: Open Reduction and Internal Fixation CT: Computed Tomography ROM: Range of Motion | 443 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical |
| What is the recommended treatment for a highly comminuted intra-articular and open fracture? | External fixator (ligamentotaxis) | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical management of osteoporosis AP: Antero-posterior ORIF: Open Reduction and Internal Fixation CT: Computed Tomography ROM: Range of Motion | 317 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical |
| What is the recommended treatment for fractures that are highly comminuted, intra-articular, and open? | External fixator (ligamentotaxis) | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical management of osteoporosis AP: Antero-posterior ORIF: Open Reduction and Internal Fixation CT: Computed Tomography ROM: Range of Motion | 317 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726645316_3_fracture_distal_end_radius.pdf | Adult Immobilise in POP cast Displaced Try closed reduction and Plaster of Paris (POP) Check x-ray Continue Plaster of Paris (POP) Comminuted with Intrarticular Not comminuted Minimally displaced or are extra-articular unfit for surgery Reduced Not reduced ORIF with plating Get CT ORIF according to fracture pattern External fixator (ligamentotaxis) Highly comminuted intra-articular and Open fracture Guidelines for operative intervention ∙ Radial shortening of >3 mm ∙ Dorsal tilt of >10 [degrees] ∙ Intra-articular step-off of >2 mm Closed Reduction and Casting/Splinting with or without medical |