Hand Clinics RSS feed: Current Issue. Hand Clinics updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in hand surgery and is presented under the direction of an experienced guest editor. http://www.hand.theclinics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Hand Clinics0749-0712282May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.hand.theclinics.com/article/PIIS0749071212000248/abstract?rss=yesContributors10.1016/S0749-0712(12)00024-8Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9iiiivhttp://www.hand.theclinics.com/article/PIIS074907121200025X/abstract?rss=yesContents10.1016/S0749-0712(12)00025-XHand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9vviiihttp://www.hand.theclinics.com/article/PIIS0749071212000261/abstract?rss=yesForthcoming Issues10.1016/S0749-0712(12)00026-1Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9ixixhttp://www.hand.theclinics.com/article/PIIS0749071212000170/abstract?rss=yesIn this era of evidence-based medicine, long cherished beliefs and myths are constantly challenged by critically examining available data to form a scientific basis for treatment selection. Despite over 200 years of treating distal radius fractures, and many thousands of publications on this topic, surgeons and patients alike are still vexed that we have not arrived at a consensus regarding the most optimal treatment option for a particular injury type and for a unique patient characteristic. This Hand Clinics volume strives to synthesize the best available evidence by providing a comprehensive analysis of the current treatments for distal radius fractures. The majority of the authors for this volume hail from the Wrist and Radius Injury Surgical Trial (WRIST) study group. This group is the largest collaboration of hand surgeons in the world, consisting of 19 sites and over 50 hand surgeons who will be participating in this clinical trial. For the first time, the WRIST study group will randomize patients over 60 years of age into K-wire fixation, external fixation, or volar locking plating fixation to identify the most optimal treatment for this prevalent injury. At the same time, an observational group of subjects with similar fracture types will be treated with casting to exam the outcomes of casting treatment and compare them to the outcomes of surgical treatment. This ambitious 5-year study supported by the National Institutes of Health is entitled, “A Clinical Trial for the Surgical Treatment of Distal Radius Fractures in the Elderly.” This project is currently underway and should provide robust level 1 data that will help to guide future treatment decisions for distal radius fractures.PrefaceKevin C. Chung10.1016/j.hcl.2012.03.009Hand Clinics 28, 2 (2012)2012-04-16Hand Clinics2012-04-16282S0749-0712(11)X0006-9xixiihttp://www.hand.theclinics.com/article/PIIS0749071212000182/abstract?rss=yesTo the members of the WRIST study group for your continued support to advance our knowledge on the treatment of distal radius fractures. Dedication10.1016/j.hcl.2012.03.010Hand Clinics 28, 2 (2012)2012-04-05Hand Clinics2012-04-05282S0749-0712(11)X0006-9xiiixiiihttp://www.hand.theclinics.com/article/PIIS074907121200008X/abstract?rss=yesDistal radius fractures (DRFs) have been a common affliction for millennia, but their treatment is a more recent development resulting from human erudition. Although immobilization has served as the only available treatment for most of our history, many advances have been made in the management of DRFs over the last century as orthopedics has grown. Yet the topic remains hotly contested in the literature and, given the frequency of the injury, research continues to focus on it. This article traces the evolution of DRF treatment to provide a context for the future.The Evolution of Distal Radius Fracture Management: A Historical TreatiseRafael J. Diaz-Garcia, Kevin C. Chung10.1016/j.hcl.2012.02.007Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9105111http://www.hand.theclinics.com/article/PIIS0749071212000029/abstract?rss=yesDistal radius fractures are one of the most common types of fractures. Although the pediatric and elderly populations are at greatest risk for this injury, distal radius fractures still have a significant impact on the health and well-being of young adults. Data from the past 40 years have documented a trend toward an overall increase in the prevalence of this injury in both the pediatric and elderly populations. Understanding the epidemiology of this fracture is an important step toward the improvement of treatment strategies and the development of preventive measures with which to target this debilitating injury.The Epidemiology of Distal Radius FracturesKate W. Nellans, Evan Kowalski, Kevin C. Chung10.1016/j.hcl.2012.02.001Hand Clinics 28, 2 (2012)2012-04-16Hand Clinics2012-04-16282S0749-0712(11)X0006-9113125http://www.hand.theclinics.com/article/PIIS0749071212000066/abstract?rss=yesDistal radius fractures (DRFs) are the most common fracture treated by physicians, but questions remain regarding optimal management. Fracture patterns, biomechanics, and treatment strategies have been debated for more than 200 years, and research shows many controversies regarding long-held beliefs. Although these common myths have been propagated and considered fact, they are not based on the best-available evidence. This article illustrates some of the major controversies regarding the management of DRFs. To provide optimal care in a world of evidence-based medicine, clinicians must shift their thinking and accept that some of the indoctrinated ideas may represent a flawed heuristic approach.Common Myths and Evidence in the Management of Distal Radius FracturesRafael J. Diaz-Garcia, Kevin C. Chung10.1016/j.hcl.2012.02.005Hand Clinics 28, 2 (2012)2012-03-26Hand Clinics2012-03-26282S0749-0712(11)X0006-9127133http://www.hand.theclinics.com/article/PIIS0749071212000030/abstract?rss=yesIn North America, the rate of nonoperative management of displaced distal radius fractures has declined as the rate of internal fixation has increased. Volar locking plate fixation has increased in popularity despite a lack of supportive level 1 evidence. Issues of cost-effectiveness are relevant because there is no best-practice treatment at this stage. Clinicians should be aware of the goals of treatment and challenges, particularly in managing elderly patients with distal radius fractures. Large, randomized controlled trials or meta-analyses may provide answers about when operative intervention is favored over nonoperative management and which operative intervention provides the best outcomes.Management of Distal Radius Fractures from the North American PerspectiveAlbert Yoon, Ruby Grewal10.1016/j.hcl.2012.02.002Hand Clinics 28, 2 (2012)2012-03-26Hand Clinics2012-03-26282S0749-0712(11)X0006-9135144http://www.hand.theclinics.com/article/PIIS0749071212000091/abstract?rss=yesThere is no unified consensus view on the management of distal radius fractures within Europe. This is partially because of the failure of clinical studies to demonstrate superiority of one treatment technique over the others. Nonclinical factors, such as cost and operating room availability, also contribute to the decision making regarding treatment, and there remains uncertainty as to the criteria that need to be fulfilled to achieve a good functional result. This article therefore does not describe a unified European viewpoint, but the viewpoint of two Europeans working within the health care system of one European country.Extra-Articular Fractures of the Distal Radius—A European View PointA. Karantana, T.R.C. Davis10.1016/j.hcl.2012.03.001Hand Clinics 28, 2 (2012)2012-04-09Hand Clinics2012-04-09282S0749-0712(11)X0006-9145150http://www.hand.theclinics.com/article/PIIS0749071212000157/abstract?rss=yesThere is limited data regarding the epidemiology, pathology, and management of distal radius fractures from centers in Asia. The advanced economies in Asia include Hong Kong, Japan, Korea, Singapore, and Taiwan, whereas the prominent emerging economies are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, compares the management of distal radius fractures in the advanced and emerging Asian economies and how they compare with the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in Asia.An Asian Perspective on the Management of Distal Radius FracturesSandeep J. Sebastin, Kevin C. Chung10.1016/j.hcl.2012.03.007Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9151156http://www.hand.theclinics.com/article/PIIS0749071212000108/abstract?rss=yesThe distal radioulnar joint (DRUJ) is a complex articulation allowing significant rotational and translational motion. Stability of the DRUJ depends on bony contact, intrinsic stabilizers of the triangular fibrocartilage complex, and extrinsic stabilizers of the distal forearm. Understanding the anatomy of this articulation is paramount in clinical decision making for the treatment of disorders involving the DRUJ.Anatomy and Biomechanics of the Distal Radioulnar JointJerry I. Huang, Douglas P. Hanel10.1016/j.hcl.2012.03.002Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9157163http://www.hand.theclinics.com/article/PIIS074907121200011X/abstract?rss=yesThere is no established outcome measure designated as the superior measure when evaluating the results of distal radius fracture management. Although there are many used in the literature, there are only a few that have been validated to specifically predict recovery after a distal radius fracture. Additionally, there are few comparative trials that attempt to directly measure the predictive abilities of specific outcome measures. This article discusses the common scales and scores used to measure the functional recovery after distal radius fracture management and provides evidence-based literature to assess the reliability of these measures to predict outcomes.How to Measure Outcomes of Distal Radius Fracture TreatmentAndrew W. Ritting, Jennifer M. Wolf10.1016/j.hcl.2012.03.003Hand Clinics 28, 2 (2012)2012-04-05Hand Clinics2012-04-05282S0749-0712(11)X0006-9165175http://www.hand.theclinics.com/article/PIIS0749071212000042/abstract?rss=yesThere has been a surge in the operative management of distal radius fractures. Closed reduction, external fixation, and open reduction with internal fixation each have advantages and disadvantages. The purpose of this review is not to provide the clinician with an algorithm for treatment of distal radius fractures. These fractures span an extensive spectrum of severity across age groups and demographics. Fortunately, the surgeon holds a vast array of options to provide care for patients with distal radius fractures. The choice of fixation or conservative care resides in the personality of the fracture and the needs of the patients.Treatment Strategies of Distal Radius FracturesJoshua G. Bales, Peter J. Stern10.1016/j.hcl.2012.02.003Hand Clinics 28, 2 (2012)2012-03-22Hand Clinics2012-03-22282S0749-0712(11)X0006-9177184http://www.hand.theclinics.com/article/PIIS0749071212000121/abstract?rss=yesNumerous methods of treatment are available for the management of distal radius fractures, with modern trends favoring volar fixed-angle distal radius plates. Whatever the method of fixation, recognition, management, and prevention of the known associated complications are essential to achieve a good outcome. This article reviews the common preventable complications that are associated with operative treatment of distal radius fractures, including tendon injuries, inadequate reduction, subsidence or collapse, intra-articular placement of pegs or screws, nerve injuries, complex regional pain syndrome, carpal tunnel syndrome, and compartment syndrome.Avoiding and Treating Perioperative Complications of Distal Radius FracturesPeter C. Rhee, David G. Dennison, Sanjeev Kakar10.1016/j.hcl.2012.03.004Hand Clinics 28, 2 (2012)2012-04-09Hand Clinics2012-04-09282S0749-0712(11)X0006-9185198http://www.hand.theclinics.com/article/PIIS0749071212000194/abstract?rss=yesFractures of the distal radius and ulnar styloid have the potential to disturb the normal function of the distal radioulnar joint (DRUJ), resulting in loss of motion, pain, arthritis, or instability. The DRUJ can be adversely affected by several mechanisms, including intra-articular injury with step-off, shortening, and angulation of an extra-articular fracture; injury to the radioulnar ligaments; ulnar styloid avulsion fracture; and injury of secondary soft tissue stabilizers. This article discusses the management of the DRUJ and ulnar styloid fracture in the presence of a distal radius fracture.Management of the Distal Radioulnar Joint and Ulnar Styloid FractureDouglas M. Sammer, Kevin C. Chung10.1016/j.hcl.2012.03.011Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9199206http://www.hand.theclinics.com/article/PIIS0749071212000169/abstract?rss=yesDespite encouraging results from small case series, correction of distal radius malunion remains a challenging procedure with uncertain outcomes. The most appropriate treatment for a distal radius malunion is prevention. If a symptomatic malunion is discovered, correction should be undertaken as early as possible. It is recommended that action be taken within six months of the primary injury to decrease the negative impact of soft-tissue contracture on the eventual reconstruction. Although some patients complain about residual problems after malunion surgery, corrective surgery has been shown to improve both radiographic and functional outcomes, and may prevent future secondary problems.Management of Malunions of the Distal RadiusSteven C. Haase, Kevin C. Chung10.1016/j.hcl.2012.03.008Hand Clinics 28, 2 (2012)2012-04-16Hand Clinics2012-04-16282S0749-0712(11)X0006-9207216http://www.hand.theclinics.com/article/PIIS0749071212000054/abstract?rss=yesThe interest in developing biomaterials to augment fracture healing continues to grow. New products promise early return to function with minimal morbidity; however, indications to use these products remain unclear. An ideal bone graft material stimulates bone healing and provides structural stability while being biocompatible, bioresorbable, easy to use, and cost-effective. This article reviews the biology of bone grafts and the clinical evidence in the use of bone graft substitutes for the treatment of distal radius fractures.The Use of Bone Grafts and Substitutes in the Treatment of Distal Radius FracturesKagan Ozer, Kevin C. Chung10.1016/j.hcl.2012.02.004Hand Clinics 28, 2 (2012)2012-03-29Hand Clinics2012-03-29282S0749-0712(11)X0006-9217223http://www.hand.theclinics.com/article/PIIS0749071212000133/abstract?rss=yesDistal radius fractures account for approximately 15% of all fractures in adults, and are the most common fractures seen in the emergency department. Soft-tissue injuries associated with distal radius fractures may influence strategies for the acute management of the fracture, but also may be a source of persisting pain and/or disability despite fracture healing. This article describes soft-tissue injuries and considerations for treatment associated with distal radius fractures, including injuries to the skin, tendon and muscle, ligaments, the triangular fibrocartilage complex, neurovascular structures, and related conditions such as compartment syndrome and complex regional pain syndrome.Management of Soft-Tissue Injuries in Distal Radius FracturesFraser J. Leversedge, Ramesh C. Srinivasan10.1016/j.hcl.2012.03.005Hand Clinics 28, 2 (2012)2012-04-09Hand Clinics2012-04-09282S0749-0712(11)X0006-9225233http://www.hand.theclinics.com/article/PIIS0749071212000145/abstract?rss=yesStretching exercises are an important part of recovery after sustaining a fracture of the distal radius. However, from the patient's perspective, painful stretching exercises can be counterintuitive after injury. Stretching exercises are straightforward and do not require a significant amount of coaching. It is ultimately the protectiveness, passivity, and sometimes a sense of futility that require coaching. The key for the provider is to empathize with the difficult and counterintuitive nature of the recovery process.Recovery After Fracture of the Distal RadiusArjan G.J. Bot, David C. Ring10.1016/j.hcl.2012.03.006Hand Clinics 28, 2 (2012)2012-04-09Hand Clinics2012-04-09282S0749-0712(11)X0006-9235243http://www.hand.theclinics.com/article/PIIS0749071212000078/abstract?rss=yesWhether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury.Future Treatment and Research Directions in Distal Radius FractureJesse Jupiter10.1016/j.hcl.2012.02.006Hand Clinics 28, 2 (2012)2012-03-16Hand Clinics2012-03-16282S0749-0712(11)X0006-9245248http://www.hand.theclinics.com/article/PIIS0749071212000273/abstract?rss=yesIndex10.1016/S0749-0712(12)00027-3Hand Clinics 28, 2 (2012)2012-05-01Hand Clinics2012-05-01282S0749-0712(11)X0006-9249252