Page 95 - Hospital Authority Convention 2017

Masterclasses

M3.1 Recent Advances in Management of Distal Radius Fracture 13:15 Room 423 & 424

Strategies in Fragility Distal Radius Fracture
Chow YY
Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
Distal radius fracture has always been a common clinical entity in orthopaedics practice. When such fracture happens in
an elderly patient, it should not be treated as “just another fracture”. The term “fragility fracture” has been used to describe
fractures happening in patients with fragile bones. When we grow old, our bones will become fragile. With the global ageing
populations, we are facing a rapid increase in such fractures worldwide, Hong Kong is no exception. When a patient presents
with fragility fracture of the wrist, it signifies that the patient has come to a stage in his/her life that more and more healthcare
service is needed. Focusing on the fracture itself, there has been a lot of advances in the clinical management over the
past 10 to 15 years. New implants are now available in market that could allow us to fix fragile bones with much better
outcomes than before. Artificial bone substitutes are also very good in filling large bone defects after injury which is not
uncommon in osteoporotic bones. Similar to most medical devices, all these new armamentarium are expensive. The other
related treatments indicated for this group of patient would include rehabilitation services, pharmacological management
of osteoporosis and in some cases, long-term institutionalised care because of the underlying health issues. All of these
are very expensive. It is the duty of the clinicians to present these potential problems to the Hospital Authority. Hopefully
appropriate long-term plans in prevention and comprehensive management of this fracture will be in place soon. Fragility
fracture of the wrist might look apparently simple to many healthcare service policy makers but for sure it is going to impose
a big burden to our future healthcare services budget. Tuesday, 16 May

M3.2 Recent Advances in Management of Distal Radius Fracture 13:15 Room 423 & 424

Will Casting be Enough for Distal Radius Fracture?
Chan PT
Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong

Treatment of distal radius fracture had been evolving for past two decades. Our armamentarium of treatment for distal radius
is ever expanding. While there is no golden standard treatment, the old techniques, namely casting, still play an important
role in the management of these common fractures.
Close reduction and casting have been the treatment of choice for those of stable fracture. Yet, it is important to identify
those unstable fracture or fracture with articular incongruity. These may be benefit from other treatment methods. Whilst the
outcome in carefully selected cases is acceptable, studies had shown that more than 40% conservatively treated patients
will need subsequent operations. Meticulous monitoring to look for loss of reduction is important for success of conservative
treatment. Yet, this will place a heavy workload in the busy outpatient clinic.

When the fracture is malunited after casting, trapezoidal osteotomy is an effective method to correct the alignment and
improve symptoms. In past few years, we have performed trapezoidal osteotomy in more than 10 malunited distal radius. The
clinical outcomes of this procedure are good in most cases.

93