Referencias Aaos

Evidence Table 1
Nerve Dysfunction After Distal Radius Fracture Reduction

Included and Excluded Articles
Included or
Author Title
Reason for Exclusion
Henry, et al. A prospective plan to minimise median nerve related complications associated with operatively treated
2007 distal radius fractures INCLUDED
Dyer, et al. Does not report patient
Predictors of acute carpal tunnel syndrome associated with fracture of the distal radius
2008 oriented outcomes
Bienek, et al. Patients do not have nerve
Peripheral nerve compression neuropathy after fractures of the distal radius
2006 dysfunction after reduction
Fuller, et al. Patients do not have nerve
Carpal canal pressures after volar plating of distal radius fractures
Odumala, et al. Patients do not have nerve
Prophylactic carpal tunnel decompression during buttress plating of the distal radius--is it justified?
Zoubos, et al. Patients do not have nerve
Surgical treatment of 35 volar Barton fractures. No need for routine decompression of the median nerve
Hove, et al. Patients do not have nerve
Nerve entrapment and reflex sympathetic dystrophy after fractures of the distal radius
Dresing, et al. Patients do not have nerve
Compartment pressure in the carpal tunnel in distal fractures of the radius. A prospective study
AAOS Clinical Practice Guidelines Unit Page 1 of 138 v 1.0 12.05.09

Evidence Table 2
Quality and Design of Prospective Non-Randomized Controlled Studies
All groups have similar outcome
Same center for expiremental
experimental group results

Follow Up - 80% or more
All groups concurrently
All groups have similar
characteristics at entry
and control group data
control group results

performance at entry
● = Yes ○ = No × = Not Reported
Crossover - equal
Crossover - equal
n/a = not applicable
treated
Author Outcome Duration N Comparison(s)
Henry, et al.
2007
Carpal Tunnel Syndrome
10 - 140
Weeks
374
MND w/ CTR vs.
No MND, no CTR ● ○ ● ● ● n/a n/a
Henry, et al.
2007
Neuropathic Pain Syndrome
10 - 140
Weeks
374
MND w/ CTR vs.
No MND, no CTR ● ○ ● ● ● n/a n/a

Evidence Table 3
Prospective Non-Randomized Controlled Studies DATA
Author Outcome Duration N Treatment(s) Result
Henry, et al. 10 - 140 MND with CTR 0%

Carpal Tunnel Syndrome 93
2007 Weeks (Agee) 0/93 patients
Carpal Tunnel Syndrome 76
2007 Weeks (FCR sheath release of TCL) 0/76 patients
Henry, et al. 10 - 140 0%
Carpal Tunnel Syndrome 205 No MND, no CTR
2007 Weeks 0/205 patients
Neuropathic Pain Syndrome 93
2007 Weeks (Agee) 0/93 patients
Neuropathic Pain Syndrome 76
2007 Weeks (FCR sheath release of TCL) 0/76 patients
Henry, et al. 10 - 140 0%
Neuropathic Pain Syndrome 205 No MND, no CTR
2007 Weeks 0/205 patients

Evidence Table 4
Treatment of Adequately Reduced and Maintained Unstable Distal Radius Fracture
Included or
Author Title
No studies were identified by the literature search

Evidence Table 5
Operative vs. Non-operative Treatment of Unstable Distal Radius Fractures
Included or
Author Title
Young, et al.
2003
Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods INCLUDED
McQueen, et al. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods
1996 of treatment INCLUDED
Abbaszadegan, et al. External fixation of plaster cast for severely displaced Colles' fractures? Prospective 1-year study of 46
1990 patients INCLUDED
Howard, et al. External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of
1989 anatomical and functional results INCLUDED
Pring, et al.
1988
Bipolar fixation of fractures of the distal end of the radius: a comparative study INCLUDED
Abramo, et al. Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using
Not best available evidence
2008 DASH as outcome
A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint
Kreder, et al.
incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional Enrolls only stable fractures
2006
percutaneous K-wires
Zheng, et al. Reports complications only,
A comparison of conservative and surgical treatment of distal radius unstable fracture
2003 < 25 patients
Christensen, et al.
Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type Not best available evidence
2001
Kapoor, et al. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed Reports complications only,
2000 reduction, external fixation and open reduction with internal fixation < 25 patients
Gupta, et al. Colles' fracture: management by percutaneous crossed-pin fixation versus plaster of Paris cast
Severity of injury not defined
1999 immobilization
Patient oriented outcomes
Lagerstrom, et al.
Recovery of isometric grip strength after Colles' fracture: a prospective two-year study compare gender not
1999
intervention
Stoffelen, et al.
Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures Duplicate study
1999
Stoffelen, et al.
Conservative treatment versus Kapandji-pinning for extra-articular distal radius fractures Cannot locate publication
1999
Stoffelen, et al.
Kapandji pinning or closed reduction for extra-articular distal radius fractures Severity of injury not defined
1998

Evidence Table 5
Included or
Author Title
Cohen, et al. Reports complications only,
Distal radius fractures: a prospective randomized comparison of fibreglass tape with QuickCast
1997 < 25 patients
Rodriguez-Merchan, et al. Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients Reports complications only,
1997 between 46 and 65 years of age < 25 patients
vanDijk, et al.
Dynamic external fixation versus non-operative treatment of severe distal radial fractures Not best available evidence
1996
Merchan, et al. Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of
Severity of injury not reported
1992 age
Shankar, et al. Reports complications only,
Comminuted Colles' fractures: a prospective trial of management
1992 < 25 patients
Stein, et al. Reports complications only,
Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases
1990 < 25 patients
Kongsholm, et al.
Plaster cast versus external fixation for unstable intraarticular Colles' fractures Not best available evidence
1989
Solgaard, et al.
External fixation or a cast for Colles' fracture Not best available evidence
1989
Solgaard, et al. Displaced distal radius fractures. A comparative study of early results following external fixation, functional
1989 bracing in supination, or dorsal plaster immobilization
Boyd, et al.
The outcome of fractures of the distal radius in young adults Not best available evidence
1988
Jenkins, et al. Does not report patient
External fixation and recovery of function following fractures of the distal radius in young adults
Kaukonen, et al. Functional recovery after fractures of the distal forearm. Analysis of radiographic and other factors
1988 affecting the outcome
Schmalholz, et al. Does not report patient
A scintimetric study of Colles' fracture. Comparison between cementation and closed treatment
Jenkins, et al. Reports complications only,
External fixation of Colles' fractures. An anatomical study
1987 < 25 patients

Evidence Table 6
Quality and Design of Randomized Controlled Trials

Those rating outcome Blinded

Stochastic Randomization

Allocation Concealment

Crossover - equal
Crossover - equal
Patients Blinded
Author Outcome Duration N Treatment(s)
Young, et al.
2003
Pain free 7 Years 85
External fixation - bridging vs.
Cast × ● ○ ○ ○ × n/a n/a
McQueen, et al.
1996
Complications n/a 109
Cast × ● ○ ○ ● × n/a n/a
Abbaszadegan, et al.
1990
Function - VAS 8 Weeks 46
Cast × × ○ ○ ● ● n/a n/a
1990
Pain - VAS 8 Weeks 46
Cast × × ○ ○ ● ● n/a n/a
1990
Cast × × ○ ○ ● ● n/a n/a
1990
Cast × × ○ ○ ● ● n/a n/a
1990
Cast × × ○ ○ ● ● n/a n/a
1990
Cast × × ○ ○ ● ● n/a n/a
1990
Function - VAS 1 Year 46
Cast × × ○ ○ ● ● n/a n/a
1990
Pain - VAS 1 Year 46
Cast × × ○ ○ ● ● n/a n/a
Howard, et al.
1989
Cast × × ○ ○ ● ● n/a n/a
Pring, et al.
1988
Bipolar fixation vs.
Cast × × ○ × ● ● n/a n/a

Evidence Table 7
Randomized Controlled Studies DATA
Author Outcome Duration N Treatment(s) Operative Non-operative
Young, et al. External fixation - bridging vs. 83% 79%

2003 Cast (30/36 patients) (39/49 patients)
Abbaszadegan, et al. † External fixation - bridging vs. 7 (range: NR)
Function - VAS 8 Weeks 46 5 (range: NR)
1990 Cast p = 0.1*
1990 Cast p = 0.7*
1990 Cast p = 0.1*
Function - VAS 1 Year 46 9 (range: NR)
1990 Cast p = 0.02*
Abbaszadegan, et al. ‡ External fixation - bridging vs. 2 (range: NR)
Pain - VAS 8 Weeks 46 3 (range: NR)
1990 Cast p = 0.4*
1990 Cast p = 0.1*
Abbaszadegan, et al. ‡ External fixation - bridging vs. 0.5 (range: NR)
1990 Cast p = 0.009*
Pain - VAS 1 Year 46 1 (range: NR)
1990 Cast p = 0.002*
†: median score 0 - 10 where 10 is normal function (unit of measurement not reported); ‡: median score 0 - 10 (unit of measurement not reported), * reported by author(s)

Evidence Table 8
Operative Treatments for Distal Radius Fractures
Included or
Author Title
Krukhaug, et al. External fixation of fractures of the distal radius: a randomized comparison of the Hoffman compact II non-
2009 bridging fixator and the Dynawrist fixator in 75 patients followed for 1 year INCLUDED
Egol, et al. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for
2008 unstable fractures of the distal radius: a randomised, prospective trial INCLUDED
Leung, et al. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial
2008 fractures. A randomized study INCLUDED
vanManen, et al.
2008
Bio-resorbable versus metal implants in wrist fractures: a randomised trial INCLUDED
Kreder, et al. Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-
2005 articular fractures of the distal radius: a randomised, controlled trial INCLUDED
Harley, et al. Augmented external fixation versus percutaneous pinning and casting for unstable fractures of the distal
2004 radius--a prospective randomized trial INCLUDED
Krishnan, et al. Intra-articular fractures of the distal radius: a prospective randomised controlled trial comparing static
2003 bridging and dynamic non-bridging external fixation INCLUDED
Werber, et al.
2003
External fixation of distal radial fractures: four compared with five pins: a randomized prospective study INCLUDED
Hahnloser, et al. Internal fixation of distal radius fractures with dorsal dislocation: pi-plate or two 1/4 tube plates? A
1999 prospective randomized study INCLUDED
McQueen, et al. Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus
1998 non-bridging external fixation INCLUDED
Ludvigsen, et al. External fixation versus percutaneous pinning for unstable Colles' fracture. Equal outcome in a
1997 randomized study of 60 patients INCLUDED
Hutchinson, et al. Pins and plaster vs external fixation in the treatment of unstable distal radial fractures. A randomized
1995 prospective study INCLUDED
Pritchett, et al.
1995
External fixation or closed medullary pinning for unstable Colles fractures? INCLUDED
Raskin, et al.
1993
Unstable articular fractures of the distal radius. Comparative techniques of ligamentotaxis INCLUDED
Andersen, et al.
Colles' Fracture Treated with Non-Bridging External Fixation: A 1-Year Follow-Up Not best available evidence
2009
Figl, et al.
Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results Not best available evidence
2009

Evidence Table 8
Included or
Author Title
Jupiter, et al. Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter
2009 prospective case series
Mirza, et al. Fractures of the distal radius treated with cross-pin fixation and a nonbridging external fixator, the CPX
2009 system: a preliminary report
Othman, et al.
Fixation of dorsally displaced distal radius fractures with volar plate Not best available evidence
2009
Wong, et al. Palmar fixation of dorsally displaced distal radius fractures using locking plates with Smartlock locking
2009 screws
Abramo, et al. Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using
2008 DASH as outcome
Adani, et al.
The treatment of distal radius articular fractures through lcp system Not best available evidence
2008
Chen, et al.
Treatment of Distal Radius Fractures with Percutaneous Pinning and Pin-in-plaster Not best available evidence
2008
Chung, et al. Comparative outcomes study using the volar locking plating system for distal radius fractures in both
2008 young adults and adults older than 60 years
Cooper, et al. A short term functional outcome study comparing closed reduction percutaneous wire fixation with open
2008 reduction internal fixation for fractures of the distal radius: A pilot study
Gerald, et al.
Volar plate fixation of AO type C2 and C3 distal radius fractures, a single-center study of 55 patients Not best available evidence
2008
Glickel, et al. Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius
2008 fractures
Grala, et al.
Hybrid external fixation for neglected fractures of the distal radius: results after one year Not best available evidence
2008
Hayes, et al. Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: a
2008 retrospective study of 588 patients
Ilyas, et al.
Intramedullary fixation of displaced distal radius fractures: a preliminary report Not best available evidence
2008
Lattmann, et al.
Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius Not best available evidence
2008
Lutsky, et al. Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation Does not report patient
2008 from a volar approach oriented outcomes

Evidence Table 8
Included or
Author Title
Mehboob, et al.
Fixation of extra articular distal radial fractures with non bridging external fixator Not best available evidence
2008
Osada, et al.
Prospective study of distal radius fractures treated with a volar locking plate system Not best available evidence
2008
Pieske, et al. Titanium alloy pins versus stainless steel pins in external fixation at the wrist: a randomized prospective Not relevant, not considered
2008 study for this guideline
Sammer, et al.
A comparative study of fragment-specific versus volar plate fixation of distal radius fractures Not best available evidence
2008
Arora, et al.
Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate Not best available evidence
2007
Chang, et al. Fragment-specific fracture fixation and double-column plating of unstable distal radial fractures using AO
2007 mini-fragment implants and Kirschner wires
Gerostathopoulos, et al.
Trimed fixation system for displaced fractures of the distal radius Not best available evidence
2007
Snow, et al. Function Versus Position: A Randomized Controlled Trial of Interfocal Kirschner Wiring of Unstable Distal Does not report patient
2007 Radial Fractures oriented outcomes
Szyluk, et al.
Results of operative treatment of unstable distal radius fractures using percutaneous K wire fixation Not best available evidence
2007
Chung, et al.
Treatment of unstable distal radial fractures with the volar locking plating system Not best available evidence
2006
Dai, et al.
Treatment of volar Barton's fractures: comparison between two common surgical techniques Not best available evidence
2006
Egol, et al. Not relevant, not considered
Treatment of external fixation pins about the wrist: a prospective, randomized trial
2006 for this guideline
Goldfarb, et al.
Fifteen-year outcome of displaced intra-articular fractures of the distal radius Not best available evidence
2006
Gruber, et al. Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center
2006 study of 102 patients over a 2-year period
Kamath, et al.
Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study Not best available evidence
2006
Lozano-Calderon, et al.
Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation Not best available evidence
2006

Evidence Table 8
Included or
Author Title
Ruch, et al.
Volar versus dorsal plating in the management of intra-articular distal radius fractures Not best available evidence
2006
Simic, et al.
Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment Not best available evidence
2006
Suckel, et al.
Dorsal (AO/ASIF) pi-plate osteosynthesis in the treatment of distal intraarticular radius fractures Not best available evidence
2006
Arora, et al.
External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient? Not best available evidence
2005
Gradl, et al. Fractures of the distal radius treated with a nonbridging external fixation technique using multiplanar k-
2005 wires
A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction
Grewal, et al. Insufficient reporting of
and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external
2005 outcomes
fixation
Khanduja, et al. Complications and functional outcome following fixation of complex, intra-articular fractures of the distal
2005 radius with the AO Pi-Plate
Lutz, et al.
Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius Not best available evidence
2005
Rikli, et al.
Dorsal double-plate fixation of the distal radius Not best available evidence
2005
Ruch, et al.
Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution Not best available evidence
2005
Ruschel, et al.
Treatment of unstable extra-articular distal radius fractures by modified intrafocal Kapandji method Not best available evidence
2005
Westphal, et al.
Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF Not best available evidence
2005
Wong, et al.
Volar fixation of dorsally displaced distal radial fracture using locking compression plate Not best available evidence
2005
Wright, et al. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus
2005 external fixation
Aggarwal, et al.
Open reduction and internal fixation of volar Barton's fractures: a prospective study Not best available evidence
2004

Evidence Table 8
Included or
Author Title
Anand, et al.
Role of dynamic external fixator in the management of fractures of distal end of radius Not best available evidence
2004
Hargreaves, et al. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried Does not report patient
2004 wires oriented outcomes
Krukhaug, et al.
Experience with the AO Pi-plate for displaced intra-articular fractures of the distal radius Not best available evidence
2004
Prokop, et al. Do angle stable implants provide advantages? Treatment of distal radius fractures with the locking
2004 compression plate (LCP)
Ring, et al.
Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius Not best available evidence
2004
Uchikura, et al.
Comparative study of nonbridging and bridging external fixators for unstable distal radius fractures Not best available evidence
2004
Zamzuri, et al. External fixation versus internal fixation for closed unstable intra-articular fracture of the distal radius. Early
2004 results from a prospective study
Gangopadhyay, et al.
A comparative study between longitudinal and 'T' incisions for dorsal plating of the distal radius Not best available evidence
2003
Kamano, et al.
Palmar Plating with Calcium Phosphate Bone Cement for Unstable Colles' Fractures Not best available evidence
2003
Letsch, et al. Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate
2003 position
Rikli, et al.
Complex fractures of the distal radius Retrospective case series
2003
Rozental, et al. Functional outcome and complications following two types of dorsal plating for unstable fractures of the
2003 distal part of the radius
DePK;Nijs, et al.
The 'Clip U2', a new device in treating distal radial fractures Not best available evidence
2002
Konrath, et al. Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation
2002 system
Mehta, et al. Local osteopenia associated with management of intra-articular distal radial fractures by insertion of
2002 external fixation pins in the distal fragment: prospective study
Orbay, et al.
Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report Not best available evidence
2002

Evidence Table 8
Included or
Author Title
Rosenthal, et al.
Intrafocal pinning of distal radius fractures: a simplified approach Not best available evidence
2002
Rozental, et al.
Open fractures of the distal radius Not best available evidence
2002
Sato, et al.
Antegrade intramedullary K-wire fixation for distal radial fractures Not best available evidence
2002
Rogachefsky, et al. Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction
2001 and combined internal and external fixation
Schneeberger, et al. Open reduction and plate fixation of displaced AO type C3 fractures of the distal radius: restoration of
2001 articular congruity in eighteen cases
Auge, et al.
The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy Not best available evidence
2000
Haddad, et al.
External fixation of distal radial fractures: 3 or 5 weeks of external fixation Not best available evidence
2000
Hede, et al. Comparison of intramedullary fixation and percutaneous pinning of displaced and comminuted Colles'
2000 fractures: a prospective and consecutive study
Jakob, et al. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73
2000 consecutive patients
Kaempffe, et al.
External fixation for distal radius fractures: effect of distraction on outcome Not best available evidence
2000
Kapoor, et al. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed Reports complications only,
2000 reduction, external fixation and open reduction with internal fixation < 25 patients
Klein, et al.
Results of transarticular fixator application in distal radius fractures Not best available evidence
2000
McKenna, et al.
External fixation of distal radial fractures Not best available evidence
2000
Brady, et al.
The unstable distal radial fracture one year post Kapandji intrafocal pinning Not best available evidence
1999
Fritz, et al.
Combined Kirschner wire fixation in the treatment of Colles fracture. A prospective, controlled trial Not best available evidence
1999
Goslings, et al.
Three-dimensional dynamic external fixation of distal radial fractures. A prospective study Not best available evidence
1999

Evidence Table 8
Included or
Author Title
Carter, et al. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a
1998 multicenter study of 73 fractures
Kawaguchi, et al.
Recurrent dorsal angulation of the distal radius fracture during dynamic external fixation Not best available evidence
1998
Trumble, et al.
Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation Not best available evidence
1998
Cannegieter, et al.
Cancellous grafting and external fixation for unstable Colles' fractures Not best available evidence
1997
Catalano, et al. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after
1997 open reduction and internal fixation
Fitoussi, et al.
Treatment of displaced intra-articular fractures of the distal end of the radius with plates Not best available evidence
1997
Hove, et al.
Closed reduction and external fixation of unstable fractures of the distal radius Not best available evidence
1997
Hove, et al. Open reduction and internal fixation of displaced intraarticular fractures of the distal radius. 31 patients
1997 followed for 3-7 years
Ponziani, et al.
The external fixator for the treatment of wrist fractures Not best available evidence
1997
Putnam, et al. Treatment of unstable distal radius fractures: methods and comparison of external distraction and ORIF
1997 versus external distraction-ORIF neutralization
Ring, et al.
Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures Not best available evidence
1997
Zanotti, et al.
Intra-articular fractures of the distal end of the radius treated with an adjustable fixator system Not best available evidence
1997
Zoubos, et al.
Surgical treatment of 35 volar Barton fractures. No need for routine decompression of the median nerve Not best available evidence
1997
Dowdy, et al.
Intrafocal (Kapandji) pinning of unstable distal radius fractures: a preliminary report Not best available evidence
1996
Lenoble, et al.
Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations Not best available evidence
1995
Agee, et al.
Treatment of comminuted distal radius fractures: an approach based on pathomechanics Not best available evidence
1994

Evidence Table 8
Included or
Author Title
Habernek, et al. Unstable distal radius fractures treated by modified Kirschner wire pinning: anatomic considerations,
1994 technique, and results
Keating, et al.
Internal fixation of volar-displaced distal radial fractures Not best available evidence
1994
Sommerkamp, et al. Dynamic external fixation of unstable fractures of the distal part of the radius. A prospective, randomized Reports complications only,
1994 comparison with static external fixation < 25 patients
Steffen, et al.
Twelve years follow-up of fractures of the distal radius treated with the AO external fixator Not best available evidence
1994
Trumble, et al.
Factors affecting functional outcome of displaced intra-articular distal radius fractures Not best available evidence
1994
Eglseder, et al.
Open half-pin insertion for distal radial fractures Not best available evidence
1993
Kaempffe, et al. Severe fractures of the distal radius: effect of amount and duration of external fixator distraction on
1993 outcome
Suso, et al. Comminuted intra-articular fractures of the distal end of the radius treated with the Hoffmann external
1993 fixator
Tsukazaki, et al.
Ulnar wrist pain after Colles' fracture. 109 fractures followed for 4 years Not best available evidence
1993
Casteleyn, et al. Does not report validated,
Biodegradable rods versus Kirschner wire fixation of wrist fractures. A randomised trial
1992 patient oriented outcomes
Field, et al.
Long-term prognosis of displaced Colles' fracture: a 10-year prospective review Not best available evidence
1992
Helm, et al.
The chauffeur's fracture: simple or complex? Not best available evidence
1992
Missakian, et al.
Open reduction and internal fixation for distal radius fractures Not best available evidence
1992
Altissimi, et al.
Comminuted articular fractures of the distal radius. Results of conservative treatment Not best available evidence
1991
Geissler, et al.
Percutaneous and limited open reduction of the articular surface of the distal radius Not best available evidence
1991
Horesh, et al. The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO
1991 external fixation device. A prospective three-and-one-half-year follow-up study

Evidence Table 8
Included or
Author Title
Jakim, et al.
External fixation for intra-articular fractures of the distal radius Not best available evidence
1991
Strange-Vognsen, et al. Intraarticular fractures of the distal end of the radius in young adults. A 16 (2-26) year follow-up of 42
1991 patients
vanRaay, et al.
External fixation of Smith's fracture. 16 patients followed for 2 years Not best available evidence
1991
Verhaven, et al.
External fixation for comminuted intra-articular wrist fractures Not best available evidence
1991
Yen, et al.
A semiinvasive method for articular Colles' fractures Not best available evidence
1991
vanLeeuwen, et al.
Operative treatment of Smith-Goyrand fractures Not best available evidence
1990
Bennett, et al.
Intramedullary fixation of unstable distal radius fractures. A method of fixation allowing early motion Not best available evidence
1989
Bradway, et al. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of
1989 the radius
Lennox, et al.
Use of the Clyburn External Fixator in fractures of the distal radius Not best available evidence
1989
Rayhack, et al.
Transulnar percutaneous pinning of displaced distal radial fractures: a preliminary report Not best available evidence
1989
Smith, et al.
Open reduction and internal fixation of volar lip fractures of the distal radius Not best available evidence
1988
Clyburn, et al.
Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius Not best available evidence
1987
Lacroix, et al.
Operative treatment of unstable distal radial fractures Not best available evidence
1987
Peyroux, et al. The Kapandji technique and its evolution in the treatment of fractures of the distal end of the radius.
1987 Report on a series of 159 cases
Foster, et al.
Update on external fixators in the treatment of wrist fractures Not best available evidence
1986
Knirk, et al.
Intra-articular fractures of the distal end of the radius in young adults Not best available evidence
1986

Evidence Table 8
Included or
Author Title
Melone, et al.
Open treatment for displaced articular fractures of the distal radius Not best available evidence
1986
Weber, et al. Severely comminuted distal radial fracture as an unsolved problem: complications associated with external
1986 fixation and pins and plaster techniques
Nakata, et al.
External fixators for wrist fractures: a biomechanical and clinical study Not best available evidence
1985
Vaughan, et al.
Treatment of unstable fractures of the distal radius by external fixation Not best available evidence
1985
Bossi, et al.
External fixation in the treatment of fractures of the distal forearm Not best available evidence
1984
Lucas, et al.
An analysis of hand function in patients with colles' fracture treated by Rush rod fixation Not best available evidence
1981
Marsh, et al.
Treatment of comminuted fractures of the distal radius with self-contained skeletal traction Not best available evidence
1972
Blichert-Toft, et al.
Colles' fracture treated with modified Bohler technique Not best available evidence
1971

Evidence Table 9




Crossover - equal
Crossover - equal
Patients Blinded
Krukhaug, et al.
2009
DASH 1 Year 71
External fixation - non-bridging vs.
External fixation - dynamic bridging × ● ○ ● ● ● n/a n/a
Egol, et al.
2008
DASH 3 Months 77
External fixation - bridging and K wires vs.
Volar locking plate ● ● ○ ● ● × n/a n/a
Egol, et al.
2008
Pain - VAS 3 Months 77
Egol, et al.
2008
DASH 6 Months 77
Egol, et al.
2008
Egol, et al.
2008
DASH 1 Year 77
Egol, et al.
2008
Leung, et al.
2008
Social activity
(none- slight)
n/a 144
External fixation - bridging and K-wires vs.
Plate(s) ● ● ○ ○ ● × n/a n/a
Leung, et al.
2008
Activities of daily living
(none- slight)
n/a 144
Plate(s) ● ● ○ ○ ● × n/a n/a
Leung, et al.
2008
Normal work
(none- slight)
n/a 144
Plate(s) ● ● ○ ○ ● × n/a n/a
vanManen, et al.
2008
DASH 1 Year 32
Bio-resorbable plate vs.
Metal plate × ● ● ● ● × n/a n/a
Kreder, et al.
2005
SF-36 (bodily pain) n/a 118
Indirect reduction and percutaneous fixation vs.
Open reduction and internal fixation ● × ○ ○ ○ × n/a n/a
Kreder, et al.
2005
MFA upper limb n/a 118
Indirect reduction and percutaneous fixation vs.
Open reduction and internal fixation ● × ○ ○ ○ × n/a n/a

Evidence Table 9




Crossover - equal
Crossover - equal
Patients Blinded
Harley, et al.
2004
DASH 6 Months 41
Augmented external fixation - bridging vs.
Percutaneous pinning × × ○ ● ● × n/a n/a
Harley, et al.
2004
SF-36 (physical) 6 Months 41
Harley, et al.
2004
SF-36 (mental) 6 Months 41
Harley, et al.
2004
DASH 12 Months 33
Percutaneous pinning × × ○ ● ○ × n/a n/a
Harley, et al.
2004
SF-36 (physical) 12 Months 33
Harley, et al.
2004
SF-36 (mental) 12 Months 33
Krishnan, et al.
2003
External fixation - non-bridging × ● ○ ○ ● × n/a n/a
Krishnan, et al.
2003
External fixation - non-bridging × ● ○ ○ ● × n/a n/a
Werber, et al.
2003
External fixation - four pins, bridging vs.
External fixation - five pins, bridging ○ × ○ ○ ● × n/a n/a

Evidence Table 9




Crossover - equal
Crossover - equal
Patients Blinded
Hahnloser, et al.
1999
Pain - VAS (none) n/a 46
Dorsal plate vs.
Two 1/4 tube plates ○ ○ ● ○ ● × n/a n/a
Hahnloser, et al.
1999
Activities of daily living n/a 46
Dorsal plate vs.
Hahnloser, et al.
1999
Pain - VAS (mild, 0-3) n/a 46
Dorsal plate vs.
Hahnloser, et al.
1999
Pain - VAS (moderate, 4-7) n/a 46
Dorsal plate vs.
Hahnloser, et al.
1999
Pain - VAS (severe, 8-10) n/a 46
Dorsal plate vs.
McQueen, et al.
1998
Pain 1 Year 56
External fixation - non-bridging × ● ○ × ● ● n/a n/a
McQueen, et al.
1998
McQueen, et al.
1998
Pain, DRUJ 1 Year 56
McQueen, et al.
1998
Pain, carpal 1 Year 56
Ludvigsen, et al.
1997
Percutaneous pinning vs.
External fixation - bridging × ● ○ ○ ● ○ n/a n/a
Hutchinson, et al.
1995
Pins and plaster vs.
External fixation - bridging × × ○ ○ ● × n/a n/a
Pritchett, et al.
1995
Medullary pinning × × ○ ○ ● × n/a n/a
Raskin, et al.
1993
Final
Followup
60
Pins and Plaster vs.
External fixation - bridging × × ○ ○ ● × n/a n/a

Evidence Table 10
Treatment(s)
Author Outcome Duration N Group I Group II
Group I is listed first, Group II is listed second
Krukhaug, et al. External fixation - non-bridging vs. 9 13

DASH 1 Year 71
2009 External fixation - dynamic bridging (95% CI: 3, 14) (95% CI: 8, 20)
Egol, et al. † External fixation - bridging and K wires vs.
Pain - VAS 3 Months 77 1.8 ± 2.2 2.3 ± 2.5
2008 Volar locking plate
Pain - VAS 6 Months 77 2.3 ± 2.3 2.6 ± 2.4
Pain - VAS 1 Year 77 2.1 ± 2.7 2.5 ± 2.9
Egol, et al. External fixation - bridging and K wires vs.
DASH 3 Months 77 25.4 ± 21.1 19.5 ± 20.1
DASH 6 Months 77 32.6 ± 23.8 25.0 ± 21.7
DASH 1 Year 77 17.2 ± 33.7 13.0 ± 30.9
Leung, et al. Activities of daily living External fixation - bridging and K-wires vs. 86% 92%
n/a 144
2008 (none- slight) Plate(s) (64/74 patients) (64/70 patients)
Leung, et al. Social activity External fixation - bridging and K-wires vs. 76% 81%
n/a 144
Leung, et al. Normal work External fixation - bridging and K-wires vs. 76% 84%
n/a 144
vanManen, et al. Bio-resorbable plate vs.
DASH 1 Year 32 17.08 ± 17.84 15.49 ± 16.35
2008 Metal plate
Kreder, et al. Indirect reduction and percutaneous fixation vs. -18.6 (95% CI: -33.0, -4.1)
MFA upper limb n/a 118
2005 Open reduction and internal fixation ANOVA favors Group I
Kreder, et al. Indirect reduction and percutaneous fixation vs. 0.452 (95% CI: -0.1, 1.5)
SF-36 (bodily pain) n/a 118
2005 Open reduction and internal fixation ANOVA not statistically significant
Krishnan, et al. ‡ External fixation - bridging vs. 0.9 (Range: NR)
Pain - VAS 6 Weeks 60 1.4 (Range: NR)
2003 External fixation - non-bridging p = ns
Krishnan, et al. ‡ External fixation - bridging vs. 0 (Range: NR)
Pain - VAS 26 Weeks 60 0 (Range: NR)
2003 External fixation - non-bridging p = ns
†: mean score 0 - 10 where 10 is severe pain, measured in mm; ‡: median score 0 - 10 (unit of measurement not reported), *reported by author(s)

Evidence Table 10
Treatment(s)
Author Outcome Duration N Group I Group II
Group I is listed first, Group II is listed second
Harley, et al. Augmented external fixation - bridging vs.

DASH 6 Months 41 22 ± 19 22 ± 22
2004 Percutaneous pinning
DASH 12 Months 33 23 ± 23 15 ± 18
SF-36 (mental) 6 Months 41 51 ± 12 54 ± 8
SF-36 (mental) 12 Months 33 52 ± 12 54 ± 8
SF-36 (physical) 6 Months 41 48 ± 7 46 ± 11
SF-36 (physical) 12 Months 33 45 ± 11 48 ± 11
Hahnloser, et al. Dorsal plate vs. 66.7% 80%
Activities of daily living n/a 46
1999 Two 1/4 tube plates (14/21 patients) (20/25 patients)
Hahnloser, et al. Dorsal plate vs. 33% 44%
Pain - VAS (none) n/a 46
Pain - VAS (mild, 0-3) n/a 46
Pain - VAS (moderate, 4-7) n/a 46
Pain - VAS (severe, 8-10) n/a 46
McQueen, et al. External fixation - bridging vs. 1.2 ± NR
1998 Pain - VAS* 1 Year 56
External fixation - non-bridging
1.3 ± NR
p = ns*
McQueen, et al. External fixation - bridging vs. 57% 50%
Pain 1 Year 56
1999 External fixation - non-bridging (16/28 patients) (14/28 patients)
Pain, DRUJ 1 Year 56
Pain, carpal 1 Year 56
Raskin, et al. Final Pins and Plaster vs. 100% 100%
Activities of daily living 60
1993 Followup External fixation - bridging (30/30 patients) (30/30 patients)
*: mean score 0 -10 (unit of measurement not reported), *reported by author(s)

Evidence Table 11
Operative vs. Non-operative Treatment of Distal Radius Fractures in Patients Over Age 55
Included or
Author Title
Azzopardi, et al. Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in
2005 a cast versus supplementary percutaneous pinning INCLUDED
Hegeman, et al. Primary external fixation versus plaster immobilization of the intra-articular unstable distal radial fracture in
2004 the elderly INCLUDED
Roumen, et al.
1991
Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement INCLUDED
Arora, et al. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in
2009 patients older than 70 years: nonoperative treatment versus volar locking plating
Synn, et al.
Distal radius fractures in older patients: is anatomic reduction necessary? Not best available evidence
2009
Abramo, et al. Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using Combines casting and
2008 DASH as outcome operative results
Moroni, et al.
Cast vs external fixation: a comparative study in elderly osteoporotic distal radial fracture patients Insufficient data
2004
Board, et al. Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular Reports complications only,
1999 distal radial fractures in patients over 55 years < 25 patients
Horne, et al. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal Reports complications only,
1990 radial fractures < 25 patients

Evidence Table 12




Crossover - equal
Crossover - equal
Patients Blinded
Azzopardi, et al.
2005
Cast ● × ○ ○ ● × n/a n/a
Azzopardi, et al.
2005
SF-36 (mental) 1 Year 57
Cast ● × ○ ○ ● × n/a n/a
Azzopardi, et al.
2005
SF-36 (physical) 1 Year 57
Cast ● × ○ ○ ● × n/a n/a
Hegeman, et al.
2004
Function - difficulty lifting cup 6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Function - difficulty w/ fine hand
coordination
6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Function - difficulty w/ heavy
load bearing
6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Function - difficulty wringing 6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, radiocarpal 6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, radioulnar 6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, ulnocarpal 6 Weeks 32
Cast × × ○ ○ ● ● n/a n/a

Evidence Table 12




Crossover - equal
Crossover - equal
Patients Blinded
Hegeman, et al.
2004
Function - difficulty lifting cup 3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
coordination
3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
load bearing
3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Function - difficulty wringing 3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, radiocarpal 3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, radioulnar 3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, ulnocarpal 3 Months 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Function - difficulty lifting cup 1 Year 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
coordination
1 Year 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
load bearing
1 Year 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Function - difficulty wringing 1 Year 32
Cast × × ○ ○ ● ● n/a n/a

Evidence Table 12




Crossover - equal
Crossover - equal
Patients Blinded
Hegeman, et al.
2004
Pain, radiocarpal 1 Year 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, radioulnar 1 Year 32
Cast × × ○ ○ ● ● n/a n/a
Hegeman, et al.
2004
Pain, ulnocarpal 1 Year 32
Cast × × ○ ○ ● ● n/a n/a
External fixation - following
Roumen, et al.
1991
Pain (continuous) 26 Weeks 101 redisplacement vs.
Cast - following redisplacement
× × ○ × ● × n/a n/a
External fixation - following

Roumen, et al.
1991
Pain (on movement) 26 Weeks 101 redisplacement vs.
× × ○ × ● × n/a n/a
External fixation- following

Roumen, et al.
1991
Pain (ulnar compression) 26 Weeks 101 redisplacement vs.
× × ○ × ● × n/a n/a

Evidence Table 13
Azzopardi, et al. † Percutaneous pinning vs.

Pain - VAS 1 Year 57 0.7 ± 1.3 1.2 ± 1.6
2005 Cast
Azzopardi, et al. Percutaneous pinning vs.
SF-36 (mental) 1 Year 57 51.0 ± 13.2 50.4 ± 8.6
2005 Cast
Azzopardi, et al. Percutaneous pinning vs.
SF-36 (physical) 1 Year 57 42.2 ± 9.7 38.2 ± 11.2
2005 Cast
Hegeman, et al. External fixation - bridging vs. 60% 35%
Pain, radiocarpal 6 Weeks 32
Pain, radiocarpal 3 Months 32
Pain, radiocarpal 1 Year 32
Pain, radioulnar 6 Weeks 32
Pain, radioulnar 3 Months 32
Pain, radioulnar 1 Year 32
Pain, ulnocarpal 6 Weeks 32
Pain, ulnocarpal 3 Months 32
Pain, ulnocarpal 1 Year 32
†: mean score 0 - 10 (unit of measurement not reported)

Evidence Table 13

Function - difficulty lifting cup 6 Weeks 32
Function - difficulty lifting cup 3 Months 32
Function - difficulty lifting cup 1 Year 32
Function - difficulty wringing 6 Weeks 32
Function - difficulty wringing 3 Months 32
Function - difficulty wringing 1 Year 32
Hegeman, et al. Function - difficulty w/ External fixation - bridging vs. 80% 82%
6 Weeks 32
2004 fine hand coordination Cast (12/15 patients) (14/15 patients)
3 Months 32
1 Year 32
3 Months 32
2004 heavy load bearing Cast (12/15 patients) (13/15 patients)
6 Weeks 32
1 Year 32
Roumen, et al. External fixator vs. 5% 0%
Pain (continuous) 26 Weeks 43
Pain (on movement) 26 Weeks 43
Pain (ulnar compression) 26 Weeks 43

Evidence Table 14
Locking Plates for Treatment of Distal Radius Fractures in Patients Over Age 55
Included or
Author Title
Oshige, et al. A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius
2007 fractures in elderly patients: intrafocal pinning versus volar locking plating INCLUDED
Chung, et al. Comparative outcomes study using the volar locking plating system for distal radius fractures in both Not relevant, comparison of
2008 young adults and adults older than 60 years age groups
Does not compare locking
Jakubietz, et al. A randomised clinical study comparing palmar and dorsal fixed-angle plates for the internal fixation of AO
plates to other non-locking
2008 C-type fractures of the distal radius in the elderly
plate operative treatment
Does not compare locking
Atroshi, et al. Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized
plates to other non-locking
2006 assessor-blind clinical trial of 38 patients followed for 1 year
plate operative treatment
Fu, et al. Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted Does not report validated,
2006 distal radius fractures in osteoporotic patients patient oriented outcomes
Kamiloski, et al.
External fixation in patients with age over 65 years with distal radius fracture Not best available evidence
2006
Hegeman, et al. External fixation for unstable intra-articular distal radial fractures in women older than 55 years.
2005 Acceptable functional end results in the majority of the patients despite significant secondary displacement
Koshimune, et al. A randomized comparison of locking and non-locking palmar plating for unstable Colles' fractures in the Does not report validated,
2005 elderly patient oriented outcomes
Shiota, et al.
Conehead wedging screw for distal radius fractures in elderly patients Not best available evidence
2003
Moroni, et al. Improvement of the bone-pin interface strength in osteoporotic bone with use of hydroxyapatite-coated Reports complications only,
2001 tapered external-fixation pins. A prospective, randomized clinical study of wrist fractures < 25 patients
Trumble, et al.
Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation Not best available evidence
1998

Evidence Table 15
Locking Plates for Treatment of Distal Radius Fractures in Patients Over Age 55


Crossover - equal
Crossover - equal
treated
Oshige, et al.
2007
Intrafocal pinning vs.
Volar locking plate ● ● ● ● ● n/a n/a

Evidence Table 16
Non-operative Treatment of Displaced Distal Radius Fractures
Included or
Author Title
Tumia, et al. Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective,
2003 randomised, controlled trial INCLUDED
Moir, et al.
1995
A new functional brace for the treatment of Colles' fractures INCLUDED
Ledingham, et al.
1991
On immediate functional bracing of Colles' fracture INCLUDED
Bunger, et al.
1984
Early results after Colles' fracture: functional bracing in supination vs dorsal plaster immobilization INCLUDED
Stewart, et al. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster
1984 casts INCLUDED
Monument, et al. Not relevant, not considered
Quantifying the amount of padding improves the comfort and function of a fibreglass below-elbow cast
Not relevant, study does not
Wik, et al. report patient oriented
Colles' fracture: dorsal splint or complete cast during the first 10 days?
2009 outcomes after treatment is
complete
Makhni, et al. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative
2008 treatment
Foldhazy, et al.
Long-term outcome of nonsurgically treated distal radius fractures Not best available evidence
2007
Jaremko, et al. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving
2007 conservative treatment?
Kulej, et al. Efficacy of closed reduction and maintenance of surgical outcome in plaster cast immobilization in different
2007 types of distal radius fractures
Bong, et al. A comparison of immediate postreduction splinting constructs for controlling initial displacement of Does not compare cast to
2006 fractures of the distal radius: a prospective randomized study of long-arm versus short-arm splinting splint
Dixon, et al.
Which Colles' fractures should be manipulated? Not best available evidence
2005
Anzarut, et al. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal
2004 radius fractures
O'Connor, et al. Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a Only enrolls minimally
2003 plaster cast displaced fractures

Evidence Table 16
Included or
Author Title
Smilovic, et al.
Conservative treatment of extra-articular Colles' type fractures of the distal radius: prospective study Not best available evidence
2003
Earnshaw, et al. Closed reduction of Colles fractures: Comparison of manual manipulation and finger-trap traction - A Does not report patient
2002 prospective, randomized study oriented outcomes
Chang, et al. Conservative treatment of redisplaced Colles' fractures in elderly patients older than 60 years old -
2001 anatomical and functional outcome
Cohen, et al. Does not report validated,
Focused rigidity casting: a prospective randomised study
Leung, et al.
Conservative treatment of intra-articular fractures of the distal radius--factors affecting functional outcome Not best available evidence
2000
Young, et al. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients
2000 older than 60 years
Byl, et al. Functional limitation immediately after cast immobilization and closed reduction of distal radius fractures:
1999 preliminary report
Stoffelen, et al. Does not report validated,
Minimally displaced distal radius fractures: do they need plaster treatment?
1997 < 25 patients
Jensen, et al. Does not report validated,
Management of undisplaced or minimally displaced Colles' fracture: One or three weeks of immobilization
Kelly, et al. Does not report patient
Is manipulation of moderately displaced Colles' fracture worthwhile? A prospective randomized trial
Christensen, et al.
Length of immobilisation after fractures of the distal radius Not best available evidence
1995
Altissimi, et al. Does not report patient
Early and late displacement of fractures of the distal radius. The prediction of instability
Kopylov, et al.
Fractures of the distal end of the radius in young adults: a 30-year follow-up Not best available evidence
1993
Tsukazaki, et al.
1993
Warwick, et al.
Function ten years after Colles' fracture Not best available evidence
1993

Evidence Table 16
Included or
Author Title
Gupta, et al. Does not report validated,
The treatment of Colles' fracture. Immobilisation with the wrist dorsiflexed
Moir, et al.
Intracast pressure measurements in Colles' fractures Not best available evidence
1991
Abbaszadegan, et al. Only enrolls minimally
Fixation not needed for undisplaced Colles' fracture
1989 displaced fractures
Ferris, et al. Does not report patient
Brace treatment of Colles' fracture
Jenkins, et al.
Mal-union and dysfunction in Colles' fracture Not best available evidence
1988
McQueen, et al.
Colles fracture: does the anatomical result affect the final function? Not best available evidence
1988
Solgaard, et al.
Function after distal radius fracture Not best available evidence
1988
Davis, et al. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial Only enrolls minimally
1987 metaphysis displaced fractures
deBruijn, et al.
Functional treatment of Colles fracture Thesis
1987
Dias, et al.
The value of early mobilisation in the treatment of Colles' fractures Enrolls only elderly patients
1987
Dias, et al. Does not report patient
The radiological deformity of Colles' fractures
Does not report patient
McAuliffe, et al.
Early mobilisation of Colles' fractures. A prospective trial oriented outcomes
1987
quantitatively
Villar, et al.
Three years after Colles' fracture. A prospective review Not best available evidence
1987
Altissimi, et al.
Long-term results of conservative treatment of fractures of the distal radius Not best available evidence
1986
Stewart, et al.
The hand complications of Colles' fractures Duplicate study
1985

Evidence Table 16
Included or
Author Title
Wilson, et al. Does not report validated,
Colles' fracture. Immobilisation in pronation or supination?
Rosetzsky, et al. Reports complications only,
Colles' fractures treated by plaster and polyurethane braces: a controlled clinical study
1982 < 25 patients
Wahlstrom, et al. Does not report patient
Treatment of Colles' fracture. A prospective comparison of three different positions of immobilization
Nielsen, et al. Reports complications only,
A new thermoplastic casting material. A comparison between plaster of Paris and Hexelite
1981 < 25 patients
vanderLW;Ericson, et al. Does not report patient
Colles' fracture. How should its displacement be measured and how should it be immobilized?
Sarmiento, et al.
Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation Insufficient data
1980
Hollingsworth, et al.
The importance of the ulnar side of the wrist in fractures of the distal end of the radius Not best available evidence
1976
Pool, et al.
Colles's fracture. A prospective study of treatment Not best available evidence
1973
Bygren, et al.
Social effects of Colles' fracture Not best available evidence
1969

Evidence Table 17




Crossover - equal
Crossover - equal
Patients Blinded
Tumia, et al.
2003
Pain - Likert 10 Days 182
Cast vs.
Functional brace ● × ○ ● ● × n/a n/a
Tumia, et al.
2003
Pain - Likert 5 Weeks 182
Cast vs.
Tumia, et al.
2003
Cast vs.
Tumia, et al.
2003
Cast vs.
Tumia, et al.
2003
Cast vs.
Moir, et al.
1995
Pain - VAS 10-14 Days 79
Full forearm cast vs.
Brace ● × ○ ○ ● ● n/a n/a
Moir, et al.
1995
Pain - VAS 5-6 Weeks 79
Brace ● × ○ ○ ● ● n/a n/a
Moir, et al.
1995
Brace ● × ○ ○ ● ● n/a n/a
Moir, et al.
1995
Brace ● × ○ ○ ● ● n/a n/a
Moir, et al.
1995
Brace ● × ○ ○ ● ● n/a n/a

Evidence Table 17




Crossover - equal
Crossover - equal
Patients Blinded
Ledingham, et al.
1991
Below elbow cast vs.
Functional brace × × ○ × ● × n/a n/a
Bunger, et al.
1984
Below or above elbow cast vs.
Functional brace in supination × × ○ × ● × n/a n/a
Stewart, et al.
1984
Above elbow cast-brace in supination ○ ○ ○ ● ● × n/a n/a

Evidence Table 18
Author Outcome Duration N Treatment(s) Cast Brace
Tumia, et al. † Cast vs. 1.8 ± NR

Pain - Likert 10 Days 182 2.1 ± NR
2003 Functional brace p = 0.19*
Pain - Likert 5 Weeks 182 1.1 ± NR
Moir, et al. ‡ Full forearm cast vs. 3 (range: NR)
Pain - VAS 10-14 Days 79 4 (range: NR)
1995 Brace p = 0.5*
Pain - VAS 5-6 Weeks 79 2 (range: NR)
1995 Brace p = 0.02*
1995 Brace p = 0.048*
1995 Brace p = 0.3*
1995 Brace p = 0.4*
†: mean score 0 - 4 (0: no pain, 1: occasional pain on heavy activity, 2: frequent pain on heavy activity, 3: frequent pain on normal activity, 4: frequent pain at rest)
‡: median score 0 - 10 where 10 is most severe pain (unit of measurement not reported), *reported by author(s)

Evidence Table 19
Non-operative Treatment of Undisplaced or Minimally Displaced Distal Radius Fractures
Included or
Author Title
O'Connor, et al. Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a
2003 plaster cast INCLUDED
Tumia, et al. Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective,
2003 randomised, controlled trial INCLUDED
1989
Fixation not needed for undisplaced Colles' fracture INCLUDED
Davis, et al. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial
1987 metaphysis INCLUDED
complete
2008 treatment
Foldhazy, et al.
2007
Bong, et al. A comparison of immediate postreduction splinting constructs for controlling initial displacement of Does not compare cast to
2006 fractures of the distal radius: a prospective randomized study of long-arm versus short-arm splinting splint
Dixon, et al.
2005
Smilovic, et al.
2003

Evidence Table 19
Included or
Author Title
Leung, et al.
2000
1997 < 25 patients
Christensen, et al.
1995
Moir, et al. Only enrolls displaced
A new functional brace for the treatment of Colles' fractures
1995 fractures
Kopylov, et al.
1993
Tsukazaki, et al.
1993
Warwick, et al.
1993

Evidence Table 19
Included or
Author Title
Ledingham, et al. Only enrolls displaced
On immediate functional bracing of Colles' fracture
1991 fractures
Moir, et al.
1991
Jenkins, et al.
1988
McQueen, et al.
1988
Solgaard, et al.
1988
deBruijn, et al.
1987
Dias, et al.
1987
McAuliffe, et al.
1987
quantitatively
Villar, et al.
1987
Altissimi, et al.
1986
Stewart, et al.
1985
Bunger, et al. Only enrolls displaced
Early results after Colles' fracture: functional bracing in supination vs dorsal plaster immobilization
1984 fractures
Stewart, et al. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster Only enrolls displaced
1984 casts fractures

Evidence Table 19
Included or
Author Title
1982 < 25 patients
1981 < 25 patients
Sarmiento, et al.
1980
1976
Pool, et al.
1973
Bygren, et al.
1969

Evidence Table 20




Crossover - equal
Crossover - equal
Patients Blinded
O'Connor, et al.
2003
Pain - VAS 1 Week 66
Elastic/aluminum brace ○ ○ ○ ● ● ● n/a n/a
O'Connor, et al.
2003
O'Connor, et al.
2003
Tumia, et al.
2003
Pain - Likert 10 Days 147
Cast vs.
Tumia, et al.
2003
Cast vs.
Tumia, et al.
2003
Cast vs.
Tumia, et al.
2003
Cast vs.
Tumia, et al.
2003
Cast vs.
1989
Pain - VAS 11 Days 68
Dorsal plaster cast vs.
Elastic bandage × × ○ × ● × n/a n/a
1989
1989
1989

Evidence Table 20




Crossover - equal
Crossover - equal
Patients Blinded
Davis, et al.
1987
Elastic tubular brace × × ○ ○ ● ● n/a n/a
Davis, et al.
1987
Davis, et al.
1987
ADL - handling coin >5 Weeks 52
Davis, et al.
1987
ADL - use of knife/fork >5 Weeks 52
Davis, et al.
1987
ADL - using a can opener >5 Weeks 52
Davis, et al.
1987
ADL - turning key >5 Weeks 52
Davis, et al.
1987
ADL - carrying shopping bag >5 Weeks 52

Evidence Table 21
O'Connor, et al. † Below elbow cast vs.

Pain - VAS 1 Week 66 3±1 3±1
2003 Elastic/aluminum brace
Pain - VAS 2 Weeks 66 2±1 3±1
Pain - VAS 6 Weeks 66 3±1 2±1
Tumia, et al. ‡ Cast vs. 2.2 ± NR
Pain - Likert 10 Days 147 2.4 ± NR
2003 Functional brace p = 0.27**
Abbaszadegan, et al. Dorsal plaster cast vs. 4.0 ± NR
1989 Pain - VAS* 11 Days 68
Elastic bandage
4.7 ± NR
p = 0.09**
Abbaszadegan, et al. Dorsal plaster cast vs. 3.4± NR
1989 Pain - VAS* 4 Weeks 68
Elastic bandage
3.7 ± NR
p = 0.4**
Elastic bandage
3.2 ± NR
p < 0.001**
1989 Pain - VAS* 1 Year 68
Elastic bandage
1.9 ± NR
p = 0.06**
†: mean score 0 - 10 (unit of measurement not reported)
‡: mean score 0 - 4 (0: no pain, 1: occasional pain on heavy activity, 2: frequent pain on heavy activity, 3: frequent pain on normal activity, 4:frequent pain at rest)
*: mean score 0 - 10 (unit of measurement not reported)
**: reported by author(s)

Evidence Table 21
Davis, et al. † Below elbow cast vs.

Pain - VAS 4 Weeks 52 5.8 ± 4.7 4.0 ± 4.4
1987 Elastic tubular brace
Davis, et al. † Below elbow cast vs.
Pain - VAS 6 Weeks 52 3.6 ± 3.2 2.6 ± 3.1
1987 Elastic tubular brace
Davis, et al. Below elbow cast vs. 96% 85%
ADL - handling coin >5 Weeks 52
1987 Elastic tubular brace (24/25 patients) (23/27 patients)
ADL - use of knife/fork >5 Weeks 52
ADL - using a can opener >5 Weeks 52
ADL - turning key >5 Weeks 52
ADL - carrying shopping bag >5 Weeks 52
†: mean score 0 - 20 cm

Evidence Table 22
Above vs. Below Elbow Cast Treatment of Distal Radius Fractures
Included or
Author Title
Bong, et al. A comparison of immediate postreduction splinting constructs for controlling initial displacement of
2006 fractures of the distal radius: a prospective randomized study of long-arm versus short-arm splinting INCLUDED
complete
2008 treatment
Foldhazy, et al.
2007
Dixon, et al.
2005
O'Connor, et al. Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a Does not compare above
2003 plaster cast elbow to below elbow cast
Smilovic, et al.
2003
Tumia, et al. Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, Does not compare above
2003 randomised, controlled trial elbow to below elbow cast

Evidence Table 22
Included or
Author Title
Leung, et al.
2000
1997 < 25 patients
Christensen, et al.
1995
Moir, et al. Does not compare above
A new functional brace for the treatment of Colles' fractures
1995 elbow to below elbow cast
Kopylov, et al.
1993
Tsukazaki, et al.
1993
Warwick, et al.
1993
Ledingham, et al. Does not compare above
On immediate functional bracing of Colles' fracture
Moir, et al.
1991

Evidence Table 22
Included or
Author Title
Abbaszadegan, et al. Does not compare above
Fixation not needed for undisplaced Colles' fracture
Jenkins, et al.
1988
McQueen, et al.
1988
Solgaard, et al.
1988
Davis, et al. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial Does not compare above
1987 metaphysis elbow to below elbow cast
deBruijn, et al.
1987
Dias, et al.
1987
McAuliffe, et al.
1987
quantitatively
Villar, et al.
1987
Altissimi, et al.
1986
Stewart, et al.
1985
Bunger, et al. Does not compare above
Early results after Colles' fracture: functional bracing in supination vs dorsal plaster immobilization
Stewart, et al. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster Does not compare above
1984 casts elbow to below elbow cast

Evidence Table 22
Included or
Author Title
1982 < 25 patients
1981 < 25 patients
Sarmiento, et al.
1980
1976
Pool, et al.
1973
Bygren, et al.
1969

Evidence Table 23




Crossover - equal
Crossover - equal
Patients Blinded
Bong, et al.
2006
DASH 1-2 Weeks 85
Sugar tong cast vs.
Radial gutter cast ● × ○ ○ ○ × n/a n/a

Evidence Table 24
Author Outcome Duration N Treatment(s) Sugar Tong Radial Gutter
Bong, et al. Sugar tong cast vs.

DASH 1-2 Weeks 85 70 ± 15 62 ± 19
2006 Radial gutter cast

Evidence Table 25
Arthroscopy and Fluoroscopy in the Treatment of Intra-articular Distal Radius Fractures
Included or
Author Title
Varitimidis, et al.
2008
Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? INCLUDED
Ruch, et al. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius
2004 fractures INCLUDED
Atesok, et al. Not relevant, non-DRF
The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures
2007 diagnosis
Hardy, et al.
Wrist arthroscopy and intra-articular fractures of the distal radius in young adults Not best available evidence
2006
Grechenig, et al.
Distal radius fractures: The value of wrist arthroscopy in the acute setting Not best available evidence
2004
Edwards, et al.
Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction Not best available evidence
2001
Lindau, et al.
Wrist arthroscopy in distal radial fractures using a modified horizontal technique Not best available evidence
2001
Shih, et al.
Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius Not best available evidence
2001
Mehta, et al.
Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach Not best available evidence
2000
Not relevant, arthoscopy
Doi, et al. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared
without intraoperative
1999 with open reduction and internal fixation
fluoroscopy
Adolfsson, et al.
Arthroscopically-assisted reduction of intra-articular fractures of the distal radius Not best available evidence
1998

Evidence Table 26




Crossover - equal
Crossover - equal
Patients Blinded
Varitimidis, et al.
2008
DASH 3 Months 40
Arthroscopy and Fluoroscopy vs.
Fluoroscopy only × ● ● ● ● × n/a n/a
Varitimidis, et al.
2008
DASH 12 Months 40
Varitimidis, et al.
2008
DASH 24 Months 40


Crossover - equal
Crossover - equal
treated
Ruch, et al.
2004
DASH
12-17
Months
30
Fluoroscopy only ● × ○ ● ● n/a n/a

Evidence Table 27
Arthroscopy and
Author Outcome Duration N Comparison(s) Fluoroscopy only
Fluoroscopy
Varitimidis, et al. Arthroscopy and Fluoroscopy vs.

DASH 3 Months 40 12 ± 4.1 25 ± 8.5
2008 Fluoroscopy only
DASH 12 Months 40 4.7 ± 4.4 7.9 ± 8.4
DASH 24 Months 40 4.8 ± 4.2 8.3 ± 7.4

Arthroscopy and
Author Outcome Duration N Comparison(s) Fluoroscopy only
Fluoroscopy
Ruch, et al. 12-17 Arthroscopy and Fluoroscopy vs. 11 ± NR

DASH 30 19 ± NR
2004 Months Fluoroscopy only p = ns*
*: reported by author(s)

Evidence Table 28
Associated Carpal Fractures or Ligament Injuries with Distal Radius Fractures
Included or
Author Title
Varitimidis, et al.
2008
Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? INCLUDED
Forward, et al. Ligament injuries are not
Intercarpal ligament injuries associated with fractures of the distal part of the radius
2007 treated
Owers, et al. Ultrasound changes in the extensor pollicis longus tendon following fractures of the distal radius--a Does not report patient
2007 preliminary report oriented outcomes
Lindau, et al. Less than 10 patients per
Cartilage injuries in distal radial fractures
2003 group
Ruch, et al. Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-
Retrospective case series
2003 articular distal radius fractures
Lindau, et al. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal Does not report validated,
2000 radial fractures patient oriented outcomes
Combines patients with and
Laulan, et al. Intracarpal ligamentous lesions associated with fractures of the distal radius: outcome at one year. A
without associated carpal
1999 prospective study of 95 cases
injuries
Peicha, et al. Midterm results of arthroscopic treatment of scapholunate ligament lesions associated with intra-articular Less than 10 patients per
1999 distal radius fractures group
The clinical importance of carpal instabilities following distal radial fractures
Hove, et al. Does not report validated,
Simultaneous scaphoid and distal radial fractures
Mohanti, et al. Does not report patient
Study of triangular fibrocartilage of the wrist joint in Colles' fracture

Evidence Table 29




Crossover - equal
Crossover - equal
Patients Blinded
Varitimidis, et al.
2008
DASH 3 Months 40
Treatment of ligament injuries vs.
No treatment × ● ● ● ● × n/a n/a
Varitimidis, et al.
2008
DASH 12 Months 40
Varitimidis, et al.
2008
DASH 24 Months 40

Evidence Table 30
Treated ligament
Author Outcome Duration N Comparison(s) No treatment
Injuries
Varitimidis, et al. Treatment of ligament injuries vs.

DASH 3 Months 40 12 ± 4.1 25 ± 8.5
2008 No treatment
DASH 12 Months 40 4.7 ± 4.4 7.9 ± 8.4
2008 No treatment
DASH 24 Months 40 4.8 ± 4.2 8.3 ± 7.4
2008 No treatment

Evidence Table 31
Advanced Imaging for Intra-articular Distal Radius Fractures
Included or
Author Title
Harness, et al. The influence of three-dimensional computed tomography reconstructions on the characterization and
2006 treatment of distal radial fractures INCLUDED
Richards, et al.
1997
Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures INCLUDED
Geissler, et al.
1996
Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius INCLUDED
Bombaci, et al. Not diagnostic accuracy,
The value of plain X-rays in predicting TFCC injury after distal radial fractures
2008 incidence study
Does not investigate
Kwon, et al.
Fluoroscopic diagnosis of scapholunate interosseous ligament injuries in distal radius fractures diagnostic accuracy of
2008
advanced imaging
Welling, et al.
MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns Severity of injury not reported
2008
Kumar, et al. Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study Does not investigate patients
2005 (Canberra Area Scaphoid Trial) with intra-articular DRF
Nikken, et al. Acute wrist trauma: value of a short dedicated extremity MR imaging examination in prediction of need for
2005 treatment
Nikken, et al. Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of
2005 randomized controlled trial
Akdemir, et al. Does not investigate patients
Value of bone scintigraphy in patients with carpal trauma
2004 with intra-articular DRF
Kiuru, et al.
Wrist injuries; diagnosis with multidetector CT Severity of injury not reported
2004
Remplik, et al.
Diagnosis of acute fractures of the extremities: comparison of low-field MRI and conventional radiography Severity of injury not reported
2004
Annamalai, et al. Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult Does not investigate patients
2003 fractures with intra-articular DRF
Mack, et al.
Clinical impact of MRI in acute wrist fractures Severity of injury not reported
2003
Russin, et al. Should the routine wrist examination for trauma be a four-view study, including a semisupinated oblique Does not investigate
2003 view? advanced imaging
Akahane, et al. Static scapholunate dissociation diagnosed by scapholunate gap view in wrists with or without distal Does not investigate
2002 radius fractures advanced imaging

Evidence Table 31
Included or
Author Title
Chern, et al. Not specific to intra-articular
Sonography for monitoring closed reduction of displaced extra-articular distal radial fractures
2002 fractures
Gabler, et al. Diagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and Does not investigate patients
2001 plain radiographs still state of the art? with intra-articular DRF
Katz, et al. Not diagnostic accuracy,
Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment?
2001 observer reliability study
Rozental, et al.
Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture diagnostic accuracy of
2001
advanced imaging
DeSmet, et al. Does not investigate
Are oblique views needed for trauma radiography of the distal extremities?
1999 advanced imaging
Lohman, et al.
MR imaging in suspected acute trauma of wrist bones Severity of injury not reported
1999
Spence, et al. Insufficient data for diagnostic
MRI of fractures of the distal radius: comparison with conventional radiographs
1998 accuracy
Cole, et al. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: Not diagnostic accuracy,
1997 reliability of plain radiography versus computed tomography observer reliability study
Pruitt, et al.
Computed tomography scanning with image reconstruction in evaluation of distal radius fractures diagnostic accuracy of
1994
advanced imaging
Larsen, et al.
An algorithm for acute wrist trauma. A systematic approach to diagnosis Severity of injury not reported
1993
Johnston, et al. Insufficient data for diagnostic
Computerized tomographic evaluation of acute distal radial fractures
1992 accuracy

2006
Author
Harness, et al.
N
25
AAOS Clinical Practice Guidelines Unit

Index Test
Radiograph plus
2D CT and/or 3D CT
● = Yes ○ = No ? = Not Reported
Operative findings
Reference Standard
Spectrum bias
avoided
Selection criteria described
Page 61 of 138
Appropriate reference standard
Evidence Table 32
Disease progression bias

avoided
Partial verification bias avoided
Differential verification bias

avoided
Incorporation bias avoided
Index test execution described
Reference standard execution

Quality of Diagnostic Accuracy Studies (QUADAS) Results
described
Test review bias

avoided
Diagnostic review bias
avoided
Clinical review bias
avoided
Uninterpretable/Intermediate test
result(s) reported
v 1.0 12.05.09
Withdrawals explained
● ● ● ● ● ● ● ● ● ● ● ● ● ●
Evidence Table 33
Diagnostic Accuracy Studies DATA
Author N Index Test Reference Standard True Positives False Positives False Negatives True Negatives
Harness, et al. † Coronal fracture line with

100 Operative findings 62 10 15 13
2006 radiographs plus 2D CT
2006 radiographs plus 2D/3D CT
Harness, et al. † Articular depression with
Harness, et al. † Articular comminution with
†: 25 patients x 4 independent evaluators = 100 observations

Evidence Table 34
Locking Plates and Bone Grafting in Distal Radius Fracture
Included or
Author Title

Evidence Table 35
Bone Grafts/Substitutes for Distal Radius Fractures
Included or
Author Title
Rajan, et al. Cancellous allograft versus autologous bone grafting for repair of comminuted distal radius fractures: a
2006 prospective, randomized trial INCLUDED
Cassidy, et al.
2003
Norian SRS cement compared with conventional fixation in distal radial fractures. A randomized study INCLUDED
Zimmermann, et al. Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression
2003 fractures of the distal radius in osteoporotic women INCLUDED
Sanchez-Sotelo, et al. Treatment of fractures of the distal radius with a remodellable bone cement: a prospective, randomised
2000 study using Norian SRS INCLUDED
Kopylov, et al. Norian SRS versus external fixation in redisplaced distal radial fractures. A randomized study in 40
1999 patients INCLUDED
Schmalholz, et al.
1990
External skeletal fixation versus cement fixation in the treatment of redislocated Colles' fracture INCLUDED
Schmalholz, et al.
1989
Bone cement for redislocated Colles' fracture. A prospective comparison with closed treatment INCLUDED
Huber, et al. Open reduction and palmar plate-osteosynthesis in combination with a nanocrystalline hydroxyapatite
2006 spacer in the treatment of comminuted fractures of the distal radius
Rogachefsky, et al. The use of tricorticocancellous bone graft in severely comminuted intra-articular fractures of the distal
2006 radius
Tyllianakis, et al.
Graft-supplemented, augmented external fixation in the treatment of intra-articular distal radial fractures Not best available evidence
2006
Willcox, et al.
Treatment of distal radial fractures with grafting and K-wiring Not best available evidence
2005
Zhang, et al.
External fixation and bone grafting for collapsed and comminuted distal radius fracture Not best available evidence
2005
Kamano, et al.
Palmar Plating with Calcium Phosphate Bone Cement for Unstable Colles' Fractures Not best available evidence
2003
Lutz, et al. Intraarticular Colles' fractures - Open reduction, internal fixation, and filling of defect with autogenous
2003 corticocancellous bone
Jeyam, et al. Less than 10 patients per
Controlled trial of distal radial fractures treated with a resorbable bone mineral substitute
2002 group

Evidence Table 35
Included or
Author Title
Kopylov, et al. Norian SRS versus functional treatment in redisplaced distal radial fractures: a randomized study in 20 Less than 10 patients per
2002 patients group
Tyllianakis, et al.
Use of injectable calcium phosphate in the treatment of intra-articular distal radius fractures Not best available evidence
2002
Widman, et al. Reports complications only,
Primary bone grafting does not improve the results in severely displaced distal radius fractures
2002 < 25 patients
Kopylov, et al. Radiostereometric analysis of distal radial fracture displacement during treatment: a randomized study Does not report patient
2001 comparing Norian SRS and external fixation in 23 patients oriented outcomes
Sakano, et al.
Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer Not best available evidence
2001
Werber, et al.
Osseous integration of bovine hydroxyapatite ceramic in metaphyseal bone defects of the distal radius Not best available evidence
2000
Herrera, et al.
Treatment of unstable distal radius fractures with cancellous allograft and external fixation Not best available evidence
1999
Cannegieter, et al.
Cancellous grafting and external fixation for unstable Colles' fractures Not best available evidence
1997
Chapman, et al. Not relevant, non-DRF
Treatment of acute fractures with a collagen-calcium phosphate graft material. A randomized clinical trial
1997 diagnosis
McBirnie, et al.
Early open reduction and bone grafting for unstable fractures of the distal radius Not best available evidence
1995
Leung, et al. Ligamentotaxis for comminuted distal radial fractures modified by primary cancellous grafting and
1991 functional bracing: long-term results
Leung, et al.
An effective treatment of comminuted fractures of the distal radius Not best available evidence
1990
Leung, et al.
Ligamentotaxis and bone grafting for comminuted fractures of the distal radius Not best available evidence
1989
Schmalholz, et al. Does not report patient
A scintimetric study of Colles' fracture. Comparison between cementation and closed treatment

Evidence Table 36




Crossover - equal
Crossover - equal
Patients Blinded
Rajan, et al.
2006
(moderate - severe)
12 Months 90
Allograft vs.
Autograft ○ ○ ○ ○ × × n/a n/a
Rajan, et al.
2006
(none- slight)
12 Months 90
Allograft vs.
Rajan, et al.
2006
Pain - VAS
(discomforting - intense)
12 Months 90
Allograft vs.
Rajan, et al.
2006
Pain - VAS
(none - mild)
12 Months 90
Allograft vs.
Cassidy, et al.
2003
Calcium phosphate vs.
Casting or External Fixation ○ × ○ ○ × × n/a n/a
Zimmermann, et al.
2003
DASH - function/symptom
21 - 29
Months
52
Percutaneous Pinning × × ○ ○ × × n/a n/a
Zimmermann, et al.
2003
DASH - music/sport/work
21 - 29
Months
52
Percutaneous Pinning × × ○ ○ × × n/a n/a
Sanchez-Sotelo, et al.
2000
Pain, radiocarpal - VAS
(none)
3 Months 110
Casting ● × ○ ○ × × n/a n/a
2000
(mild)
3 Months 110
2000
(moderate)
3 Months 110
2000
(severe)
3 Months 110

Evidence Table 36




Crossover - equal
Crossover - equal
Patients Blinded
2000
Pain, radioulnar - VAS
(none)
3 Months 110
2000
(mild)
3 Months 110
2000
(moderate)
3 Months 110
2000
(severe)
3 Months 110
2000
(none)
6 Months 110
2000
(mild)
6 Months 110
2000
(moderate)
6 Months 110
2000
(severe)
6 Months 110
2000
(none)
6 Months 110
2000
(mild)
6 Months 110
2000
(moderate)
6 Months 110
2000
(severe)
6 Months 110

Evidence Table 36




Crossover - equal
Crossover - equal
Patients Blinded
2000
(none)
12 Months 110
2000
(mild)
12 Months 110
2000
(moderate)
12 Months 110
2000
(severe)
12 Months 110
2000
(none)
12 Months 110
2000
(mild)
12 Months 110
2000
(moderate)
12 Months 110
2000
(severe)
12 Months 110
Kopylov, et al.
1999
External fixation × × ○ ○ ● ● n/a n/a
Kopylov, et al.
1999
Kopylov, et al.
1999
Function - VAS 1 Year 38
Kopylov, et al.
1999

Evidence Table 36




Crossover - equal
Crossover - equal
Patients Blinded
McQueen, et al.
1996
Autograft vs.
Casting or External Fixation × ● ○ ○ × × n/a n/a
Schmalholz, et al.
1990
Pain free 2 Months 48
Methylmethacrylate vs.
External Fixation ○ ○ ○ ○ ○ ○ n/a n/a
Schmalholz, et al.
1990
Schmalholz, et al.
1990
Schmalholz, et al.
1990
Schmalholz, et al.
1989
Casting ○ ○ ○ ○ × × n/a n/a
Schmalholz, et al.
1989
Schmalholz, et al.
1989
Schmalholz, et al.
1989
Schmalholz, et al.
1989

Evidence Table 37
Author Outcome Duration N Treatment(s) Bone Void Filler Control Group
Zimmermann, et al. 21 - 29 Calcium phosphate vs. 10 20

DASH - function/symptom 52
2003 Months Percutaneous Pinning (range, 0 - 35) (range, 5 - 60)
Zimmermann, et al. 21 - 29 Calcium phosphate vs. 9 24
DASH - music/sport/work 52
2003 Months Percutaneous Pinning (range, 0 - 16) (range, 3 - 55)
Sanchez-Sotelo, et al. Pain, radiocarpal Calcium phosphate vs. 75% 53%
3 Months 110
2000 VAS (none) Casting (41/55 patients) (29/55 patients)
6 Months 110
12 Months 110
3 Months 110
2000 VAS (mild) Casting (5/55 patients) (10/55 patients)
6 Months 110
12 Months 110
3 Months 110
2000 VAS (moderate) Casting (6/55 patients) (9/55 patients)
6 Months 110
12 Months 110
3 Months 110
2000 VAS (severe) Casting (3/55 patients) (7/55 patients)
6 Months 110
12 Months 110

Evidence Table 37
Sanchez-Sotelo, et al. Pain, radioulnar Calcium phosphate vs. 82% 55%

3 Months 110
6 Months 110
12 Months 110
3 Months 110
6 Months 110
12 Months 110
3 Months 110
6 Months 110
12 Months 110
3 Months 110
6 Months 110
12 Months 110

Evidence Table 37
Kopylov, et al. † Calcium phosphate vs. 33 ± NR

Function - VAS 5 Weeks 40 66 ± NR
1999 External fixation p = NR
Function - VAS 1 Year 38 11 ± NR
1999 External fixation p = NR
Pain - VAS 7 Weeks 40 22 ± NR
1999 External fixation p = ns*
Pain - VAS 1 Year 38 8 ± NR
1999 External fixation p = ns*
Schmalholz, et al. Methylmethacrylate vs. 39% 28%
1990 External Fixation (9/23 patients) (7/25 patients)
1989 Casting (7/24 patients) (0/23 patients)
†: mean score 0 - 100 mm where 0 is perfect result and 100 is unberable problems

Evidence Table 38
Author Outcome Duration N Treatment(s) Allograft Autograft
Rajan, et al. Activities of daily living Allograft vs. 89% 87%

12 Months 90
2006 (none- slight) Autograft (39/44 patients) (40/46 patients)
Rajan, et al. Activities of daily living Allograft vs. 11% 13%
12 Months 90
2006 (moderate - severe) Autograft (5/44 patients) (6/46 patients)
Rajan, et al. Pain - VAS Allograft vs. 91% 85%
12 Months 90
2006 (none - mild) Autograft (40/44 patients) (39/46 patients)
Rajan, et al. Pain - VAS Allograft vs. 9% 15%
12 Months 90
2006 (discomforting - intense) Autograft (4/44 patients) (7/46 patients)

Evidence Table 39
Serial Radiographs in Non-operative Treatment of Distal Radius Fracture
Included or
Author Title

Evidence Table 40
Two vs. Three Pins (K wires) for Distal Radius Fractures
Included or
Author Title
Ruschel, et al. Does not compare two vs.
Treatment of unstable extra-articular distal radius fractures by modified intrafocal Kapandji method
2005 three pins
Strohm, et al. Does not compare two vs.
Two procedures for Kirschner wire osteosynthesis of distal radial fractures. A randomized trial
2004 three pins
Brady, et al. Does not compare two vs.
The unstable distal radial fracture one year post Kapandji intrafocal pinning
1999 three pins
Fritz, et al. Does not compare two vs.
Combined Kirschner wire fixation in the treatment of Colles fracture. A prospective, controlled trial
1999 three pins
Rayhack, et al. Does not compare two vs.
Transulnar percutaneous pinning of displaced distal radial fractures: a preliminary report
1989 three pins

Evidence Table 41
Bone Density Screening after Distal Radius Fracture
Included or
Author Title
Barrett-Connor, et al. Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results
2008 from the National Osteoporosis Risk Assessment (NORA) INCLUDED
Schousboe, et al. Association between self-reported prior wrist fractures and risk of subsequent hip and radiographic
2005 vertebral fractures in older women: a prospective study INCLUDED
Gunnes, et al. How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802
1998 postmenopausal women INCLUDED
Mallmin, et al. Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study
1993 with 24 years of follow-up INCLUDED
Gardsell, et al.
1989
The predictive value of fracture, disease, and falling tendency for fragility fractures in women INCLUDED
Cooper, et al.
1988
Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain INCLUDED
Boutroy, et al. Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist Insufficient data for fracture
2008 fracture in postmenopausal women risk
Kanis, et al. Insufficient data for fracture
FRAX and the assessment of fracture probability in men and women from the UK
2008 risk
Kely, et al. When continuity of care breaks down: A systems failure in identification of osteoporosis risk in older Insufficient data for fracture
2008 patients treated for minimal trauma fractures risk
Kulej, et al. Insufficient data for fracture
Epidemiology of distal radius fractures in own material--own experience
2008 risk
Kurup, et al. Insufficient data for fracture
Secondary prevention of osteoporosis after Colles fracture: Current practice
2008 risk
Lippuner, et al. Insufficient data for fracture
Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women
2008 risk
Rozental, et al. Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective Insufficient data for fracture
2008 randomized intervention risk
Szulc, et al. High bone turnover is associated with accelerated bone loss but not with increased fracture risk in men Insufficient data for fracture
2008 aged 50 and over: the prospective MINOS study risk
Vico, et al. High-Resolution Peripheral Quantitative Computed Tomography Analysis at the Distal Radius and Tibia Insufficient data for fracture
2008 Discriminates Patients with Recent Wrist and Femoral Neck Fractures risk
Ashe, et al. Insufficient data for fracture
Hand dominance and bone response after a distal radial fracture: a peripheral QCT study
2007 risk

Evidence Table 41
Included or
Author Title
Endres, et al. Insufficient data for fracture
Diagnosis and treatment of osteoporosis in postmenopausal women with distal radius fracture in Germany
2007 risk
Freedman, et al. Insufficient data for fracture
Missed opportunities in patients with osteoporosis and distal radius fractures
2007 risk
Harrington, et al. Osteoporosis disease management for fragility fracture patients: New understandings based on three Insufficient data for fracture
2007 years' experience with an osteoporosis care service risk
Melton, et al. Contribution of in vivo structural measurements and load/strength ratios to the determination of forearm Insufficient data for fracture
2007 fracture risk in postmenopausal women risk
Moffett, et al. Insufficient data for fracture
Association of the VDR translation start site polymorphism and fracture risk in older women
2007 risk
Nordvall, et al. Are distal radius fractures due to fragility or to falls? A consecutive case-control study of bone mineral Insufficient data for fracture
2007 density, tendency to fall, risk factors for osteoporosis, and health-related quality of life risk
Sornay-Rendu, et al. Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, Insufficient data for fracture
2007 partially independent of decreased BMD measured by DXA: the OFELY study risk
Talbot, et al. Secondary prevention of osteoporosis: Calcium, Vitamin D and bisphosphonate prescribing following distal Insufficient data for fracture
2007 radial fracture risk
Becker, et al. Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: Insufficient data for fracture
2006 correlations with risk factors, fracture type, gender and ethnicity risk
Clowes, et al. Device-specific thresholds to diagnose osteoporosis at the proximal femur: an approach to interpreting Insufficient data for fracture
2006 peripheral bone measurements in clinical practice risk
Edwards, et al. Women with wrist fractures are at increased risk for future fractures because of both skeletal and non- Insufficient data for fracture
2006 skeletal risk factors risk
Henry, et al. Insufficient data for fracture
Fracture Risk (FRISK) Score: Geelong Osteoporosis Study
2006 risk
Iba, et al. Underutilization of antiosteoporotic drugs by orthopedic surgeons for prevention of a secondary Insufficient data for fracture
2006 osteoporotic fracture risk
Korpelainen, et al. Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index--a Insufficient data for fracture
2006 population-based study risk
Prince, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double- Insufficient data for fracture
2006 blind, placebo-controlled trial in elderly women risk
Szulc, et al. Bone fragility: failure of periosteal apposition to compensate for increased endocortical resorption in Insufficient data for fracture
2006 postmenopausal women risk

Evidence Table 41
Included or
Author Title
Clowes, et al. The discriminative ability of peripheral and axial bone measurements to identify proximal femoral, Insufficient data for fracture
2005 vertebral, distal forearm and proximal humeral fractures: a case control study risk
Hegeman, et al. Effective case-finding of osteoporosis in a Fracture and Osteoporosis Clinic in Groningen: An analysis of Insufficient data for fracture
2005 the first 100 patients risk
Hung, et al. Insufficient data for fracture
Low BMD is a risk factor for low-energy Colles' fractures in women before and after menopause
2005 risk
Jaglal, et al. Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture Insufficient data for fracture
2005 projections wrong? risk
Kelsey, et al. Insufficient data for fracture
Reducing the risk for distal forearm fracture: preserve bone mass, slow down, and don't fall!
2005 risk
Kronhed, et al. Insufficient data for fracture
Impact of a community-based osteoporosis and fall prevention program on fracture incidence
2005 risk
Malochet-Guinamand, et al. Osteoporosis treatment in postmenopausal women after peripheral fractures: Impact of information to Insufficient data for fracture
2005 general practitioners risk
Naves, et al. Insufficient data for fracture
Determinants of incidence of osteoporotic fractures in the female Spanish population older than 50
2005 risk
Nevitt, et al. Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study Insufficient data for fracture
2005 of osteoporotic fractures risk
Sornay-Rendu, et al. Rate of forearm bone loss is associated with an increased risk of fracture independently of bone mass in Insufficient data for fracture
2005 postmenopausal women: the OFELY study risk
Sosa, et al. Postmenopausal women with colles' fracture have lower values of bone mineral density than controls as Insufficient data for fracture
2005 measured by quantitative ultrasound and densitometry risk
Sowers, et al. Insufficient data for fracture
Elevated serum fluoride concentrations in women are not related to fractures and bone mineral density
2005 risk
Szulc, et al. Insufficient data for fracture
Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study
2005 risk
Weichetova, et al. The risk of Colles' fracture is associated with the collagen I alpha1 Sp1 polymorphism and ultrasound Insufficient data for fracture
2005 transmission velocity in the calcaneus only in heavier postmenopausal women risk
Ashe, et al. Wristwatch-distal radial fracture as a marker for osteoporosis investigation: a controlled trial of patient Insufficient data for fracture
2004 education and a physician alerting system risk
Dai, et al. Insufficient data for fracture
Loss of bone mass after Colles' fracture: a follow-up study
2004 risk

Evidence Table 41
Included or
Author Title
Hagino, et al. Case-control study of risk factors for fractures of the distal radius and proximal humerus among the Insufficient data for fracture
2004 Japanese population risk
Hollevoet, et al. Insufficient data for fracture
Tibial ultrasound velocity in women with wrist fracture
2004 risk
Holmberg, et al. Insufficient data for fracture
Forearm bone mineral density in 1294 middle-aged women: a strong predictor of fragility fractures
2004 risk
Itoh, et al. Insufficient data for fracture
Relationship between bone mineral density of the distal radius and ulna and fracture characteristics
2004 risk
Johnell, et al. Insufficient data for fracture
Mortality after osteoporotic fractures
2004 risk
McClung, et al. Prevention of postmenopausal bone loss: six-year results from the Early Postmenopausal Intervention Insufficient data for fracture
2004 Cohort Study risk
Moffett, et al. Association of the G-174C variant in the interleukin-6 promoter region with bone loss and fracture risk in Insufficient data for fracture
2004 older women risk
Smith, et al. Insufficient data for fracture
Treatment of osteoporosis: missed opportunities in the hospital fracture clinic
2004 risk
Ahlborg, et al. Insufficient data for fracture
Bone loss and bone size after menopause
2003 risk
Hillier, et al. Insufficient data for fracture
Nulliparity and fracture risk in older women: the study of osteoporotic fractures
2003 risk
Hollevoet, et al. Insufficient data for fracture
Outcome of distal radius fractures in relation to bone mineral density
2003 risk
Kanterewicz, et al. Insufficient data for fracture
Vertebral morphometric X-ray absorptiometry in women with Colles' fracture
2003 risk
MacIntyre, et al. In vivo measurement of apparent trabecular bone structure of the radius in women with low bone density Insufficient data for fracture
2003 discriminates patients with recent wrist fracture from those without fracture risk
Myers, et al. Insufficient data for fracture
Secondary and tertiary prevention in the management of low-trauma fracture
2003 risk
Naves, et al. The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish Insufficient data for fracture
2003 population risk
Ozdurak, et al. Quantitative forearm muscle strength influences radial bone mineral density in osteoporotic and healthy Insufficient data for fracture
2003 males risk

Evidence Table 41
Included or
Author Title
Silman, et al. Risk factors for Colles' fracture in men and women: results from the European Prospective Osteoporosis Insufficient data for fracture
2003 Study risk
Stone, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Insufficient data for fracture
2003 Osteoporotic Fractures risk
Blake, et al. Absolute fracture risk varies with bone densitometry technique used: A theoretical and in vivo study of Insufficient data for fracture
2002 fracture cases risk
Bouxsein, et al. Digital X-ray radiogrammetry predicts hip, wrist and vertebral fracture risk in elderly women: a prospective Insufficient data for fracture
2002 analysis from the study of osteoporotic fractures risk
Kanterewicz, et al. Association between Colles' fracture and low bone mass: age-based differences in postmenopausal Insufficient data for fracture
2002 women risk
Knapp, et al. Insufficient data for fracture
Multisite quantitative ultrasound: Colles' fracture discrimination in postmenopausal women
2002 risk
Robinson, et al. Refractures in patients at least forty-five years old. a prospective analysis of twenty-two thousand and Insufficient data for fracture
2002 sixty patients risk
Rozental, et al. Insufficient data for fracture
Survival among elderly patients after fractures of the distal radius
2002 risk
Tuck, et al. Insufficient data for fracture
Is distal forearm fracture in men due to osteoporosis?
2002 risk
vanStaa, et al. Insufficient data for fracture
Does a fracture at one site predict later fractures at other sites? A British cohort study
2002 risk
Vogt, et al. Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk Insufficient data for fracture
2002 factors. The study of osteoporotic fractures risk
Wu, et al. Insufficient data for fracture
Fractures between the ages of 20 and 50 years increase women's risk of subsequent fractures
2002 risk
Garnero, et al. Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in Insufficient data for fracture
2001 osteoporosis risk
Gnudi, et al. Bone mineral density and bone loss measured at the radius to predict the risk of nonspinal osteoporotic Insufficient data for fracture
2001 fracture risk
Ingle, et al. Insufficient data for fracture
Bone loss from the hand in women following distal forearm fracture
2001 risk
Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds
2001 risk

Evidence Table 41
Included or
Author Title
Khan, et al. Insufficient data for fracture
Osteoporosis follow-up after wrist fractures following minor trauma
2001 risk
Nguyen, et al. Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Insufficient data for fracture
2001 Osteoporosis Epidemiology Study risk
Nielsen, et al. Geometric properties of distal radius and pathogenesis of Colles fracture: a peripheral quantitative Insufficient data for fracture
2001 computed tomography study risk
Olschewski, et al. Insufficient data for fracture
Assessment of osteoporosis using standard radiographs of the wrist
2001 risk
Ringsberg, et al. The impact of long-term moderate physical activity on functional performance, bone mineral density and Insufficient data for fracture
2001 fracture incidence in elderly women risk
Schneider, et al. Insufficient data for fracture
Bone quality parameters of the distal radius as assessed by pQCT in normal and fractured women
2001 risk
Varenna, et al. Unbalanced diet to lower serum cholesterol level is a risk factor for postmenopausal osteoporosis and Insufficient data for fracture
2001 distal forearm fracture risk
Xie, et al. Bone density and geometric properties of the distal radius in displaced and undisplaced Colles' fractures: Insufficient data for fracture
2001 quantitative CT in 70 women risk
Adolphson, et al. Clodronate increases mineralization of callus after Colles' fracture: a randomized, double-blind, placebo- Insufficient data for fracture
2000 controlled, prospective trial in 32 patients risk
Cauley, et al. Insufficient data for fracture
Risk of mortality following clinical fractures
2000 risk
Cortet, et al. In vivo comparison between computed tomography and magnetic resonance image analysis of the distal Insufficient data for fracture
2000 radius in the assessment of osteoporosis risk
Cortet, et al. Does high-resolution computed tomography image analysis of the distal radius provide information Insufficient data for fracture
2000 independent of bone mass? risk
Gnudi, et al. Quantitative ultrasound and bone densitometry to evaluate the risk of nonspine fractures: a prospective Insufficient data for fracture
2000 study risk
Long-term risk of osteoporotic fracture in Malmo
2000 risk
Phipps, et al. Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older Insufficient data for fracture
2000 women risk
vanderPoest, et al. Insufficient data for fracture
The effect of alendronate on bone mass after distal forearm fracture
2000 risk

Evidence Table 41
Included or
Author Title
Wigderowitz, et al. Insufficient data for fracture
Bone mineral density of the radius in patients with Colles' fracture
2000 risk
Center, et al. Insufficient data for fracture
Mortality after all major types of osteoporotic fracture in men and women: an observational study
1999 risk
Cortet, et al. Insufficient data for fracture
Image analysis of the distal radius trabecular network using computed tomography
1999 risk
Cuddihy, et al. Insufficient data for fracture
Forearm fractures as predictors of subsequent osteoporotic fractures
1999 risk
Itkin, et al. Insufficient data for fracture
Correlates of bone mineral density in nursing home residents
1999 risk
Dai, et al. Insufficient data for fracture
Osteoporosis in Colles fracture
1998 risk
Earnshaw, et al. Colles' fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a Insufficient data for fracture
1998 prospective study of bone mineral density and bone turnover rate risk
Feskanich, et al. Insufficient data for fracture
Vitamin D receptor genotype and the risk of bone fractures in women
1998 risk
Formica, et al. Comparative assessment of bone mineral measurements using dual X-ray absorptiometry and peripheral Insufficient data for fracture
1998 quantitative computed tomography risk
Fox, et al. Insufficient data for fracture
Family history and risk of osteoporotic fracture. Study of Osteoporotic Fractures Research Group
1998 risk
Kessenich, et al. Insufficient data for fracture
Health-related quality of life and participation in osteoporosis clinical trials
1998 risk
Nijs, et al. Diagnostic sensitivity of peripheral quantitative computed tomography measurements at ultradistal and Insufficient data for fracture
1998 proximal radius in postmenopausal women risk
Sanders, et al. The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the Insufficient data for fracture
1998 community: The Geelong osteoporosis study risk
Torgerson, et al. Insufficient data for fracture
Prescribing by general practitioners after an osteoporotic fracture
1998 risk
Crespo, et al. Insufficient data for fracture
Complementary medical treatment for Colles' fracture: a comparative, randomized, longitudinal study
1997 risk
Duppe, et al. Insufficient data for fracture
A single bone density measurement can predict fractures over 25 years
1997 risk

Evidence Table 41
Included or
Author Title
Honkanen, et al. Associations of early premenopausal fractures with subsequent fractures vary by sites and mechanisms of Insufficient data for fracture
1997 fractures risk
Aspray, et al. Insufficient data for fracture
Low bone mineral content is common but osteoporotic fractures are rare in elderly rural Gambian women
1996 risk
Browner, et al. Insufficient data for fracture
Mortality following fractures in older women. The study of osteoporotic fractures
1996 risk
Gordon, et al. In vivo assessment of trabecular bone structure at the distal radius from high-resolution computed Insufficient data for fracture
1996 tomography images risk
Graafmans, et al. Insufficient data for fracture
Different risk profiles for hip fractures and distal forearm fractures: a prospective study
1996 risk
Lafferty, et al. Correlations of dual-energy X-ray absorptiometry, quantitative computed tomography, and single photon Insufficient data for fracture
1996 absorptiometry with spinal and non-spinal fractures risk
Peel, et al. Insufficient data for fracture
Rate of bone loss from lumbar spine in women with distal forearm fracture
1996 risk
Riis, et al. Low bone mass and fast rate of bone loss at menopause: equal risk factors for future fracture: a 15-year Insufficient data for fracture
1996 follow-up study risk
Cummings, et al. Insufficient data for fracture
Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group
1995 risk
Johnston, et al. Identification of patients with low bone mass by single photon absorptiometry and single-energy X-ray Insufficient data for fracture
1995 absorptiometry risk
Kroger, et al. Insufficient data for fracture
Ultrasound attenuation of the calcaneus in normal subjects and in patients with wrist fracture
1995 risk
Stegman, et al. Comparison of speed of sound ultrasound with single photon absorptiometry for determining fracture odds Insufficient data for fracture
1995 ratios risk
Dretakis, et al. Decreased broadband ultrasound attenuation of the calcaneus in women with fragility fracture. 85 Colles' Insufficient data for fracture
1994 and hip fracture cases versus 77 normal women risk
Gilfillan, et al. Insufficient data for fracture
Determinants of forearm mineral density and its correlation with fracture history in women
1994 risk
Mallmin, et al. Distal radius fracture is an early sign of general osteoporosis: bone mass measurements in a population- Insufficient data for fracture
1994 based study risk
Mallmin, et al. Insufficient data for fracture
Risk factors for fractures of the distal forearm: a population-based case-control study
1994 risk

Evidence Table 41
Included or
Author Title
Nevitt, et al. Bone mineral density predicts non-spine fractures in very elderly women. Study of Osteoporotic Fractures Insufficient data for fracture
1994 Research Group risk
Peel, et al. Insufficient data for fracture
Distal forearm fracture as risk factor for vertebral osteoporosis
1994 risk
Wasnich, et al. Insufficient data for fracture
Spine fracture risk is predicted by non-spine fractures
1994 risk
Adolphson, et al. No effects of piroxicam on osteopenia and recovery after Colles' fracture. A randomized, double-blind, Insufficient data for fracture
1993 placebo-controlled, prospective trial risk
Bickerstaff, et al. Insufficient data for fracture
Changes in cortical and trabecular bone in algodystrophy
1993 risk
Cooper, et al. Insufficient data for fracture
Population-based study of survival after osteoporotic fractures
1993 risk
Cummings, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Insufficient data for fracture
1993 Group risk
Lauritzen, et al. Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and Insufficient data for fracture
1993 their seasonal variation risk
Melton, et al. Insufficient data for fracture
Long-term fracture prediction by bone mineral assessed at different skeletal sites
1993 risk
Nguyen, et al. Insufficient data for fracture
Prediction of osteoporotic fractures by postural instability and bone density
1993 risk
Ooms, et al. Insufficient data for fracture
Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women
1993 risk
Wong, et al. Total and regional bone mineral densities in women with Colles' fractures: a comparative study with Insufficient data for fracture
1993 normal matched controls risk
Black, et al. Insufficient data for fracture
Axial and appendicular bone density predict fractures in older women
1992 risk
Kelsey, et al. Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Insufficient data for fracture
Mallmin, et al. Colles' fracture associated with reduced bone mineral content. Photon densitometry in 74 patients with Insufficient data for fracture
1992 matched controls risk
Olsson, et al. Insufficient data for fracture
Reduced cancer morbidity and mortality in a prospective cohort of women with distal forearm fractures
1992 risk

Evidence Table 41
Included or
Author Title
Hansen, et al. Insufficient data for fracture
Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study
1991 risk
Seeley, et al. Which fractures are associated with low appendicular bone mass in elderly women? The Study of Insufficient data for fracture
1991 Osteoporotic Fractures Research Group risk
Thamsborg, et al. Insufficient data for fracture
Effect of different doses of nasal salmon calcitonin on bone mass
1991 risk
Cummings, et al. Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Insufficient data for fracture
Gardsell, et al. Insufficient data for fracture
The predictive value of forearm bone mineral content measurements in men
1990 risk
Lester, et al. Insufficient data for fracture
Update on the use of distal radial bone density measurements in prediction of hip and Colles' fracture risk
1990 risk
Smith, et al. Insufficient data for fracture
Quantitative gamma-ray computed tomography of the radius in normal subjects and osteoporotic patients
1990 risk
Wallace, et al. Hormone replacement therapy acceptability to Nottingham post-menopausal women with a risk factor for Insufficient data for fracture
1990 osteoporosis risk
Cimino, et al. Insufficient data for fracture
The effects of calcium on bone mineral density in postmenopausal women with colles fractures
1989 risk
Eastell, et al. Insufficient data for fracture
Colles' fracture and bone density of the ultradistal radius
1989 risk
Eastell, et al. Unequal decrease in bone density of lumbar spine and ultradistal radius in Colles' and vertebral fracture Insufficient data for fracture
1989 syndromes risk
Hassager, et al. Insufficient data for fracture
Usefulness of bone mass measurements by photon absorptiometry
1989 risk
Horowitz, et al. Insufficient data for fracture
Mineral density of bone in the forearm in premenopausal women with fractured wrists
1988 risk
Hui, et al. Insufficient data for fracture
Age and bone mass as predictors of fracture in a prospective study
1988 risk
Crilly, et al. Insufficient data for fracture
Postural stability and Colles' fracture
1987 risk
Finsen, et al. Insufficient data for fracture
Colles' fracture as an indicator of increased risk of hip fracture. An epidemiological study
1987 risk

Evidence Table 41
Included or
Author Title
Harma, et al. Insufficient data for fracture
Trabecular osteopenia in Colles' fracture
1986 risk
Wasnich, et al. Insufficient data for fracture
Prediction of postmenopausal fracture risk with use of bone mineral measurements
1985 risk
Hesp, et al. Insufficient data for fracture
Decreased radial bone mass in Colles' fracture
1984 risk
Owen, et al. Insufficient data for fracture
Colles' fracture and subsequent hip fracture risk
1982 risk
Hutchinson, et al. Insufficient data for fracture
Post-menopausal oestrogens protect against fractures of hip and distal radius. A case-control study
1979 risk
Lamke, et al. Insufficient data for fracture
Bone mineral content in women with Colles' fracture: effect of calcium supplementation
1978 risk
Nilsson, et al. Insufficient data for fracture
Bone mineral content and fragility fractures
1977 risk
Nilsson, et al. Insufficient data for fracture
Long-term observations on the loss of bone mineral following colles' fracture
1975 risk
Gay, et al. Insufficient data for fracture
Radial fracture as an indicator of osteoporosis: a 10-year follow-up study
1974 risk
Nillson, et al. Insufficient data for fracture
The bone mineral content in the forearm of women with colles' fracture
1974 risk

Evidence Table 42


result(s) reported
Test review bias
Spectrum bias
described
avoided
avoided
avoided
avoided
avoided
avoided
Author N Index Test Reference Standard
Barrett-Connor, et al.
2008
158940
Incident Distal Radius
Fracture
Subsequent Fragility
Fracture ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Schousboe, et al.
2005
9704
Fracture
Fracture ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Gunnes, et al.
1998
29802
Fracture
Fracture ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Mallmin, et al.
1993
2676
Fracture
Fracture ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Gardsell, et al.
1989
1076
Fracture
Fracture ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Cooper, et al.
1988
900
Fracture
Fracture ● ● ● ● ● ● ● ● ● ● ● ● ● ●

Evidence Table 43
True False False True
Author N Index Test Reference Standard Age/sex
Positives Positives Negatives Negatives
Barrett-Connor, et al. Incident Distal Radius Female with wrist

158940 Subsequent Fragility Fracture 639 8026 3677 146598
2008 Fracture fracture after age 45
158940 Subsequent Hip Fracture 104 8561 593 149682
158940 Subsequent Spine Fracture 59 8606 610 149665
Schousboe, et al. Incident Distal Radius Female with previous
2005 Fracture wrist fracture (age: NR)
Schousboe, et al. Incident Distal Radius Female with previous
Gunnes, et al. Incident Distal Radius Female with wrist
Gunnes, et al. Incident Distal Radius Female with wrist
Mallmin, et al. Incident Distal Radius Female or male with wrist
Gardsell, et al. Incident Distal Radius Female with previous
1076 Subsequent Fragility Fracture 85 198 173 620
Cooper, et al. Incident Distal Radius Female or male with wrist

Evidence Table 44
DRUJ Instability with Distal Radius Fractures
Included or
Author Title
Lindau, et al.
2000
Distal radioulnar instability is an independent worsening factor in distal radial fractures INCLUDED
Roysam, et al.
1993
The distal radio-ulnar joint in Colles' fractures INCLUDED
Ruch, et al. Distal radius fractures: a comparison of tension band wiring versus ulnar outrigger external fixation for the
2005 management of distal radioulnar instability
Lindau, et al. Patients with laxity of the distal radioulnar joint after distal radial fractures have impaired function, but no Less than 10 patients per
2002 loss of strength group
May, et al. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal
2002 radioulnar joint instability
Lindau, et al. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal Does not report validated,
2000 radial fractures patient oriented outcomes
The importance of the distal radioulnar joint in distal radial fractures

Evidence Table 45


Crossover - equal
Crossover - equal
treated
Lindau, et al.
2000
Pain - VAS (at rest) >1 Year 76
Unstable DRUJ vs.
Stable DRUJ ● ● ● ● ● n/a n/a
Lindau, et al.
2000
Pain - VAS (at load) >1 Year 76
Unstable DRUJ vs.
Stable DRUJ ● ● ● ● ● n/a n/a
Roysam, et al.
1993
Pain free 6 Weeks 170
DRUJ involvement vs.
No DRUJ involvement ● × ● ● ● n/a n/a
Roysam, et al.
1993
Roysam, et al.
1993
Pain free 1 Year 170

Evidence Table 46
Author Outcome Duration N Comparison(s) Unstable DRUJ Stable DRUJ
Lindau, et al. † Unstable DRUJ vs.

Pain - VAS (at rest) >1 Year 76 10 ± 6.75 0 ± 2.5
2000 Stable DRUJ
Lindau, et al. † Unstable DRUJ vs.
Pain - VAS (at load) >1 Year 76 40 ± 14.25 10 ± 7.5
2000 Stable DRUJ
Author Outcome Duration N Comparison(s) DRUJ Involvement No DRUJ Involvement
Roysam, et al. Pain free DRUJ involvement vs. 44% 75%

6 Weeks 170
1993 around ulnar head No DRUJ involvement (36/81 patients) (67/89 patients)
Roysam, et al. Pain free DRUJ involvement vs. favors
6 Months 170 NR
1993 around ulnar head No DRUJ involvement p < 0.001 *
Roysam, et al. Pain free DRUJ involvement vs. favors
1 Year 170 NR
1993 around ulnar head No DRUJ involvement p < 0.001 *
†: mean score 0 - 100 mm, *: reported by author(s)

Evidence Table 47
Assessment of DRUJ Alignment in Distal Radius Fractures
Included or
Author Title
Nakamura, et al.
1995
Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography INCLUDED
Mino, et al. Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint. A
1985 prospective study INCLUDED
Kim, et al. Assessment of distal radioulnar joint instability after distal radius fracture: comparison of computed Insufficient data for diagnostic
2008 tomography and clinical examination results accuracy
Kwon, et al. Not relevant, comparsion of
Fluoroscopic diagnosis of scapholunate interosseous ligament injuries in distal radius fractures
2008 carpal bone measurements
Park, et al. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar
Not relevant, CT only
2008 joint translation
Cho, et al. Not relevant, comparsion of
Assessment of four midcarpal radiologic determinations
Pan, et al.
Displacement of the distal radioulnar joint of clinically symptom-free patients Not relevant, CT only
2003
Robertson, et al. Not relevant, comparsion of
The sensitivity of carpal bone indices to rotational malpositioning
Lo, et al. Less than 10 patients per
The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation
2001 group
Chiang, et al.
Computerized tomography in the diagnosis of subluxation of the distal radioulnar joint Not relevant, CT only
1998
Waters, et al.
Noninvasive measurement of distal radius instability Cadaver study
1997
Yang, et al. Not relevant, comparsion of
Scaphopisocapitate alignment: criterion to establish a neutral lateral view of the wrist
Nakamura, et al.
Criteria for diagnosing distal radioulnar joint subluxation by computed tomography Not relevant, CT only
1996
Larsen, et al. Not relevant, comparsion of
Measurements of carpal bone angles on lateral wrist radiographs
Larsen, et al. Not relevant, comparsion of
Observer variability in measurements of carpal bone angles on lateral wrist radiographs
Mino, et al. The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of
Cadaver study
1983 the distal radioulnar joint

Evidence Table 48


result(s) reported
Test review bias
Spectrum bias
described
avoided
avoided
avoided
avoided
avoided
avoided
Author N Index Test Reference Standard
Nakamura, et al.
1995
56
Bilateral, standard
lateral x-rays
CT ● ● ● ● ● ● ● ● ● ? ? ? ● ●
Mino, et al.
1985
15 True lateral x-ray CT ● ● ● ● ● ● ● ● ● ? ? ? ● ●

Evidence Table 49
Author N Index Test Reference Standard True Positives False Positives False Negatives True Negatives
Nakamura, et al. Bilateral,

36 CT 13 2 1 20
1995 standard lateral x-rays*
Nakamura, et al. Bilateral,
20 CT 10 3 1 6
1995 standard lateral x-rays**
Mino, et al. †
15 True lateral x-ray CT 4 0 4 5
1985
*: lateral is assessed as difference between pisoscaphoid distance of injured wrist and uninjured wrist, < 3mm
**: lateral is assessed as difference between pisoscaphoid distance of injured wrist and uninjured wrist, > 4mm
†: lateral is assessed as "complete superimposition of the proximal pole of the scaphoid on the lunate and triquetrum", 2 patients did not meet this criteria

Evidence Table 50
Evaluation of Pain During Follow-up After Distal Radius Fracture
Included or
Author Title

Evidence Table 51
Hand Therapy for Distal Radius Fractures
Included or
Author Title
Krischak, et al.
2009
Physiotherapy after volar plating of wrist fractures is effective using a home exercise program INCLUDED
Maciel, et al.
2005
A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures INCLUDED
Kay, et al.
2000
The effect of passive mobilisation following fractures involving the distal radius: a randomised study INCLUDED
Wakefield, et al.
2000
The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius INCLUDED
Taylor, et al. The effectiveness of passive joint mobilisation on the return of active wrist extension following Colles'
1994 fracture: a clinical trial INCLUDED
Kay, et al. An advice and exercise program has some benefits over natural recovery after distal radius fracture: a Did not compare formal
2008 randomised trial therapy to non-formal therapy
Haren, et al. A prospective randomized controlled trial of Manual Lymph Drainage (MLD) for the reduction of hand Does not report patient
2006 oedema after distal radius fracture oriented outcomes
Lyngcoln, et al.
The relationship between adherence to hand therapy and short-term outcome after distal radius fracture Not best available evidence
2005
Christensen, et al. Does not report validated,
Occupational therapy and Colles' fractures
Haren, et al. Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal Does not report patient
2000 radius: a prospective clinical study oriented outcomes
Watt, et al. Less than 10 patients per
Do Colles' fracture patients benefit from routine referral to physiotherapy following cast removal?
2000 group
Oskarsson, et al.
Physiotherapy: an overestimated factor in after-treatment of fractures in the distal radius? Not best available evidence
1997
Toomey, et al. Not relevant, not considered
Clinical evaluation of the effects of whirlpool on patients with Colles' fractures
Pasila, et al. Does not report validated,
Role of physical therapy in recovery of function after Colles' fracture

Evidence Table 52




Crossover - equal
Crossover - equal
Patients Blinded
Krischak, et al.
2009
PRWE 6 Weeks 46
Supervised therapy vs.
Home based × × ○ ○ ● ● n/a n/a
Maciel, et al.
2005
PRWE - Activity 6 Weeks 35
Home based × ● ○ ○ ● ● n/a n/a
Maciel, et al.
2005
PRWE - Pain 6 Weeks 35
Maciel, et al.
2005
PRWE - Participation 6 Weeks 35
Maciel, et al.
2005
PRWE Total 6 Weeks 35
Maciel, et al.
2005
PRWE - Activity 24 Weeks 33
Maciel, et al.
2005
PRWE - Pain 24 Weeks 33
Maciel, et al.
2005
PRWE - Participation 24 Weeks 33
Maciel, et al.
2005
PRWE Total 24 Weeks 33
Kay, et al.
2000
Home based ● × ○ ● ● ● n/a n/a
Kay, et al.
2000

Evidence Table 52




Crossover - equal
Crossover - equal
Patients Blinded
Kay, et al.
2000
Wakefield, et al.
2000
Home based ● × ○ ○ ● × n/a n/a
Kay, et al.
2000
Wakefield, et al.
2000
Home based ● × ○ ○ ● × n/a n/a
Wakefield, et al.
2000
Home based ● × ○ ○ ○ × n/a n/a
Taylor, et al.
1994
Number of days to discharge n/a 30
Sham therapy × × ● × ● ● n/a n/a

Evidence Table 53
Author Outcome Duration N Treatment(s) Supervised Therapy Control Group
Krischak, et al. Supervised therapy vs.

PRWE 6 Weeks 46 36.1 ± 13.9 18.5 ± 15.9
2009 Home based
Maciel, et al. Supervised therapy vs.
PRWE - Activity 6 Weeks 35 27.9 ± 28.2 34.7 ± 28.2
2005 Home based
PRWE - Activity 24 Weeks 33 19.6 ± 29.4 24.7 ± 26.4
2005 Home based
PRWE - Pain 6 Weeks 35 29.2 ± 23.4 28.4 ± 19.2
2005 Home based
PRWE - Pain 24 Weeks 33 26.3 ± 25.4 28.9 ± 21.3
2005 Home based
PRWE - Participation 6 Weeks 35 21.4 ± 24.1 21.3 ± 24.3
2005 Home based
PRWE - Participation 24 Weeks 33 13.7 ± 23.9 18.3 ± 25.0
2005 Home based
PRWE Total 6 Weeks 35 26.9 ± 24.0 28.2 ± 20.6
2005 Home based
PRWE Total 24 Weeks 33 21.4 ± 24.5 24.8 ± 22.2
2005 Home based
Kay, et al. † Supervised therapy vs.
Function - VAS 3 Weeks 39 3.95 (IQR: 2.00, 4.95) 3.00 (IQR: 2.45, 4.95)
2000 Home based
Kay, et al. † Supervised therapy vs.
Function - VAS 6 Weeks 39 1.95 (IQR: 0.45, 4.04) 1.95 (IQR: 0.95, 2.45)
2000 Home based
Kay, et al. ‡ Supervised therapy vs.
Pain - VAS 3 Weeks 39 1.95 (IQR: 1.00, 3.04) 1.45 (IQR: 1.00, 3.54)
2000 Home based
Kay, et al. ‡ Supervised therapy vs.
Pain - VAS 6 Weeks 39 0.95 (IQR: 0.45 - 3.54) 1.20 (IQR: 0.08 - 3.04)
2000 Home based
†: median score 0 - 10 where 0 is no pain and 10 is worst pain imaginable, ‡: median score 0 - 10 where 0 is no difficulty using the wrist for daily activities and 10 is daily activities were extremely difficult

Evidence Table 53
Author Outcome Duration N Treatment(s) Supervised Therapy Control Group
Wakefield, et al. Supervised therapy vs.

Home based
2.3 ± 2.2 2.0 ± 2.1

2000 Pain - VAS* 3 Months 90
Home based
1.4 ± 1.6 1.4 ± 1.7

2000 Pain - VAS* 6 Months 66
Home based
0.9 ± 1.6 0.8 ± 1.4
Taylor, et al. Supervised therapy vs.

Number of days to discharge n/a 30 28.5 ± 8.8 24.4 ± 8.5
1994 Sham Physiotherapy
*mean score 0 - 10 cm
Evidence Table 54
Immediate Active Finger Motion after Diagnosis of Distal Radius Fracture
Included or
Author Title
Evidence Table 55
Post-operative Wrist Motion for Distal Radius Fractures
Included or
Author Title
2008
Wrist mobilization following volar plate fixation of fractures of the distal part of the radius INCLUDED
Allain, et al. Trans-styloid fixation of fractures of the distal radius. A prospective randomized comparison between 6-
1999 and 1-week postoperative immobilization in 60 fractures INCLUDED
Yamamoto, et al.
Treatment for unstable Colles' fractures using external fixation Could not obtain
2004
VangHansen, et al. Does not enroll operatively
A comparison of 3 and 5 weeks immobilization for older type 1 and 2 Colles' fractures
1998 treated patients
Millett, et al. Does not enroll operatively
Early mobilization in the treatment of Colles' fracture: a 3 year prospective study
Dias, et al. Does not enroll operatively
The value of early mobilisation in the treatment of Colles' fractures
McAuliffe, et al. Does not enroll operatively
Early mobilisation of Colles' fractures. A prospective trial
Evidence Table 56




Crossover - equal
Crossover - equal
Patients Blinded
2008
DASH 3 Months 56
Early motion vs.
Late motion ● × ○ ○ ● × n/a n/a
2008
Pain - ordinal 3 Months 56
Early motion vs.
Late motion ● × ○ ○ ● ● n/a n/a
2008
DASH 6 Months 54
Early motion vs.
Late motion ● × ○ ○ ● × n/a n/a
2008
Early motion vs.
Late motion ● × ○ ○ ● ● n/a n/a
Allain, et al.
1999
Early motion vs.
Late motion ○ ○ ○ ● ● × n/a n/a
Allain, et al.
1999
Early motion vs.
Late motion ○ ○ ○ ● ● × n/a n/a
McQueen, et al.
1996
Early motion vs.
Late motion × ● ○ ○ ● × n/a n/a
Evidence Table 57
Author Outcome Duration N Comparison(s) Early motion Late motion
Lozano-Calderon, et al. Early motion vs. 19 17

DASH 3 Months 56
2008 Late motion (95% CI: 13, 25) (95% CI: 11, 23)
Lozano-Calderon, et al. Early motion vs. 8.5 8.1
DASH 6 Months 54
2008 Late motion (95% CI: 2.6, 14) (95% CI: 2, 14)
Lozano-Calderon, et al. † Early motion vs. 2.4 2.4
2008 Late motion (95% CI: 1.7, 3.2) (95% CI: 1.6, 3.2)
Lozano-Calderon, et al. † Early motion vs. 1.5 1.9
2008 Late motion (95% CI: 0.7, 2.3) (95% CI: 1.1, 2.7)
Allain, et al. ‡ Early motion vs. 9.5 ± NR
Pain - VAS 4 Weeks 60 8.5 ± NR
1999 Late motion p = ns*
Allain, et al. ‡ Early motion vs. 13 ± NR
Pain - VAS 1 Year 60 12.5 ± NR
1999 Late motion p = ns*
†: mean score 0 -10 where 0 is no pain and 10 is worst possible pain, authors describe scale as ordinal, ‡: mean score 0 - 15 where 15 is no pain and 0 is worst possible pain, * reported by author(s)
Evidence Table 58
Removal of Percutaneous Pins and/or External Fixator in Distal Radius Fracture
Included or
Author Title
Haddad, et al.
2000
External fixation of distal radial fractures: 3 or 5 weeks of external fixation INCLUDED
Kaempffe, et al.
2000
External fixation for distal radius fractures: effect of distraction on outcome INCLUDED
1993 outcome INCLUDED
Evidence Table 59


Crossover - equal
Crossover - equal
treated
Haddad, et al.
2000
Solgaard score
Final
follow-up
37
3 weeks external fixation vs.
5 weeks external fixation ● × ● ○ ● n/a n/a
Evidence Table 60
Quality and Design of Prognostic Studies
Variables of interest discussed
Unambiguous coding scheme

Variables of interest identified
Explicit fitting procedure
Goodness-of-fit reported
10 patients per variable
Test of collinearity
Model validation
Kaempffe, et al. Final

2000
Duration of external fixation
follow-up
19 External fixation ● ● ● ● ○ ● ○ ○
1993
Duration of external fixation
follow-up
Evidence Table 61
Author Outcome Duration N Comparison(s) 3 weeks 5 weeks
Haddad, et al. Final 3 weeks external fixation vs.

Solgaard score 37 6.5 ± 4.5 6 ± 3.5
2000 follow-up 5 weeks external fixation
Evidence Table 62
Sustained Wrist Distraction with External Fixation of Distal Radius Fracture
Included or
Author Title
Kaempffe, et al.
2000
External fixation for distal radius fractures: effect of distraction on outcome INCLUDED
1993 outcome INCLUDED
Evidence Table 63
Sustained Wrist Distraction with External Fixation of Distal Radius Fracture
Quality and Design of Prognostic Studies
Variables of interest discussed
Unambiguous coding scheme

Variables of interest identified
Explicit fitting procedure
Goodness-of-fit reported
10 patients per variable
Test of collinearity
Model validation

2000
Amount of distraction
follow-up
1993
Amount of distraction
follow-up
Evidence Table 64
Vitamin and Mineral Adjuvant Treatments for Distal Radius Fractures
Included or
Author Title
Zollinger, et al. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized,
2007 controlled, multicenter dose-response study INCLUDED
Zollinger, et al.
1999
Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomised trial INCLUDED
Rozental, et al. Comparison of radiographic fracture healing in the distal radius for patients on and off bisphosphonate
2009 therapy
Itoh, et al. Treatment of distal radius fractures with a wrist-bridging external fixation: The value of alternating electric
oriented outcomes
2008 current stimulation
quantitatively
Patil, et al. Does not report patient
Prospective, double blind, randomized, controlled trial of simvastatin in human fracture healing
Challis, et al. Cyclic pneumatic soft-tissue compression enhances recovery following fracture of the distal radius: a Does not report patient
2007 randomised controlled trial oriented outcomes
Costantino, et al. Less than 10 patients per
Treatment of wrist and hand fractures with natural magnets: preliminary report
2007 group
Talbot, et al. Secondary prevention of osteoporosis: Calcium, Vitamin D and bisphosphonate prescribing following distal Does not report patient
2007 radial fracture oriented outcomes
Cheing, et al.
Ice and pulsed electromagnetic field to reduce pain and swelling after distal radius fractures See Recommendation 27
2005
Frankel, et al.
Management of non-union with pulsed low-intensity ultrasound therapy--international results Non-Union
2002
Adolphson, et al. Clodronate increases mineralization of callus after Colles' fracture: a randomized, double-blind, placebo-
oriented outcomes
2000 controlled, prospective trial in 32 patients
quantitatively
Evidence Table 64
Included or
Author Title
Basso, et al. The effect of low frequency, long-wave ultrasound therapy on joint mobility and rehabilitation after wrist Does not report patient
1998 fracture oriented outcomes
Cook, et al. Not relevant, comparison of
Acceleration of tibia and distal radius fracture healing in patients who smoke
1997 smoking status
Kristiansen, et al. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A
See Recommendation 27
1997 multicenter, prospective, randomized, double-blind, placebo-controlled study
Thomas, et al. The use of an oral prostaglandin inhibitor following splintage in fractures of the distal radius--a prospective Not relevant, not considered
1986 trial for this guideline

Stimulation of fracture healing with electromagnetic fields of extremely low frequency (EMF of ELF)
Pasila, et al. Mobilization of stiff hands after 104 Colles' fractures: a comparison between the value of the Movelat and Does not report patient
1980 its base cream oriented outcomes
Sillar, et al. Does not report validated,
Proteolytic enzymes for minimizing deformities associated with Colles' fracture
Evidence Table 65




Crossover - equal
Crossover - equal
Patients Blinded
Zollinger, et al.
2007
Complex Regional Pain
Syndrome
1 Year 427
Vitamin C (all doses) vs.
Placebo ● ● ● ● ● ● n/a n/a
Zollinger, et al.
2007
Syndrome
1 Year 217
Vitamin C 1500 mg vs.
Zollinger, et al.
2007
Syndrome
1 Year 213
Zollinger, et al.
2007
Syndrome
1 Year 195
Zollinger, et al.
1999
Reflex Sympathetic Dystrophy 1 Year 115
Evidence Table 66
Author Outcome Duration N Treatment(s) Adjuvant Therapy Control Group
Zollinger, et al. Complex Regional Pain Vitamin C (all doses) vs. 2.4% 10%
1 Year 427
2007 Syndrome Placebo (8/328 patients) (10/99 patients)
Zollinger, et al. Complex Regional Pain Vitamin C 1500 mg vs. 2% 10%
1 Year 217
1 Year 213
1 Year 195
Zollinger, et al. Vitamin C 500 mg vs. 8% 22%
Reflex Sympathetic Dystrophy 1 Year 115
1999 Placebo (4/52 patients) (14/63 patients)
Evidence Table 67
Mechanical Adjuvant Treatments for Distal Radius Fractures
Included or
Author Title
Cheing, et al.
2005
Ice and pulsed electromagnetic field to reduce pain and swelling after distal radius fractures INCLUDED
Kristiansen, et al. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A
1997 multicenter, prospective, randomized, double-blind, placebo-controlled study INCLUDED
Rozental, et al. Comparison of radiographic fracture healing in the distal radius for patients on and off bisphosphonate
2009 therapy
Itoh, et al. Treatment of distal radius fractures with a wrist-bridging external fixation: The value of alternating electric
oriented outcomes
2008 current stimulation
quantitatively
Patil, et al. Does not report patient
Prospective, double blind, randomized, controlled trial of simvastatin in human fracture healing
Challis, et al. Cyclic pneumatic soft-tissue compression enhances recovery following fracture of the distal radius: a Does not report patient
2007 randomised controlled trial oriented outcomes
Costantino, et al. Less than 10 patients per
Treatment of wrist and hand fractures with natural magnets: preliminary report
2007 group
Talbot, et al. Secondary prevention of osteoporosis: Calcium, Vitamin D and bisphosphonate prescribing following distal Does not report patient
2007 radial fracture oriented outcomes
Zollinger, et al. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized,
See Recommendation 26
2007 controlled, multicenter dose-response study
Frankel, et al.
Management of non-union with pulsed low-intensity ultrasound therapy--international results Non-Union
2002
Adolphson, et al. Clodronate increases mineralization of callus after Colles' fracture: a randomized, double-blind, placebo-
oriented outcomes
2000 controlled, prospective trial in 32 patients
quantitatively
Zollinger, et al.
Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomised trial See Recommendation 26
1999
Evidence Table 67
Included or
Author Title
Basso, et al. The effect of low frequency, long-wave ultrasound therapy on joint mobility and rehabilitation after wrist Does not report patient
1998 fracture oriented outcomes
Cook, et al. Not relevant, comparison of
Acceleration of tibia and distal radius fracture healing in patients who smoke
1997 smoking status
Thomas, et al. The use of an oral prostaglandin inhibitor following splintage in fractures of the distal radius--a prospective Not relevant, not considered
1986 trial for this guideline

Stimulation of fracture healing with electromagnetic fields of extremely low frequency (EMF of ELF)
Pasila, et al. Mobilization of stiff hands after 104 Colles' fractures: a comparison between the value of the Movelat and Does not report patient
1980 its base cream oriented outcomes
Sillar, et al. Does not report validated,
Proteolytic enzymes for minimizing deformities associated with Colles' fracture
Evidence Table 68




Crossover - equal
Crossover - equal
Patients Blinded
Cheing, et al.
2005
Ice vs.
Control × × ○ × ● ● n/a n/a
Cheing, et al.
2005
PEMF vs.
Control × × ● × ● ● n/a n/a
Cheing, et al.
2005
PEMF + Ice vs.
Cheing, et al.
2005
Ice vs.
Cheing, et al.
2005
PEMF vs.
Control × × ● × ● ● n/a n/a
Cheing, et al.
2005
PEMF + Ice vs.
Kristiansen, et al.
1997
Number of fractures healed 6 Weeks 61
Ultrasound vs.
Placebo ● ○ ● ● ● ● n/a n/a
Kristiansen, et al.
1997
Ultrasound vs.
Kristiansen, et al.
1997
Ultrasound vs.
Kristiansen, et al.
1997
Ultrasound vs.
Kristiansen, et al.
1997
Time to healing n/a 61
Ultrasound vs.
Evidence Table 69
Author Outcome Duration N Treatment(s) Adjuvant Therapy Control Group
Cheing, et al. † Ice vs.

Pain - VAS 3 Days 38 3.0 ± 0.87 3.7 ± 1.2
2005 Control
Cheing, et al. † Ice vs.
Pain - VAS 5 Days 38 2.2 ± 0.87 3.1 ± 1.1
2005 Control
Cheing, et al. † PEMF vs.
Pain - VAS 3 Days 38 3.8 ± 1.1 3.7 ± 1.2
2005 Control
Cheing, et al. † PEMF vs.
Pain - VAS 5 Days 38 3.3 ± 1.2 3.1 ± 1.1
2005 Control
Cheing, et al. † PEMF + Ice vs.
Pain - VAS 3 Days 39 3.8 ± 1.3 3.7 ± 1.2
2005 Control
Cheing, et al. † PEMF + Ice vs.
Pain - VAS 5 Days 39 2.6 ± 1.5 3.1 ± 1.1
2005 Control
Kristiansen, et al. Ultrasound vs. 20% 3%
Kristiansen, et al. Time to healing Ultrasound vs.
n/a 61 61 ± 26.55 98 ± 40.61
1997 (days from fracture) Placebo
†: mean score 0 - 10 cm where 0 is no pain and 10 is pain as bad as it could be
Evidence Table 70
Treatment of Concomitant Distal Ulna Fractures
Included or
Author Title
Zenke, et al. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal
2009 radius INCLUDED
Ekenstam, et al.
1989
Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study INCLUDED
Ruchelsman, et al. Outcome Following Acute Primary Distal Ulna Resection for Comminuted Distal Ulna Fractures at the
2009 Time of Operative Fixation of Unstable Fractures of the Distal Radius
Souer, et al. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a
2009 distal radial fracture
Seitz, et al. Resection of comminuted ulna head fragments with soft tissue reconstruction when associated with distal Does not report validated,
2007 radius fractures patient oriented outcomes
Ring, et al. Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal
2004 radius
May, et al. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal
2002 radioulnar joint instability
The importance of the distal radioulnar joint in distal radial fractures
Biyani, et al. Does not report validated,
Fractures of the distal radius and ulna
Tsukazaki, et al. Does not report validated,
Poor correlation between functional results and radiographic findings in Colles' fracture
Evidence Table 71




Crossover - equal
Crossover - equal
Patients Blinded
Ekenstam, et al.
1989
Operative treatment of ulna vs.
Non-operative treatment of ulna ○ ○ ○ × ● × n/a n/a
Evidence Table 72


Crossover - equal
Crossover - equal
treated
Zenke, et al.
2009
DASH 1 Week 118
No ulnar styloid fracture vs.
Fracture of base or tip of ulnar styloid ● ● ● ● ● n/a n/a
Zenke, et al.
2009
DASH 2 Weeks 118
Zenke, et al.
2009
DASH 4 Weeks 118
Zenke, et al.
2009
DASH 8 Weeks 118
Zenke, et al.
2009
DASH 12 Weeks 118
Zenke, et al.
2009
DASH 24 Weeks 118
Zenke, et al.
2009
Pain, ulnar wrist
Final
Followup
118
Evidence Table 73
Non-operative
Author Outcome Duration N Treatment(s) Operative treatment
treatment
Ekenstam, et al. Operative fixation of ulna vs. 79% 67%

1989 Non-operative treatment of ulna (15/19 patients) (14/21 patients)
Evidence Table 74
No ulnar Ulnar base Ulnar tip
fracture fracture fracture
Zenke, et al. No ulnar styloid fracture vs.

DASH 1 Week 118 52.83 ± 2.37 58.9 ± 2.45 59.34 ± 2.44
2009 Fracture of base or tip of ulnar styloid
DASH 2 Weeks 118 35.67 ± 2 40.4 ± 2 42.18 ± 1.85
DASH 4 Weeks 118 18.35 ± 1.41 25.75 ± 2.3 27.82 ± 1.85
DASH 8 Weeks 118 10.8 ± 1.34 13.76 ± 1.41 17.61 ± 1.56
DASH 12 Weeks 118 7.4 ± 0.965 7.7 ± 0.96 10.95 ± 1.11
DASH 24 Weeks 118 2.96 ± 0.57 4.14 ± 0.74 4.74 ± 0.67
Zenke, et al. Final No ulnar styloid fracture vs. 6.0 % 4.9% 0.0%
Pain, ulnar wrist 118
2009 Followup Fracture of base or tip of ulnar styloid (3/50 patients) (2/41 patients) (0/27 patients)
Evidence Table 75
Concurrent Operative Treatments for Depressed Lunate Fossa or 4-part Distal Radius Fracture
Included or
Author Title
Evidence Table 76
Articles Excluded at Full Text Review (not reported elsewhere)
Author Title Reason for Exclusion
Hirashima, et al. Does not report patient

Evaluating bone union of distal radius fractures by measuring impedance values
Ilyas, et al.
Intramedullary fixation of distal radius fractures Surgical Technique
2009
Sung, et al. Not relevant, non-DRF
Reuse of external fixation components: a randomized trial
2008 diagnosis
Thomson, et al. Not relevant, specific to
Complex regional pain syndrome (type 1): a comparison of 2 diagnostic criteria methods
2008 CRPS diagnosis
Ty, et al. Not relevant, non-DRF
Computed tomography for triage of suspected scaphoid fractures
2008 diagnosis
vanRiet, et al. Not relevant, non-DRF
Documentation of associated injuries occurring with radial head fracture
2008 diagnosis
Chung, et al.
Treatment of unstable distal radial fractures with the volar locking plating system: Surgical technique Surgical Technique
2007
DiMarcantonio, et al.
Nonbridging external fixation comparable to volar plating for distal radius fractures Commentary
2007
Gaskin, et al. Not relevant, pediatric
How accurate and reliable are doctors in estimating fracture angulation?
2007 population
Goris, et al. Delayed recovery and late development of complex regional pain syndrome in patients with an isolated Not relevant, specific to
2007 fracture of the distal radius: prediction of a regional inflammatory response by early signs CRPS diagnosis
Hollevoet, et al.
Anterior fracture displacement in Colles' fractures after Kapandji wiring in women over 59 years Retrospective case series
2007
MacDermid, et al.
Predictors of time lost from work following a distal radius fracture Intervention not reported
2007
Malizos, et al. Scaphoid nonunions: management with vascularized bone grafts from the distal radius: a clinical and Not relevant, non-DRF
2007 functional outcome study diagnosis
Schurmann, et al. Not relevant, specific to
Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods
2007 CRPS diagnosis
Souer, et al. Not relevant, non-DRF
Perilunate fracture-dislocations of the wrist: comparison of temporary screw versus K-wire fixation
2007 diagnosis
Akesson, et al. Not relevant, proximal radius
Primary nonoperative treatment of moderately displaced two-part fractures of the radial head
2006 fractures
Bhattacharyya, et al.
Antibiotics vs an antimicrobial dressing for pin-track infection Could not obtain
2006
Evidence Table 76
Cardone, et al.
Technique to assess the rigidity of callus bone during external fixation of distal radial fractures Abstract
2006
Ginn, et al. Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical
Surgical Technique
2006 technique
Jupiter, et al. A prospective randomized trial of nonbridging external fixation using multiplanar K-wires versus volar
Abstract
2006 plating for unstable fractures of the distal radius
Lozano-Calderon, et al. Prospective randomized comparison of early vs. late wrist mobilization after volar plate fixation of distal
Abstract
Rozental, et al. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the
2006 distal radius
Sahin, et al. Not relevant, non-DRF
Efficacy of salmon calcitonin in complex regional pain syndrome (type 1) in addition to physical therapy
2006 diagnosis
Beeres, et al. Not relevant, non-DRF
Outcome of routine bone scintigraphy in suspected scaphoid fractures
2005 diagnosis
Boutroy, et al. In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative
Healthy population
2005 computed tomography
Cooper, et al.
The effects of early therapeutic intervention for patients following fractured distal radius [thesis] Thesis
2005
Fawzy, et al.
Open reduction and internal fixation of distal radial fractures using the Pi-plate Retrospective case series
2005
Goldfarb, et al. Not relevant, non-DRF
Functional outcome after fracture of both bones of the forearm
2005 diagnosis
Grala, et al. Less than 10 patients per
Hybrid external fixation of unstable distal radius fractures: Initial experience
2005 group
Kamano, et al.
Palmar plating for AO/ASIF C3.2 fractures of the distal radius with arthroscopically assisted reduction Retrospective case series
2005
Mittal, et al. Use of bio-resorbable implants for stabilisation of distal radius fractures: the United Kingdom patients'
Not relevant, opinion survey
2005 perspective
Petersen, et al.
Ulnar shortening osteotomy after Colles fracture Osteotomy
2005
Puchalski, et al. Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role Not relevant, specific to
2005 of psychological factors CRPS diagnosis
Rieger, et al.
CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results Malunion
2005
Evidence Table 76
Slutsky, et al.
Nonbridging external fixation of intra-articular distal radius fractures Cadaver study
2005
Dailiana, et al. Not relevant, non-DRF
Scaphoid nonunions treated with vascularised bone grafts: MRI assessment
2004 diagnosis
Dicpinigaitis, et al.
Can external fixation maintain reduction after distal radius fractures? Retrospective case series
2004
Durmus, et al. Not relevant, specific to
The efficiency of electromagnetic field treatment in Complex Regional Pain Sydrome Type I
2004 CRPS treatment
George, et al. The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after
Malunion
2004 Colles' fracture
Goldfarb, et al.
Arthroscopically assisted fracture fixation Commentary
2004
Hartigan, et al.
Opinion: Fixation of both fractures Commentary
2004
Keller, et al. The (pi) plate: An implant for unstable extension fractures of the distal radius in patients with osteoporotic
Surgical Technique
2004 bone
Livani, et al. Not relevant, non-DRF
Bridging plate osteosynthesis of humeral shaft fractures
2004 diagnosis
Senall, et al. Not relevant, non-DRF
Ultrasound for the early diagnosis of clinically suspected scaphoid fracture
2004 diagnosis
Smith, et al.
The 45 degrees pronated oblique view for volar fixed-angle plating of distal radius fractures Surgical Technique
2004
Abe, et al. Not relevant, non-DRF
A benefit of the volar approach for wrist arthroscopy
2003 diagnosis
Afzal, et al.
Treatment of fractures of the distal radius with external fixator Could not obtain
2003
Anglen, et al.
The clinical use of bone stimulators Could not obtain
2003
Grigoryan, et al. Quantitative and qualitative assessment of closed fracture healing using computed tomography and
Intervention not reported
2003 conventional radiography
McKee, et al. Hydroxyapatite cement was not as effective as intrafocal Kirschner-wire fixation for acute fractures of the
Commentary
2003 distal part of the radius [comment]
Shabat, et al.
Simultaneous distal radius and hip fractures in elderly patients--implications to rehabilitation Retrospective case series
2003
Evidence Table 76
Sommer, et al. Not relevant, non-DRF

First clinical results of the Locking Compression Plate (LCP)
2003 diagnosis
Adams, et al. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint Not relevant, non-DRF
2002 instability diagnosis
Brink, et al.
Should we use the pi-plate instead of the T-plate for distal radius fracture fixation and osteotomies? Abstract
2002
Cai, et al. Rehabilitative effect on external fixator or cast immobilization for unstable intra-articular fracture of distal
Could not obtain
2002 radius
Dickson, et al. Not relevant, non-DRF
The use of BoneSource hydroxyapatite cement for traumatic metaphyseal bone void filling
2002 diagnosis
Garcia-Elias, et al. Not relevant, non-DRF
Failed ulnar head resection: prevention and treatment
2002 diagnosis
Grafstein, et al.
Comparison of three immobilization techniques in the management of acute distal radius fractures Abstract
2002
Livingstone, et al. Intravenous regional guanethidine blockade in the treatment of post-traumatic complex regional pain Not relevant, specific to
2002 syndrome type 1 (algodystrophy) of the hand CRPS treatment
Sennwald, et al.
Unstable distal radial fractures treated by external fixation: an analytical review Retrospective case series
2002
Stein, et al.
Bridging external fixation plus K-wires Commentary
2002
Tornetta, et al.
Distal radius fracture Commentary
2002
Bialocerkowski, et al.
A home program is as effective as in-rooms treatment in the management of distal radius fracture Commentary
2001
Birklein, et al. Despite clinical similarities there are significant differences between acute limb trauma and complex Not relevant, specific to
2001 regional pain syndrome I (CRPS I) CRPS diagnosis
Handoll, et al.
Pitfalls in research: Insights from studies of treatment of distal radius fractures in adults Duplicate study
2001
McKee, et al.
The Norian skeletal repair system was effective for fractures of the distal radius Commentary
2001
Sprivulis, et al. Not relevant, non-DRF
Same-day X-ray reporting is not needed in well-supervised emergency departments
2001 diagnosis
Starch, et al. Not relevant, proximal radius
Magnetic resonance imaging of the interosseous membrane of the forearm
2001 fractures
Evidence Table 76
Strohm, et al. Comparison of two different osteosynthetic management methods of distal Colles-type radius fractures
Foreign language
2001 with Kirschner wires
Emami, et al.
A safer pin position for external fixation of distal radial fractures Commentary
2000
Franck, et al. Distal radial fractures - Is the small non-bridging external fixator an alternative? A randomised, prospective
Foreign language
2000 study
Russe, et al.
The bioresorpable osteosynthesis of distal radius fractures Foreign language
2000
Sanchez, et al.
Treatment of distal radius fractures with remodelable bone cement Duplicate study
2000
Angelov, et al.
Observations on Ulson fixation for fractures of the distal radius Foreign language
1999
Bretlau, et al. Not relevant, non-DRF
Diagnosis of scaphoid fracture and dedicated extremity MRI
1999 diagnosis
Fischer, et al. Includes more than 20%
The radio-radial external fixator in the treatment of fractures of the distal radius
1999 pediatric patients
Korner, et al.
The use of biodegradable pins in the operative treatment of distal radial fractures Abstract
1999
Kreder, et al. A randomized controlled trial of indirect reduction & percutaneous fixation versus ORIF for displaced intra-
Abstract
1999 articular distal radius fractures
Schurmann, et al. Assessment of peripheral sympathetic nervous function for diagnosing early post-traumatic complex Not relevant, specific to
1999 regional pain syndrome type I CRPS diagnosis
Bickley, et al. Not relevant, non-DRF
Self-tapping versus standard tapped titanium screw fixation in the upper extremity
1998 diagnosis
Cooney, et al.
Distal radius fractures: external fixation proves best Commentary
1998
David, et al.
One-year results of the osteosythesis of distal radius fractures with resorpable pins Foreign language
1998
Fikry, et al.
Distal radial fractures: Kapandji's or Py's pinning? Foreign language
1998
Flinkkila, et al. AO and Frykman's classifications of Colles' fracture. No prognostic value in 652 patients evaluated after 5
1998 years
Illarramendi, et al. Evaluation of simplified Frykman and AO classifications of fractures of the distal radius. Assessment of
Could not obtain
1998 interobserver and intraobserver agreement
Evidence Table 76
Kafury, et al.
Primary wrist arthrodesis in a severe intra-articular distal radial fracture Case report
1998
VanGelderen, et al. Short tau inversion recovery magnetic resonance imaging in occult scaphoid injuries: effect on Not relevant, non-DRF
1998 management diagnosis
Fellmann, et al. Clinical and radiological results 12 years after conservative treatment of distal radius fractures: A long
Foreign language
1997 term follow-up study
Field, et al. Not relevant, specific to
Algodystrophy is an early complication of Colles' fracture. What are the implications?
1997 algodystrophy diagnosis
Franck, et al. Prospective randomised study on the functional therapy of distal radius fracture with non-joint overlapping
Foreign language
1997 fixture externally verses Spick-wire osteosynthesis with lower-arm plaster
Kendall, et al. Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department- Not relevant, anaesthesia
1997 which is best? study
Laulan, et al. The different types of algodystrophy after fracture of the distal radius. Predictive criteria of outcome after 1 Not relevant, specific to
1997 year algodystrophy diagnosis
Muller, et al.
Osteosynthesis of radius fracture loco typico with new resorpable polyactide pins Foreign language
1997
Nagy, et al.
Long-term results of radioscapholunate fusion following fractures of the distal radius Non-acute DRF
1997
Rahamimov, et al.
The effect of malunion of distal radial fractures on hand function Foreign language
1997
Richards, et al. Not diagnostic accuracy,
Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures
Borrero, et al.
Molded Kirschner wire for fixation of Barton's fracture dislocations of the radius Could not obtain
1996
Geissler, et al. Not diagnostic accuracy,
Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius
Neumann, et al.
External fixation or percutaneous pin fixation in distal intraarticular radius fractures in elderly patients Foreign language
1996
Geissler, et al.
Arthroscopically assisted reduction of intra-articular fractures of the distal radius Surgical Technique
1995
Mikic, et al. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint Not relevant, non-DRF
1995 instability diagnosis
O'Bierne, et al. Not relevant, non-DRF
Wrist arthrodesis using a dynamic compression plate
1995 diagnosis
Evidence Table 76
Bickerstaff, et al. Not relevant, specific to

Algodystrophy: an under-recognized complication of minor trauma
Blatter, et al. Comparative study of two methods of plaster cast fixation in the treatment of Colles' fracture. A
Foreign language
1994 prospective randomized study
Fernandez, et al. Less than 10 patients per
Technique and results of external fixation of complex carpal injuries
1993 group
Effect of guanethidine on the natural history of post-traumatic algodystrophy
1993 algodystrophy treatment
Frykman, et al. External fixators for treatment of unstable wrist fractures. A biomechanical, design feature, and cost Not relevant, biomechanic
1993 comparison study
Features of algodystrophy ten years after Colles' fracture
Axelrod, et al. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal
Commentary
The use of nasal calcitonin in the treatment of post-traumatic algodystrophy
1991 algodystrophy treatment
Radiographic changes in algodystrophy of the hand
Atkins, et al. Not relevant, specific to
Features of algodystrophy after Colles' fracture
Algodystrophy following Colles' fracture
The use of dolorimetry in the assessment of post-traumatic algodystrophy of the hand
Frykman, et al. Not relevant, biomechanic
Comparison of eleven external fixators for treatment of unstable wrist fractures
1989 study
McQueen, et al.
Management of distal radial fractures Commentary
1989
Ekenstam, et al.
Capsulotomy of the distal radio ulnar joint Non-acute DRF
1988
Pattee, et al. Anterior and posterior marginal fracture-dislocations of the distal radius. An analysis of the results of Less than 10 patients per
1988 treatment group
Roesgen, et al. Corrective osteotomy of the distal radius after fracture to restore the function of wrist joint, forearm, and
Osteotomy
1988 hand
Evidence Table 76
Roth, et al.
Healing of extra-articular angulated apex volar fractures of the distal radius Malunion
1988
Solgaard, et al. Displaced distal radius fractures. A comparative study of treatment by external fixation, dorsal plaster
Duplicate study
1988 immobilisation and functional bracing in supination
Kongsholm, et al. not relevant, method of
Reduction of Colles' fractures without anaesthesia using a new dynamic bone alignment system
1987 reduction
Wechsler, et al. Less than 10 patients per
Computed tomography diagnosis of distal radioulnar subluxation
1987 group
Ametewee, et al. Not relevant, includes
Fractures of the distal radius with anterior displacement: Smith's and Barton's fractures
1986 pediatric patients
Kongsholm, et al. Does not report patient
Carpal tunnel pressure in the acute phase after Colles' fracture
Solgaard, et al.
Early displacement of distal radius fracture Retrospective case series
1986
Falch, et al. 3 years treatment with 1.25(OH)2 Vitamin D3 does not reduce bone loss or fracture rate in
Could not obtain
1985 postmenopausal women with fracture of the distal forearm
Mortier, et al.
The importance of the posteromedial fragment and its specific pinning in fractures of the distal radius Foreign language
1983
Chapman, et al.
Complications of distal radial fractures: pins and plaster treatment Retrospective case series
1982
Krolner, et al. Bone mass of the axial and the appendicular skeleton in women with Colles' fracture: its relation to
Could not obtain
1982 physical activity
Cooney, et al.
Complications of Colles' fractures Retrospective case series
1980
Frykman, et al. Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal
Could not obtain
1967 radio-ulnar joint and impairment of nerve function. A clinical and experimental study
Systematic Reviews Screened for Additional Articles
Author Title
Busse, et al. 2009 Low intensity pulsed ultrasonography for fractures: Systematic review of randomised controlled trials
Functional assessment in patients with osteoporotic wrist fractures treated with external fixation: A review of randomized
Hoang-Kim, et al. 2009
trials
Bajammal, et al. 2008 The use of calcium phosphate bone cement in fracture treatment. A meta-analysis of randomized trials
Goldhahn, et al. 2008 Influence of osteoporosis on fracture fixation--a systematic literature review
Handoll, et al. 2008 Different methods of external fixation for treating distal radial fractures in adults
Handoll, et al. 2008 Bone grafts and bone substitutes for treating distal radial fractures in adults
McHardy, et al. 2008 Chiropractic Treatment of Upper Extremity Conditions: A Systematic Review
Mollon, et al. 2008 Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials
Porrino, et al. 2008 Misquotation of a commonly referenced hand surgery study
Schadel-Hopfner, et al. 2008 Evidence-based hand surgery: the role of Cochrane reviews
Handoll, et al. 2007 External fixation versus conservative treatment for distal radial fractures in adults
Handoll, et al. 2007 Percutaneous pinning for treating distal radial fractures in adults
Handoll, et al. 2006 Rehabilitation for distal radial fractures in adults
Margaliot, et al. 2005 A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures
Smith, et al. 2005 Volar fixed-angle plating of the distal radius

Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after
Haentjens, et al. 2004
Colles' or spine fracture: Colles' fracture as an early and sensitive marker of skeletal fragility in white men
Kanis, et al. 2004 A meta-analysis of previous fracture and subsequent fracture risk
Paksima, et al. 2004 A meta-analysis of the literature on distal radius fractures: review of 615 articles
Haentjens, et al. 2003 Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis
From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research
Handoll, et al. 2003
agenda
Handoll, et al. 2003 Surgical interventions for treating distal radial fractures in adults
Handoll, et al. 2003 Closed reduction methods for treating distal radial fractures in adults
Handoll, et al. 2003 Conservative interventions for treating distal radial fractures in adults
Busse, et al. 2002 The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis
Managing fractures of the distal radius in adults. Clinical and research implications from systematic reviews of existing
Handoll, et al. 2002
trials
Systematic Reviews Screened for Additional Articles
Author Title
Handoll, et al. 2002 Anaesthesia for treating distal radial fracture in adults
Lindau, et al. 2002 The radioulnar joint in distal radial fractures
McKay, et al. 2001 Assessment of complications of distal radius fractures and development of a complication checklist
duKamp, et al. 2000 The advantages and disadvantages of Bier's blocks and haematoma blocks for Colles' fractures in A&E
Klotzbuecher, et al. 2000 Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis
Larsen, et al. 1997 Nonunion rates of limited carpal arthrodesis: a meta-analysis of the literature
Narrative Reviews Screened for Additional Articles
Author Title
Berglund, et al. 2009 Complications of volar plate fixation for managing distal radius fractures
Brodeur-Lyons, et al. 2009 It's all in the hands. Distal radius fractures: common and complicated
Jawa, et al. 2009 Fracture-Associated Nerve Dysfunction
Patel, et al. 2009 Bone Graft Substitutes: Current Uses in Hand Surgery
Tsai, et al. 2009 The distal radioulnar joint
Chloros, et al. 2008 Current concepts in wrist arthroscopy
del, et al. 2008 Dry arthroscopy of the wrist: its role in the management of articular distal radius fractures
Henry, et al. 2008 Distal radius fractures: current concepts
Keast-Butler, et al. 2008 Biology versus mechanics in the treatment of distal radial fractures
Korsic, et al. 2008 Non-hip peripheral osteoporotic fractures: epidemiology and significance
Parkinson, et al. 2008 Whole bone geometry and bone quality in distal forearm fracture
Siska, et al. 2008 External adjuncts to enhance fracture healing: What is the role of ultrasound?
Suhm, et al. 2008 Injectable bone cement augmentation for the treatment of distal radius fractures: a review
Vasenius, et al. 2008 Operative treatment of distal radius fractures
Amadio, et al. 2007 What's new in hand surgery
Chen, et al. 2007 Management of distal radial fractures
Gofton, et al. 2007 Distal radius fractures: nonoperative and percutaneous pinning treatment options
Katz, et al. 2007 Advances in arthroscopic surgery: Indications and outcomes
Kawamura, et al. 2007 Management of wrist injuries
Kim, et al. 2007 Internal fixation of distal radius fractures
Martineau, et al. 2007 Plating for distal radius fractures
Raia, et al. 2007 What's new in distal radius fracture treatment for 2007
Schurmann, et al. 2007 Early diagnosis in post-traumatic complex regional pain syndrome
Arnander, et al. 2006 Fractures of the distal radius
Badia, et al. 2006 Volar Plating of Distal Radius Fractures
Dantuluri, et al. 2006 Intramedullary Fixation of Fractures of the Distal Radius
Author Title
Dennison, et al. 2006 Median nerve injuries associated with distal radius fractures
Dudley, et al. 2006 Considerations in Dorsal Plating of Distal Radius Fractures
Glickel, et al. 2006 Closed Reduction and Percutaneous Pinning for Distal Radius Fractures
McQueen, et al. 2006 Nonbridging External Fixation of the Distal Radius
Medoff, et al. 2006 Fragment-Specific Fixation of Distal Radius Fractures
Osterman, et al. 2006 Arthroscopy in the Treatment of Distal Radial Fractures with Assessment and Treatment of Associated Injuries
Raskin, et al. 2006 Distal Radius Fractures: External Fixation and Supplemental K-Wires
Fragment-Specific Fixation of Distal Radius Fractures Using the 2.4 mm Synthes Locking System-A Rationale for
Rikli, et al. 2006
Treatment
Szabo, et al. 2006 Distal radioulnar joint instability
Gutow, et al. 2005 Avoidance and treatment of complications of distal radius fractures
Karnezis, et al. 2005 Treatment and complications of distal radius fractures
Medoff, et al. 2005 Essential radiographic evaluation for distal radius fractures
Catalano, et al. 2004 Assessment of articular displacement of distal radius fractures
Kanis, et al. 2004 Epidemiology of osteoporosis and fracture in men
Segalman, et al. 2004 Scaphoid proximal pole fractures and nonunions
Smith, et al. 2004 Early active rehabilitation for operatively stabilized distal radius fractures
Gaebler, et al. 2003 Ulnar procedures for post-traumatic disorders of the distal radioulnar joint
Ladd, et al. 2003 Bone graft substitutes in the radius and upper limb
Ruch, et al. 2003 Open reduction and internal fixation of the distal radius
Swan, et al. 2003 Distal radius plating options
Cummings, et al. 2002 Epidemiology and outcomes of osteoporotic fractures
Ring, et al. 2002 Intra-articular fractures of the distal radius
Smith, et al. 2002 Comprehensive management of soft-tissue injuries associated with distal radius fractures
Amin, et al. 2001 Osteoporosis in men
Eastell, et al. 2001 Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action?
Michlovitz, et al. 2001 Distal radius fractures: therapy practice patterns
Author Title
Rubin, et al. 2001 The use of low-intensity ultrasound to accelerate the healing of fractures
Geissler, et al. 2000 Percutaneous and limited open reduction of intra-articular distal radial fractures
Geusens, et al. 2000 Algodystrophy
Seitz, et al. 2000 Perils and pitfalls of external fixation for distal radius fractures
Warden, et al. 2000 Acceleration of fresh fracture repair using the sonic accelerated fracture healing system (SAFHS): a review
Westkaemper, et al. 2000 Intrafocal (Kapandji) pinning of the distal radius
Ladd, et al. 1999 Use of bone-graft substitutes in distal radius fractures
Rodriguez-Merchan, et al. 1998 Management of comminuted fractures of the distal radius in the adult. Conservative or surgical?
Sherman, et al. 1998 Rational treatment of distal radioulnar joint pathology
Trumble, et al. 1998 Intra-articular fractures of the distal aspect of the radius
Whipple, et al. 1998 The role of arthroscopy in the treatment of wrist injuries in the athlete
Cohen, et al. 1997 Calcium phosphate bone cement--the Norian skeletal repair system in orthopedic surgery
Gilbert, et al. 1997 Imaging of acute injuries to the wrist and hand
Lips, et al. 1997 Epidemiology and predictors of fractures associated with osteoporosis
Metz, et al. 1997 Ligamentous instabilities of the wrist
Eastell, et al. 1996 Forearm fracture
Kaempffe, et al. 1996 External fixation for distal radius fractures: adverse effects of excess distraction
Metz, et al. 1996 Update on imaging techniques of the wrist and hand
Black, et al. 1995 Why elderly women should be screened and treated to prevent osteoporosis
Cummings, et al. 1995 Bone mass measurements and risk of fracture in Caucasian women: A review of findings from prospective studies
Whipple, et al. 1995 The role of arthroscopy in the treatment of intra-articular wrist fractures
Breslau, et al. 1994 Calcium, estrogen, and progestin in the treatment of osteoporosis
Seitz, et al. 1994 Complications and problems in the management of distal radius fractures
Agee, et al. 1993 External fixation. Technical advances based upon multiplanar ligamentotaxis
Hertel, et al. 1993 Static external fixation of the wrist
Metz, et al. 1993 Imaging techniques for distal radius fractures and related injuries
Author Title
Seitz, et al. 1993 External fixation of distal radius fractures. Indications and technical principles
Solgaard, et al. 1993 Distal radius fractures. Classification, function and recommendations to treatment
Aulicino, et al. 1991 Acute injuries of the distal radioulnar joint
Burk, et al. 1991 Imaging of the distal radioulnar joint
Bassett, et al. 1987 Displaced intraarticular fractures of the distal radius

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Evidence Table 1

Nerve Dysfunction After Distal Radius Fracture Reduction

AAOS Clinical Practice Guidelines Unit Page 1 of 138 v 1.0 12.05.09

All groups have similar outcome

Same center for expiremental

experimental group results

and control group data

control group results

AAOS Clinical Practice Guidelines Unit Page 2 of 138 v 1.0 12.05.09

Henry, et al. 10 - 140 MND with CTR 0%

AAOS Clinical Practice Guidelines Unit Page 3 of 138 v 1.0 12.05.09

No studies were identified by the literature search

AAOS Clinical Practice Guidelines Unit Page 4 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 5 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 6 of 138 v 1.0 12.05.09

All groups have similar outcome

experimental group results

Follow Up - 80% or more

control group results

Author Outcome Duration N Treatment(s)

AAOS Clinical Practice Guidelines Unit Page 7 of 138 v 1.0 12.05.09

Young, et al. External fixation - bridging vs. 83% 79%

AAOS Clinical Practice Guidelines Unit Page 8 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 9 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 10 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 11 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 12 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 13 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 14 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 15 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 16 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 17 of 138 v 1.0 12.05.09

AAOS Clinical Practice Guidelines Unit Page 18 of 138 v 1.0 12.05.09

All groups have similar outcome

experimental group results

Follow Up - 80% or more

control group results

Author Outcome Duration N Treatment(s)

AAOS Clinical Practice Guidelines Unit Page 19 of 138 v 1.0 12.05.09

All groups have similar outcome

experimental group results

Follow Up - 80% or more

control group results

Author Outcome Duration N Treatment(s)

AAOS Clinical Practice Guidelines Unit Page 20 of 138 v 1.0 12.05.09

All groups have similar outcome

experimental group results

Follow Up - 80% or more

control group results

Author Outcome Duration N Treatment(s)

AAOS Clinical Practice Guidelines Unit Page 21 of 138 v 1.0 12.05.09

Krukhaug, et al. External fixation - non-bridging vs. 9 13

AAOS Clinical Practice Guidelines Unit Page 22 of 138 v 1.0 12.05.09

Harley, et al. Augmented external fixation - bridging vs.

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All groups have similar outcome

experimental group results

Follow Up - 80% or more

control group results

Author Outcome Duration N Treatment(s)

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All groups have similar outcome