Shoji Kristin E, Earp Brandon E, Rozental Tamara D
Harvard Combined Orthopaedic Residency Program, Boston, MA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA.
J Hand Surg Am. 2018 Feb;43(2):115-122. doi: 10.1016/j.jhsa.2017.09.006. Epub 2017 Oct 18.
To compare clinical and radiographic outcomes of distal radius fractures (DRF) treated with nonsurgical management in female postmenopausal patients receiving bisphosphonate (BP) therapy at the time of injury with those not receiving BP therapy.
We prospectively enrolled 33 female postmenopausal patients with 35 DRF between December 2010 and January 2014 at 2 Level I tertiary care centers. Eleven patients with 12 DRF were currently receiving BP at the time of injury (BP group) and were compared with 22 controls with 23 DRF (CONT group) who were not receiving BP at the time of injury. All were postmenopausal women with fragility fractures managed nonsurgically. Primary outcomes were radiographic healing measured by the Radius Union Scoring System (RUSS) score and clinical and functional outcomes. Radiographs, range of motion, pinch and grip strength, Patient-Rated Wrist Evaluation scores, and Disability of the Arm, Shoulder, and Hand scores were determined at 6, 9, and 12 weeks and 1 year from time of injury and compared between groups.
The BP and CONT groups were similar in terms of age, comorbidities, and fracture severity. Both groups had progressively improving RUSS scores from the time of injury throughout subsequent evaluation, and all patients achieved radiographic union. Fracture healing was similar in both groups at 6, 9, and 12 weeks after injury. The RUSS scores were slightly better in the CONT group at 1 year. There were no differences in wrist range of motion, pinch, grip, Patient-Rated Wrist Evaluation, or Disability of the Arm, Shoulder, and Hand scores at any time point after injury.
Patients receiving BP at the time of DRF had clinical outcomes similar to those not receiving antiresorptive treatment. Although there was a small difference in RUSS scores at 1 year after injury, this was not clinically relevant and all fractures united in a similar time frame with no healing complications. These results suggest that BP may be continued throughout nonsurgical management of DRF without detrimental effects on healing or function.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
比较在受伤时接受双膦酸盐（BP）治疗的绝经后女性患者与未接受BP治疗的绝经后女性患者，采用非手术治疗桡骨远端骨折（DRF）的临床和影像学结果。
2010年12月至2014年1月期间，我们在2家一级三级护理中心前瞻性纳入了33例患有35处DRF的绝经后女性患者。11例患有12处DRF的患者在受伤时正在接受BP治疗（BP组），并与22例患有23处DRF的对照组（CONT组）进行比较，后者在受伤时未接受BP治疗。所有患者均为绝经后脆性骨折且接受非手术治疗。主要结局指标为通过桡骨愈合评分系统（RUSS）评分测量的影像学愈合情况以及临床和功能结局。在受伤后6周、9周、12周和1年时确定X线片、活动范围、捏力和握力、患者自评腕关节评估评分以及手臂、肩部和手部功能障碍评分，并在组间进行比较。
BP组和CONT组在年龄、合并症和骨折严重程度方面相似。两组从受伤时起至随后的评估中，RUSS评分均逐渐改善，且所有患者均实现影像学愈合。受伤后6周、9周和12周时，两组的骨折愈合情况相似。CONT组在1年时的RUSS评分略好。受伤后任何时间点的腕关节活动范围、捏力、握力、患者自评腕关节评估或手臂、肩部和手部功能障碍评分均无差异。
DRF患者在受伤时接受BP治疗的临床结果与未接受抗吸收治疗的患者相似。尽管受伤后1年时RUSS评分存在微小差异，但这在临床上并不相关，且所有骨折均在相似的时间内愈合，无愈合并发症。这些结果表明，在DRF的非手术治疗过程中可继续使用BP，而不会对愈合或功能产生不利影响。
研究类型/证据水平：预后性研究II级。
