The edition · Orthopaedics
Displaced distal radius fracture: start in a cast, operate if it slips
Cost data from the CAST trial show delayed plating costs no more than plating straight away, while a polytrauma meta-analysis revisits early total care and a hip arthroscopy cohort counts the pudendal cost of traction.
The edition in brief
Today's orthopaedics edition opens on polytrauma. A meta-analysis of 20 mostly observational studies (18,852 patients) found early total care was associated with less sepsis, shorter stays and fewer operations than damage control orthopaedics, with no detectable difference in mortality, ARDS or multiple organ failure, which points back to physiological selection rather than one strategy for all. A prospective cohort of 93 hip arthroscopies with a perineal post found 83% had early pudendal nerve symptoms and 39% urogenital or sexual dysfunction; all resolved by a year, and each extra 10 minutes of traction raised the odds by about 60%. A meta-analysis of 17 studies linked an antibiotic-loaded hydrogel coating to fewer periprosthetic joint infections (OR 0.14), on evidence that is largely non-randomised. The pearl covers checking alignment at each fracture-clinic visit for a casted distal radius. The edition closes on a cost analysis from the CAST trial of 693 adults with displaced distal radius fractures: non-operative treatment cost about €2,212 per patient against €4,339 for direct plating and €4,393 for plating after redisplacement, a €58 difference that supports a trial of cast treatment with close radiographic follow-up.
Early total care or damage control: less sepsis, no clear mortality difference
In resuscitated polytrauma patients, early definitive fixation was linked to less sepsis and shorter stays, so let physiology rather than habit set the timing.
Pudendal symptoms after post-assisted hip arthroscopy are common and traction-dependent
Warn patients about temporary pudendal symptoms after post-assisted hip arthroscopy, ask about them at follow-up, and keep traction time short.
Antibiotic-loaded hydrogel coating linked to fewer periprosthetic infections
Antibiotic-loaded hydrogel coating was linked to fewer joint infections, but the evidence is largely non-randomised and mixed in setting.
Watching a casted distal radius for redisplacement
X-ray a casted displaced distal radius fracture at one and two weeks and decide on fixation by two weeks if it slips.
Distal radius fracture: delayed plating costs no more than plating at once
For displaced distal radius fractures that reduce well, consider a cast first with close follow-up, as later plating cost no more than plating at once.
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