1
|
Lüdi S, Kurz C, Deforth M, Ghafoor H, Haefeli M, Honigmann P. Radiological, Clinical and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures. J Hand Surg Am 2022; 48:377-387. [PMID: 35190216 DOI: 10.1016/j.jhsa.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/17/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures. METHODS We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires. RESULTS Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients. CONCLUSION The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent. LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Simona Lüdi
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Charlotte Kurz
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Handclinic AG Rüti, Rüti, Switzerland
| | - Manja Deforth
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Mathias Haefeli
- Hand Surgery, Kantonsspital Graubünden, Chur, Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Medical Additive Manufacturing research group, Department of Biomedical Engineering, University of Basel, Switzerland
| |
Collapse
|
2
|
Devaux N, Henning J, Haefeli M, Honigmann P. The Retinaculum Flap for Dorsal Fixation of Distal Radius Fractures. J Hand Surg Am 2018; 43:391.e1-391.e7. [PMID: 29618418 DOI: 10.1016/j.jhsa.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
In spite of the more popular volar approach for plating of distal radius fractures (DRFs), there are still indications for dorsal plating and even combined dorsovolar plating in complex DRFs. Dorsal plating carries a concern for complications such as tenosynovitis, extensor tendon adhesions, and delayed extensor tendon ruptures. These risks can be minimized by use of modern low-profile plates and the use of an extensor retinaculum flap to cover the distal plate and screws. We describe the technique of the dorsal retinaculum flap for dorsal plating of DRFs.
Collapse
Affiliation(s)
- Noémie Devaux
- Department of Hand Surgery, Kantonsspital, Baselland Liestal, Liestal, Switzerland
| | - Julia Henning
- Department of Hand Surgery, Kantonsspital, Baselland Liestal, Liestal, Switzerland; Department of Plastic and Hand Surgery, Inselspital, Bern, Switzerland
| | - Mathias Haefeli
- Department of Hand Surgery, Kantonsspital, Baden, Switzerland
| | - Philipp Honigmann
- Department of Hand Surgery, Kantonsspital, Baselland Liestal, Liestal, Switzerland.
| |
Collapse
|
3
|
Smektala R, Endres HG, Dasch B, Bonnaire F, Trampisch HJ, Pientka L. [Quality of care after distal radius fracture in Germany. Results of a fracture register of 1,201 elderly patients]. Unfallchirurg 2009; 112:46-54. [PMID: 19104764 DOI: 10.1007/s00113-008-1523-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study is the first to document the quality of inpatient care provided to elderly patients with distal radius fracture in Germany. PATIENTS AND METHODS Inpatient care provided to 1,201 patients age 65 or older with isolated distal radius fracture was documented in a prospective cohort study conducted at 242 acute care clinics in Germany between January 2002 and September 2003. RESULTS The median patient age was 75, and nearly 90% of patients were female. Approximately 71% of patients were classified as ASA I or II, and 28% were ASA III. The most common comorbidity was arterial hypertension (60%). Seventy-five percent of patients were admitted on the day of the accident; of these, 63% had surgery on the same day, and 20% on the following day. The primary form of anaesthesia was general anaesthesia (55%). The predominant fracture management procedure was percutaneous K-wire osteosynthesis (56% of cases), followed by plate osteosynthesis (44%). The length of hospital stay after plate osteosynthesis (median 8.5 days) was more than twice as long as after K-wire osteosynthesis (median 4 days). The rate of postoperative complications typical of each procedure was around 10%. Roughly 90% of patients were discharged to home. Although evidence of osteoporosis was observed in 62% of women and 50% of men, only 7.9% of patients were prescribed osteoporosis-specific medication. CONCLUSIONS Unexpected findings were the predominance of general anaesthesia and percutaneous K-wire osteosynthesis. Osteoporosis, affecting a majority of elderly women, is neglected in clinical practice. Good quality of care is reflected by the low rate of complications.
Collapse
Affiliation(s)
- R Smektala
- Chirurgische Universitätsklinik, Abteilung für Unfallchirurgie, Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-Universität Bochum, Bochum.
| | | | | | | | | | | |
Collapse
|
4
|
[Combined dorsal and palmar plate osteosynthesis for intraarticular distal radius fractures]. Unfallchirurg 2009; 111:607-12. [PMID: 18512038 DOI: 10.1007/s00113-008-1454-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Complex comminuted intraarticular fractures of the distal radius require anatomic restoration. In rare cases, this aim can only be achieved by a combined dorsal and volar plate fixation despite increasing experience with volar locking compression implants. This retrospective quality control study investigated functional, radiological and subjective outcomes of patients treated with this technique. METHODS Between March 1999 and January 2003, 30 out of 360 patients who were operated on for an unstable distal radius fracture with complex C2/C3 type distal radius fractures at the Division of Trauma Surgery of the University Hospital Zurich, had been treated with a combined dorso-palmar plate fixation (dorsal two 1/4 tubular plates, volar 3.5 mm T-plate) and were included in this study (9 female, 21 male, mean age 52 years). Of the 30 patients 25 could be evaluated at an average of 29 months after injury. RESULTS Anatomic reconstruction could not be achieved in all cases, 56% showed mild and 28% explicit signs of arthrosis. Flexion reached 66% and extension 75% of the contralateral wrist, whereas pronation reached 98% and supination 91%, respectively. Grip strength achieved 75% of that of the contralateral side and 10 patients (40%) developed a complex regional pain syndrome (CRPS). Return to work was possible 120 days after the injury. CONCLUSION With the dorso-palmar plate fixation joint reconstruction in complex intraarticular distal radius fractures can be achieved with a satisfactory subjective, functional, and radiologic result, although additional soft tissue injury was caused by the bilateral approach. The patient has to be informed of the high rate of CRPS and the long period of disability.
Collapse
|