1
|
Fleifel D, Pytiak AV, Jin X, Cizmic Z, Vaidya R. Biomechanics of Subcutaneous Locked Plating Versus Burke Plate and External Fixator for Comminuted Distal Radius Fractures. Cureus 2023; 15:e39142. [PMID: 37332475 PMCID: PMC10275508 DOI: 10.7759/cureus.39142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Background External fixators that span the wrist have been the historical norm in treating distal radius fractures. We have modified a dorsal distraction approach by using a subcutaneously applied locked bridge plate through two small incisions superficial to the extensor tendons and outside the extensor compartment. The purpose of this study was to biomechanically evaluate this modified method of fixation for comminuted distal radius fractures in comparison with two established constructs. Methods Matched cadaver specimens were used to model an AO Type 23-C3 distal radius fracture. Biochemical testing for stiffness during axial compressive loading was done on three constructs: a conventional Burke distraction plate, the subcutaneous internal fixation plating technique, and an external fixator. All specimens were cyclically loaded for 3000 cycles and then retested. Results The modified construct was found to be stiffer than the external fixator (p=0.013). When compared to the Burke plate, the modified construct was significantly less stiff before axial cycling (p=0.025). However, the difference was not maintained after cycling, and the post-axial loading stiffness difference was non-significant (p=0.456). Conclusion Our data demonstrate the biomechanical integrity of the subcutaneous plating technique for the fixation of comminuted distal radius fractures. It is stiffer than an external fixator and has the theoretical advantage of avoiding pin-tract infections. In addition, it is subcutaneous and not a cumbersome external construct. Our construct is minimally invasive, and it does not violate the dorsal extensor compartments. This allows for finger movement even while the construct is in place.
Collapse
Affiliation(s)
- Dominik Fleifel
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
| | - Andrew V Pytiak
- Department of Pediatric Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, USA
| | - Xin Jin
- Department of Biomedical Engineering, Wayne State University School of Medicine, Detroit, USA
| | - Zlatan Cizmic
- Department of Orthopaedic Surgery, St. John Providence Hospital, Southfield, USA
| | - Rahul Vaidya
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
| |
Collapse
|
2
|
Huang YM, Chen CY, Lin KC, Lai WY, Lin YY, Fu YJ, Tarng YW. Using Trident distal radial locking plate to fix the fracture of distal radius volar rim. J Chin Med Assoc 2023; 86:426-430. [PMID: 36661280 DOI: 10.1097/jcma.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The volar locking plates have been widely used in a variety of distal radius fractures, but they still have several limitations when dealing with small fragments located around the watershed line with widely reported complications. The volar rim fragments play a critical role in radiocarpal joint stability and failing to secure the volar rim fragment usually results in carpal instability, subluxation, or even dislocation. This study investigates clinical outcomes in the use of a novel implant, the Trident distal radial (TDR) locking plate to treat distal radius fracture with the intermedium column edge (lunate fossa volar rim) fragment involvement. METHODS A retrospective study of 25 patients was conducted, all patients had intermedium column fractures with lunate fossa volar rim involvement and treat with the TDR between January 2016 and December 2019. The clinical assessment outcomes included VAS Pain, PRWE, and DASH scores. Objective measurements included ROM of the injured wrist and grip strength. Final radiographs were used to evaluate radial inclination, volar tilt, ulnar variance, and distal radioulnar joint instability. Secondary operations related to hardware complications were also recorded. RESULTS The outcome revealed that the mean VAS Pain Score was 1.3, mean DASH score was 10.5, and mean PRWE score was 9.3. Objective measurements revealed good ROM recovery and an 89% gripping strength recovery compared with contralateral hand. Radiographic measurements revealed good maintenance of volar tilt, radial inclination, and mean ulnar variance. There were no complications related to the implant and all fracture sites were union. CONCLUSION We believe that the TDR provided more stable fixation among distal radial fractures that predominantly involved the intermedial column and volar rim fragment, and allowing early rehabilitation. We could obtain excellent results in the wrist ROM, gripping power, and Pain Score (VAS).
Collapse
Affiliation(s)
- Yin-Ming Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ying Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yih-Wen Tarng
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
3
|
Li H, Wang D, Zhang W, Xu C, Xiong D, Li J, Zhang L, Tang P. Evaluating the biomechanical performance of Ti6Al4V volar plates in patients with distal radius fractures. Front Bioeng Biotechnol 2023; 11:1141790. [PMID: 36923459 PMCID: PMC10009098 DOI: 10.3389/fbioe.2023.1141790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
Purpose: This study aimed to investigate the biomechanical performance of three Ti6Al4V volar plates with the latest designs using a finite element model. Methods: An AO type 23-A3 distal radius fracture and the models of T plate (2.4 mm LCP Volar Distal Radius Plate), V plate (2.4 mm LCP Two-Column Volar Distal Radius Plate) and π Plate (2.4 mm Volar Rim Distal Radius Plate) (all from Depuy Synthes, West Chester, PA, USA, Ti6Al4V) were built in 3D-matic software. After assembling the internal fixation and fractures, we imported these models into the finite element analysis software (ABAQUS). An axial loading of 100 N was added to the distal end of each model. The displacements of total models and implants, the principal strains and the von Mises stresses in the plates were calculated and compared to capture the biomechanical features of the three plates. Results: The T plate, V plate and π plate represented a model displacement of 0.8414 mm, 1.134 mm and 1.936 mm, respectively. The T plate was with the implant displacement of 0.7576 mm, followed by the V plate (0.8802 mm) and the π plate (1.545 mm). The T plate had the smallest principal strain of 0.23%, the V plate showed an intermediate level of 0.28%, and the π plate had a value of 0.72%. The least peak von Mises stress was observed in the V plate with 263.6MPa, and this value was 435.6 MPa and 1050 MPa in the T plate and π plate, respectively. Conclusion: The biomechanical features of three Ti6Al4V volar locking plates in an AO type 23-A3 fracture were described in our analysis. The T plate and the V plate showed similar biomechanical performance while the π plate represented worse performance than the other two plates.
Collapse
Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Dou Xiong
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| |
Collapse
|
4
|
Yang JM, Wang CK, Lin WC, Li CY, Su FC, Jou IM, Wu PT. Comparison of ultrasound and dorsal tangential view for dorsal cortex screw penetration in volar plating of the distal radius. J Orthop Res 2023; 41:235-240. [PMID: 35451220 DOI: 10.1002/jor.25341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023]
Abstract
We compared the accuracy of the fluoroscopic dorsal tangential view (DTV) and an ultrasound (US) examination in detecting dorsal screw penetration during volar distal radius plating. In six fresh cadaveric distal radii, seven periarticular locking screws in two rows for each plate were inserted according to the measured length using a depth gauge and then replaced with another that was 1 and 2 mm longer, respectively. The actual protruded length of each screw was determined using computed tomography (CT) images. The accuracy of US and DTV measurements was determined using the intraclass correlation coefficient (ICC), as both measurements were compared with CT measurements. The ICC of US and DTV was 0.96 and 0.75, respectively, for all screws. After excluding the data for proximal-row screws, the ICC of US remained unchanged at 0.96, and that of DTV improved to 0.86. The ICC of US was significantly higher than that of DTV (p < 0.01). US had a 100% detection rate for screw protrusion of more than 1.0 mm. US examination showed excellent consistency with CT measurements and its accuracy was not affected by screw location. US might thus be a practical tool for detecting dorsal cortex screw penetration during volar distal radius plating.
Collapse
Affiliation(s)
- Jui-Ming Yang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Department of Orthopedics, Tainan ShinLau Christian Hospital, Tainan, Taiwan
| | - Chien-Kuo Wang
- Department of Radiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chin Lin
- Department of Orthopaedic Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Ting Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
5
|
Franovic S, Pietroski AD, Druskovich K, Page B, Burdick GB, Fathima B, McIntosh MJ, King EA, Muh SJ. A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:169-177. [PMID: 36974282 PMCID: PMC10039314 DOI: 10.1016/j.jhsg.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To conduct a cost-effectiveness study of nonsurgical and surgical treatment options for distal radius fractures using distinct posttreatment outcome patterns. Methods We created a decision tree to model the following treatment modalities for distal radius fractures: nonsurgical management, external fixation, percutaneous pinning, and plate fixation. Each node of the model was associated with specific costs in dollars, a utility adjustment (quality-adjusted life year [QALY]), and a percent likelihood. The nodes of the decision tree included uneventful healing, eventful healing and no further intervention, carpal tunnel syndrome, trigger finger, and tendon rupture as well as associated treatments for each event. The percent probabilities of each transition state, QALY values, and costs of intervention were gleaned from a systematic review. Rollback and incremental cost-effectiveness ratio analyses were conducted to identify optimal treatment strategies. Threshold values of $50,000/QALY and $100,000/QALY were used to distinguish the modalities in the incremental cost-effectiveness ratio analysis. Results Both the rollback analysis and the incremental cost-effectiveness ratio analysis revealed nonsurgical management as the predominant strategy when compared with the other operative modalities. Nonsurgical management dominated external fixation and plate fixation, although it was comparable with percutaneous fixation, yielding a $2,242 lesser cost and 0.017 lesser effectiveness. Conclusions The cost effectiveness of nonsurgical management is driven by its decreased cost to the health care system. Plate and external fixation have been shown to be both more expensive and less effective than other proposed treatments. Percutaneous pinning has demonstrated more favorable effectiveness in the literature than plate and external fixation and, thus, may be more cost effective in certain circumstances. Future studies may find value in investigating further clinical aspects of distal radius fractures and their association with nonsurgical management versus that with plate fixation. Type of study/level of evidence Economic/decision analysis II.
Collapse
Affiliation(s)
- Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | | | | | - Brendan Page
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | - Gabriel B. Burdick
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | - Bushra Fathima
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | | | - Elizabeth A. King
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | - Stephanie J. Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
- Corresponding author: Stephanie J. Muh, MD, Division of Hand and Upper Extremity, Department of Orthopaedic Surgery, Henry Ford Health System, West Bloomfield, MI 48202.
| |
Collapse
|
6
|
Yano K, Kaneshiro Y, Nakazawa K, Hyun S, Sakanaka H. Intra-articular fibromembranous septum after intra-articular distal radial fracture: Arthroscopic excision and factors associated with formation of the septum. J Orthop Sci 2022; 27:1044-1050. [PMID: 34330610 DOI: 10.1016/j.jos.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intra-articular fibromembranous septum in the radiocarpal joint can cause wrist contracture after distal radial fracture, but the mechanism underlying the formation of the septum is unknown. This study examined the clinical outcomes in patients treated with arthroscopic excision of the septum and the factors associated with formation of the septum in patients with and without a septum. METHODS Fifty-three patients (22 with septum and 31 without septum) treated for intra-articular distal radial fracture with arthroscopy using a volar locking plate and secondary removal of the plate were included. Clinical outcomes and radiological assessments were analyzed. RESULTS In patients with a septum, the range of wrist flexion and total wrist arc before the second operation were significantly more limited than in those without a septum (p < 0.01 and p = 0.03, respectively). The improvement rate (improvement in wrist arc divided by the wrist arc of the healthy side) after arthroscopic excision of the septum and plate removal was greater in patients with a septum than in those without a septum (6.1% vs. 2.0%, p = 0.08). The significant factors affecting formation of the septum were the residual articular gap and the height of the midradial ridge on computed tomography images. CONCLUSIONS Intra-articular fibromembranous septum after surgically treated intra-articular distal radial fracture affects limited range of motion and secondary arthroscopic excision of the septum improves the wrist range of motion. Anatomical reduction and maintenance of the articular fragment, as well as anatomical characteristics might be causes of septum formation.
Collapse
Affiliation(s)
- Koichi Yano
- Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-ku, Sakai City, Osaka, 590-0064, Japan.
| | - Yasunori Kaneshiro
- Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-ku, Sakai City, Osaka, 590-0064, Japan
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-ku, Sakai City, Osaka, 590-0064, Japan
| | - Seungho Hyun
- Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-ku, Sakai City, Osaka, 590-0064, Japan
| | - Hideki Sakanaka
- Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-ku, Sakai City, Osaka, 590-0064, Japan
| |
Collapse
|
7
|
Ghafoor H, Haefeli M, Steiger R, Honigmann P. Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases. J Wrist Surg 2022; 11:134-144. [PMID: 35478945 PMCID: PMC9038308 DOI: 10.1055/s-0041-1735839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/03/2021] [Indexed: 10/27/2022]
Abstract
Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III-V.
Collapse
Affiliation(s)
- Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Regula Steiger
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Orthopraxis Lusser, Allschwil, Switzerland
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group, University of Basel, Allschwil, Switzerland
| |
Collapse
|
8
|
Randomised controlled prospective study of the use of adhesive elastic tape for the control of hand oedema in patients with a wrist fracture treated in a cast: a study protocol. Int J Orthop Trauma Nurs 2021; 44:100881. [PMID: 34736885 DOI: 10.1016/j.ijotn.2021.100881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wrist fractures are a common occurrence, affecting patients of all ages. Wrist fracture patients often develop oedema and the presence of a cast increases the risk. The use of adhesive elastic tape is indicated for oedema control, but there is no definitive evidence of its effectiveness. This study aims to evaluate the effectiveness of the tape in control of hand oedema in wrist fracture patients with a forearm cast. METHODS We present a study protocol for a randomised controlled trial with blinded data processing. We will apply the tape to the intervention group after cast application, while the control group will receive the standard treatment. We will evaluate the circumference difference between baseline (T0) and the 7-day follow-up (T1) of both the thumb and of the other 4 fingers merged together. We will collect data regarding re-attendance to the Orthopedic Emergency Room due to "intolerance to the plaster cast". Sample size calculations resulted in a required total of 220 participants (110 per group). Ethical approval for the study has been obtained. DISCUSSION We aim to demonstrate that the use of tape improves the tolerability of the cast by reducing the oedema formation, the feeling of constriction and pain. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT04683887.
Collapse
|
9
|
Suazo Gladwin LA, Douglass N, Behn AW, Thio T, Ruch DS, Kamal RN. Safety of Releasing the Volar Capsule During Open Treatment of Distal Radius Fractures: An Analysis of the Extrinsic Radiocarpal Ligaments' Contribution to Radiocarpal Stability. J Hand Surg Am 2020; 45:1089.e1-1089.e16. [PMID: 32747049 PMCID: PMC8080674 DOI: 10.1016/j.jhsa.2020.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/18/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The contribution of the extrinsic radiocarpal ligaments to carpal stability continues to be studied. Clinically, there is a concern for carpal instability from release of the volar extrinsic ligaments during volar plating of distal radius fractures in which the integrity of the dorsal ligaments may be unknown. The primary hypothesis of this study was that serial sectioning of radiocarpal ligaments would lead to progressive ulnar translation of the carpus. METHODS We studied the stabilizing roles of the radioscaphocapitate (RSC), short radiolunate (SRL), long radiolunate (LRL), and dorsal radiocarpal (DRC) ligaments. We sequentially sectioned these ligaments in 2 groups of 5 matched pairs and measured the motion of the scaphoid and lunate with the wrist in passive neutral alignment, radial deviation, ulnar deviation, and simulated grip. Displacement of the lunate in the radioulnar plane was used as a surrogate for carpal translation. The groups differed only by the order in which the ligaments were sectioned. RESULTS In the intact state, the lunate translated ulnarly during simulated grip and radial deviation, whereas radial translation, relative to its position under resting tension, was observed during ulnar deviation. With serial sectioning, the lunate displayed increased ulnar translation in all wrist positions for both groups 1 and 2. The magnitude of ulnar translation exceeded 1 mm after sectioning the LRL plus RSC along with either the DRC or the SRL. CONCLUSIONS Sectioning of either the DRC or SRL ligaments along with release of the RSC and LRL ligaments leads to notable although minimal (<2 mm) ulnar lunate translation. CLINICAL RELEVANCE Isolated sectioning of individual radiocarpal ligaments, such as for visualization of the articular surface of the distal radius, leads to minimal ulnar translation. Because prior clinical work found no clinical complications after volar capsule release, it is posited that translation less than 2 mm creates subclinical changes in carpal mechanics.
Collapse
Affiliation(s)
| | - Nathan Douglass
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - Anthony W. Behn
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - Timothy Thio
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - David S. Ruch
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Robin N. Kamal
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| |
Collapse
|
10
|
Martin DP, Park AG, Jamison D, Jones CM, Ilyas AM. Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius. J Hand Surg Am 2019; 44:1093.e1-1093.e8. [PMID: 30898463 DOI: 10.1016/j.jhsa.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This biomechanical study compared the stability of volar locking plates (VLPs) and locking fragment-specific (LFS) dorsal and radial styloid plates for the fixation of dorsal (AO 23-B2) and radial styloid (AO 23-B1) shear fractures of the distal radius, respectively. METHODS Two groups of 6 composite radii were fixed with a VLP or an LFS dorsal plate over a simulated dorsal shear fracture. Two additional groups of 6 radii received the same VLP or an LFS radial plate to fix a radial styloid fracture. Each plated radius was tested under cyclic axial compression by a servohydraulic testing machine that recorded axial displacement per cycle. Construct stiffness was calculated from the slope of the force-displacement curve. RESULTS In the dorsal shear fracture model, the dorsal LFS plate exhibited less displacement than the VLP (0.32 ± 0.04 vs 0.43 ± 0.07 mm, respectively) and showed greater average stiffness (645 ± 64 vs 433 ± 88 N/mm, respectively). Plate type was responsible for 53.1% of the variation in displacement and 68.6% of the variation in stiffness. In the radial styloid fracture model, variations due to number of cycles elapsed and plate type were similar for displacement and stiffness in both groups. The average stiffness during cyclical nondestructive testing was 566 ± 45 and 573 ± 60 N/mm for VLP and LFS radial plating groups, respectively. CONCLUSIONS For AO 23-B2 (dorsal rim) fractures, the dorsal LFS plates exhibited significantly less displacement and greater stiffness in axial loading than VLPs. For AO 23-B1 (radial styloid) fractures, the VLP displayed similar displacement and stiffness to the radial LFS plates. CLINICAL RELEVANCE All constructs tested could be expected to withstand axial compressive forces typical of early postoperative rehabilitation.
Collapse
Affiliation(s)
- Dennis P Martin
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Andrew G Park
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - David Jamison
- Mechanical Engineering Department, Villanova University, Villanova, PA
| | - Christopher M Jones
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
11
|
Comparison of fracture healing and long-term patient-reported functional outcome between dorsal and volar plating for AO C3-type distal radius fractures. Eur J Trauma Emerg Surg 2019; 46:591-598. [PMID: 30810768 DOI: 10.1007/s00068-019-01100-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to evaluate the differences in long-term functional outcome and radiographic fracture healing between volar and dorsally approached comminuted intra-articular distal radius fractures (DRF) (AO C3-type). METHODS A retrospective, age-matched, case-control study with a 1:2 allocation ratio was conducted in 84 patients C3-type DRFs patients who underwent either dorsal locking plating (DLP) group (n = 28) or volar locking plating (VLP) group (n = 56). Standardized wrist radiographs (posterior-anterior and 15° lateral) were assessed immediately postoperative and at final follow. To evaluate for loss of reduction standard radiographic measurements were performed. Fracture healing was assessed radiologically. Patient-reported outcomes were assessed with the patient-related wrist evaluation and the EQ-5D-3L for health-related quality of life. Patient satisfaction was assessed with the use of a numeric analog scale ranging from 0 (not satisfied) to 100 (very satisfied). RESULTS All fractures united within 3 months postoperatively. Average age was 59 ± 12 years. Fifty-five patients (66%) participated in the follow-up survey at an average of 76.6 ± 23.8 months. DLP group showed a significant change in sagittal tilt compared with VLP group (3.4 ± 3.0° vs - 0.4 ± 4.1°, p < 0.001). No significant difference in other radiographic and long-term functional outcome was found between both groups (p > 0.05). CONCLUSION Dorsal locking plating fixation in C3-type DRFs resulted in a minimal, but statistically significant, volar collapse of sagittal tilt compared with volar locking plating fixation. However, this difference in volar collapse did not significantly influence the long-term clinical outcome.
Collapse
|
12
|
Loisel F, Kielwasser H, Faivre G, Rondot T, Rochet S, Adam A, Sergent P, Leclerc G, Obert L, Lepage D. Treatment of distal radius fractures with locking plates: an update. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1537-1542. [DOI: 10.1007/s00590-018-2274-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
|
13
|
Watson N, Haines T, Tran P, Keating JL. A Comparison of the Effect of One, Three, or Six Weeks of Immobilization on Function and Pain After Open Reduction and Internal Fixation of Distal Radial Fractures in Adults: A Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1118-1125. [PMID: 29975268 DOI: 10.2106/jbjs.17.00912] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimum period of immobilization following open reduction and internal fixation (ORIF) of distal radial fractures has not been established. METHODS One hundred and thirty-three adults with a distal radial fracture treated with ORIF (using a volar locked plate) were randomly allocated, with stratification according to age, to 1, 3, or 6 weeks of postoperative immobilization in a parallel-design, assessor-blinded, randomized controlled trial (RCT). After cast removal, a standardized education and exercise program was followed for 6 weeks. Primary outcomes were function (according to the Patient-Rated Wrist Evaluation [PRWE]), worst (visual analog scale [VAS]-W) and usual (VAS-U) pain in the past week, and active wrist extension and forearm supination range of motion. All measures were recorded at 6, 12, and 26 weeks following surgery. Secondary outcomes were wrist flexion, radial deviation, ulnar deviation, and forearm pronation active range of motion; function (Disabilities of the Arm, Shoulder and Hand [DASH]); grip strength; postoperative adverse events; return to work and/or usual daily activities; and compliance with the home exercise program. RESULTS More than 90% of the participants received treatment as allocated, and 87% completed the 6-month follow-up. At 6 weeks, both the 1-week and 3-week groups had significantly better PRWE scores, wrist extension, and flexion active range of motion than the 6-week group. However, no treatment group was superior to another with respect to primary or secondary outcomes at 12 weeks or 6 months following surgery. Analyses considering only the main effect of the intervention group indicated a preference for the 3-week group, which performed significantly better than the 6-week group with respect to the PRWE, pain (VAS-W and VAS-U), wrist flexion, ulnar deviation, forearm pronation active range of motion, and DASH score. CONCLUSIONS For patient function, range of motion, and pain, this investigation demonstrated that immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with those after 6 weeks of immobilization. These differences were not evident at 3 and 6 months following surgery, with the immobilization period having no significant effect on long-term function, range of motion, or pain. There were no significant differences in adverse events associated with shorter immobilization periods. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Narelle Watson
- Western Health, St. Albans, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | | | - Phong Tran
- Western Health, St. Albans, Victoria, Australia
| | | |
Collapse
|
14
|
Watson NJ, Martin SA, Keating JL. The impact of wrist fracture, surgical repair and immobilization on patients: a qualitative study. Clin Rehabil 2018; 32:841-851. [DOI: 10.1177/0269215518754614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Narelle J Watson
- Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Western Centre for Health Research & Education, Sunshine Hospital, St. Albans, VIC, Australia
| | - Sally A Martin
- Western Centre for Health Research & Education, Sunshine Hospital, St. Albans, VIC, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
15
|
Kamal RN, Ruch DS. Volar Capsular Release After Distal Radius Fractures. J Hand Surg Am 2017; 42:1034.e1-1034.e6. [PMID: 28917548 DOI: 10.1016/j.jhsa.2017.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/16/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Loss of full wrist range of motion is common after treatment of distal radius fractures. Loss of wrist extension limiting functional activities, although uncommon, can occur after volar plating of distal radius fractures. Unlike other joints in which capsular release is a common form of treatment for stiffness, this has been approached with caution in the wrist owing to concerns for carpal instability. We tested the null hypothesis that hardware removal and open volar capsular release would not lead to improved upper extremity-specific patient-reported outcome (Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire). METHODS We conducted a retrospective chart review of patients who underwent a tenolysis of the flexor carpi radialis tendon, removal of hardware, and subperiosteal release of the volar capsule (extrinsic ligaments). The primary outcome measure was patient-reported outcome on the DASH. Secondary outcomes included wrist flexion, extension, pronation, and supination, visual analog scale for pain, and radiographs/fluoroscopy for ulnocarpal translocation. RESULTS Eleven patients were treated with a mean follow-up of 4.5 years. Mean DASH scores improved after surgery. Mean wrist flexion, wrist extension, pronation, and supination improved after surgery. Mean visual analog scale scores did not change. The radiocarpal relationship on radiographs/fluoroscopy was normal. CONCLUSIONS Open volar capsular release to regain wrist extension after treatment of distal radius fractures with volar locking plates is safe and effective. Patients regain wrist extension in addition to improved DASH scores. There were no radiographic/fluoroscopic or clinical signs of ulnocarpal translocation after release of the volar extrinsic ligaments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| |
Collapse
|
16
|
Knežević J, Kodvanj J, Čukelj F, Pamuković F, Pavić A. A biomechanical comparison of four fixed-angle dorsal plates in a finite element model of dorsally-unstable radius fracture. Injury 2017; 48 Suppl 5:S41-S46. [PMID: 29122121 DOI: 10.1016/s0020-1383(17)30738-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the finite element models of two different composite radius fracture patterns, reduced and stabilised with four different fixed-angle dorsal plates during axial, dorsal and volar loading conditions. METHODS Eight different plastic models representing four AO/ASIF type 23-A3 distal radius fractures and four AO/ASIF 23-C2 distal radius fractures were obtained and fixed each with 1 of 4 methods: a standard dorsal non-anatomical fixed angle T-plate (3.5mm Dorsal T-plate, Synthes), anatomical fixed-angle double plates (2.4mm LCP Dorsal Distal Radius, Synthes), anatomical fixed angle T-plate (2.4mm Acu-Loc Dorsal Plate, Acumed) or anatomical variable-angle dorsal T-plate (3.5mm, Dorsal Plate, Zrinski). Composite radius with plate and screws were scanned with a 3D optical scanner and later processed in Abaqus Software to generate the finite element model. All models were axially loaded at 3 points (centrally, volarly and dorsally) with 50 N forces to avoid the appearance of plastic deformations of the models. Total displacements at the end of the bone and the stresses in the bones and plates were determined and compared. RESULTS Maximal von Mises stress in bone for 3-part fracture models was very similar to that in 2-part fracture models. The biggest difference between models and the largest displacements were seen during volar loading. The stresses in all models were the highest above the fracture gap. The best performance in all parameters tested was with the Zrinski plate and the most modest results were with the Synthes T-plate. CONCLUSION There was no significant difference between 2-part (AO/ASIF type 23-A3) and 3-part (AO/ASIF 23-C2) fracture models. Maximal stresses in the plates appeared above the fracture gap; therefore, it is worth considering the development of plates without screw holes above the gap.
Collapse
Affiliation(s)
- Josip Knežević
- University Hospital Split, Department of Orthopaedic Trauma, Spinčićeva 1, 21000 Split, Croatia.
| | - Janoš Kodvanj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Fabijan Čukelj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Frane Pamuković
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Arsen Pavić
- University Hospital Split, Department of Orthopaedic Trauma, Spinčićeva 1, 21000 Split, Croatia
| |
Collapse
|
17
|
Abe Y, Tokunaga S, Moriya T. Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications? Hand (N Y) 2017; 12:561-567. [PMID: 29091491 PMCID: PMC5669324 DOI: 10.1177/1558944716675129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use. METHODS Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky's plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures. RESULTS Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures. CONCLUSIONS The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.
Collapse
Affiliation(s)
- Yoshihiro Abe
- Chiba Rosai Hospital, Ichihara, Japan,Yoshihiro Abe, Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16 Tatumidai-higashi, Ichihara 290-0003, Japan.
| | | | | |
Collapse
|
18
|
Falk SSI, Mittlmeier T, Gradl G. Results of geriatric distal radius fractures treated by intramedullary fixation. Injury 2016; 47 Suppl 7:S31-S35. [PMID: 28040075 DOI: 10.1016/s0020-1383(16)30851-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal radius fracture are common injuries but no gold standard for their therapy exists. The aim of this study was to evaluate the quality of fracture care in distal radius fractures using an intramedullary implant (Targon DR interlocking nail). The nail had been developed to minimize the surgical exposure, increase fixation strength, to prevent tendon irritations and to allow for a fast return to activity. PATIENTS AND METHODS Prospective study reports the result of 43 patients with an age over 70 years (range 70-91 years) treated by closed reduction and intramedullary fixation. Inclusion criteria were displaced unilateral isolated AO A or C type fractures. The Targon DR interlocking nail was used for all patients. The minimum follow up was 12 months. RESULTS All fractures united within 2 months. At one-year follow-up the patients had a mean extension of 96.1 ± 1.5%, flexion of 91.6 ± 3.3%, pronation of 99.4 ± 0.7%, supination of 94.0 ± 2.0%, radial abduction of 98.1 ± 1.3%, ulnar deviation of 91.4 ± 3.0% and a grip strength of 91.5 ± 4.3% compared to the contralateral wrist. Pain score measured by a Visual Analogue Scale scored 0.0 ± 0.0 at rest and in activity 0.3 ± 0.3. The mean Castaing Score was good (1.06 ± 0.30) and the Gartland & Werley Score was excellent (1.50 ± 0.57). The mean radial shortening was 0.2 ± 0.1 mm and radial inclination was 3.1 ± 1.1° (range +15° to 0°). No deep soft-tissue or chronic osseous infections were observed. One patient developed a carpal tunnel syndrome. Paraesthesia or dysaesthesia of the superficial radial nerve was registered in seven patients and fully recovered in four patients. There were two cases of single screw loosening. We also found two cases of screw overlength and consecutive contact with the ulnar head, one patient underwent implant removal. Another patient developed CRPS (2.3%). We did not observe any case of hardware failure, tendon irritation or tendon rupture. CONCLUSION In geriatric patients intramedullary interlocking nailing of displaced extraarticular or intraarticular distal radius fracture with the Targon DR nail represents a viable treatment option and alternative to the use of volar interlocking plating in terms of fracture reduction, maintenance of reduction and functional outcome.
Collapse
Affiliation(s)
- Steffi S I Falk
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany.
| | - Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany
| | - Georg Gradl
- Department of Trauma, Orthopedic and Reconstructive Surgery, Munich Municipal Hospital Group, Harlaching Clinic, Munich, Germany
| |
Collapse
|
19
|
Iselin LD, Massy-Budmiger AS, Droeser RA, Mett TR, Babst R, Rikli DA. Ten Years' Follow-Up on Combined Palmar and Dorsal Internal Fixation of Complex Distal Radius Fractures. Medicine (Baltimore) 2016; 95:e3509. [PMID: 27149450 PMCID: PMC4863767 DOI: 10.1097/md.0000000000003509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Complex distal intra-articular radial fractures (AO Type C3) are rare, but are life-changing injuries. They are usually related to high-velocity trauma mechanisms in a working male population.We surveyed a cohort of these fractures treated in our institution to assess the functional long-term outcome.Twelve consecutive patients with comminuted intra-articular distal radial fractures were treated at our institution. Osteosynthesis was performed by a single senior surgeon with volar and dorsal extended approaches. The intermediate and final control included conventional X-ray, range of motion (ROM), grip strength, and the Disabilities of the Arm, Shoulder, and Hand index (DASH), as well as the Patient-rated Wrist Evaluation (PRWE) score for functional outcome at 1 and 10 years' of follow-up.At 10 years' follow-up, anatomic reconstruction with a step or gap of <1 mm was achieved in 10 of the 12 above-mentioned patients, whereas 2 patients were lost to follow-up. ROM was good to excellent in 8 patients. Median grip strength was 107% of the contralateral side. Median DASH-Index and PRWE were 2.3 and 6 respectively, at 10 years. Eight patients returned to premorbid heavy labor. One patient was retired at the time of injury.Combined volar and dorsal approaches allow achieving anatomical reconstruction in comminuted intra-articular distal radius fractures and reveal good functional outcomes at intermediate and long-time follow-up.
Collapse
Affiliation(s)
- Lukas Daniel Iselin
- From the Department of Orthopaedic Surgery and Traumatology (LDI, A-SM-B, TRM, RB), Kantonsspital Lucerne, Lucerne; Department of Surgery (RAD); and Department of Surgery (DAR), Trauma Unit, University Hospital of Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
20
|
Lee SK, Bae KW, Choy WS. Use of the radial groove view intra-operatively to prevent damage to the extensor pollicis longus tendon by protruding screws during volar plating of a distal radial fracture. Bone Joint J 2013; 95-B:1372-6. [PMID: 24078534 DOI: 10.1302/0301-620x.95b10.31453] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of this study were to assess the efficacy of a newly designed radiological technique (the radial groove view) for the detection of protrusion of screws in the groove for the extensor pollicis longus tendon (EPL) during plating of distal radial fractures. We also aimed to determine the optimum position of the forearm to obtain this view. We initially analysed the anatomy of the EPL groove by performing three-dimensional CT on 51 normal forearms. The mean horizontal angle of the groove was 17.8° (14° to 23°). We found that the ideal position of the fluoroscopic beam to obtain this view was 20° in the horizontal plane and 5° in the sagittal plane. We then intra-operatively assessed the use of the radial groove view for detecting protrusion of screws in the EPL groove in 93 fractures that were treated by volar plating. A total of 13 protruding screws were detected. They were changed to shorter screws and these patients underwent CT scans of the wrist immediately post-operatively. There remained one screw that was protruding. These findings suggest that the use of the radial groove view intra-operatively is a good method of assessing the possible protrusion of screws into the groove of EPL when plating a fracture of the distal radius.
Collapse
Affiliation(s)
- S K Lee
- Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon 302-799, South Korea
| | | | | |
Collapse
|
21
|
Fowler JR, Ilyas AM. Prospective evaluation of distal radius fractures treated with variable-angle volar locking plates. J Hand Surg Am 2013; 38:2198-203. [PMID: 24206983 DOI: 10.1016/j.jhsa.2013.08.116] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/10/2013] [Accepted: 08/13/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the radiographic, objective (range of motion and grip strength), and subjective outcomes of variable-angle volar locking plate (VAVLP) fixation for unstable distal radius fractures. METHODS Over a 12-month period, we prospectively evaluated 39 consecutive distal radius fractures treated operatively with VAVLPs. Surgical exposure, fracture reduction, plate application, and postoperative rehabilitation were uniformly performed. Clinical outcome and radiographic measures, with a minimum follow-up of 12 months, were obtained. RESULTS Final follow-up data were available in 37 patients (26 females and 11 males) with average age of 57 years (range, 16-89 y). The average follow-up time was 14 months (range, 12-22 mo). At final evaluation, average volar tilt was 3°, average radial inclination was 21°, average radial height was 12 mm, and average ulnar variance was -0.2 mm. There was no statistical difference between first postoperative and 1-year follow-up radiographs for any of the measured variables, although there were 4 cases of loss of volar tilt. Average Disabilities of the Arm, Shoulder, and Hand score was 6 and average visual analog scale pain score was 0.3. Mean grip strength at 1 year was 96% of the contralateral side. There was 1 case of variable-angle locking screw loosening and 1 case of extensor tenosynovitis requiring hardware removal. There were no tendon ruptures. CONCLUSIONS The VAVLP fixation restored and maintained acceptable reduction in all patients in this series with a complication rate comparable to standard volar fixed-angle locking plates. Treatment of unstable distal radius fractures with a VAVLP resulted in excellent clinical outcomes at 1-year follow-up. However, use of the VAVLP risks soft tissue irritation, hardware failure, and loss of fracture reduction. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- John R Fowler
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA; Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
| | | |
Collapse
|
22
|
Kodama N, Imai S, Matsusue Y. A simple method for choosing treatment of distal radius fractures. J Hand Surg Am 2013; 38:1896-905. [PMID: 24011861 DOI: 10.1016/j.jhsa.2013.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To design an easy-to-use guide for decision making in distal radius fractures in patients older than 50 years and to retrospectively analyze its ability to predict treatment in 164 patients. METHODS The present study consisted of 4 parts. The first part was a review of the literature to identify possible important factors that predict treatment outcome of distal radius fractures in patients 50 years old and older. The second part identified which of these first-tier factors that orthopedic surgeons consider to be important by a questionnaire that was sent to 83 orthopedic surgeons qualified by the Japanese Orthopedic Association with response rate of 61%. The third part further identified which of the subsets of factors best predict outcome in a retrospective study of 41 patients 50 years old or older, yielding a final subset of factors to create a scoring system. The fourth part of the study then evaluated the ability of this scoring system to predict the outcome as evaluated by the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score in a retrospective study of 164 distal radius fractures in patients 50 years old or older. RESULTS The 164 patients were divided into 4 groups by the present scoring system: conservative group, relative conservative group, relative surgical group, and surgical group according to the recommended therapeutic modalities. Clinical outcomes of those that followed the recommendation of the present scoring system resulted in favorable consequences. In contrast, the outcomes of those not following the recommendation were inferior. CONCLUSIONS The present scoring system may be used as an easy-to-use decision-making tool when choosing conservative or surgical treatment for distal radius fractures.
Collapse
Affiliation(s)
- Narihito Kodama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan.
| | | | | |
Collapse
|
23
|
Meyer C, Chang J, Stern P, Osterman AL, Abzug JM. Complications of distal radial and scaphoid fracture treatment. J Bone Joint Surg Am 2013; 95:1517-26. [PMID: 23965705 DOI: 10.2106/jbjs.9516icl] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Carissa Meyer
- University of Maryland Orthopaedics, 1 Texas Station Court, Suite 300, Timonium, MD 21093, USA
| | | | | | | | | |
Collapse
|
24
|
Fixation of distal radius fractures in adults: a review. Orthop Traumatol Surg Res 2013; 99:216-34. [PMID: 23518070 DOI: 10.1016/j.otsr.2012.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/26/2012] [Accepted: 03/22/2012] [Indexed: 02/02/2023]
Abstract
In patients for whom function is a priority, anatomic reduction and stable fixation are prerequisites for good outcomes. Several therapeutic options exist, including orthopedic treatment and internal fixation with pins (intra- and extrafocal), external fixation which may or may not bridge the wrist, and different internal fixation techniques with dorsal or palmar plates using or not, locking screws. Arthroscopy may be necessary in case of articular fracture. In the presence of significant metaphyseal bone defects, filling of the comminution with phosphocalcic cements provides better graft stability. The level of evidence is too low to allow recommending one type of fixation for one type of fracture; and different fixation options to achieve stable reduction exist, each with its own specific complications. With the new generations of palmar plate, secondary displacement is becoming a thing of the past.
Collapse
|
25
|
Osti M, Mittler C, Zinnecker R, Westreicher C, Allhoff C, Benedetto KP. Locking versus nonlocking palmar plate fixation of distal radius fractures. Orthopedics 2012; 35:e1613-7. [PMID: 23127452 DOI: 10.3928/01477447-20121023-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study compared functional and radiological outcomes after treatment of extension-type distal radius fractures with conventional titanium nonlocking T-plates or titanium 1.5-mm locking plates. A total of 60 patients were included and followed for 4 to 7 years after receiving nonlocking T-plates (group A; n=30) or locking plates (group B; n=30) with and without dorsal bone grafting. Bone grafting was significantly more often performed in the nonlocking group to increase dorsal fracture fixation and stability (P<.003). Pre- and postoperative and follow-up values for palmar tilt, radial inclination, radial shortening, and ulnar variance were recorded. Age, sex, and fracture type were similarly distributed between the 2 groups. Postoperative and follow-up evaluation revealed equal allocation of intra-articular step formation and osteoarthritic changes to both groups. The overall complication rate was 25%. Compared with the nonlocking system, patients undergoing locking plate fixation presented with statistically significantly better values for postoperative palmar tilt (5.53° vs 8.15°; P<.02) and radial inclination (22.13° vs 25.03°; P<.02). However, forearm pronation was significantly better in group A (P<.005). At follow-up, radial inclination tended to approach a statistically significant difference in favor of group B. All clinical assessment, including Mayo wrist score, Disabilities of the Arm, Shoulder, and Hand score, Green and O'Brien score, Gartland and Werley score, visual analog scale score, and grip strength, yielded no statistically significant difference between the 2 groups. Locking plates seem to provide benefits regarding surgical technique and comfort, improvement in implant anchorage (especially in osteoporotic bone), and reduce the necessity of additional bone grafting.
Collapse
Affiliation(s)
- Michael Osti
- Department of Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria.
| | | | | | | | | | | |
Collapse
|
26
|
Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 2011; 36:1135-41. [PMID: 21712136 DOI: 10.1016/j.jhsa.2011.04.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Dorsal plating of distal radius fractures with traditional 2.5-mm-thick plates is associated with extensor tendon complications. Consequently, volar locking plates have gained widespread acceptance. A new generation of 1.2- to 1.5-mm, low-profile dorsal plates was designed to minimize tendon irritation. This study examines the complication rates of low-profile dorsal plates compared with volar locking plates. METHODS We identified patients with distal radius fractures treated between September 2002 and June 2006 by low-profile dorsal or volar locking plates. Information pertaining to 7 categories of complications (hardware discomfort and pain, tendon irritation/rupture, failure of reduction, infection, complex regional pain syndrome, stiffness, and neuropathy/hypersensitivity) was collected. Complications were defined as any postoperative plating complications requiring additional surgical intervention, whereas those that only caused patient discomfort were considered secondary problems. RESULTS We included 100 patients, comprising 104 plating cases (57 dorsal, 47 volar), in this study. Overall length of follow-up was 44 ± 21 months (range, 12-80 mo). A total of 18 patients (8 dorsal, 10 volar) experienced complications, whereas 47 (25 dorsal, 22 volar) had secondary reports. Three dorsal and 4 volar patients had complete plate removals. Three dorsal and no volar plates had screw removals only. One volar plate (no dorsal plates) had a major tendon rupture (flexor pollicis longus); 3 dorsal and 3 volar plates resulted in tendon irritation complications, and 4 dorsal and 3 volar plates had secondary problems from tendon irritation. None of the above measures approached statistical significance. Volar cases were associated with significantly more neuropathic complications than dorsal cases. CONCLUSIONS Dorsal low-profile plates are not associated with significantly more tendon irritation or rupture complications. However, volar plating is associated with a higher rate of neuropathic complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
|
27
|
Matschke S, Wentzensen A, Ring D, Marent-Huber M, Audigé L, Jupiter JB. Comparison of angle stable plate fixation approaches for distal radius fractures. Injury 2011; 42:385-92. [PMID: 21144514 DOI: 10.1016/j.injury.2010.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 10/13/2010] [Accepted: 10/22/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the study was to compare radiological and functional outcomes between volar and dorsal surgical fixation of distal radius fractures using low-profile, fixed-angle implants. PATIENTS AND METHODS A total of 305 distal radius fracture patients were treated with Synthes locking compression plate (LCP) 2.4- or 3.5-mm fixation using either a volar (n=266) or dorsal (n=39) approach. The patients were examined at 6 months, 1 and 2 years for radiological assessment of fracture healing, alignment, reduction and arthritis, as well as the determination of various functional outcome scores. RESULTS Both groups were comparable with respect to baseline and injury characteristics. The complication rate was higher for the volar approach (15%). No significant differences were observed for Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form (36) Health Survey (SF-36) scores, pain, arthritis grade, grip strength and radiological measurements. However, a significantly better functional outcome represented by a low mean Gartland and Werley score was observed for the volar approach after 6 and 12 months. Significantly higher percentages of dorsal extension, palmar flexion, ulnar deviation and supination angle (relative to the mean contralateral healthy wrist) were also reported for volar approach patients at the 6-month follow-up. CONCLUSIONS Volar internal fixation of distal radius fractures with LCP DR implants can result in earlier and better functional outcome compared with the dorsal approach, yet is associated with a higher incidence of complications. After 2 years, these differences are no longer observed between the two surgical methods.
Collapse
Affiliation(s)
- S Matschke
- Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann Strasse 13, D-67071 Ludwigshafen, Germany.
| | | | | | | | | | | |
Collapse
|
28
|
Vergleich der lokalen Spongiosadichte osteoporotischer und nichtosteoporotischer distaler Radii. Unfallchirurg 2011; 114:424-30. [DOI: 10.1007/s00113-009-1735-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Huard S, Leclerc G, Sergent P, Serre A, Gasse N, Lepage D, Jeunet L, Garbuio P, Obert L. Fractures du radius distal à déplacement dorsal : corrélation entre scores fonctionnels, qualité de réduction et type de fixation. ACTA ACUST UNITED AC 2010; 29:366-72. [DOI: 10.1016/j.main.2010.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/24/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
|
30
|
Jacobi M, Wahl P, Kohut G. Repositioning and stabilization of the radial styloid process in comminuted fractures of the distal radius using a single approach: the radio-volar double plating technique. J Orthop Surg Res 2010; 5:55. [PMID: 20701799 PMCID: PMC2925339 DOI: 10.1186/1749-799x-5-55] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 08/11/2010] [Indexed: 11/15/2022] Open
Abstract
Background A possible difficulty in intra-articular fracture of the distal radius is the displacement tendency of the radial styloid process due to the tension of the brachioradialis tendon. Methods Ten patients treated within one year for complex distal radius fractures by double-plating technique with a radial buttress plate and volar locking plate, through a single volar approach, were followed prospectively during 24 months. Outcome measures included radiographic follow-up, range of motion, grip strength and score follow-up (VAS, Gartland-Werley score and patient-rated wrist evaluation). Results Ten patients with intraarticular distal radius fractures with dislocation of the radial styloid process were treated with this technique. This resulted after 24 months in good clinical outcome (mean visual analog scale 0.9; almost symmetric range of motion; mean Gartland-Werley score 2 ± 3; mean patient-rated wrist evaluation 3.2 ± 2.4). Radiologic evaluation according to the Dresdner Score revealed anatomic reduction without secondary dislocation during the follow-up and uneventful consolidation. Conclusions The described technique strongly facilitates anatomic reduction and stable fixation of intra-articular distal radius fractures with dislocation of the radial styloid process and leads to satisfactory clinical and radiographic outcome.
Collapse
Affiliation(s)
- Matthias Jacobi
- Department of Orthopaedic Surgery, Hôpital Cantonal Fribourg, 1708 Fribourg, Switzerland.
| | | | | |
Collapse
|
31
|
Adham MN, Porembski M, Adham C. Flexor tendon problems after volar plate fixation of distal radius fractures. Hand (N Y) 2009; 4:406-9. [PMID: 19283432 PMCID: PMC2787213 DOI: 10.1007/s11552-009-9180-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 02/12/2009] [Indexed: 11/29/2022]
Abstract
Four cases of flexor tendon problems which developed after volar plate fixation of distal radius fractures are presented. All cases were associated with close contact of the screws or distal edge of the plate with the flexor tendons. Poor bone stock or multiple bone fragments allowing loosening of the plate or non-locking screws cause the hardware to irritate the flexor tendons and ultimately lead to rupture. The flexor tendons involved include the flexor carpi radialis, flexor pollicis longus and flexor digitorum superficialis, and flexor digitorum profundus to the index and long fingers.
Collapse
Affiliation(s)
- Mehdi N Adham
- Southwest Orthopaedic Specialists, University of Oklahoma Health Sciences Center, 8100 S. Walker, Oklahoma City, OK 73139, USA.
| | | | | |
Collapse
|
32
|
Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D. Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am 2008; 90:1297-304. [PMID: 18519324 DOI: 10.2106/jbjs.g.01368] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plate fixation of the distal part of the radius is believed to improve wrist motion by allowing earlier exercises. We performed a clinical trial comparing mobilization of the wrist joint within two weeks (early motion) or at six weeks (late motion) after volar plate fixation of a fracture of the distal part of the radius in order to test the null hypothesis that there are no differences in the flexion-extension arc three and six months after surgery. METHODS Sixty patients with an isolated fracture of the distal part of the radius that was treated with a single, fixed-angle volar plate and screws were enrolled. Thirty patients were randomized to the early motion group, and thirty were randomized to the late motion group. Three and six months after surgery, patients underwent range of motion measurements, grip strength measurements, and radiographic evaluation. The patients also were evaluated according to the modified Gartland and Werley score and the Mayo wrist score, rated pain on a 10-point ordinal scale, and completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS There were no significant differences between the early motion group and the late motion group with regard to the average flexion-extension arc of the injured wrist at three months (104 degrees compared with 107 degrees; p = 0.61) or six months (124 degrees compared with 126 degrees; p = 0.65) after surgery. In secondary analyses, there were no significant differences in terms of selected other motions, grip strength, radiographic parameters, or the Gartland and Werley, Mayo, pain, or DASH scores. CONCLUSIONS The initiation of wrist exercises six weeks after volar plate fixation of a fracture of the distal part of the radius does not lead to decreased wrist motion compared with the initiation of wrist motion within two weeks after surgery.
Collapse
|
33
|
Rein S, Schikore H, Schneiders W, Amlang M, Zwipp H. Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg Am 2007; 32:954-61. [PMID: 17826546 DOI: 10.1016/j.jhsa.2007.05.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 05/06/2007] [Accepted: 05/08/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to define the outcome after dorsal or volar plating of Association for Osteosynthesis (AO) type C3 distal radius fractures based on the fracture morphology. METHODS Twenty-nine patients with AO type C3 distal radius fractures were surgically managed between 1996 and 2005. Group 1 (n = 15) had volar plating. Group 2 (n = 14) had dorsal plating. Outcomes were evaluated at an average of 22 months after surgery. Statistical analysis was performed using the Wilcoxon test and chi-square test. RESULTS No significant differences were seen for the scores of Gartland and Werley, Castaing, Stewart I and II, Green and O'Brien, and Disability of the Arm, Shoulder and Hand between the 2 groups. The visual and verbal pain analog scales did not show significant differences between the 2 groups. Radiology analysis showed significant difference in comparison with the contralateral side in terms of dorsopalmar inclination (3 degrees +/- 3) and distal radioulnar joint angle (98 degrees +/- 8) for the patients in group 1, whereas there were no significant differences in group 2. The development of radiographic post-traumatic arthritis was significant in both groups. Significant functional differences were seen for flexion (45 degrees +/- 15) and hand span (20 cm +/- 2) in group 1 as well as for extension (37 degrees +/- 19), flexion (42 degrees +/- 12), and radial deviation (16 degrees +/- 10) in group 2. We found more complications after dorsal plate osteosynthesis than after volar plate osteosynthesis. CONCLUSIONS This study shows satisfactory functional and subjective outcome results in both groups. Group 1 had non-significant better functional results than group 2, whereas both groups showed good to very good radiology results.
Collapse
Affiliation(s)
- Susanne Rein
- Carl Gustav Carus University Hospital of Dresden, Department of Trauma and Reconstructive Surgery, Dresden, Germany.
| | | | | | | | | |
Collapse
|
34
|
McCall TA, Conrad B, Badman B, Wright T. Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study. J Hand Surg Am 2007; 32:806-12. [PMID: 17606058 DOI: 10.1016/j.jhsa.2007.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 04/01/2007] [Accepted: 04/25/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and compare the biomechanic rigidity and strength of 3 fixed-angle plates used to treat extra-articular distal radius fractures that are dorsally unstable. Volar fixed-angle plates were compared with a dorsal fixed-angle nail plate. METHODS Three plate constructs were tested: the dorsal nail plate (DNP), distal volar radius (DVR) plate, and locking compression plate (LCP) volar distal radius plate. With anatomic, third-generation, artificial composite radii, dorsally unstable extra-articular distal radius fracture models were made by cutting a wedge osteotomy with an 8-mm dorsal gap 1 cm from the articular surface. These models were then fixed with the 3 implants by the method recommended by the manufacturer. The proximal radii of each specimen were attached to the base of a materials testing machine with a probe centered at the radial side of the lunate fossa. The specimens were loaded at a constant rate to failure under axial compression. Load and displacement were plotted graphically, and the resulting rigidities and strengths of each plate were assessed statistically. RESULTS The DVR group had significantly greater stiffness than the LCP group. The DVR group had significantly higher maximum loads than both the DNP and LCP groups. There were no significant differences in yield loads. Both the DNP and DVR groups had significantly less displacement at yield than the LCP group. CONCLUSIONS These 3 groups had similar yield loads. However, the LCP was less stiff than the DVR and had more displacement at yield than both the DVR and DNP. The yield load of all 3 implants was much higher than previously described loads for active wrist and finger motion.
Collapse
Affiliation(s)
- Todd A McCall
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32607, USA
| | | | | | | |
Collapse
|
35
|
Gruber G, Bernhardt GA, Köhler G, Gruber K. Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period. Arch Orthop Trauma Surg 2006; 126:680-5. [PMID: 16835773 DOI: 10.1007/s00402-006-0191-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. METHODS This study reports a total number of 104 DRFs in 102 patients, operatively treated, over a 2-year period with a mean follow up time of 15.6 +/- 7.2 months The patient's average age was 59.9 +/- 18.0 years. The results were evaluated according to the scores of Gartland and Werley, Castaing and the disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire. RESULTS Ninety-three patients were evaluated at final examination. Excellent and good results were achieved for 92 (98.9%) patients according to score of Gartland and Werley and for 86 (92.5%) patients regarding the scoring system of Castaing. The DASH outcome questionnaire averaged 8.0 +/- 13.7 points. INTERPRETATION This study shows, in a representative number of cases, that palmar plating of unstable fractures of the distal radius is a safe and effective treatment modality. Early surgical treatment results in optimal outcome regarding patient's quality of life.
Collapse
Affiliation(s)
- Gerald Gruber
- Department of Surgery, District Hospital of Weiz, Franz-Pichler-Strasse 85, 8160 Weiz, Austria,
| | | | | | | |
Collapse
|
36
|
de la Torre M, Moreno N, Luis R, Romero A, Moya A. Valoración de resultados en fracturas de radio distal operadas. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|