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Huang CY, Lee CC, Chen CW, Hu MH, Wu KW, Wang TM, Wang JH, Tseng TH. The Outcome of under 10 mm Single-Incision Surgery Using a Non-Specialized Volar Plate in Distal Radius Fractures: A Retrospective Comparative Study. J Clin Med 2023; 12:7670. [PMID: 38137740 PMCID: PMC10743621 DOI: 10.3390/jcm12247670] [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: 11/16/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The distal radius fracture is a common orthopedic injury. We aimed to share the surgical steps and investigate the outcomes of treating distal radius fractures with wounds ≤10 mm using a globally accessible locking plate. METHODS We collected 46 patients who underwent surgery via a <10 mm wound, with a control group consisting of 40 patients who underwent conventional procedures. Both groups were treated using the same volar plate. We compared the radiographic reduction quality, including volar tilt angle, radial inclination angle, and ulna variance. Additionally, clinical outcomes, such as pain assessed using VAS, Q-Dash score, and PRWE, were evaluated. Patient satisfaction with the wound was also analyzed. The follow-up time for the clinical outcomes was 24.2 ± 13.47 months. RESULTS There were no differences in the quality of reduction in parameters such as the volar tilt angle (p = 0.762), radial inclination angle (p = 0.986), and ulna variance (p = 0.166). Both groups exhibited comparable results in pain VAS (p = 0.684), Q-Dash score (p = 0.08), and PRWE (p = 0.134). The ≤10 mm incision group displayed an increase in satisfaction with the wound (p < 0.001). CONCLUSIONS Treating distal radius fractures with a <10 mm wound using a non-specialized locking plate is a feasible approach. It does not compromise the quality of fracture reduction or functional scores and improves wound satisfaction.
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Affiliation(s)
- Chang-Yu Huang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
- Department of Orthopaedic Surgery, En Chu Kong Hospital, New Taipei City 237, Taiwan
| | - Chia-Che Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Chih-Wei Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Ming-Hsiao Hu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
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Liverneaux P, Amiri LE, Facca S, Sapa MC. Technique, Indications and Limitations of a Minimally Invasive Approach to Treat Distal Radius Fractures and Malunions. HANDCHIR MIKROCHIR P 2023. [PMID: 36716774 DOI: 10.1055/a-1951-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. It offers the advantage of preserving ligamentotaxis, which facilitates the reduction and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intra-articular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.
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Affiliation(s)
- Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France.,ICube CNRS UMR7357, Strasbourg University, rue Boussingault, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France.,ICube CNRS UMR7357, Strasbourg University, rue Boussingault, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France
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Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature. Minim Invasive Surg 2023; 2023:3534849. [PMID: 36874928 PMCID: PMC9981297 DOI: 10.1155/2023/3534849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Surgical techniques developed for distal radius fracture fixation have become increasingly advanced, including minimally invasive plate osteosynthesis (MIPO). This study aimed to introduce and evaluate the functional outcome of a novel MIPO technique that differs from previous reports. This study included 42 patients with distal radius fractures who underwent minimally invasive surgical plating of the distal radius. All patients were treated with closed reduction, fixation using K-wire, and subsequent insertion of a volar anatomical stable angle short plate on the distal radius. An arthroscopy-assisted evaluation and repair procedure were performed to correct intra-articular involvement, triangular fibrocartilage complex tears, and scapholunate injuries. Functional outcomes were assessed using a visual analog scale score; quick disabilities of the arm, shoulder, and hand score; and postoperative range of motion of flexion, extension, supination, and pronation at the 3-month follow-up, showing significant improvement in all parameters (all p ≤ 0.05). This study provides a simpler yet reliable method with reproducible and consistent results to treat distal radius fractures using minimally invasive plating with closed reduction and plate insertion, resulting in satisfactory clinical outcomes in all patients.
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Begum R, Hourston GJM, Bochmann T, Chojnowski AJ. A Systematic 10-Year Review of the Use of Arthroscopy in the Assessment and Treatment of Intercarpal Ligament Injuries Associated with Acute Distal Radius Fracture. J Hand Surg Asian Pac Vol 2022; 27:935-944. [PMID: 36476085 DOI: 10.1142/s2424835522500862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: To review the impact that arthroscopy has made on the assessment and treatment of intercarpal (scapholunate [SL] or lunotriquetral [LT]) ligament injuries associated with acute distal radius fractures (DRF). Methods: A systematic review of EMBASE, MEDLINE and COCHRANE databases for articles published between 2011 and 2021 was performed (PROSPERO ID: CRD42021273293) which included studies reported assessment and outcomes of intercarpal ligament injuries associated with acute DRF. Methodological quality was evaluated. The rate of concomitant injury detection, role of arthroscopy and different clinical outcome assessment measurements used were compared between studies. Results: A total of 20 articles were included with data from 1,346 patients (1,358 wrists). A total of 1,024 intra-articular fractures were included and 294 extra-articular fractures (40 not specified). There was a heterogeneous mix of studies; 10 comparative and 10 non-comparative. Some studies investigated initial assessment findings only, while others assessed radiological outcomes, functional outcomes or both domains over 0.3-99 months. The overall rate of SL ligament injury associated with DRF was 35.3%, while LT ligament injury overall was 18.2%. More frequent were concomitant triangular fibrocartilage complex (TFCC) injuries (44.8%), although this review did not aim to review these. The role of arthroscopy was reviewed, which included assistance in anatomic reduction of the articular surface and systematic inspection of the surrounding soft tissues. Included studies investigated either assessment or assessment and management of intercarpal ligament injury. Meaningful meta-analysis in this heterogeneous group of studies was not possible. Outcomes of comparative studies were described in detail. Conclusions: This review suggests that arthroscopy may have a role in improving reduction of intra-articular DRF and diagnosing and managing soft tissue injuries associated with such fractures. Randomised studies are needed to evaluate whether the detection of intercarpal ligament injury in acute distal radial fractures through arthroscopic assessment alters current management and improves clinical outcome. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Rumina Begum
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - George J M Hourston
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Thomas Bochmann
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Adrian J Chojnowski
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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5
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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.
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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.
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Van Oijen GW, Van Lieshout EMM, Reijnders MRL, Appalsamy A, Hagenaars T, Verhofstad MHJ. Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:4333-4348. [PMID: 34009418 PMCID: PMC9712287 DOI: 10.1007/s00068-021-01679-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures. METHODS Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation. RESULTS Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups. CONCLUSION Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.
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Affiliation(s)
- Guido W. Van Oijen
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M. M. Van Lieshout
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maarten R. L. Reijnders
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anand Appalsamy
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Tjebbe Hagenaars
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michael H. J. Verhofstad
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Ribeiro E, Campanholi G, Acherboim M, Ruggiero GM. Mini-Invasive Surgery for Distal Radius Fractures: A Double Incision under 12 mm. J Wrist Surg 2021; 10:136-143. [PMID: 33815949 PMCID: PMC8012088 DOI: 10.1055/s-0040-1721141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
Background Distal radius fracture is one of the most common lesions in adults. Surgical techniques have evolved considerably with a clear tendency toward mini-invasive techniques. Objective Our aim is to push the limits to a 12 mm approach and evaluate its clinical and radiological results. Patients and Methods Ten fractures in nine patients were operated by a double incision with mean size 11.50 ± 3.41 mm (range 8.00-1.00) and using a specially designed volar distal locking plate. Results At the latest follow-up, visual analogue scale score for pain (0.20 ± 0.63 during rest and 0.60 ± 1.07 while making efforts) and quick DASH (quick Disabilities of the Arm, Shoulder and Hand) score (6.14 ± 7.43) were extremely low. All the range of motion parameters and grip strength were above the 95% barrier of the contralateral side, with exception of ulnar deviation. Radiological parameters obtained were located within the normal ranges. Time to return to independent daily tasks and work was 6.67 ± 5.15 and 10.14 ± 14.24 days, respectively. One case of transient carpal tunnel syndrome was solved with watchful waiting and one case of extensor tendons impingement was improved after plate removal. All patients were completely satisfied at the end of the treatment. Conclusion In conclusion, mini-invasive volar technique for distal radius fractures with special designed plates in carefully selected patients allowed us to obtain good clinical and radiological results, minimal complications, fast recovery, and high-satisfactory rates. Level of Evidence This is a Level IV, case series study.
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Affiliation(s)
- Elisabete Ribeiro
- Orthopaedic Surgery and Trauma Department, Hospital de Braga, Braga, Portugal
| | | | - Marcelo Acherboim
- Department of Orthopaedic Surgey, Hospital Albert Einstein, São Paulo, Brazil
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Mirarchi AJ, Nazir OF. Minimally Invasive Surgery: Is There a Role in Distal Radius Fracture Management? Curr Rev Musculoskelet Med 2021; 14:95-100. [PMID: 33443658 PMCID: PMC7930151 DOI: 10.1007/s12178-020-09689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This review explores minimally invasive surgical techniques for distal radius fractures and guides their use in conjunction with, or as an alternative to, volar locked plating. RECENT FINDINGS Fractures of the lunate facet, die-punch fractures, and marginal articular shear injuries present challenges that cannot be easily addressed with volar plating. The use of external fixation, Kirschner wires, and dorsal bridge plating should all be considered. These techniques, in combination and in addition to volar locked plating, continue to play an important role in fracture management. Arthroscopically assisted surgery with minimally invasive fixation allows for detailed inspection of the radiocarpal joint. Closed treatment and casting continue to play an important role in distal radius fracture care. The role of minimally invasive surgery for distal radius fractures is still being defined. While fixation using a volar locking plate is by far the most common treatment method, other techniques should be considered to improve outcomes and decrease complications.
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Affiliation(s)
- Adam J. Mirarchi
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, USA
| | - Omar F. Nazir
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, USA
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Vernet P, Gouzou S, Hidalgo Diaz JJ, Facca S, Liverneaux P. Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series. Orthop Traumatol Surg Res 2020; 106:1619-1625. [PMID: 33153957 DOI: 10.1016/j.otsr.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Since the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. OBJECTIVE The present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. MATERIAL AND METHODS The series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. RESULTS At a mean 7 months' follow-up, mean scar length was 17mm (range, 10-40mm), pain 1.13/10 (0-8), Quick-DASH 13.28 (0-86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0-91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DISCUSSION The minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. LEVEL OF EVIDENCE III; single-centre retrospective study.
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Affiliation(s)
- Paul Vernet
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Stéphanie Gouzou
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Juan José Hidalgo Diaz
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Sybille Facca
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Philippe Liverneaux
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France.
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10
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Goorens CK, De Keyzer PB, Van Royen K, Provyn S, Goubau JF. Pronator quadratus repair after volar plate fixation in distal radial fractures: evaluation of the clinical and functional outcome and of the protective role on the flexor tendons-a randomized controlled study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:541-548. [PMID: 33047176 DOI: 10.1007/s00590-020-02804-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
The objective was to evaluate pronator quadratus (PQ) repair following volar plating of distal radial fractures on clinical and functional outcome, as well as flexor tendon friction, during the first 12 months in ideally positioned plates (Soong 0). Confounding factors like variation in plate positioning, anatomical consolidation of the fracture and associated lesions were excluded. Eighty patients were included with distal radius fractures treated by volar locking plate in Soong grade 0 position, who were randomized to group PQ repair and group no repair. Sixty-five patients completed the 1-year follow-up: group PQ repair (n = 35) and group no repair (n = 30). Primary outcomes included range of motion, grip strength, pain level and QuickDASH. Secondary outcomes included distance between flexor pollicis longus (FPL) and volar rim and the largest distance between FPL and plate (soft tissue thickness occupied by PQ), assessed by ultrasonography. Mobility, grip strength and QuickDASH revealed no significant differences, except extension was significantly higher only in first 3 months and radial deviation was significantly higher only at 6 weeks after PQ repair. Pain level was significantly lower after PQ repair only in the first 3 months. Distance between FPL and volar rim and the largest distance between FPL and plate were significantly higher after PQ repair. No friction contact between FPL and volar rim was measured in both groups at all measurement moments. Consequently, protective flexor tendon effect of PQ repair could consequently not be concluded. In conclusion, clinical and functional short term benefits, except improved wrist extension and reduced pain in the first 3 months, were not proven in this study. In Soong grade 0, PQ repair is probably not necessary to prevent flexor tendon pathology. In Soong grade 1 or 2, this is still to be investigated. LEVEL OF EVIDENCE: 2.
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Affiliation(s)
- C K Goorens
- Regionaal Ziekenhuis Tienen, Kliniekstraat 45, 3300, Tienen, Belgium.
| | - P B De Keyzer
- Regionaal Ziekenhuis Tienen, Kliniekstraat 45, 3300, Tienen, Belgium.,University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - K Van Royen
- University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - S Provyn
- Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - J F Goubau
- University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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11
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Asmar G, Bellity J, Falcone MO. Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:481-490. [PMID: 32955698 DOI: 10.1007/s00590-020-02791-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. MATERIALS AND METHODS This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. RESULTS In the first phase: mean incision size was 32 mm, and mean operative time was 28.5 min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2 months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. CONCLUSION The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.
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Affiliation(s)
- Ghada Asmar
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Jonathan Bellity
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Marc-Olivier Falcone
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France. .,Clinique Internationale du Parc Monceau, 21 rue de Chazelles, 75017, Paris, France.
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12
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Fan J, Zhang X, Ji JQ, Yao Y, Li SZ, Yuan F, Cheng LM. Fixation of distal radius fracture with volar locking palmar plates while preserving pronator quadratus through the minimally invasive approach. Technol Health Care 2020; 29:167-174. [PMID: 32538887 DOI: 10.3233/thc-192113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The volar locking plate technique with an L-shaped incision of the PQ muscle through the classic volar Henry approach is a popular method for treating distal radius fractures. Recently we revised and improved this traditional technique by performing mini-invasive surgery. OBJECTIVE The purpose of this study was to evaluate the clinical effects after fixation of distal radius fracture with volar locking palmar plates while preserving the pronator quadratus through minimally invasive approach. METHODS From May 2014 to March 2017, 58 patients (38 males and 21 females) with an age range of 22-72 years (mean age 44.6 years) and with distal radius fractures underwent open reduction and internal fixation with volar locking palmar plates. The patients were classified as 23A-2 through 23C-2 according to the Orthopedic Trauma Association fracture classification system. All surgeries were completed by one trained team. The group that received volar locking palmar plates of distal radius performed with the traditional method through Henry approach involved 33 patients (21 males and 12 females) and the group that received PQ through minimally invasive approach group involved 25 patients (16 males and 9 females). We compared the two groups for wrist pain, forearm range of motion, grip strength, preoperative complications and wrist functional recovery score. RESULTS The minimum follow-up for the whole cohort was one year. The differences between the two groups were significant in terms of wrist pain, forearm range of motion, grip strength and wrist function at 1, 2, 6 weeks postoperatively, but insignificant at 3 and 12 months postoperatively. In the minimally invasive group a case of limited extension of the forefinger 3 months postoperatively was found. No significant differences were found for preoperative complications and radiographs postoperatively. CONCLUSION Fixation with volar locking palmar plates through minimally invasive approach is a satisfactory and optional method in the treatment of distal radius fractures. This technique yields better early wrist function, shortens rehabilitation time and gets high psychological satisfaction.
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Affiliation(s)
- Jian Fan
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China.,Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Xin Zhang
- Department of Orthopedics, Jiading District Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China.,Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Jia-Qing Ji
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Ying Yao
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Shan-Zhu Li
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Feng Yuan
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Li-Ming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
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Chelli M, Bronsard N, Gonzalez JF, Blasco L, Gauci MO, Boileau P. The distal-medial pilot hole: A simple way to ease volar plate positioning in extra-articular distal radius fractures. Injury 2020; 51:779-782. [PMID: 32014260 DOI: 10.1016/j.injury.2020.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 02/02/2023]
Abstract
Volar plating is one of the most used surgical treatments for dorsally displaced extra-articular distal radius fractures. However, the reduction of the dorsal tilt can be difficult. It usually requires a flexion maneuver of the wrist while maintaining and screwing the plate, which is cumbersome. Plate positioning also is a crucial step and is sometimes difficult because of the large size of the plate relative to the width of the distal radius. We use an epiphysis-first technique. We place all the epiphyseal screws before reduction, and then we take advantage of the anatomical shape of a locking plate to automatically reduce the dorsal tilt by fixing the proximal radius to the plate with cortical compression screws. To ensure easy and accurate positioning of the plate, we drill a distal medial pilot hole in a free-hand fashion 10 mm proximal to the watershed line and 10 mm lateral to the medial rim of the radius, without positioning the plate. This allows a clear view of the location of this first hole. The locking plate is then applied to the distal radius with help of a monocortical non-locking screw, and it is controlled under fluoroscopy. When this medial pilot hole is properly positioned and the plate correctly tilted on the anteroposterior view, the remaining epiphyseal holes are filled with locking screws. Then the plate is fixed on the proximal radius with bicortical compression screws, allowing an automatic reduction of the epiphyseal dorsal tilt. We believe this technique is a safe and reproducible way to position volar plates and to reduce anatomically the dorsal tilt in extra-articular posteriorly displaced distal radius fractures (AO A2 and A3). Furthermore, the automatic fracture reduction provided by this technique decreases operation time and radiation.
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Affiliation(s)
- Mikaël Chelli
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice.
| | - Nicolas Bronsard
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Jean-François Gonzalez
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Laurent Blasco
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Marc-Olivier Gauci
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
| | - Pascal Boileau
- University Institute of Locomotion and Sport - University Hospital of Nice, Hopital Pasteur 2, 30, voie Romaine 06000 Nice
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Comparison of a standard locking screw versus a double-threaded cortical compression screw for fixation of die-punch fragments in distal radius fractures with volar plating. HAND SURGERY & REHABILITATION 2019; 39:30-35. [PMID: 31734295 DOI: 10.1016/j.hansur.2019.10.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 09/16/2019] [Accepted: 10/08/2019] [Indexed: 11/22/2022]
Abstract
The aim of this study was to use a compression screw in the epiphyseal medial orifice of a volar plate to reduce and stabilize the die-punch fragment in distal radius fractures (DRF) undergoing open reduction and internal fixation (ORIF). The main hypothesis was that the range of motion (ROM) in supination would be poorer when a standard screw was used. Our case series included 19 patients with an average age of 59 years (24-91) (SD -35.32) (10 male patients and 9 females) who underwent ORIF of DRFs with a volar plate. Group I included 10 patients in which the die-punch fragment was fixed with a standard locking screw and group II included the 9 patients in which the die-punch fragment was fixed with an angle stable compression screw through both cortices. At the 6-month follow-up visit, the average ROM in flexion was 83% in group I and 81% in group II (-2.327 [-13.657; 8.960]), the ROM in extension was 91% and 89% (-2.754 [-13.410; 7.602]), the ROM in pronation was 100% and 102% (+3.178 [-5.242; 11.457]), the ROM in supination 100% and 97% (-3.171 [-10.825; 4.537]), the pain level was 0.6/10 and 1/10 (+0.106 [-0.809; 0.977]), the QuickDASH score was 8.1/100 and 17.17/100 (+5.790 [-2.934; 15.012]), the PRWE was 6.2/100 and 22/100 (+13.109 [4.416; 22.779]) and the grip strength was 95% and 74% of the contralateral side (-12.478 [-24.832; 0.538]). No complications, nonunions or revision surgery were reported in the two groups. One case of secondary displacement of the die-punch fragment occurred in each group. The main hypothesis was not proven. In conclusion, despite what several biomechanical studies have suggested, the use of double-threaded compression screws for die-punch fragment fixation in DRFs does not improve the clinical outcomes compared to standard locking screws.
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Siow BRS, Tong CRH, Satku M, Sechachalam S, Yeo CJ. Transverse or longitudinal? A survey of volar wrist incision preferences. Singapore Med J 2019; 61:548-550. [PMID: 31535152 DOI: 10.11622/smedj.2020023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In volar wrist surgery, the traditional longitudinal incision leaves a scar that may be considered cosmetically unpleasant. Recent studies suggest that transverse wrist incisions result in more aesthetically pleasing scars that are well hidden in the wrist crease. The aim of our study was to explore the public's perceptions of longitudinal versus transverse wrist scars. METHODS A prospective survey was conducted among the general public. Inclusion criteria were patients aged over 18 years with no prior surgery to the wrist. Survey questions assessed included: (a) longitudinal or transverse scar preference; (b) reasons for preference; and (c) demographic information. RESULTS There were 107 respondents from the general public. More respondents preferred longitudinal scars. Top three reasons for longitudinal scar preference were: (a) perceived damage to wrist structures by a transverse incision; (b) better cosmesis; and (c) scar from the transverse incision appearing like a self-inflicted injury. Top three reasons for transverse scar preference were: (a) easily concealed by accessories; (b) less noticeable; and (c) better cosmesis. Respondents aged 60 years and above were most concerned about possible damage to wrist structures; younger respondents were most concerned that transverse scars appeared like self-inflicted injuries. CONCLUSION Respondents from the general public preferred a longitudinal scar to a transverse one. Younger respondents were most concerned about how the transverse scar appeared like a self-inflicted injury while older respondents were most concerned with perceived functional implications of the incisions.
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Affiliation(s)
| | | | - Mala Satku
- Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Sreedharan Sechachalam
- Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Chong Jin Yeo
- Hand Surgery Associates, Mount Elizabeth Novena Specialist Centre, Singapore
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Neubauer T, Plecko M, Grechenig S, Hartmann A, Ortmaier R, Hitzl W, Feigl G. Minimal invasive plating of distal radius fractures. A safe procedure? Ann Anat 2019; 224:172-178. [PMID: 31108191 DOI: 10.1016/j.aanat.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimal invasive plate osteosynthesis (MIPO) with preservation of the pronator quadratus (PQ) muscle represents a new technique for stabilization of distal radius fractures. However, the complex anatomy of the distal radius metaphysis requires implants with features that address all morphologic specifics of this area to avoid complications, which are still reported with this technique. It was the aim of our anatomic investigation to evaluate the feasibility of plate insertion via a minimal transverse approach as well as the risk of soft- tissues compromise with the use of an implant, which is only partially adapted to the characteristics of distal radius metaphysis. METHODS Twenty forearm specimens, conservated with Thiels method, have been used for this study. The majority (n = 19/20) of implants (2.4 mm small fragment juxta-articular locking compression/ LCP T-plate -5-hole; Depuy - Synthes®, Solothurn, Switzerland) could be inserted easily and all were seated proximal to the so called "watershed line" (n = 20/20). RESULTS In a total of 8/20 specimens close contacts or potential compromise to neighboring soft- tissues was seen: perforation of the PQ muscle by the plate occurred in 2/20 specimens and was related to an extreme muscle morphology. In 7/20 specimens close contacts between the T-plate and other soft tissues were observed, which were exclusively located at the radial edge of the distal transverse bar. They affected the brachio-radialis tendon (elevation: 2/20, side-to-side contact: 3/20, overriding: 1/20) and the radial artery (elevation: 4/20, side-to-side contact: 2/20, overriding: 1/20). No significant differences of morphologic types of PQ muscle and the difficulty of plate insertion, adjustment on the bone, PQ muscle damage and contact to neighboring soft-tissues could be evaluated. CONCLUSIONS Insertion of volar radius plates through a MIPO approach can be easily accomplished without detachment and damage to the PQ muscle even with grossly adapted implants. However, perfectly pre-shaped plates which are adapted to all anatomic aspects of the distal radius metaphysis are required to achieve optimal contact with the metaphyseal bone and to avoid potential complications.
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Affiliation(s)
- T Neubauer
- Department of Trauma Surgery, Landesklinikum Horn, Spitalgasse 10, A-3580, Horn, Austria.
| | - M Plecko
- AUVA - Trauma Hospital Graz, Göstinger Str. 24, A-8020, Graz, Austria
| | - S Grechenig
- Institute of Anatomy, Medical University of Graz, Harrachgasse 21, A-8010, Graz, Austria
| | - A Hartmann
- University Clinic of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - R Ortmaier
- University Clinic of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - W Hitzl
- Department of Biostatistic, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - G Feigl
- Institute of Anatomy, Medical University of Graz, Harrachgasse 21, A-8010, Graz, Austria
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Minimally invasive internal fixation for extra-articular distal radius fracture: Comparison between volar plate and intramedullary nail. Orthop Traumatol Surg Res 2019; 105:409-415. [PMID: 30711303 DOI: 10.1016/j.otsr.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are numerous internal fixation techniques for distal radius fracture, using pins, plates or nails. Some authors have developed minimally invasive procedures. The aim of the present study was to compare two minimally invasive internal fixation techniques for unstable extra-articular distal radius fracture in women over 50 years of age: volar plate (minimally invasive plate osteosynthesis: MIPO), and intramedullary nail. HYPOTHESES The main study hypothesis was that the incision scar left by minimally invasive internal fixation is smaller using MIPO than an intramedullary nail. The secondary hypotheses were that the two techniques do not differ in terms of pain, functional score, strength, range of motion and radiologic indices. MATERIAL AND METHOD The series comprised nineteen A2.2 and one A2.1 fractures in 20 female patients with a mean age of 72 years. The first 10 (group 1) received minimally invasive internal fixation of the distal radius by MIPO, and the other 10 (group 2) by intramedullary nail locked onto the distal radius epiphysis and diaphysis. RESULTS The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail (mean, 14.3mm vs. 32.8mm). Some of the secondary hypotheses were also confirmed: there were no differences between the two techniques in terms of pain at 6 months, QuickDASH, PRWE (Patient-Reported Wrist Evaluation), range of motion or ulnar variance; two were not confirmed: pain at 6 weeks was less with intramedullary nails, and palmar slope was better with MIPO. DISCUSSION AND CONCLUSION The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail. In conclusion, the present findings showed that internal fixation of unstable extra-articular fracture in over 50-year-olds gave better clinical results at 6 weeks using an intramedullary nail, while MIPO required smaller incision. LEVEL OF EVIDENCE III, retrospective study.
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Does arthroscopic assistance improve reduction in distal articular radius fracture? A retrospective comparative study using a blind CT assessment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:405-411. [DOI: 10.1007/s00590-018-2348-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
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Minimally Invasive Plate Osteosynthesis for a Distal Radius Fracture with Forearm Skin Problem. Case Rep Orthop 2018; 2018:8195376. [PMID: 30034900 PMCID: PMC6035807 DOI: 10.1155/2018/8195376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
In this study, we performed osteosynthesis for a distal radius fracture using a minimally invasive approach for a patient with skin disorder of the forearm and obtained favorable results. This case report may provide new findings confirming the usefulness of this surgical approach for distal radius fractures. Blister formation on the right forearm was observed in a 53-year-old female who was diagnosed with a distal fracture of the right radius and underwent splinting in a local hospital, and she was referred to our hospital 2 days after the injury. Minimally invasive locking plate osteosynthesis was performed, and there was no skin lesion at this incision site. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. We reported volar locking plate osteosynthesis using the minimally invasive approach in a patient with skin disorder of the forearm. Such patients are rarely encountered. However, this minimally invasive approach is extremely useful for utilizing the advantages of volar locking plate fixation without being affected by the soft tissue environment.
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Duprat A, Diaz JJH, Vernet P, Gouzou S, Facca S, Igeta Y, Liverneaux P. Volar Locking Plate Fixation of Distal Radius Fractures: Splint versus Immediate Mobilization. J Wrist Surg 2018; 7:237-242. [PMID: 29922501 PMCID: PMC6005784 DOI: 10.1055/s-0037-1620271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
Background The goal of this study was to demonstrate that the use of a splint after performing an osteosynthesis of the distal radius with a volar locking plate is unnecessary. The main hypothesis was that postoperative flexion of the wrist was greater without a splint. Secondary hypothesis was that patients who were allowed immediate mobilization got better results in terms of pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), strength, extension, pronation, and supination. Case Description Our series included 72 patients, aged 59 years in average of which 59 were female patients. All patients had been operated for a volar locking plate fixation of a distal radius fracture. The first 36 patients (group I) were immobilized by a splint at 30° of extension of the wrist for 2 weeks. The following 36 patients (group II) were not immobilized. Results At 3 months, all the average variables were better in the group without splint (group I: flexion 74.83%, extension 83.13%, pronation 92.07%, supination 88.11%, pain 1.72/10, Quick DASH 21.78/100, PRWE 22.97/100, strength 62.96%; group II: flexion 85.50%, extension 83.4%, pronation 92.96%, supination 92.96%, pain 1.28/10, Quick DASH 19.57/100, PRWE 20.56/100, strength 66.34%). No complication was reported. Conclusion Overall, our results demonstrate that wearing a splint after volar locking plate fixation of a distal radius fracture is unnecessary.
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Affiliation(s)
- André Duprat
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
| | - Juan José Hidalgo Diaz
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
| | - Paul Vernet
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
| | - Stéphanie Gouzou
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
| | - Sybille Facca
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
| | - Yuka Igeta
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Philippe Liverneaux
- Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
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Why do we use arthroscopy for distal radius fractures? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1505-1514. [DOI: 10.1007/s00590-018-2263-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/30/2018] [Indexed: 01/12/2023]
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22
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Goorens C, Van Royen K, Grijseels S, Provyn S, De Mey J, Scheerlinck T, Goubau J. Ultrasonographic evaluation of the distance between the flexor pollicis longus tendon and volar prominence of the plate as a function of volar plate positioning and pronator quadratus repair — A cadaver study. HAND SURGERY & REHABILITATION 2018; 37:171-174. [DOI: 10.1016/j.hansur.2017.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/14/2017] [Accepted: 12/21/2017] [Indexed: 11/17/2022]
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Zemirline A, Taleb C, Naito K, Vernet P, Liverneaux P, Lebailly F. Distal radius fracture fixation with a volar locking plate and endoscopic carpal tunnel release using a single 15mm approach: Feasibility study. HAND SURGERY & REHABILITATION 2018; 37:S2468-1229(18)30068-9. [PMID: 29779839 DOI: 10.1016/j.hansur.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/31/2022]
Abstract
Distal radius fractures (DRF) may trigger, reveal or decompensate acute carpal tunnel syndrome (CTS) in 0.5-21% of cases. Internal fixation and median nerve release must then be carried out urgently. Less invasive approaches have been described for both the median nerve release using an endoscopic device and for the DRF fixation using a volar locking plate. We assessed the feasibility of DRF fixation and median nerve release through a single, minimally-invasive 15mm approach on a series of 10 cases. We reviewed retrospectively 10 consecutive cases of DRF associated with symptomatic CTS in 8 women and 2 men, aged 57 years on average. CTS was diagnosed clinically. All patients were treated during outpatient surgery with a volar locking plate and endoscopic carpal tunnel release using a single 15mm minimally-invasive approach. In one case, arthroscopic scapholunate repair was also required. Six months after the procedure, all patients were reviewed with a clinical examination and a radiological evaluation. The average values for the clinical and radiological outcomes were as follows: pain on VAS 1.5/10; QuickDASH 14.3/100; flexion 90%; extension 90.6%; pronation 95.6%; supination 87.9%; grip strength 90.1%; 2PD test 5.2mm (4-8mm). Five complications occurred: two cases of temporary dysesthesia in the territory of the median nerve and one case of temporary hypoesthesia of the palmar branch of the median nerve, which had all completely recovered; two cases of complex regional pain syndrome type I, which were still active at 6 months. Despite its methodological weaknesses, our study is the only one to describe the technical feasibility of a single 15mm minimally-invasive approach for both internal fixation using a volar locking plate and endoscopic nerve release, with no serious complications. This technique should be added to the surgical toolbox of minimally-invasive procedures for the hand and wrist.
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Affiliation(s)
- A Zemirline
- Hand Center of Brittany, Saint-Grégoire Private Hospital Center, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France.
| | - C Taleb
- Department of Orthopaedic Surgery, Mulhouse Hospital Center, 20, avenue Docteur René-Laennec, 68100 Mulhouse, France
| | - K Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - P Vernet
- Department of Hand Surgery, Strasbourg University Hospital, 10, avenue Achille-Baumann, 67400 Illkirch, France
| | - P Liverneaux
- Department of Hand Surgery, Strasbourg University Hospital, 10, avenue Achille-Baumann, 67400 Illkirch, France
| | - F Lebailly
- Clinique Saint-Paul, 3, rue des Hibiscus, 97200 Fort-De-France, France
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The best cited articles of the European Journal of Orthopaedic Surgery and Traumatology (EJOST): a bibliometric analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:533-544. [DOI: 10.1007/s00590-018-2147-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
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Abstract
This article reviews the author's currently used minimal invasive approach for volar plating of distal radius fractures. A single longitudinal incision of 1.5 cm is drawn on the lateral aspect of the flexor carpi radialis tendon in order to insert a plate under the pronator quadratus. With the wrist flexed, the plate is applied on the anterior cortex of the radius to reduce the fracture. This approach offers the advantage of preserving ligamentotaxis, which facilitates the reduction, and the small scar improves the cosmetics. It is mainly indicated for extra-articular and simple intra-articular fractures of the distal radius. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable with those obtained with an extended flexor carpi radialis approach. My colleagues and I have used it for more than 2000 cases since 2012. This technique requires practise. Attempted conversion to a larger incision is possible in case of difficulty, but this is seldom necessary.
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Igeta Y, Vernet P, Facca S, Naroura I, Hidalgo Diaz JJ, Diaz JJH, Liverneaux PA. The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1515-1522. [PMID: 29368237 DOI: 10.1007/s00590-018-2124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022]
Abstract
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used. It offers the advantage of preserving ligamentotaxis which facilitates the reduction, and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intraarticular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.
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Affiliation(s)
- Yuka Igeta
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France.,Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Paul Vernet
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Sybille Facca
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Ismaël Naroura
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | | | - Juan José Hidalgo Diaz
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Philippe A Liverneaux
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France.
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Pire E, Hidalgo Diaz JJ, Salazar Botero S, Facca S, Liverneaux PA. Long Volar Plating for Metadiaphyseal Fractures of Distal Radius: Study Comparing Minimally Invasive Plate Osteosynthesis versus Conventional Approach. J Wrist Surg 2017; 6:227-234. [PMID: 28725505 PMCID: PMC5515610 DOI: 10.1055/s-0037-1599791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/30/2017] [Indexed: 10/19/2022]
Abstract
Background Minimally invasive plate osteosynthesis (MIPO) has been used in wrist surgery for several years. The purpose of this retrospective study was to compare clinical and radiologic outcomes of MIPO technique with those of a conventional approach in the treatment of metadiaphyseal distal radius fracture by long volar plating. Materials and Methods Our series consisted of 32 fractures in 31 patients, mean age 63.9 years, including 16 men and 15 women. MIPO technique was used in 15 wrists (group 1) and conventional approach (> 60 mm of skin incision) in 17 wrists (group 2). In group 1, a long volar plate was inserted under pronator quadratus through a 15- to 30-mm distal incision then fixed to the epiphysis of the distal radius. Then, through a 15- to 30-mm proximal incision, the plate was fixed to the diaphysis of the radius, thus reducing the fracture. Results In group 1, mean distal incision size was 23.5 and 16.9 mm for proximal one. Mean total scar size (sum of both distal and proximal incisions) was 40.0 mm in group 1 and 84.1 mm in group 2. Mean tourniquet time was 58.4 minutes in group 1 and 68.9 minutes in group 2. At latest follow-up, no significant difference was noted in both the groups concerning pain, quick-DASH score, grip strength, ROM, and radiologic data. One extensor pollicis longus rupture treated by tendon transfer was done in group 1. Conclusion The MIPO technique for metadiaphyseal fractures of the distal radius by long volar plating has cosmetic and economic advantages compared with the conventional approach. Conversion to conventional approach is possible at any time in case of technical difficulties. Level of Evidence III.
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Affiliation(s)
- Emilie Pire
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, Icube, Illkirch, France
| | - Juan José Hidalgo Diaz
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, Icube, Illkirch, France
| | - Santiago Salazar Botero
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, Icube, Illkirch, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, Icube, Illkirch, France
| | - Philippe A. Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, Icube, Illkirch, France
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Possibility of Fixation of a Distal Radius Fracture With a Volar Locking Plate Through a 10 mm Approach. Tech Hand Up Extrem Surg 2017; 20:71-6. [PMID: 27015408 DOI: 10.1097/bth.0000000000000118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The management of distal radius fractures has dramatically improved due to the development of a locking plate system. In addition, mini-invasive surgery has been performed in a lot of surgical fields in recent years. The aim of the present study is to investigate the possibility of fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. Eighteen patients with distal radius fracture (mean age: 66 y; range, 28 to 88 y; 8 males and 10 females) were operated on using a volar locking plate. The incision for plating was always 10 mm long. The clinical, cosmetic, and radiologic outcomes were investigated. At 3 months' follow-up, the range of motion of the wrist joint was 67.5 degrees in flexion, 65.6 degrees in extension, 88.3 degrees in pronation, and 88.3 degrees in supination. The % grip strength compared to the healthy side ranged from 35% to 100%. The VAS, Q-DASH, and modified Mayo scores were 0.7, 8.5, and 93.3, respectively (excellent in all 18 patients). Bone union was achieved on plain x-ray radiography and cosmetic problems were satisfied in all patients. Our results suggest that it is possible to achieve fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. However, its applicability to surgery must be carefully examined. If any difficulties in plate installation or approach occur during this intervention, it will be necessary to consider switching to a conventional approach. We believe that surgeons must not adhere to a mini-invasive approach.
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Prunières G, Hidalgo Diaz JJ, Vernet P, Salazar Botero S, Facca S, Liverneaux PA. Is there a relevance of suction drainage in non-septic wrist surgery? Orthop Traumatol Surg Res 2017; 103:453-455. [PMID: 28163242 DOI: 10.1016/j.otsr.2017.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/15/2016] [Accepted: 01/17/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION No rational argument leads to conclude to the benefit or the innocuousness of drainage in non-septic wrist surgery. HYPOTHESIS The goal of this study was to validate the hypothesis that for those indications drainage is unnecessary. MATERIAL AND METHOD We reviewed 1001 consecutive cases, concerning 885 patients, 58 years old in average. RESULTS Out of 1001 procedures, 9 patients were operated on both sides, 145 were operated twice of which 130 for the implantation and then the removal of surgical material. None were reoperated for hematomas. Three patients were initially treated for an osteosynthesis using an anterior plate of distal radius and secondarily reoperated due to sepsis, one of them twice. The material was removed from two patients. The average time of tourniquet for those 3 osteosynthesis was significantly superior (84.33min) to the average time for the 595 other anterior distal radius plates (45.35min). CONCLUSION The results of our study show that suction drainage in non-septic wrist surgery is unnecessary. LEVEL OF EVIDENCE III descriptive retrospective study.
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Affiliation(s)
- G Prunières
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - J J Hidalgo Diaz
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - P Vernet
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - S Salazar Botero
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - S Facca
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - P A Liverneaux
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France.
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Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures. Plast Reconstr Surg 2017; 139:717e-724e. [DOI: 10.1097/prs.0000000000003076] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luigi Medda P, Matheron AS, Hidalgo Diaz JJ, Maire N, Vernet P, Facca S, Liverneaux P. Minimally invasive hardware removal after minimally invasive distal radius plate osteosynthesis (MIPO): Feasibility study in a 388 case series. Orthop Traumatol Surg Res 2017; 103:85-87. [PMID: 27923763 DOI: 10.1016/j.otsr.2016.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS The aim of the present study was to assess the technical feasibility of minimally invasive volar plate removal following distal radius fracture. MATERIAL AND METHODS Three hundred and eighty-eight plates removed from 387 patients (357 females: mean age, 50 years) were assessed retrospectively. The incision used the primary minimally invasive approach and was closed after plate removal by intradermal continuous suture, without drainage or immobilization. RESULTS Mean scar size was 22.2mm preoperatively, and the incision was 19.8mm at start and 21.4mm at end of procedure, these differences being non-significant. The scar was enlarged by accidental skin tear in 13 cases and intentionally by lancet in 11 cases. There were 29 screw-related complications, 1 bone crack without clinical impact, and 1 plate fracture. There were no postoperative complications. DISCUSSION The present results demonstrate the feasibility of removing a volar plate on the distal radius via a 20-mm approach. These findings should be confirmed on a future study comparing minimally invasive plate ablation and conventional approaches.
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Affiliation(s)
- P Luigi Medda
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - A-S Matheron
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - J J Hidalgo Diaz
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - N Maire
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - P Vernet
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - S Facca
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - P Liverneaux
- Department of hand surgery, SOS main, CCOM, university hospital of Strasbourg, FMTS, university of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France.
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Mares O, Coulomb R, Lazerges C, Bosch C, Kouyoumdjian P. Les voies d’abord des fractures du radius distal : une mise au point. HAND SURGERY & REHABILITATION 2016; 35S:S39-S43. [DOI: 10.1016/j.hansur.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/31/2016] [Accepted: 03/03/2016] [Indexed: 10/20/2022]
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Liverneaux P, Ichihara S, Facca S, Hidalgo Diaz J. Résultats de l’ostéosynthèse par plaque antérieure et abord mini-invasif (MIPO) des fractures de l’extrémité distale du radius : mise au point. HAND SURGERY & REHABILITATION 2016; 35S:S80-S85. [DOI: 10.1016/j.hansur.2016.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 10/20/2022]
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The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Scand J Pain 2016; 14:84-88. [PMID: 28850441 DOI: 10.1016/j.sjpain.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/08/2016] [Accepted: 10/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Complex regional pain syndrome (CRPS) is a challenging complication after surgery or trauma. This study sought to determine the incidence of CRPS after a second inciting event in a previously unaffected extremity in patients with a history of an ongoing CRPS diagnosis in another extremity. METHODS A retrospective review identified patients with CRPS seen in clinic over a 20-month period. The incidence of CRPS after subsequent surgery or injury in a previous unaffected extremity was determined and compared to an average incidence reported in the literature. RESULTS Ninety-three patients had a diagnosis of primary CRPS. Nineteen (20.4%) developed CRPS in one or more additional extremity compared to the incidence of 23.4 per 100,000 (0.0234%) in the literature (odds ratio 1069.6, p<0.0001, 95% CI 562.0-2035.7). Twenty patients had a documented secondary injury or surgery in a second extremity. Fifteen (75%) developed secondary CRPS compared to a CRPS incidence rate of 6.4% following distal radius fracture, as determined by literature review (odds ratio 11.7, p<0.001, 95% CI 5.9-23.2). CONCLUSIONS These result suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. IMPLICATIONS Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.
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Taleb C, Zemirline A, Lebailly F, Bodin F, Facca S, Gouzou S, Liverneaux P. Minimally invasive osteotomy for distal radius malunion: A preliminary series of 9 cases. Orthop Traumatol Surg Res 2015; 101:861-5. [PMID: 26454409 DOI: 10.1016/j.otsr.2015.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/05/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
UNLABELLED The rate of malunion after distal radius fractures is 25% after conservative treatment and 10% after surgery. Their main functional repercussion related to ulno-carpal conflict is loss of wrist motion. We report a retrospective clinical series of minimally invasive osteotomies. The series consisted of 9 cases of minimally invasive osteotomies with volar locking plate fixation. All osteotomies healed. The average pain was 5.3/10 preoperatively and 2.1/10 at last follow-up. The mean Quick DASH was 55.4/100 preoperatively and 24.24/100 at last follow-up. Compared to the opposite side, the average wrist flexion was 84.11%, the average wrist extension was 80.24%, the average pronation was 95.33% and the average supination was 93.9%. With similar results to those of the literature, our short series confirms the feasibility of minimally invasive osteotomy of the distal radius for extra-articular malunion. TYPE: Case-series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Taleb
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France
| | - A Zemirline
- Hand Surgery Department, Private Hospital Saint-Grégoire, 35760 Rennes, France
| | - F Lebailly
- Hand Surgery Department, Saint-Paul Institute, 97200 Fort-de-France, Martinique
| | - F Bodin
- Plastic Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, 67000 Strasbourg, France
| | - S Facca
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France
| | - S Gouzou
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France
| | - P Liverneaux
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France.
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Gutierrez Olivera N, Ruchelli L, Iglesias S, Capomassi M, Allende C. Minimally invasive plate osteosynthesis in distal radius fractures with metaphyseal extension: A series of 13 cases. ACTA ACUST UNITED AC 2015; 34:227-33. [PMID: 26359856 DOI: 10.1016/j.main.2015.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 05/25/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED To evaluate objective and subjective outcomes after minimally invasive volar locked plate fixation of distal radius fractures with metaphyseal extension, we retrospectively evaluated 13 patients with unstable distal radius fractures with metaphyseal extension, treated by minimally invasive volar locked plating. Patients' average age was 41 years. Two volar incisions, 2 to 3cm long, were made; indirect reduction was performed and a volar locked T-plate was placed submuscularly under fluoroscopy guidance. Twelve fractures healed after an average of 2.46 months; one patient needed revision due to a new injury. The plate had to be removed in one patient. On X-rays, radial height averaged 12.78mm, radial inclination averaged 21.34° and volar tilt averaged 8.22°. Flexion averaged 75°, extension 71.5°, pronation 82.08° and supination 83.08°. Grip strength averaged 83.75% of the contralateral wrist. The DASH score averaged 13.91 points and pain assessed on VAS averaged 0.92 points. In unstable distal radius fractures with metaphyseal extension, minimally invasive plate osteosynthesis using volar locked plates led to good reduction and stable fixation, with low pain levels, and good functional and esthetic results. Indirect reduction techniques, fluoroscopy, and restoration of radial length, rotation and alignment, are necessary to achieve these outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- N Gutierrez Olivera
- Sanatorio Allende, Instituto Allende de Cirugía Reconstructiva de los Miembros, Independencia 726, 5000 Córdoba, Argentina.
| | - L Ruchelli
- Sanatorio Allende, Instituto Allende de Cirugía Reconstructiva de los Miembros, Independencia 726, 5000 Córdoba, Argentina
| | - S Iglesias
- Sanatorio Allende, Instituto Allende de Cirugía Reconstructiva de los Miembros, Independencia 726, 5000 Córdoba, Argentina
| | - M Capomassi
- Instituto Dr. Jaime Slullitel, Sanatorio de la Mujer, Rosario, Argentina
| | - C Allende
- Sanatorio Allende, Instituto Allende de Cirugía Reconstructiva de los Miembros, Independencia 726, 5000 Córdoba, Argentina; Universidad Católica de Córdoba, Córdoba, Argentina
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