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Bell JA, James NF, Mauck BM, Calandruccio JH, Weller WJ. The Pitfalls of Difficult Distal Radius Fractures and Provisional Reduction. Orthop Clin North Am 2024; 55:113-122. [PMID: 37980096 DOI: 10.1016/j.ocl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Distal radius fractures are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate treatment options. These fractures can be difficult injuries to treat surgically based on a large variability of fracture patterns, bone quality, and anatomy. It is important to understand the potential pitfalls associated with the treatment of difficult distal radius fractures to prevent avoidable complications. Some of these pitfalls include but are not limited to appropriate surgical exposure and soft tissue handling, provisional reduction, fixation type, and augmentation of fracture fixation.
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Affiliation(s)
- Jared A Bell
- Department of Orthopedic Surgery, University of Florida Health Jacksonville, 655 8th Street West, Jacksonville, FL 32209, USA
| | - Nicholas F James
- Department of Orthopedic Surgery, University of Florida Health Jacksonville, 655 8th Street West, Jacksonville, FL 32209, USA.
| | - Benjamin M Mauck
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - James H Calandruccio
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - William J Weller
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
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Vogels S, Debeij J, Hoencamp R, Ritchie ED. Rupture of the brachioradialis muscle following blunt trauma. A case report. Trauma Case Rep 2022; 42:100702. [PMID: 36226031 PMCID: PMC9550525 DOI: 10.1016/j.tcr.2022.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
A 50-year old healthy male lost control over the pull string of a milling machine, which strangulated his right elbow and forearm with high velocity. Magnetic resonance imaging of the right upper extremity revealed a substantial tear in the muscle belly of the musculus brachioradialis with multiple small defects in the surrounding musculature of the forearm. The affected arm was immobilized for 1 week with an above the elbow cast. In the following months, guided training and strengthening exercises were performed. The patient could return to his physically demanding work after 10 months and regained full function of his hand and wrist after 18 months. This case report demonstrates that short immobilization followed by extensive and guided strength training has been observed to result in persisting weakness of elbow flexion but good functional outcome for the wrist and hand.
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Affiliation(s)
- Sanne Vogels
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands,Trauma Research Unit, Department of Trauma Surgery, Erasmus MC, Rotterdam, the Netherlands,Corresponding author at: Alrijne Hospital, Department of Surgery, Simon Smitweg 1, 2353 GA Leiderdorp, the Netherlands.
| | - Jan Debeij
- Hand, Wrist and Elbow Center, Haga Hospital, The Hague, the Netherlands,Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands,Trauma Research Unit, Department of Trauma Surgery, Erasmus MC, Rotterdam, the Netherlands,Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewan D. Ritchie
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
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Xing MH, Ansari E, O'Malley QF, Khorsandi A, Khan MN, Urken ML. Radiation necrosis of the pharyngeal soft tissue: Unique clinical entity reconstructed with a previously unreported composite brachioradialis and flexor digitorum superficialis radial forearm flap. Head Neck 2020; 42:E23-E29. [PMID: 32783228 DOI: 10.1002/hed.26405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The radial forearm free flap (RFFF) is a versatile flap commonly used in head and neck reconstructive surgery. We describe the use of a composite RFFF that includes muscle for reconstruction of a hostile wound of the posterior pharyngeal wall. METHODS A 54-year-old male with a history of recurrent right palatine tonsil HPV+ squamous cell carcinoma developed severe soft tissue necrosis of the posterior pharyngeal wall secondary to reirradiation. The defect was reconstructed with a composite RFFF that included the brachioradialis (BR) muscle and the flexor digitorum superficialis (FDS) muscle. RESULTS Restoration of this complex defect was successfully accomplished with minimal donor site functional deficits and satisfactory functional outcomes including decannulation and resumption of oral intake. CONCLUSION This composite RFFF can be effectively used to reconstruct a hostile wound of the posterior pharyngeal wall. Incorporation of muscle in the reconstruction of complex wounds with soft tissue necrosis is beneficial.
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Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Edward Ansari
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Quinn F O'Malley
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, USA
| | - Mohemmed Nazir Khan
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Mark L Urken
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
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Hosapatna M, Souza AD, Rao M, Hari Ankolekar V. Morphology and innervation of brachioradialis and flexor carpi radialis and their utility in tendon transfer surgeries: A Cadaveric Study. Morphologie 2019; 104:91-96. [PMID: 31761660 DOI: 10.1016/j.morpho.2019.10.046] [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: 07/02/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Brachioradialis (BR) muscle flap is easy to harvest, provides a stable coverage to the cubital fossa as it is well vascularized. The BR andflexor carpi radialis (FCR) tendons are utilized in tendon transfer to restore the normal hand function. Therefore, the present study describes the morphology of the muscle bellies and the tendons of BR and FCR along with their pattern of innervation. MATERIALS AND METHODS The study was carried out on 27 upper limbs of formalin-fixed, adult human cadavers. Length and width of the bellies of BR and FCR were measured. The number of motor branches and their distances from the bi-epicondylar line was measured. RESULTS The mean lengths of BR and FCR bellies were 21.22±2.18cm and 16.15±2.39cm, and the lengths of their tendons were, 12.67±1.13cm and 12.48±1.72cm respectively. BR received a single motor branch in 19 upper limbs. However, FCR received single motor branch in 25 limbs as a common trunk. One upper limb received three motor branches to BR, and two upper limbs received two motor branches to FCR. The most proximal and distal branches to the BR were ranged between 6.3-2.2cm proximal to the bi-epicondylar line. Those to the FCR were ranged between 3.5-6.9cm distal to the bi-epicondylar line. CONCLUSION The motor branches to the BR and FCR are variable in their origin, and the knowledge of such variations is essential for identifying them while performing selective neurotomy surgeries.
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Affiliation(s)
- M Hosapatna
- MD Anatomy, Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, 576104 Manipal, Karnataka, India
| | - A D Souza
- MD Anatomy, Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, 576104 Manipal, Karnataka, India
| | - M Rao
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - V Hari Ankolekar
- MD Anatomy, Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, 576104 Manipal, Karnataka, India.
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Brachioradialis Flap for Soft Tissue Coverage of Posterior Elbow Wounds: Case Report and Surgical Technique. Tech Hand Up Extrem Surg 2018; 23:2-5. [PMID: 30395081 DOI: 10.1097/bth.0000000000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The posterior aspect of the elbow is an area prone to chronic wound complications due to its prominence and the tensile forces resulting from elbow range of motion. In situations in which local wound care fails, various options for soft tissue coverage are available, including the anconeus, lateral arm, radial forearm, extensor carpi radialis longus, and flexor carpi ulnaris flaps. Each option offers unique considerations depending on the complexity and extent of the soft tissue defect. In situations in which coverage of a large defect is required, or when primary soft tissue coverage options fail, an alternative option is the brachioradialis rotational muscle flap. We present a review of the literature, case report, and surgical technique using the brachioradialis muscle for coverage of a large posterior elbow wound after failure of an anconeus flap.
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Forearm-Based Turnover Muscle Flaps for Elbow Soft-Tissue Reconstruction: A Comparison of Regional Coverage Based on Distal Flap Perfusion. Plast Reconstr Surg 2018; 142:152-157. [PMID: 29652763 DOI: 10.1097/prs.0000000000004472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elbow wounds pose a reconstructive challenge. Prior studies have described the vascular anatomy of both the brachioradialis and flexor carpi ulnaris muscle flaps. The goal of this study was to describe the distal flap perfusion of the flexor carpi radialis, with a direct comparison of the brachioradialis, flexor carpi ulnaris, and flexor carpi radialis muscle flaps for coverage around the elbow. METHODS Six fresh-frozen upper extremity specimens were dissected for brachioradialis, flexor carpi radialis, and flexor carpi ulnaris flaps. Vascular data from prior studies were combined with our anatomical measurements to determine the area of perfused coverage around the elbow for the brachioradialis and flexor carpi ulnaris. The flexor carpi radialis flap distal vascular perfusion was examined separately with transverse sections at 1-cm intervals after India ink injections to determine distal flap perfusion and elbow coverage. Perfusion data were plotted on x and y axes over the posterior elbow. RESULTS The brachioradialis muscle covered an average of 56 percent of the x axis and 7.4 percent of the y axis. The flexor carpi ulnaris muscle covered an average of 90 percent of the elbow along the x axis and 23.3 percent of elbow along the y axis. The flexor carpi radialis covered an average of 34 percent of the x axis and 4.8 percent of the y axis. CONCLUSION The flexor carpi ulnaris muscle provides the most versatile and robust coverage over the posterior elbow, followed by the brachioradialis muscle, which consistently provides coverage over the lateral epicondyle.
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The role of brachioradialis release during AO type C distal radius fracture fixation. Orthop Traumatol Surg Res 2017; 103:1099-1103. [PMID: 28782697 DOI: 10.1016/j.otsr.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/21/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, whether this common procedure makes the reduction and fixation easier and affects the elbow function has not been fully understood. HYPOTHESIS Brachioradialis (BR) release during volar plate fixation for type C distal radius fractures makes internal reduction and fixation easier, and it does not adversely affect wrist or elbow function. MATERIAL AND METHODS A total of 74 patients treated with 2.4mm volar locking compression column plate (VCP) were analyzed for type C distal radius fractures prospectively. The patients were divided into two groups, group A with BR release and group B without BR release. The two groups were compared in terms of "internal reduction and fixation time" during the operation, wrist and elbow function including the scores of Gartland and Werley (G-W), Patient-related wrist evaluation score (PRWE), Mayo Elbow Performance Score (MEPS), the Disabilities of the arm, shoulder, and hand (DASH) and a Visual analog scale (VAS) for pain at 6 and 12 months postoperatively. The radial inclination angle, palmar tilt angle and ulnar variance were also measured from the radiographs. RESULTS According to the follow-up of the 74 patients, no significant differences were observed between the two groups on MEPS, DASH, G-W, PRWE, VAS and radiological outcomes at 6 and 12 months postoperatively. Mean time of reduction and internal fixation was significantly shorter in group A than that in group B. CONCLUSION Release of the BR for type C distal radius fractures facilitated the surgical procedure and did not adversely affect elbow and wrist function. LEVEL OF EVIDENCE II, prospective comparative study.
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Fontaine C, Bry R, Laronde P, Guerre E, Aumar A. [Descriptive, radiographic, topographic and functional anatomy applied to distal radius fractures]. HAND SURGERY & REHABILITATION 2016; 35S:S3-S14. [PMID: 27890208 DOI: 10.1016/j.hansur.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/17/2016] [Accepted: 07/04/2016] [Indexed: 10/20/2022]
Abstract
Extensive anatomical knowledge is needed in order to correctly treat distal radius fractures: normal and pathological osteology of the distal radius, distal radio-ulnar joint and radiocarpal joint-both on the descriptive and functional level-the neurovascular and muscular environments of the distal radius-which are essential to the surgical approaches-and the angles that need to be restored during the reduction. All of these concepts are broached in this article.
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Affiliation(s)
- C Fontaine
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France; Laboratoire d'automatique, de mécanique et d'informatique industrielle et humaine (LAMIH), université de Valenciennes et du Hainaut-Cambrésis, Le-Mont-Houy, 59313 Valenciennes cedex, France.
| | - R Bry
- Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France; Laboratoire d'automatique, de mécanique et d'informatique industrielle et humaine (LAMIH), université de Valenciennes et du Hainaut-Cambrésis, Le-Mont-Houy, 59313 Valenciennes cedex, France
| | - P Laronde
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
| | - E Guerre
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
| | - A Aumar
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
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Ballaz L, Raison M, Detrembleur C, Gaudet G, Lemay M. Joint torque variability and repeatability during cyclic flexion-extension of the elbow. BMC Sports Sci Med Rehabil 2016; 8:8. [PMID: 27073689 PMCID: PMC4828922 DOI: 10.1186/s13102-016-0033-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Abstract
Background Joint torques are generally of primary importance for clinicians to analyze the effect of a surgery and to obtain an indicator of functional capability to perform a motion. Given the current need to standardize the functional evaluation of the upper limb, the aim of this paper is to assess (1) the variability of the calculated maximal elbow joint torque during cyclic elbow flexion-extension movements and (2) participant test-retest repeatability in healthy young adults. Calculations were based on an existing non-invasive method including kinematic identification and inverse dynamics processes. Methods Twelve healthy young adults (male n = 6) performed 10 elbow flexion-extension movement carrying five different dumbbells (0, 1, 2, 3 and 4 kg) with several flexion-extension frequencies (½, 1/3, ¼ Hz) to evaluate peak elbow joint torques. Results Whatever the condition, the variability coefficient of trial peak torques remained under 4 %. Bland and Altman plot also showed good test-retest, whatever the frequency conditions for the 0, 1, 2, and 3 kg conditions. Conclusion The good repeatability of the flexion-extension peak torques represents a key step to standardize the functional evaluation of the upper limb.
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Affiliation(s)
- Laurent Ballaz
- Department of kinanthropology, Université du Québec à Montréal, Montreal, Qc Canada ; Research & Engineering Chair Applied to Pediatrics (RECAP), Marie Enfant Rehabilitation Centre (CRME) - Research Center - Sainte-Justine UHC, and École Polytechnique de Montréal, Montreal, Qc Canada
| | - Maxime Raison
- Department of mechanical engineering, École Polytechnique de Montréal, Montreal, Qc Canada ; Research & Engineering Chair Applied to Pediatrics (RECAP), Marie Enfant Rehabilitation Centre (CRME) - Research Center - Sainte-Justine UHC, and École Polytechnique de Montréal, Montreal, Qc Canada ; CRME - Research Center, Office GR-123, 5200, East Bélanger Street, H1T 1C9 Montréal, QC Canada
| | - Christine Detrembleur
- Institute of NeuroSciences (IoNS), Université catholique de Louvain, Bruxelles, Belgium
| | - Guillaume Gaudet
- Department of mechanical engineering, École Polytechnique de Montréal, Montreal, Qc Canada ; Research & Engineering Chair Applied to Pediatrics (RECAP), Marie Enfant Rehabilitation Centre (CRME) - Research Center - Sainte-Justine UHC, and École Polytechnique de Montréal, Montreal, Qc Canada
| | - Martin Lemay
- Department of kinanthropology, Université du Québec à Montréal, Montreal, Qc Canada ; Research & Engineering Chair Applied to Pediatrics (RECAP), Marie Enfant Rehabilitation Centre (CRME) - Research Center - Sainte-Justine UHC, and École Polytechnique de Montréal, Montreal, Qc Canada
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Kim JK. In reply. J Hand Surg Am 2015; 40:862-3. [PMID: 25813931 DOI: 10.1016/j.jhsa.2015.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, South Korea
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Xie RG. Regarding "The effect of brachioradialis release during distal radius fracture fixation on elbow flexion strength and wrist function". J Hand Surg Am 2015; 40:862. [PMID: 25813932 DOI: 10.1016/j.jhsa.2015.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Ren-Guo Xie
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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The effect of brachioradialis release during distal radius fracture fixation on elbow flexion strength and wrist function. J Hand Surg Am 2014; 39:2246-50. [PMID: 25218141 DOI: 10.1016/j.jhsa.2014.07.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify whether brachioradialis (BR) release during volar plate fixation for a distal radius fracture affects elbow flexion strength and wrist function. METHODS A total of 42 consecutive patients who were treated by open reduction volar plate fixation for unstable distal radius fractures were enrolled in this study. The BR was not released in 20 of 42 patients (BR preserved group) and was released in 22 patients (BR released group). The primary outcome variable was isokinetic strength and endurance testing of elbow flexion measured by the Cybex isokinetic system 3 months after surgery. Measured at the same time, secondary outcome variables were grip strength, a visual analog scale score for wrist pain, Disabilities of the Arm, Shoulder, and Hand score, and radiographic parameters. We used Mann-Whitney U tests to compare these variables between groups. RESULTS Neither elbow flexion strength and endurance nor any of the secondary outcome variables differed significantly between groups. CONCLUSIONS Release of the BR during a volar approach for a distal radius fracture did not adversely affect elbow flexion strength and wrist function. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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