1
|
Drummond I, Durand-Hill M, Jones N, O'Hagan PJ, Edwards D. Systematic review: dorsal bridge plating in distal radius fractures. Musculoskelet Surg 2024; 108:359-366. [PMID: 38967772 PMCID: PMC11371870 DOI: 10.1007/s12306-024-00822-4] [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] [Received: 07/13/2023] [Accepted: 05/03/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Distal radius fractures are the most common upper limb fractures in adults (up to 18% of all fractures in the Emergency Department). Conservative management is possible for the majority, the preferred surgical technique being volar plate fixation. Dorsal bridge plating (DBP) is an alternative method of treatment for complex fractures. DBP acts as an internal fixator and can be used in patients needing early rehabilitation. This systematic review assesses the demographics, functional and radiological outcomes and complications of using DBP in patients with distal radius fractures compared to volar plate fixation. METHODS A literature search of PubMed, Cochrane, EMBASE and Google Scholar was performed according to PRISMA guidelines. Seven hundred and sixty-one articles were found; 11 articles met the inclusion criteria. Cadaveric studies and case studies of less than five patients were excluded. Primary outcome measures were functional and radiological outcomes. Complications were recorded as secondary outcomes. RESULTS Three hundred and ninety-four patients were included in the study with an average age of 54.8 years (53.9% male and 46.1% female). Weighted mean follow-up was 55.2 weeks; the mean time to plate removal was 17.3 weeks with a mean DASH score of 25.7. The weighted range of movement was 46.9° flexion, 48.8° extension, 68.4° pronation and 67.5° supination. The radiological parameters show satisfactory outcomes with a mean radial height of 10mm, volar tilt of 3.1°, ulnar variance of 0.5mm and radial inclination of 18.8°. The complication rate was 11.4%. Digital stiffness was the most common complication but improved if tenolysis was performed at plate removal. CONCLUSIONS DBP is a good alternative to volar plating for complex distal radius fractures. The functional outcomes showed a slight loss of range of movement, whereas the radiological outcomes were within recommended limits. A significant disadvantage of the plate is the need for further surgical removal.
Collapse
Affiliation(s)
- I Drummond
- Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - M Durand-Hill
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - N Jones
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - P J O'Hagan
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Edwards
- Royal London Hospital, Barts Health NHS Trust, London, UK
- Centre for Neuroscience, Surgery and Trauma within Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
2
|
Emmert AS, Swenson AK, Matar RN, Ross PR, Stern PJ. Characterization of Major Complications of Bridge Plating of Distal Radius Fractures at a Level I Trauma Center. Hand (N Y) 2024:15589447241257964. [PMID: 38869067 DOI: 10.1177/15589447241257964] [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] [Indexed: 06/14/2024]
Abstract
BACKGROUND Comminuted, markedly displaced distal radius fractures can cause instability requiring advanced stabilization with dorsal bridge plating. However, published complication rates of bridge plating widely vary. We hypothesize that complications of bridge plating of distal radius fractures are more prevalent than published rates. METHODS A retrospective review was performed on all patients at an academic level I trauma center treated with a bridge plate for a distal radius fracture from 2014 to 2022. RESULTS Sixty-five wrists were included in the final analysis: average age 53 years, male 51%, average plate retention 4 months, and average follow-up 6 months. Carpal tunnel release (CTR) was performed at time of primary procedure in 7 (10%) cases. Radial height, radial inclination, dorsal tilt, and ulnar variance were all significantly improved (P < .001). Grip strength, flexion, extension, and supination were significantly limited (P < .03). Twenty-one patients (32%) developed 35 major complications requiring unplanned reoperation, including mechanical hardware-related complication (15%), deep infection (11%), nonunion/delayed union (9%), adhesions (6%), median neuropathy (6%), symptomatic arthritis (5%), and tendon rupture (2%). Plate breakage occurred in 3 patients (5%) and was always localized over the central drill holes of the bridge plate. CONCLUSIONS Major complications for bridge plating of distal radius fractures were higher at our institution than previously published. Plate breakage should prompt reconsideration of plate design to avoid drill holes over the wrist joint. Signs and symptoms of carpal tunnel syndrome should be carefully assessed at initial presentation, and consideration for concomitant CTR should be strongly considered.
Collapse
Affiliation(s)
| | - Alan K Swenson
- Orthopedic Physicians Alaska, OrthoAlaska, Anchorage, USA
| | | | | | - Peter J Stern
- University of Cincinnati College of Medicine, OH, USA
| |
Collapse
|
3
|
Esworthy GP, Shaji V, Duraku L, Wu F, Power DM. Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature. J Wrist Surg 2024; 13:282-292. [PMID: 38808186 PMCID: PMC11129887 DOI: 10.1055/s-0043-1770791] [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: 10/12/2022] [Accepted: 05/22/2023] [Indexed: 05/30/2024]
Abstract
Background Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results. There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.
Collapse
Affiliation(s)
- George P. Esworthy
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - Vibha Shaji
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - Liron Duraku
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Feiran Wu
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
| | - Dominic M. Power
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
| |
Collapse
|
4
|
Carroll TJ, Dondapati A, Malin M, Ketonis C, Hammert W, Gonzalez R. Clinical and Radiographic Outcomes Following Volar-Locked Plating Versus Dorsal Bridge Plating for Distal Radius Factures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:227-232. [PMID: 38903832 PMCID: PMC11185889 DOI: 10.1016/j.jhsg.2023.11.008] [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] [Received: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose Distal radius fractures (DRFs) indicated for operative intervention are most commonly treated with volar-locked plating (VLP); however, dorsal bridge plating (DBP) has been used as an alternative fixation method. The purpose of this study was to use a propensity score to match and compare the radiographic and clinical outcomes of patients undergoing isolated VLP or DBP for DRFs. Methods We performed a retrospective, propensity score-matched analysis of patients undergoing isolated VLP or DBP treatment for isolated DRFs from 2015 to 2022 at a single level-1 trauma center. Patients were propensity score-matched by a total of eight demographic and comorbidity factors, AO Foundation/Orthopedic Trauma Association classification, and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Our primary outcomes included postoperative complications, wrist and forearm range of motion (ROM), grip strength, and radiographic measurements, including radial height, radial inclination, volar tilt, and articular step-off. Results Overall, 415 DBP and 2075 VLP were successfully propensity score-matched and included in this study. Grip strength and ROM measurements at the 6-month follow-up, including wrist flexion, wrist extension, forearm pronation, forearm supination, radial deviation, and ulnar deviation, were increased in the VLP compared with DBP (P < .05). Complication rates among both the groups were relatively low; however, the rates of malunion and nonunion were significantly higher among the DBP group (P < .05). Radial height, radial inclination, and articular step-off were improved in the VLP group compared with the DBP group (P < .05); however, volar tilt was similar between groups. PROMIS upper extremity and physical function were significantly higher among the VLP group (P < .05). No significant difference was noted in PROMIS pain interference between the groups. Conclusions When compared with DBP, patients undergoing VLP are more likely to have improved clinical and radiographic outcomes. Although improvement in wrist and forearm ROM and radiographic parameters is statistically significant, it may not be clinically relevant. Type of study/level of evidence Therapeutic III.
Collapse
Affiliation(s)
- Thomas John Carroll
- Department of Orthopaedic Surgery, University of Rochester School, University of Rochester, Rochester, NY
| | - Akhil Dondapati
- Department of Orthopaedic Surgery, University of Rochester School, University of Rochester, Rochester, NY
| | - Michaela Malin
- Department of Orthopaedic Surgery, University of Rochester School, University of Rochester, Rochester, NY
| | - Constantinos Ketonis
- Department of Orthopaedic Surgery, University of Rochester School, University of Rochester, Rochester, NY
| | - Warren Hammert
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Ronald Gonzalez
- Department of Orthopaedic Surgery, University of Rochester School, University of Rochester, Rochester, NY
| |
Collapse
|
5
|
Fones L, O'Mara LC, Gallant G, Kwok M, Abboudi J, Beredjiklian P. Distal Radius Fracture Therapy Utilization Following Traditional Open Reduction and Internal Fixation and Dorsal Bridge Plate Fixation. Cureus 2024; 16:e54875. [PMID: 38533157 PMCID: PMC10964216 DOI: 10.7759/cureus.54875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Background Many distal radius fractures are treated with a volar locking plate, but a minority undergo dorsal bridge plate fixation. This study's primary purpose was to compare therapy utilization following distal radius fractures treated with traditional open reduction and internal fixation (ORIF) versus dorsal bridge plate fixation. Secondary outcomes were time to first and last therapy visits and therapy costs. Methods Patients over 18 years old who underwent distal radius ORIF between January 2021 and August 2022 at a single regional orthopedic practice were identified. Patients who underwent post-operative hardware removal were retrospectively reviewed to identify dorsal bridge plate fixation patients. This resulted in "traditional ORIF" and "dorsal bridge plate" groups. Therapy visit number, cost, and payor (insurance type including Medicare, private insurance, worker's compensation, automobile policy, and private pay) were collected. Results In total, 1,376 patients met the inclusion criteria. Of these, 713 of the 1,283 (55.6%) patients in the traditional ORIF group and 25 of the 44 patients (56.8%) in the dorsal bridge plate group attended therapy at our institution. Traditional ORIF and dorsal bridge plate patients averaged 12.6(±10) and 24(±18.7) therapy visits in the one-year following ORIF, respectively. Time to last therapy visit was 90.9(±60) and 175.2(±72.1) days in the traditional ORIF and dorsal bridge plate groups, respectively. Total therapy cost was $1,219(±$1,314) and $2,015(±$1,828) in the traditional ORIF and dorsal bridge plate groups with similar out-of-pocket costs. Conclusions Dorsal bridge plate fixation patients attended a greater number of therapy sessions, had a longer time from surgery until therapy end, and had a higher therapy total cost relative to traditional ORIF, but both groups had similar patient out-of-pocket therapy costs.
Collapse
Affiliation(s)
- Lilah Fones
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Lauren C O'Mara
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Gregory Gallant
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Moody Kwok
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jack Abboudi
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| |
Collapse
|
6
|
Komura S, Hirakawa A, Hirose H, Yamamoto K, Matsushita Y, Matsumoto K, Akiyama H. Reconstruction of a severe comminuted distal radius fracture with a large segmental bone defect by dorsal bridge plating combined with a vascularized fibular graft: A case report. J Orthop Sci 2023; 28:1508-1512. [PMID: 34507872 DOI: 10.1016/j.jos.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hitoshi Hirose
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kyosuke Yamamoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
7
|
Lui H, Kakar S. Dorsal Subluxation of The Proximal Carpal Row with the Use of a Bridge Plate. J Wrist Surg 2023; 12:442-445. [PMID: 37841356 PMCID: PMC10569840 DOI: 10.1055/s-0042-1757440] [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: 03/28/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022]
Abstract
Background Spanning bridge plates were first popularized for fixation of complex distal radius fractures. However, indications for their use have expanded including the surgical treatment algorithm for treating conditions such as Kienböck's disease. Traditionally, initial surgical treatment of Lichtman Stages II to III Kienböck's disease included lunate decompression, unloading, and revascularization procedures. The addition of a dorsal spanning bridge plate further facilitates lunate offloading and may improve bone revascularization. Case Description We report a complication of proximal carpal row dorsal subluxation secondary to dorsal spanning plate fixation in a patient with Stage IIIb Kienböck's disease. The patient had undergone wrist arthroscopy, lunate forage, radius core decompression, and spanning plate fixation. At 6 weeks after surgery, radiographic imaging demonstrated dorsal subluxation of the proximal carpal row that was corrected upon bridge plate removal. Serial radiographs during follow-up showed no further carpal subluxation without Kienböck's disease progression at 12 months postremoval of hardware. Patient remains pain free and has returned to elite level sport. Literature Review To our knowledge no previous cases of proximal carpal row subluxation with the use of dorsal bridge plate has been reported in the literature. Clinical Relevance Proximal row carpal subluxation can occur with dorsal bridge plate fixation.
Collapse
Affiliation(s)
- Hayman Lui
- Division of Hand Surgery, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
8
|
Chung SR, Chung KC. Recognizing and Treating Unique Distal Radius Fracture Patterns that are Prone to Displacement. Hand Clin 2023; 39:279-293. [PMID: 37453757 DOI: 10.1016/j.hcl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
An unstable distal radius fracture is one that is not capable of resisting displacement after initial closed reduction. The challenge in managing distal radius fractures is identifying which fractures are prone to displacement. Currently, there are no standard criteria for assessing the stability of distal radius fractures. The fracture pattern and patient characteristics should be taken into consideration when treating distal radius fractures. This article discusses how to recognize and manage distal radius fractures that are prone to displacement.
Collapse
Affiliation(s)
- Sze Ryn Chung
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, 20, College Road, 169856 Singapore
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
| |
Collapse
|
9
|
Patzkowski JC, Dunn JC. Editorial Comment: Selected Proceedings From the Society of Military Orthopaedic Surgeons 2021 Annual Meeting. Clin Orthop Relat Res 2022; 480:2108-2110. [PMID: 36173767 PMCID: PMC9555938 DOI: 10.1097/corr.0000000000002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jeanne C. Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
- Assistant Professor of Surgery, Texas Tech University, El Paso, TX, USA
| | - John C. Dunn
- Assistant Professor of Surgery, Texas Tech University, El Paso, TX, USA
| |
Collapse
|
10
|
Lüdi S, Kurz C, Deforth M, Ghafoor H, Haefeli M, Honigmann P. Radiological, Clinical and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures. J Hand Surg Am 2022; 48:377-387. [PMID: 35190216 DOI: 10.1016/j.jhsa.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/17/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures. METHODS We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires. RESULTS Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients. CONCLUSION The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent. LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Simona Lüdi
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Charlotte Kurz
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Handclinic AG Rüti, Rüti, Switzerland
| | - Manja Deforth
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Mathias Haefeli
- Hand Surgery, Kantonsspital Graubünden, Chur, Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Medical Additive Manufacturing research group, Department of Biomedical Engineering, University of Basel, Switzerland
| |
Collapse
|
11
|
Abstract
The management of distal radius fractures has evolved considerably in the last two decades. Techniques and hardware have improved so much that the surgeon can usually assure good results in these debilitating fractures. Yet no one method can be used for all injuries, as the personality of each fracture demands a customized approach. Furthermore, what works in one age group may not work in another. For this reason, every available treatment has its own space in our options. The need for surgeons to be well versed in all techniques is critical. We offer a concise update of important evolutionary and current treatment guidelines for this common fracture.
Collapse
Affiliation(s)
| | - Jesse B Jupiter
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tamara D Rozental
- Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Innsbruck, Austria
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, International University of Health and Welfare, Tokyo, Japan
| | - Gregory I Bain
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
| |
Collapse
|
12
|
Zeidan M, Stephens AR, Zhang C, Presson AP, Kazmers NH. Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:235-239. [PMID: 34632351 PMCID: PMC8496877 DOI: 10.1016/j.jhsg.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF. Methods Adult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score. Results Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern. Conclusions At mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation. Type of study/level of evidence Prognostic IV.
Collapse
Affiliation(s)
- Michelle Zeidan
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | | | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
| | | |
Collapse
|