1
|
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.
Collapse
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
| |
Collapse
|
2
|
Chen Z, Zhu Y, Zhang W, Eltagy H, Elerian S. Comparison of Intramedullary Nail and Volar Locking Plate for Distal Radius Fractures: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Cureus 2021; 13:e17972. [PMID: 34667661 PMCID: PMC8516498 DOI: 10.7759/cureus.17972] [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: 09/14/2021] [Indexed: 12/03/2022] Open
Abstract
Operative intervention with a volar locking plate (VLP) is currently the gold standard for the fixation of distal radius fractures. Intramedullary nailing (IMN) of the distal radius is a novel technique that aims to reduce soft tissue complications due to a smaller surgical incision while maintaining the benefits of a rigid fracture fixation. The aim of this systematic review and meta-analysis was to investigate the functional, clinical, and radiological outcomes of all published randomised controlled trials (RCTs) comparing patient outcomes of VLP and IMN in distal radius fracture fixation. Three databases (Ovid MEDLINE, EMBASE, and Cochrane Library) were searched in July 2021. The inclusion criteria were RCTs comparing fixation of extra-articular or simple intra-articular distal radius with VLP or IMN and availability of full text in English. Children under the age of 18 were excluded. Seven trials with a total of 398 patients were included in this meta-analysis. The meta-analysis showed that there were improved short-term clinical outcomes favouring IMN, although there were no significant differences in terms of functional, radiological, and long-term clinical outcomes. Analysis showed that outcomes of IMN are comparable with VLP for fixation of extra-articular and simple intra-articular distal radius fractures. However, these results should be interpreted with caution due to the small sample size. We recommend that further high-quality trials are required to establish the role of IMN in distal radius fixation.
Collapse
Affiliation(s)
- Zehong Chen
- Trauma and Orthopaedics, Sandwell General Hospital, Birmingham, GBR
| | - Yinan Zhu
- Oral and Maxillofacial Surgery, University College Hospital, London, GBR
| | - Wei Zhang
- Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, SGP
| | - Hassan Eltagy
- Trauma and Orthopaedics, Sandwell General Hospital, Birmingham, GBR
| | - Sherif Elerian
- Trauma and Orthopaedics, Sandwell General Hospital, Birmingham, GBR
| |
Collapse
|
3
|
Carula BC, Pereira MDS, Ferreira APB, Ayzemberg H, Steglich V, Stangarlin TS. Analysis of the Clinical and Radiological Results of Bridge Plate Versus External Fixation in Comminuted Distal Radius Fractures. Rev Bras Ortop 2021; 56:61-68. [PMID: 33627901 PMCID: PMC7895615 DOI: 10.1055/s-0040-1713393] [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: 08/16/2019] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate and compare the clinical and radiological outcomes of patients with comminuted distal radius fractures treated with an external fixator or a dorsal bridge plate. Methods In total, 45 patients were analyzed 1 year after surgery; 18 were treated with an external fixator, and 25 received a dorsal bridge plate. An analog pain scale and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were applied, in addition to radiographic, strength and range of motion assessments. Statistical analyzes were performed using the chi-squared test and the Mann-Whitney non-parametric test. Results Fractures were more common in women over 60 years old who suffered falls from their own height. Both methods demonstrated similar functional and radiological results. Infections were more prevalent in patients receiving external fixators, but their residual grip strength was better. Reflex sympathetic neuropathy was more common in subjects treated with a dorsal bridge plate. Conclusion Our analysis showed no consensus on the superiority of one method over the other. Each method had advantages and disadvantages, but both led to good, similar outcomes. The treatment must be chosen according to the profile of the trauma, the patient's clinical conditions, the surgeon's experience, and the availability of materials.
Collapse
Affiliation(s)
- Beatriz Canhoto Carula
- Instituto de Ortopedia e Traumatologia de Joinville, Hospital Municipal São José, Joinville, SC, Brasil
| | - Matheus da Silva Pereira
- Instituto de Ortopedia e Traumatologia de Joinville, Hospital Municipal São José, Joinville, SC, Brasil
| | | | - Henrique Ayzemberg
- Serviço de Residência Médica, Instituto de Ortopedia e Traumatologia de Joinville, Hospital Municipal São José, Joinville, SC, Brasil
| | - Valdir Steglich
- Serviço de Residência Médica, Instituto de Ortopedia e Traumatologia de Joinville, Hospital Municipal São José, Joinville, SC, Brasil
| | - Tiago Salati Stangarlin
- Serviço de Residência Médica, Instituto de Ortopedia e Traumatologia de Joinville, Hospital Municipal São José, Joinville, SC, Brasil
| |
Collapse
|
4
|
Aita MA, Rodrigues FL, Alves KHCR, de Oliveira RK, Ruggiero GM, Rodrigues LMR. Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study. J Wrist Surg 2019; 8:408-415. [PMID: 31579551 PMCID: PMC6773580 DOI: 10.1055/s-0039-1692480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.
Collapse
Affiliation(s)
- Marcio Aurelio Aita
- Division of Orthopedic and Trauma—Hand and Microsurgery, Department of Surgery, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fabio Lucas Rodrigues
- Division of Orthopedic and Trauma—Hand and Microsurgery, Department of Surgery, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | | | | | - Luciano Miller Reis Rodrigues
- Division of Orthopedic and Trauma—Hand and Microsurgery, Department of Surgery, Faculdade de Medicina do ABC, Santo Andre, Brazil
| |
Collapse
|
5
|
Zhang B, Chang H, Yu K, Bai J, Tian D, Zhang G, Shao X, Zhang Y. Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2161-2169. [DOI: 10.1007/s00264-017-3460-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
|
6
|
The influence of bone density and anisotropy in finite element models of distal radius fracture osteosynthesis: Evaluations and comparison to experiments. J Biomech 2015; 48:4116-4123. [PMID: 26542787 DOI: 10.1016/j.jbiomech.2015.10.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022]
Abstract
Continuum-level finite element (FE) models can be used to analyze and improve osteosynthesis procedures for distal radius fractures (DRF) from a biomechanical point of view. However, previous models oversimplified the bone material and lacked thorough experimental validation. The goal of this study was to assess the influence of local bone density and anisotropy in FE models of DRF osteosynthesis for predictions of axial stiffness, implant plate stresses, and screw loads. Experiments and FE analysis were conducted in 25 fresh frozen cadaveric radii with DRFs treated by volar locking plate osteosynthesis. Specimen specific geometries were captured using clinical quantitative CT (QCT) scans of the prepared samples. Local bone material properties were computed based on high resolution CT (HR-pQCT) scans of the intact radii. The axial stiffness and individual screw loads were evaluated in FE models, with (1) orthotropic inhomogeneous (OrthoInhom), (2) isotropic inhomogeneous (IsoInhom), and (3) isotropic homogeneous (IsoHom) bone material and compared to the experimental axial stiffness and screw-plate interface failures. FE simulated and experimental axial stiffness correlated significantly (p<0.0001) for all three model types. The coefficient of determination was similar for OrthoInhom (R(2)=0.807) and IsoInhom (R(2)=0.816) models but considerably lower for IsoHom models (R(2)=0.500). The peak screw loads were in qualitative agreement with experimental screw-plate interface failure. Individual loads and implant plate stresses of IsoHom models differed significantly (p<0.05) from OrthoInhom and IsoInhom models. In conclusion, including local bone density in FE models of DRF osteosynthesis is essential whereas local bone anisotropy hardly effects the models׳ predictive abilities.
Collapse
|