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Wahbeh JM, Kelley BV, Shokoohi C, Park SH, Devana SK, Ebramzadeh E, Sangiorio SN, Jeffcoat DM. Comparison of a 2.7-mm and 3.5-mm locking compression plate for ulnar fractures: a biomechanical evaluation. OTA Int 2023; 6:e278. [PMID: 37497388 PMCID: PMC10368380 DOI: 10.1097/oi9.0000000000000278] [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: 09/18/2022] [Accepted: 05/22/2023] [Indexed: 07/28/2023]
Abstract
Objectives Implant prominence after ulnar fracture fixation may be mitigated by the use of lower profile plates. The biomechanical strength and stability of 2.7-mm and 3.5-mm locking compression plates for fixation were compared. Methods Two fracture conditions, transverse (N = 10) and oblique (N = 10), were evaluated in an in vitro study. Half of the specimens for each condition were fixed with 2.7-mm plates and the other half with 3.5-mm plates, all fixed with conventional dynamic compression mechanisms. Specimens were loaded under ±2 Nm of cyclic axial torsion, then under 10 Nm of cyclic cantilever bending, and bending to failure. Interfragmentary motion and strain were analyzed to determine construct stability as a function of fracture pattern and plate size. Results Interfragmentary motion was significantly larger in all constructs fixed with 2.7-mm plates, compared with 3.5-mm plates (P < 0.01). The 2.7-mm constructs with transverse fractures had the greatest motion, ranging between 5° and 10° under axial rotation and 5.0-6.0 mm under bending. Motions were the lowest for 3.5-mm constructs with oblique fractures, ranging between 3.2 and 4.2 mm under bending and 2°-3.5° for axial rotation. For oblique fractures, the bending moment at ultimate failure was 31.4 ± 3.6 Nm for the 2.7-mm constructs and 10.0 ± 1.9 Nm for 3.5-mm constructs (P < 0.01). Similarly, for transverse fractures, the bending moment was 17.9 ± 4.0 Nm for the 2.7-mm constructs and 9.7 ± 1.3 Nm for the 3.5-mm constructs (P < 0.01). Conclusions Although 3.5-mm plates were more effective at reducing fracture motion, they were consistently associated with refracture at the distal-most screw hole under load to failure. By contrast, 2.7-mm plates plastically deformed despite excessive loads, potentially avoiding a subsequent fracture. Level of Evidence Level V.
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Affiliation(s)
- Jenna M. Wahbeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA
- University of California, Los Angeles, Department of Bioengineering, Los Angeles, CA
| | - Benjamin V. Kelley
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Cyrus Shokoohi
- University of California, Los Angeles, Department of Bioengineering, Los Angeles, CA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Sai K. Devana
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Sophia N. Sangiorio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA
- University of California, Los Angeles, Department of Bioengineering, Los Angeles, CA
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA
| | - Devon M. Jeffcoat
- University of California, Los Angeles, Department of Orthopaedic Surgery, Los Angeles, CA
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Giddins G. The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability? J Hand Surg Eur Vol 2023; 48:230-245. [PMID: 36638098 DOI: 10.1177/17531934221140238] [Citation(s) in RCA: 1] [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] [Indexed: 01/14/2023]
Abstract
The importance of distal radioulnar joint problems associated with distal radial fractures is recognized increasingly. But there remains considerable disagreement about how to treat these problems both acutely and chronically. This review outlines the knowledge about the natural history of ulnar-sided wrist problems with distal radials fractures. In particular, the recent increased understanding of the almost inevitable joint instability associated with distal radial fractures is highlighted, including the unreliability of clinical assessment and hence why there has been so much misunderstanding. Provided there is reasonable bony alignment, most ulnar-sided wrist problems can be treated non-operatively initially (typically for over a year) in anticipation of substantial improvement with time. The exception is early marked subluxation of the distal radioulnar joint (DRUJ) blocking forearm rotation, which needs urgent (typically closed) reduction.
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Gauthier M, Beaulieu JY, Nichols L, Hannouche D. Ulna hook plate osteosynthesis for ulna head fracture associated with distal radius fracture. J Orthop Traumatol 2022; 23:39. [PMID: 35972706 PMCID: PMC9381665 DOI: 10.1186/s10195-022-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Distal ulna head or neck fracture is commonly associated with distal radius fracture. Treatment of these fractures remains controversial. Plate osteosynthesis is commonly performed. The purpose of this study was to observe clinical and radiological outcomes in ulna hook plate osteosynthesis for distal ulna fracture associated with distal radius fracture. Materials and methods This retrospective study between 2010 and 2018 included patients presenting combined displaced distal ulna fracture and distal radius fracture who were treated with ulna hook plate osteosynthesis. Patient evaluation included pain measurement with the visual analog scale, wrist range of motion, grip and pinch strengths, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and Mayo wrist score. Preoperative radiographs were reviewed to classify the distal ulna fracture according to Biyani. Bone union was evaluated on postoperative X-rays. At final follow-up, the usual radiographic parameters were measured and distal radioulnar joint (DRUJ) osteoarthritis was assessed. Results A total of 48 patients were included. Mean age was 63 years old and mean follow-up was 28 months. According to the Biyani classification, there were 12 type I, 4 type II, 8 type III, and 24 type IV distal ulna fractures. Wrist flexion was 60°, extension 57°, pronation 85°, and supination 80°. Grip strength was 21 kg (86% of the uninjured opposite side). Pinch strength was 6.6 kg (92% of the uninjured opposite side). Clinical scores were very good to excellent, with a mean Q-DASH of 12 and a Mayo wrist score of 90. Discomfort or pain due to the implant that required implant removal was reported in 29%, and was higher in younger patients. Nonunion was observed in two cases and secondary implant displacement in one case. These three cases required secondary intervention with ulna head resection, which was higher in Biyani type IV. DRUJ osteoarthritis was observed in 12 patients (31%) and was higher in older patients. Conclusions Ulna hook plate fixation gives good clinical results and a high rate of fracture union, but complications are common. Implant irritation is a frequent complication, especially in young patients, and often requires implant removal. Level of evidence: IV
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Affiliation(s)
- Morgan Gauthier
- Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Jean-Yves Beaulieu
- Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Lucille Nichols
- Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Traumatology, University Hospitals of Geneva, Geneva, Switzerland
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Kurozumi T, Miyamoto H, Suzuki T, Watanabe Y. Does Simultaneous Fixation of Both Distal Radius and Distal Ulnar Fractures Improve Outcomes? A Retrospective Cohort Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211038089. [PMID: 34434592 PMCID: PMC8381409 DOI: 10.1177/21514593211038089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Distal metaphyseal ulnar fractures are often found in
conjunction with distal radius fractures. However, there is no consensus on optimal
management. The purpose of this study was to determine whether simultaneous fixation of
both distal radius and distal ulnar fractures would improve outcomes. Materials and
Methods: Patients treated for distal radial fractures over a 4-year period at our
trauma center were identified, and their medical records were analyzed. Twenty-three
patients met the inclusion criteria for this study. All radius fractures were fixed using
a volar locking plate. Fourteen ulnar fractures were treated with surgical fixation, and
nine were treated conservatively. Data were collected on patient demographics, mechanism
of injury, whether it was a closed or open fracture, Gustilo classification, AO/OTA
classification, immobilization period, follow-up period, and type of treatment. Physical
findings comprising the active range of motion and grip strength and radiological
findings, including the ulnar variance compared to the healthy side and bone union, were
evaluated. Clinical outcomes were assessed using the quick Disabilities of the Arm,
Shoulder, and Hand scores. Results: There was no significant difference
between the groups in the quick Disabilities of the Arm, Shoulder, and Hand scores, but
the arc of dorsi-palmar flexion was more restricted in the operative group than in the
conservative group. Other results were not significantly different between the two groups.
Discussion: Fixation of distal metaphyseal ulnar fractures can be
challenging, and several studies have shown the validity of conservative treatments. This
supports the view that if the distal radius fracture is anatomically and rigidly fixed,
distal metaphyseal ulnar fractures can be successfully managed conservatively.
Conclusion: Our results did not show any merit in the simultaneous fixation
of both distal radius and distal ulnar fractures. Thus, needless surgery should be
avoided.
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Affiliation(s)
- Taketo Kurozumi
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Hideaki Miyamoto
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Takashi Suzuki
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
| | - Yoshinobu Watanabe
- Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan
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Zhang Y, Shao Q, Yang C, Ai C, Zhou D, Yu Y, Sun G. Finite element analysis of different locking plate fixation methods for the treatment of ulnar head fracture. J Orthop Surg Res 2021; 16:191. [PMID: 33722253 PMCID: PMC7958469 DOI: 10.1186/s13018-021-02334-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Ulnar head fractures are increasingly higher with the growing proportion of the elderly people. Failure to achieve a stable anatomic reduction of ulna head fracture may lead to a distal radioulnar joint (DRUJ) dysfunction and nonunion of the distal radius. Due to the lack of the postoperative reporting outcomes and the biomechanical studies, it has not been well established about the optimal management of the comminuted distal ulna head fracture. Hence, the purpose of this study is to use finite element analysis to explain the advantages and disadvantages of ulnar-side locking plate fixation compared with dorsal-side locking plate fixation and its screw arrangement in the treatment of ulnar head fractures. Methods FE models of the ulnar head fracture and the models of ulnar-side locking plate and dorsal-side plate with two or three distal screws was constructed. In order to simulate forces acting on the ulnar and the osteosynthesis material during daily-life activity in subjects who underwent reconstructive surgery, we applied three loading conditions to each model, viz. 20 N axial compression, 50 N axial compression, 1 N∙m torsion moment, 1 N∙m lateral bending moments, and 1 N∙m extension bending moments. Under these conditions, values of the von Mises stress (VMS) distribution of the implant, peak VMS, the relative displacement of the head and shaft fragments between the fracture ends and the displacement and its direction of the models were investigated. Results The stress values of ulnar-side plates were lower than those of dorsal-side plates. And the ulnar-plate fixation system also has smaller maximum displacement and relative displacement. When adding a screw in the middle hole of the ulnar head, the values of model displacement and the peak stress in fixation system are lower, but it may evidently concentrate the stress on the middle screw. Conclusions In conclusion, our study indicated that ulnar-side locking plates resulted in a lower stress distribution in the plate and better stability than dorsal-side locking plates for ulnar head fracture fixation. Adding an additional screw to the ulnar head could increase the stability of the fixation system and provide an anti-torsion function. This study requires clinical confirmation of its practicality in the treatment of ulnar head fractures. This study requires clinical confirmation as to its practicality in the treatment of ulnar head fracture.
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Affiliation(s)
- Yue Zhang
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Qin Shao
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Changqing Ai
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China
| | - Di Zhou
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yang Yu
- Walkman biomaterial CO., LTD, Tianjin, 301609, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, Tongji University School of Medicine, No 150, Ji Mo Road, Shanghai, 200120, China.
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Ma Y, Yin Q, Rui Y, Gu S, Yang Y. Image classification for Die-punch fracture of intermediate column of the distal radius. Radiol Med 2017; 122:928-933. [PMID: 28776224 DOI: 10.1007/s11547-017-0797-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to analyze the imaging findings of Die-punch fracture of intermediate column of the distal radius, and to explore the clinical application value of image classification. METHODS The clinical data of 45 patients who were admitted to our hospital from May 2010 to October 2016 were analyzed retrospectively. All patients met the inclusion criteria for Die-punch fracture. X-ray and CT scan were performed to examine the fracture, and the results were assessed by two doctors in a double blind method. Finally, the image classification of Die-punch fracture was formulated. RESULTS According to the imaging features of Die-punch fracture, it was divided into four types: type I (dorsal type, 15 cases), type II (volar type, 8 cases), type III (splitting type, 10 cases), type IV (collapsed type, 12 cases). The accuracy rate of CT was 100% (45/45). The misclassification rate of X-ray was 15.6% (7/45) and the missed diagnosis rate was 11.1% (5/45). CONCLUSIONS CT examination could accurately diagnose Die-punch fracture and perform preoperative image classification.
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Affiliation(s)
- Yunhong Ma
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Ying Yang
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
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