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Kim S, Gong HS. The Effect of Providing Audiovisual Surgical Information on Decisional Conflict in Patients Undergoing Plate Fixation for Distal Radius Fractures. Clin Orthop Surg 2021; 13:18-23. [PMID: 33747373 PMCID: PMC7948042 DOI: 10.4055/cios20092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
Abstract
Backgroud Patients experiencing acute trauma have limited time for their involvement in shared decision making, which may lead to decisional conflict. The purpose of this study was to evaluate whether providing audiovisual surgical information can reduce decisional conflict when deciding between surgical and nonsurgical treatment in patients with distal radius fractures (DRFs) and to evaluate factors that may affect decisional conflict. Methods We prospectively enrolled 50 consecutive patients who presented with acute DRFs and chose to undergo surgery, for which volar plate fixation was recommended. We randomized these patients into 2 groups. The test group was given a video clip of audiovisual surgical information in addition to regular information while the control group was only given regular information. The video clip consisted of the purpose, procedure, and effect of the surgery, precautions and complications after the operation, and other treatment options that could be performed if operation was not performed. At 2 weeks after the surgery, we evaluated patients' decisional conflict using a decisional conflict scale (DCS). In addition, we evaluated factors that might affect decisional conflict, such as age, dominant hand, comorbidities, history of previous operations, perceived disability, and provision of the video clip. Results The test group showed significantly lower DCS scores than the control group (19.6 vs. 32.1, p = 0.001). In multivariate analysis, younger age and provision of the video clip were associated with lower DCS scores. Conclusions This study has demonstrated that providing information through audiovisual media such as video clips could reduce decisional conflict in patients who chose to undergo plate fixation for DRFs. This study also suggests that older patients may need more careful doctor-patient communication as they have more decisional conflict than younger patients.
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Affiliation(s)
- Sehun Kim
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Yao X, Wu L, Li J, Huang W, Wang C, Gu Z, Wang Y. [Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:809-813. [PMID: 32666720 DOI: 10.7507/1002-1892.201911108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures. Methods Between July 2014 and July 2018, 15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation. There were 6 males and 9 females, aged from 30 to 66 years with an average age of 56.6 years. The cause of injury was falling from height in 2 cases and falling in 13 cases. All of them were fresh closed injuries. The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association (AO/OTA) classification. There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability. The time from injury to operation was 6 to 9 days with an average of 7.3 days. The fracture healing and the radial height, palm inclination, and ulnar deviation were observed by X-ray reexamination. Cooney score was used to evaluate the effectiveness. Results All incisions healed by first intention. All patients were followed up 12-24 months, with an average of 14.6 months. X-ray films showed that all fractures healed, and the healing time ranged from 5 to 10 months, with an average of 8.2 months. No internal fixation failure or secondary fracture displacement occurred. At last follow-up, the radial height, palm inclination, and ulnar deviation recovered well, and the differences between pre- and post-operation were significant ( P<0.05). The pain, function, activity, and grip strength scores and the total score of Cooney score were significantly higher than those before operation ( P<0.05). There were 11 cases of excellent, 3 cases of good, and 1 case of good, with an excellent and good rate of 93%. Conclusion For extreme distal radius fractures, the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radialheight, palm inclination, and ulnar deviation, fix firmly, and recover the wrist joint function exercise early, and obtain satisfactory effectiveness.
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Affiliation(s)
- Xiaoke Yao
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Lingna Wu
- Intensive Care Unit, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Jianhua Li
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Wengang Huang
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Chongwen Wang
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Zuchao Gu
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Yue Wang
- Department of Orthopedics, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu Sichuan, 610072, P.R.China
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Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients. Orthop Traumatol Surg Res 2020; 106:319-323. [PMID: 32044260 DOI: 10.1016/j.otsr.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/18/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of the distal radius fracture in elderly remains controversial. The objective was to assess the outcomes of volar locking plate for displaced complete intra-articular distal radius fractures in elderly as compared to younger patients. HYPOTHESIS The outcomes in elderly patients would be comparable with those in younger patients with a low rate of complications. MATERIAL AND METHODS Non-randomised prospective comparative study between 70 patients older than 65 years and 46 younger patients with AO type-C fractures. The main outcome was Disabilities Arm, Shoulder and Hand (DASH) score. Secondary variables were Patient-Rated Wrist Evaluation (PRWE) score, range of motion, Visual Analogue Scale (VAS) for pain, and grip strength. Radiological measurements were also performed. RESULTS The mean follow-up was 30.9 (range, 24-53) months. There were no significant differences in mean DASH, PRWE, VAS-pain, wrist motion or radiological parameters at final follow-up. Multivariate analysis showed that the functional outcomes were significantly influenced by baseline ulnar positivity greater than 3mm at baseline but not by age. DISCUSSION The study hypothesis was confirmed. Surgical treatment with volar locking plate for displaced complete intra-articular fractures of the distal radius in elderly patients represents a safe and effective treatment alternative with similar early complication rate than in younger. LEVEL OF EVIDENCE III, cohort study.
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Kong L, Kou N, Wang Y, Lu J, Tian D, Zhang B. The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures. Med Sci Monit 2019; 25:6598-6604. [PMID: 31477682 PMCID: PMC6738010 DOI: 10.12659/msm.915824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to evaluate the influence of distal radius fractures (DRFs) malalignment on the treatment outcomes in patients over age 65 years. Material/Methods We retrospectively reviewed the records on fresh DRFs treated with closed reduction from December 2014 to January 2018. After treatment, patients were evaluated for the determination of grip strength, the Visual Analog Scale (VAS) during wrist movement, the Patient-Rated Wrist Evaluation (PRWE), the Disabilities of the Arm, Shoulder and Hand (DASH) score, the appearance satisfaction, and active wrist range of motion (ROM). Results A total of 96 patients with complete data were included in our study. During follow-up, there were 75 patients (78.1%) with acceptable reduction and 21 patients (21.9%) with unacceptable reduction. Compared with those having acceptable alignment in the distal radius, patients with unacceptable alignment had weak grip strength, were unsatisfied appearance, and had severe flexion as well as ulnar deviation limitation at 6-month follow-up. A significant correlation was found between ulnar positive variance and grip strength (r=−0.35, P=0.03), as well as dorsal angulation and flexion movement (r=−0.31, P=0.02). Conclusions Conservative treatment should be used differently, even in elderly patients. For low-demand patients, it is not necessary to restore all anatomic radiographic parameters, as malalignment does not increase disability or pain score. However, for patients who are still healthy and active, satisfactory reduction is the first choice, as malalignment can lead to decreased grip strength, dissatisfaction with appearance, and certain wrist limitations.
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Affiliation(s)
- Lingde Kong
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Ningzhao Kou
- Department of Orthopedics, Ningjin County Hospital of Hebei Province, Xingtai, Hebei, China (mainland)
| | - Yanxue Wang
- Department of Pharmacy, Ningjin County Hospital of Hebei Province, Xingtai, Hebei, China (mainland)
| | - Jian Lu
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Dehu Tian
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Bing Zhang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Ali M, Brogren E, Wagner P, Atroshi I. Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations: A Long-Term Follow-up. J Bone Joint Surg Am 2018; 100:633-639. [PMID: 29664849 DOI: 10.2106/jbjs.17.00107] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. METHODS In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of ≥10°, ulnar variance of ≥3 mm, and/or radial inclination of ≤15°. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. RESULTS Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Malunion was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. CONCLUSIONS Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Muhanned Ali
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Hässleholm, Sweden
| | - Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Hässleholm, Sweden.,Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly. INTERNATIONAL ORTHOPAEDICS 2018; 42:2243-2248. [DOI: 10.1007/s00264-018-3903-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol 2018; 43:142-147. [PMID: 28870129 DOI: 10.1177/1753193417727139] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Alejandro Lizaur-Utrilla
- 1 Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain.,2 Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Rectenwald JP, Bentley KA, Murray PM, Saha S. Strain as a Function of Time in Extrinsic Wrist Ligaments Tensioned Through External Fixation. Hand (N Y) 2018; 13:60-64. [PMID: 28720046 PMCID: PMC5755868 DOI: 10.1177/1558944717692091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study is to determine the time-dependent dissipation of extrinsic wrist ligament tension following the application external fixation with axial distraction of the wrist in a cadaveric model. METHODS Six paired fresh-frozen cadaveric specimens underwent mechanical testing simulating external fixation with 1 arm of each pair osteotomized to simulate a distal radius fracture. The change in tension was then recorded over 24 hours. RESULTS The rate of stress relaxation decreased with time. The average loss in tension in the control arms and osteotomized arms was 55% and 59%, respectively, over a 24-hour period. There was no statistically significant difference in the stress relaxation behavior between the 2 groups. CONCLUSION This study further supports the recommendation that comminuted distal radius fractures treated with an external fixator should have Kirschner wire augmentation or other additional means of fixation to help maintain fracture length and alignment. The results of this study call in to question the efficacy of ligamentotaxis alone through external fixation as the sole means of maintaining reduction of displaced, unstable distal radius fractures.
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Affiliation(s)
| | | | - Peter M. Murray
- Mayo Clinic, Jacksonville, FL, USA,Peter M. Murray, Professor and Chair, Department of Orthopedic Surgery and Consultant in Orthopedic Surgery and Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Yin F, Rui Y, Li F, Liu J, Wu Y, Lu Y, Ma Y, Sun Z. [Effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1414-1417. [PMID: 29806378 PMCID: PMC8498268 DOI: 10.7507/1002-1892.201704091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/29/2017] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures. Methods Between January 2014 and May 2016, 21 patients who suffered from extreme distal radial fractures were treated by arthroscopy-assisted combined fixation of Kirschner wire and external fixator. There were 14 males and 7 females with an age of 32-57 years (mean, 42.3 years). The causes of injury included falling in 13 cases and traffic accident in 8 cases. The fracture type included 8 cases of type 23C1, 9 cases of type 23C2, and 4 cases of type 23C3 according to AO/OTA classification. The time from injury to operation was 3-7 days (mean, 4.4 days). The Mayo score and disability of arm, shoulder, and hand (DASH) score were used to assess the pain and function of the wrist joint. Results There was no needle red swelling, tendon irritation, or orther early complications. All the patients were followed up 10-35 months (mean, 18.3 months). The fracture healing time was 9-13 weeks (mean, 10.6 weeks). At last follow-up, the Mayo score was 87-94 (mean, 90.9); and 17 cases were excellent and 4 were good. The DASH score was 7-13 (mean, 10.6). Conclusion Arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures has the advantages of firm fixation, early functional exercise, less postoperative complications, and good functional recovery of wrist joint.
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Affiliation(s)
- Fei Yin
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
| | - Yongjun Rui
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
| | - Fengfeng Li
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000,
| | - Jun Liu
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
| | - Yongwei Wu
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
| | - Yao Lu
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
| | - Yunhong Ma
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
| | - Zhenzhong Sun
- Department of Orthopedics, Wuxi Orthopedic Hospital Affiliated to Soochow University (the Ninth People's Hospital of Wuxi City), Wuxi Jiangsu, 214000, P.R.China
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Roh YH, Lee BK, Baek JR, Noh JH, Gong HS, Baek GH. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg Am 2015; 40:34-41. [PMID: 25446409 DOI: 10.1016/j.jhsa.2014.09.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare surgical outcomes of volar locking plates (VP) and external fixation (EF) (with or without intra-focal fixation) for AO-type C2 and C3 fractures of the distal radius. METHODS From an initial group of 92 patients with AO-type C2 and C3 distal radius fractures who were enrolled in a prospective, randomized study comparing volar plate fixation with external fixation (with or without intra-focal fixation), 74 patients were studied. The researchers evaluated functional assessments (wrist range of motion, grip strength, and Michigan Hand Questionnaire) at each patient visit and measured radiographic assessment (radial inclination, volar tilt, ulnar variance, and articular congruity) at 12 months. RESULTS The grip strength of the VP group was significantly greater than that of the EF group at 3 and 6 months. The range of motion was significantly greater in the VP group than in the EF group at 3 months. There were no significant differences in the range of motion and grip strength between the 2 groups at 12 months. The Michigan Hand Questionnaire score was higher in the VP group than in the EF group at 3 months but was same at 12 months. There was no significant difference between groups with respect to volar tilt or radial inclination. The VP group showed superior radiologic outcomes in terms of the ulnar variance. One patient in the VP group and 3 in the EF group had an intra-articular stepoff deformity greater than 2 mm. This difference did not reach statistical significance. CONCLUSIONS These results for functional recovery after distal radius surgery offer insight into treatment decisions and interpretations of treatment outcomes for patients with comminuted intra-articular distal radius fractures.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Beom Koo Lee
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Ryoon Baek
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ho Noh
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Peters AC, Lafferty PM, Jacobson AR, Cole PA. The Effect of Articular Reduction After Fractures on Posttraumatic Degenerative Arthritis: A Critical Analysis Review. JBJS Rev 2013; 1:01874474-201312000-00004. [PMID: 27490507 DOI: 10.2106/jbjs.rvw.m.00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Paul M Lafferty
- Department of Orthopaedics, Regions Hospital, Mail Stop: 11503L, 640 Jackson Street, St. Paul, MN 55101
| | - Aaron R Jacobson
- Department of Orthopaedics, Regions Hospital, Mail Stop: 11503L, 640 Jackson Street, St. Paul, MN 55101
| | - Peter A Cole
- Department of Orthopaedics, Regions Hospital, Mail Stop: 11503L, 640 Jackson Street, St. Paul, MN 55101
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Fok MWM, Klausmeyer MA, Fernandez DL, Orbay JL, Bergada AL. Volar plate fixation of intra-articular distal radius fractures: a retrospective study. J Wrist Surg 2013; 2:247-254. [PMID: 24436824 PMCID: PMC3764245 DOI: 10.1055/s-0033-1350086] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text. Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted. Results With an average follow-up of 28 months (range 24-70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury. Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach. Level IV retrospective case series.
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Affiliation(s)
- Margaret W. M. Fok
- Department of Orthopaedic Surgery and Hand Surgery, Lindenhof Hospital, Bern, Switzerland
| | - Melissa A. Klausmeyer
- Department of Orthopaedic Surgery and Hand Surgery, Lindenhof Hospital, Bern, Switzerland
| | - Diego L. Fernandez
- Department of Orthopaedic Surgery and Hand Surgery, Lindenhof Hospital, Bern, Switzerland
| | - Jorge L. Orbay
- The Miami Hand and Upper Extremity Institute, Miami, Florida
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Abstract
Distal radius fractures are the most frequent lesions encountered during clinical practice. The treatment is controversial and still debated in the literature. For a correct management of these lesions many authors recently emphasised the importance of anatomical reduction, a stable fixation and early joint mobilisation. We report our experience in the daily management of these lesions. The fractures are evaluated considering fracture type, fracture reduction criteria, adequacy of reduction criteria and overall fracture stability. The best treatment option must be decided in accordance to the type of fracture, the extent of metaphyseal comminution, the quality of the bone and the medical condition of the patient.
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Herzberg G, Izem Y, Al Saati M, Plotard F. “PAF” analysis of acute distal radius fractures in adults. Preliminary results. ACTA ACUST UNITED AC 2010; 29:231-5. [DOI: 10.1016/j.main.2010.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 07/01/2010] [Accepted: 07/06/2010] [Indexed: 11/25/2022]
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