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Crook JL, Pientka W, Zhang AY, Golden A, Koehler D, Sammer D. Risk factors for surgical site infection after surgical treatment of closed distal radial fractures. J Hand Surg Eur Vol 2024; 49:310-315. [PMID: 37666217 DOI: 10.1177/17531934231194672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
We assessed operatively treated closed distal radial fractures to identify independent risk factors for surgical site infection after treatment. A retrospective review was carried out of 531 operatively treated closed distal radial fractures over a 5-year period. Multiple logistic regression was performed with infection as the dependent variable, using a stepwise regression procedure to select variables to construct the final model. In total, 19 (3.6%) fractures were complicated by postoperative surgical site infection. Uncontrolled diabetes with HbA1c >7, the presence of external fixation or external Kirschner wires, and tobacco use were significant independent predictors of infection. Age and time in the operating room were also statistically significant predictors but deemed to be not clinically meaningful.Level of evidence: IV.
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Affiliation(s)
- Jennifer L Crook
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - William Pientka
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Andrew Y Zhang
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Ann Golden
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Daniel Koehler
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Douglas Sammer
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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Bell JA, James NF, Mauck BM, Calandruccio JH, Weller WJ. The Pitfalls of Difficult Distal Radius Fractures and Provisional Reduction. Orthop Clin North Am 2024; 55:113-122. [PMID: 37980096 DOI: 10.1016/j.ocl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Distal radius fractures are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate treatment options. These fractures can be difficult injuries to treat surgically based on a large variability of fracture patterns, bone quality, and anatomy. It is important to understand the potential pitfalls associated with the treatment of difficult distal radius fractures to prevent avoidable complications. Some of these pitfalls include but are not limited to appropriate surgical exposure and soft tissue handling, provisional reduction, fixation type, and augmentation of fracture fixation.
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Affiliation(s)
- Jared A Bell
- Department of Orthopedic Surgery, University of Florida Health Jacksonville, 655 8th Street West, Jacksonville, FL 32209, USA
| | - Nicholas F James
- Department of Orthopedic Surgery, University of Florida Health Jacksonville, 655 8th Street West, Jacksonville, FL 32209, USA.
| | - Benjamin M Mauck
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - James H Calandruccio
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - William J Weller
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
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Hong DY, Kunes JA, Tedesco LJ, Danford NC, Strauch RJ. Anatomic Risks with Overpenetration of the Volar Locking Plates' Proximal Holes. J Wrist Surg 2023; 12:534-539. [PMID: 38213563 PMCID: PMC10781574 DOI: 10.1055/s-0043-1768926] [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: 09/12/2022] [Accepted: 04/03/2023] [Indexed: 01/13/2024]
Abstract
Background Volar locking plate fixation (VLP) is commonly used to treat distal radius fractures (DRF). Risk of dorsal compartment injury with distal screw hole fixation has been studied; however, the risk with proximal screw hole fixation is not well studied. Purpose The goal of this study was to investigate the risk of dorsal structure injury from the screw holes proximal to the two distal rows. Methods Nine cadaveric forearms were used. After volar distal radius exposure, a long VLP was applied. Kirschner wires were placed through the most proximal holes into the dorsal compartments. The extensor structures penetrated were noted and tagged with hemoclips. The distance from the dorsal cortex to the structures was measured. Results The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscle bodies were only penetrated; no tendons were penetrated. Proportion of muscle penetration increased with the more proximal screw holes. EPB was more likely to be penetrated distally and APL proximally; both were injured at holes 2 and 3. The extensors were 2 mm from the dorsal cortex of the radius on average; this did not decrease with compression of the forearm. Conclusions This is the first study to examine the anatomic risk of extensor structure injury with VLP proximal screw hole penetration. No extensor tendons were penetrated by these proximal screw holes; first dorsal compartment muscle bellies may be irritated with overpenetration. Our findings suggest that proximal VLP screws do not need to be downsized if they are not over 2 mm prominent.
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Affiliation(s)
- Daniel Y. Hong
- Columbia University Medical Center, New York City, New York
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Shim BJ, Kim DY, Lee SS, Cho MS, Hwang JT. Comparison of the conventional Henry approach and trans-flexor carpi radialis approach for the treatment of distal radius fracture: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e31936. [PMID: 36626505 PMCID: PMC9750658 DOI: 10.1097/md.0000000000031936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Few studies have compared the clinical outcomes of the conventional Henry approach and trans-flexor carpi radialis (FCR) approach. The purpose of this study was to compare the clinical and radiologic outcomes of the conventional Henry approach and trans-FCR approach for the treatment of distal radius fractures. We compared 20 wrists that underwent the conventional Henry approach with 20 wrists that underwent the trans-FCR approach for open reduction and internal fixation of distal radius fracture. The clinical and radiological parameters were checked at 3 months, 6 months, and 1 year after surgery. A visual analogue scale score, the modified Mayo wrist score, range of motion, and grip strength were collected. In addition, tenderness in the area of the FCR tendon were assessed. Regarding radiologic evaluations, the radial inclination, radial height, volar tilt, and ulna variance were measured. In the trans-FCR approach group, 15 patients complained of tenderness in the area of the FCR tendon at 3 months after surgery, which was significantly higher than those of conventional Henry approach group (P < .05). In the conventional Henry approach group, the tenderness had resolved spontaneously by 1 year after surgery in 19 patients. The trans-FCR approach can cause discomfort such as tenderness to the area of the FCR tendon compared to the conventional Henry approach, but there is no significant difference in the final clinical and radiologic outcomes.
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Affiliation(s)
- Bum-Jin Shim
- Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Buk-gu, Daegu, Republic of Korea
| | - Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Min-Soo Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
- *Correspondence: Jung-Taek Hwang, Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea (e-mail: )
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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.
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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
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LIMA LUCIANACASCÃO, COSTA ANTONIOCARLOSDA, SALGADO PEDROSIRE, ONOUE ANACLAUDIAFERNANDEZ. ANATOMICAL STUDY OF VOLAR FACE OF DISTAL RADIUS AND COMPARISON WITH THE SHAPE OF LOCKING VOLAR PLATES. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e257953. [DOI: 10.1590/1413-785220223005e257953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022]
Abstract
ABSTRACT Objective: To evaluate the volar cortical angle (VCA), the variation in lateral and intermediate columns, the shape and pattern of the watershed line (WL) of the distal radius and its correlation with locking volar plates available. Methods: 27 human cadaveric radial bones of the Department of Morphology and nine locking volar plates of six different companies were analyzed. VCA were measured from lateral and intermediate columns and their corresponding values on plates, as well as comparing the relief of radius and plates. In the WL analysis, we compared the standard format found on the radius and its equivalent on plates and divided into four types: biconvex, convex, ulnar convex and plan. Results: VCA varied between columns of the distal radius extremity. The mean in the lateral column was 153.40 degrees and 146.06 degrees in the intermediate. Four of nine plates showed no variation in volar angulation. From 27 distal radius, 13 showed convex pattern and 12 had biconvex, whereas most plates (seven of the nine analyzed) were biconvex drawing. Conclusion: Radial bone anatomy was variable. The intermediate column was, on average, steeper than lateral column. Synthes®-2 plate presented the closest design to the anatomy of the distal end of the radial bone, followed by Newclip®-2 plate. Level of Evidence II, Anatomic and Descriptive Study.
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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.
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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
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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.
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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
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Lameijer CM, Ten Duis HJ, Haag CMSC, El Moumni M, van der Sluis CK. The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant? Disabil Rehabil 2020; 43:3777-3788. [PMID: 32356451 DOI: 10.1080/09638288.2020.1753247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Following distal radius fractures in young non-osteoporotic patients, clinical relevancy of outcome has been scarcely reported. Outcome can be put in perspective by using measurement errors of radiological measurements and Minimal Important Change when reporting on clinician and patient reported outcome. Aim of this study was to assess the clinical relevance of radiological measurements, clinician and patient reported outcomes following distal radius fractures in young non-osteoporotic patients.Methods: Retrospective cohort study. Non-osteoporotic patients following a distal radius fracture were selected. Radiographs of both wrists were obtained at baseline, 6 weeks and at follow-up. Active range of motion and grip strength measurements were obtained at the follow-up visit and 4 questionnaires were answered to assess pain, upper extremity functioning, and health status.Results: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years at the time of injury were included. Median follow up was 62 months (IQR 53.0-84.5). Several radiological measurements evolved statistically significantly over time, however none exceeded measurement errors. Flexion/extension difference of injured compared to uninjured wrist (mean difference 11.2°, t = -7.5, df = 72, p < 0.001), exceeded Minimal Important Change, while grip strength differences did not. When comparing patients with DRFs to healthy controls, only the differences on Patient Reported Wrist Evaluation subscales "pain", "function" and total scores exceeded minimal important change (8, 10 and 13 points, respectively). Multivariable regression analysis revealed statistically significant relationships between residual step-off and respectively diminished flexion/extension (B = -36.8, 95% CI -62; -11.1, p = 0.006), diminished radial/ulnar deviation (B = -17.9, 95% CI -32.0; -3.9, p = 0.013) and worse ShortForm-36 "mental component score" (B = -15.4, 95% CI -26.6; -4.2, p < 0.001).Conclusion: Radiological measurements following distal radius fractures seem to evolve over time, but differences were small and were probably not clinically relevant. Range of motion, in particular flexion/extension, was impaired to such extend that it was noticeable for a patient, whereas grip strength was not impaired. The Patient Reported Wrist Evaluation was clinically relevantly diminished. Residual articular incongruency seems to influence range of motion.Implications for rehabilitationReporting Minimal Important Change regarding clinician and patient reported outcome following distal radius fractures is of more clinical value than reporting on statistical significance.Following distal radius fractures, the changes in radiological measurements do not seem to reflect a clinical relevant change.Range of motion, in particular flexion/extension, should be measured following distal radius fractures, as this might be impaired in a clinically relevant way.Measuring grip strength is of less importance following distal radius fractures, because grip strength does not seem to be affected.Residual articular incongruency seems to influence range of motion and therefore should be reduced to a minimum when treating non-osteoporotic patients.
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Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Jan Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Guerrero EM, Lauder A, Federer AE, Glisson R, Richard MJ, Ruch DS. Metacarpal Position and Lunate Facet Screw Fixation in Dorsal Wrist-Spanning Bridge Plates for Intra-Articular Distal Radial Fracture: A Biomechanical Analysis. J Bone Joint Surg Am 2020; 102:397-403. [PMID: 31904607 DOI: 10.2106/jbjs.19.00769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A dorsal wrist-spanning plate (DWSP) can be affixed to the second or third metacarpal, depending on the morphology of the distal radial fracture (DRF) and on surgeon preference, but comparative biomechanical analyses between these methods are limited. This biomechanical study compared fixation to the second metacarpal versus the third metacarpal as measured by lunate facet fragment displacement in a cadaveric model of an axially loaded intra-articular DRF. The construct rigidity with the addition of an intrafragmentary lunate facet locking screw was also evaluated. METHODS A sample size of 14 cadaveric matched pairs was calculated to achieve 81.7% power. The 28 limbs were randomized to DWSP fixation to the second metacarpal (Group 1) or third metacarpal (Group 2); each wrist underwent an osteotomy simulating an unstable intra-articular DRF. Limbs were tested at axial loads of 50, 100, 150, 200, 250, and 300 N. Lunate facet displacement from the metaphyseal fragment at each load was measured with use of differential variable reluctance transducers. After initial testing, a locking screw was placed through the plate into the lunate facet fragment in the third metacarpal group (Group 3). Displacement measurements were repeated for all loads. Paired 2-tailed t tests with Bonferroni correction (significance, p < 0.008) were performed to assess differences in fragment stability between groups. RESULTS The average fracture displacement at 300 N was 0.8 mm in Group 1, 0.4 mm in Group 2, and 0.2 mm in Group 3. Plating to the third metacarpal more effectively resisted displacement compared with the second metacarpal at all axial loads (p < 0.008). The addition of a lunate facet screw further stiffened the construct at loads of ≥200 N (p < 0.008). CONCLUSIONS Plate fixation to the third metacarpal with an intrafragmentary screw was the most biomechanically favorable construct, although other factors may favor an alternative distal fixation site. Mean displacement of the lunate facet fragment at 300 N was <1 mm in all groups. CLINICAL RELEVANCE The present study demonstrated that a DWSP affixed to the third metacarpal with an intrafragmentary screw provides the most effective stabilization of the lunate facet fragment in intra-articular DRFs. This study validates the use of intrafragmentary screws to increase stability in DWSP fixation.
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Affiliation(s)
- Evan M Guerrero
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander Lauder
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, Colorado
| | - Andrew E Federer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Richard Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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11
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Galle SE, Harness NG, Hacquebord JH, Burchette RJ, Peterson B. Complications of Radial Column Plating of the Distal Radius. Hand (N Y) 2019; 14:614-619. [PMID: 29484901 PMCID: PMC6759978 DOI: 10.1177/1558944718760861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Distal radius fractures treated with open reduction and internal fixation are commonly stabilized with a volar locking plate; however, more complex fracture patterns may require supplemental fixation with fragment-specific implants. The objective of this study was to evaluate the outcomes of distal radius fractures treated with radial column plates. Methods: A consecutive series of 61 patients who sustained distal radius fractures underwent radial column plating alone or in conjunction with other implants between August 2006 and January 2014. Thirty-one patients returned for follow-up or returned a mailed questionnaire at an average of 4.1 years. The outcomes measures included Visual Analog Scale (VAS); Disabilities of the Arm, Shoulder and Hand (DASH); and Patient-Rated Wrist Evaluation (PRWE) scores. Results: Sixty-one patients with a mean age of 55 years (range, 20-87) met inclusion criteria and were available for follow-up or chart review at an average of 5.2 years (range, 1.6-9.0 years). Seventeen of 61 (28%) underwent radial column plate removal. Twenty patients returned for final follow-up examination, and 11 completed questionnaires via mail. Subjective scores included a mean postoperative VAS of 0.72, DASH score of 17.2, and PRWE score of 15.7. Hardware sensitivity and wrist stiffness were the most common complications at final follow-up. Conclusions: Radial column plating of the distal radius is a safe treatment modality and a valuable adjunct in the setting of complex distal radius fractures, but patients should be counseled that there is a 28% chance that hardware removal may be required. Our retrospective review found evidence of few complications and objective scores consistent with return to normal function.
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Affiliation(s)
| | - Neil G. Harness
- Kaiser Permanente, Anaheim, CA,
USA,Neil G. Harness, Kaiser Permanente Orange
County, Kraemer Medical Office 1, 3460 E. La Palma Avenue, Anaheim, CA 92806,
USA.
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12
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Lans J, Alvarez J, Kachooei AR, Ozkan S, Jupiter JB. Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps. J Wrist Surg 2019; 8:118-123. [PMID: 30941251 PMCID: PMC6443535 DOI: 10.1055/s-0038-1673407] [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: 02/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Background The dorsal lunate facet fragment represents part of a complex articular injury of the distal radius and is challenging to reduce through a standard volar approach. We propose reduction through a standard volar approach and intraoperative dorsal lunate facet reduction using a bone forceps. To evaluate the postoperative reduction, we used computed tomography (CT) scan. Methods We retrospectively included 60 patients with a median follow-up of 44 weeks. Fracture reduction was evaluated using pre- and direct postoperative CT scans of the wrist, measuring the articular gap and step of the sigmoid notch. The range of motion was evaluated clinically by the treating physician. Bivariate analysis was performed to compare pre- and postoperative radiographic measurements and to compare wrist range of motion. Results When comparing the injured with the uninjured wrist, there was a significant difference in flexion, extension, pronation, and supination. In 87% of the patients, there was complete radiographic reduction of the fracture. Conclusion This study shows that dorsal ulnar lunate facet fracture fragments in distal radius fractures can be reduced through a standard volar approach with the help of an intraoperative bone reduction forceps. Using wrist CT, we showed that 87% of the patients with a dorsal ulnar lunate facet fragment had a postoperative articular step or gap of <1 mm. Level of Evidence : This is a level IV, therapeutic study.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josefina Alvarez
- Department of Traumatology, British Hospital, Montevideo, Uruguay
| | - Amir R. Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sezai Ozkan
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Lauder A, Hanel DP. Spanning Bridge Plate Fixation of Distal Radial Fractures. JBJS Rev 2019; 5:01874474-201702000-00002. [PMID: 28248738 DOI: 10.2106/jbjs.rvw.16.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander Lauder
- Department of Orthopaedics, University of Washington, Seattle, Washington
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14
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Stecco A, Arioli R, Buemi F, Parziale G, Trisoglio A, Soligo E, Cerini P, Leigheb M, Brambilla M, Di Nardo G, Guzzardi G, Carriero A. Overcoming metallic artefacts from orthopaedic wrist volar plating on a low-field MRI scanner. Radiol Med 2018; 124:392-399. [PMID: 30560500 DOI: 10.1007/s11547-018-0973-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To quantitatively compare the artefact reduction between standard and metallic artefact reduction (MAR) fast spin echo (FSE) T2 sequences in a low-field magnetic resonance imaging (MRI) scanner (0.3 T) in patients with titanium volar wrist plating. MATERIALS AND METHODS Sixteen patients with fractures of the distal radius, treated with titanium volar wrist plating and screws, were examined using a dedicated 0.3 T MRI scanner. Coronal standard FSE T2, FSE T2 high bandwidth (HiBW) and FSE T2 view angle tilting (VAT) sequences were performed. Metallic artefact volume, consisting of both "black" and "bright" artefacts, was calculated for each sequence. Quantitative differences were compared using repeated measures ANOVA test (P < 0.05). RESULTS FSE T2 HiBW and FSE T2 VAT showed a significant reduction in artefact volume compared to the standard sequence. Differences between the artefact volume of the standard FSE T2, HiBW and VAT sequences were statistically significant for both the "black" and "bright" artefacts (P < 0.0001). Differences between the 1.5 HiBW and VAT sequences were statistically significant (black P < 0.0001, bright P < 0.0302). CONCLUSIONS MAR sequences significantly reduced metallic artefacts in vivo using a 0.3 T MRI scanner.
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Affiliation(s)
- Alessandro Stecco
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy.
| | - Roberto Arioli
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Francesco Buemi
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Giuseppe Parziale
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandra Trisoglio
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Soligo
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Paolo Cerini
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Massimiliano Leigheb
- Orthopaedics and Traumatology Department, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Gerardo Di Nardo
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Carriero
- Radiology Institute, Services Diagnosis and Therapies Department, Maggiore della Carità Hospital, University of Eastern Piedmont - UPO University, Corso Mazzini 18, 28100, Novara, Italy
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15
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Zalzal P, Safir O, Alhalawani A, Papini M, Towler M. Percutaneous upper extremity fracture fixation using a novel glass-based adhesive. J Orthop 2018; 15:67-69. [PMID: 29657441 DOI: 10.1016/j.jor.2018.01.033] [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] [Received: 07/24/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022] Open
Abstract
Objective To develop a surgical technique for percutaneous upper extremity fracture fixation using a novel glass-based adhesive. Methods Three intact upper extremity cadaveric specimens with undisturbed soft tissues were obtained. Two were used to model a wrist fracture, and the third to model a proximal humerus fracture. Fractures were produced using a small osteotome in a percutaneous fashion. Banna Bone Adhesive (BBA) was delivered to the fracture site percutaneously using a 16 gauge needle under bi-planar fluoroscopic guidance. After setting of the adhesive, the specimens were dissected to qualitatively assess BBA delivery and placement. Results The adhesive could readily be delivered through the 16 gauge needle with an appropriate amount of pressure applied to the syringe. Using the fluoroscope, the adhesive could be seen to flow into the fracture site with minimal extravagation into the surrounding soft tissues. Successful bonding of the fracture fragments was observed. Conclusions Percutaneous delivery of BBA into a fracture of the distal radius and proximal humerus may be a feasible fracture fixation technique. Biomechanical testing and animal model testing are required to further develop this procedure.
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Affiliation(s)
- Paul Zalzal
- Oakville Trafalgar Memorial Hospital, Oakville, L6J 3L7, Ontario, Canada
| | - Oleg Safir
- Mount Sinai Hospital, Toronto, M5G 1X5, Ontario, Canada
| | - Adel Alhalawani
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, M5B 2K3, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B 1W8, Ontario, Canada
| | - Marcello Papini
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, M5B 2K3, Ontario, Canada
| | - Mark Towler
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, M5B 2K3, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B 1W8, Ontario, Canada
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16
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Lameijer CM, ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 2018; 138:1699-1712. [PMID: 30317380 PMCID: PMC6224009 DOI: 10.1007/s00402-018-3046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.
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Affiliation(s)
- C. M. Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - H. J. ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - D. Vroling
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. T. Hartlief
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - C. K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Lameijer CM, Ten Duis HJ, Dusseldorp IV, Dijkstra PU, van der Sluis CK. Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 2017; 137:1499-1513. [PMID: 28770349 PMCID: PMC5644687 DOI: 10.1007/s00402-017-2765-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The objective of this systematic review was to analyze (1) prevalence of radiological posttraumatic arthritis (PA), (2) associations of PA with outcome measures and (3) predictors of PA following distal radius fractures in non-osteoporotic patients. MATERIALS AND METHODS Nineteen studies were included (10 open source data). RESULTS In total, 733 patients were described with a weighted mean age of 37 years (range 25-54) at the time of the injury. Follow-up ranged from 13 months to 38 years. Overall prevalence of PA was 50% and 37% in the open source data. Radial deviation was significantly worse in patients with PA (N = 49, mean 14°, SD 6° versus N = 55, mean 17°, SD 6°, p = 0.037). No analysis could be performed regarding patient reported outcome measures, because of limited data. Articular incongruence was a significant predictor for PA. CONCLUSIONS A high prevalence of PA was found in non-osteoporotic patients following a distal radius fracture. PA following a distal radial fracture was associated with a limited radial deviation and flexion, but not with grip strength. Articular incongruence predicted PA. Patient reported outcome measures should be investigated more thoroughly to be able to understand the value of using these instruments in interpreting outcome in follow-up of non-osteoporotic patients following a distal radius fracture. LEVEL OF EVIDENCE Level of evidence 3 (Phillips et al. Levels of Evidence-Oxford Centre for Evidence-based Medicine, 1).
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Affiliation(s)
- C M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands.
| | - H J Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands
| | - I van Dusseldorp
- Medical Center Leeuwarden, MCL Academy, Leeuwarden, The Netherlands
| | - P U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Knežević J, Kodvanj J, Čukelj F, Pamuković F, Pavić A. A biomechanical comparison of four fixed-angle dorsal plates in a finite element model of dorsally-unstable radius fracture. Injury 2017; 48 Suppl 5:S41-S46. [PMID: 29122121 DOI: 10.1016/s0020-1383(17)30738-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the finite element models of two different composite radius fracture patterns, reduced and stabilised with four different fixed-angle dorsal plates during axial, dorsal and volar loading conditions. METHODS Eight different plastic models representing four AO/ASIF type 23-A3 distal radius fractures and four AO/ASIF 23-C2 distal radius fractures were obtained and fixed each with 1 of 4 methods: a standard dorsal non-anatomical fixed angle T-plate (3.5mm Dorsal T-plate, Synthes), anatomical fixed-angle double plates (2.4mm LCP Dorsal Distal Radius, Synthes), anatomical fixed angle T-plate (2.4mm Acu-Loc Dorsal Plate, Acumed) or anatomical variable-angle dorsal T-plate (3.5mm, Dorsal Plate, Zrinski). Composite radius with plate and screws were scanned with a 3D optical scanner and later processed in Abaqus Software to generate the finite element model. All models were axially loaded at 3 points (centrally, volarly and dorsally) with 50 N forces to avoid the appearance of plastic deformations of the models. Total displacements at the end of the bone and the stresses in the bones and plates were determined and compared. RESULTS Maximal von Mises stress in bone for 3-part fracture models was very similar to that in 2-part fracture models. The biggest difference between models and the largest displacements were seen during volar loading. The stresses in all models were the highest above the fracture gap. The best performance in all parameters tested was with the Zrinski plate and the most modest results were with the Synthes T-plate. CONCLUSION There was no significant difference between 2-part (AO/ASIF type 23-A3) and 3-part (AO/ASIF 23-C2) fracture models. Maximal stresses in the plates appeared above the fracture gap; therefore, it is worth considering the development of plates without screw holes above the gap.
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Affiliation(s)
- Josip Knežević
- University Hospital Split, Department of Orthopaedic Trauma, Spinčićeva 1, 21000 Split, Croatia.
| | - Janoš Kodvanj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Fabijan Čukelj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Frane Pamuković
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia
| | - Arsen Pavić
- University Hospital Split, Department of Orthopaedic Trauma, Spinčićeva 1, 21000 Split, Croatia
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Gangopadhyay S, Ravi K, Packer G. Dorsal Plating of Unstable Distal Radius Fractures Using a Bio-Absorbable Plating System and Bone Substitute. ACTA ACUST UNITED AC 2016; 31:93-100. [PMID: 16293358 DOI: 10.1016/j.jhsb.2005.09.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 09/15/2005] [Indexed: 11/29/2022]
Abstract
This study reports the results of open reduction and internal fixation of 26 unstable, intraarticular, dorsally displaced fractures of the distal radius using a bio-absorbable dorsal distal radius (Reunite) plate and calcium phosphate (Biobon) bone substitute. The bio-absorbable plate has the advantage of being low profile, easily contourable and angularly stable. In the majority of cases, this plate produces functional results comparable with metal plates. The Gartland and Werley score was excellent or good in 21 patients. The theoretical advantage over metal plates is in eliminating the need to remove the plate and hence the need for a second operation if implant-related extensor tenosynovitis occurs. Inflammatory tissue reaction to the degradation products of the plate is a potential concern, although the co-polymer ratio used in this plate appears to have reduced the severity of this reaction, which was seen in two patients in this series. The reduction was lost in five patients with severe dorsal comminution. Following this experience, we do not recommend this plating system for fractures with a metaphyseal gap of greater than 7 mm following reduction.
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20
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Horii E, Ohmachi T, Nakamura R. The Primary Sauve–Kapandji Procedure—For Treatment of Comminuted Distal Radius and Ulnar Fractures. ACTA ACUST UNITED AC 2016; 30:60-6. [PMID: 15620494 DOI: 10.1016/j.jhsb.2004.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Accepted: 09/07/2004] [Indexed: 11/21/2022]
Abstract
We have performed primary Sauve–Kapandji procedures on four patients with severe open comminuted fractures of both the distal radius and ulna. The fragmented distal ulna was fixed to the sigmoid notch in order to stabilize the ulnar side of the carpus, and a proximal pseudoarthrosis was maintained for forearm rotation. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 76°, the mean pronation/supination arc was 135°, and grip strength was 64% of the contralateral side. All patients returned to their work or daily activities within short time period without any additional surgical treatment, except for removal of implants in three patients. The primary Sauve–Kapandji procedure is effective for the reconstruction of severely combined distal radius and ulnar fractures.
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Affiliation(s)
- E Horii
- From the Hand Division, Orthopedic Department, Nagoya University, 65 Tsuruma, Showa-ku, Nagoya 466-8550, Japan
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21
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Takeuchi N, Hotokezaka S, Okada T, Yuge H, Mae T, Iwamoto Y. Recovery of Wrist Function after Volar Locking Plate Fixation for Distal Radius Fractures. J Hand Surg Asian Pac Vol 2016; 21:199-206. [PMID: 27454634 DOI: 10.1142/s2424835516500193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of our present study was to examine the recovery of the postoperative wrist function, and to compare the range of motion among each direction ofthe wrist joint during the same time periods after surgery for distal radius fractures. METHODS Twenty patients treated with a volar locking plate were evaluated. The active range of motion and grip strength were assessed at four weeks, six weeks, three months, six months and one year after surgery. RESULTS The ratio of the range of motion in pronation and supination recovered significantly earlier than for any other directions within six months after surgery (p = 0.0205), however, the ratio of the range of motion among the six directions was not significantly different at one year after surgery (p = 0.0823). The recovery of the range of motion in flexion was 96.8% compared with the contralateral wrist at one year after surgery, and it was not significantly lower than that in extension, radial deviation or ulnar deviation (97.8%, 93.5%, 94.4%, respectively). The grip strength of dominant hand recovered from 50% after four weeks to 66% after six weeks, 83% after three months, 91% after six months and 106% at the examination performed after one year compared with the uninjured non-dominant hand. The grip strength of non-dominant hand recovered from 52% after four weeks to 59% after six weeks, 79% after three months, 84% after six months and 94% at the examination performed after one year compared with the uninjured dominant hand. The mean DASH score was 5.3. CONCLUSIONS The range of motion in flexion can achieve similar improvement to that in the other directions by obtaining the appropriate postoperative parameters. The optimal postoperative radiographic parameters were thus identified to be essential for successfully obtaining a recovery of the wrist function for unstable distal radius fractures.
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Affiliation(s)
- Naohide Takeuchi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Hotokezaka
- 2 Department of Trauma and Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Takamitsu Okada
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidehiko Yuge
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takao Mae
- 2 Department of Trauma and Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Yukihide Iwamoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
Complications following any form of distal radius fixation remain prevalent. With an armamentarium of fixation options available to practicing surgeons, familiarity with the risks of newer plate technology as it compares with other conventional methods is crucial to optimizing surgical outcome and managing patient expectations. This article presents an updated review on complications following various forms of distal radius fixation.
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Affiliation(s)
- Dennis S Lee
- Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232, USA.
| | - Douglas R Weikert
- Orthopaedic Surgery and Rehabilitation, Hand and Upper Extremity Center, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 3200, Nashville, TN 37232, USA
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23
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Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg Am 2015; 40:1554-62. [PMID: 26143028 DOI: 10.1016/j.jhsa.2015.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the functional outcomes of patients treated with dorsal spanning distraction bridge plate fixation for distal radius fractures. METHODS All adult patients at our institution who underwent treatment of a unilateral distal radius fracture using a dorsal bridge plate from 2008 to 2012 were identified retrospectively. Patients were enrolled in clinical follow-up to assess function. Wrist range of motion, grip strength, and extension torque were measured systematically and compared with the contralateral, uninjured wrist. Patients also completed Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation outcomes questionnaires. RESULTS Eighteen of 100 eligible patients, with a minimum of 1 year from the time of implant removal, were available for follow-up (mean, 2.7 y). All fracture patterns were comminuted and intra-articular (AO 23.C3). There were significant decreases in wrist flexion (43° vs 58°), extension (46° vs 56°), and ulnar deviation (23° vs 29°) compared with the contralateral uninjured wrist. Grip strength was 86% and extension torque was 78% of the contralateral wrist. Comparison of dominant and nondominant wrist injuries identified nearly complete recovery of grip (95%) and extension (96%) strength of dominant-sided wrist injuries, compared with grip (79%) and extension (65%) strength in those with an injured nondominant wrist. Mean Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 16 and 14, respectively. There were 2 cases of postoperative surgical site pain and no cases of infection, tendonitis, or tendon rupture. CONCLUSIONS Distraction bridge plate fixation for distal radius fractures is safe with minimal complications. Functional outcomes are similar to those published for other treatment methods. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Alexander Lauder
- Department of Orthopaedics, University of Washington, Seattle, WA.
| | - Sonya Agnew
- Division of Plastic Surgery, Northwestern University, Jesse Brown VAMC, Chicago, IL
| | - Karim Bakri
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
| | | | - Douglas P Hanel
- Department of Orthopaedics, University of Washington, Seattle, WA
| | - Jerry I Huang
- Department of Orthopaedics, University of Washington, Seattle, WA
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24
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Fragment-specific fixation of complex distal radial fractures with small intraarticular fragments; volar locked plate augmented with Kirschner wires. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
UNLABELLED Small variations within normal range of radiographic parameters, except ulnar variance and volar tilt, do not influence the final functional outcome in distal radius fractures. INTRODUCTION There are many reports in the literature on the relationship between radiographic variables and their influence on the final outcome of distal radius fractures. Most authors report that a good functional result depends on anatomical restoration of the articular surface and extra-articular alignment. The aim of this study was to verify if it is really necessary to restore anatomic radiographic parameters to obtain satisfactory functional outcome in distal radius fractures treated with volar plate. MATERIALS AND METHODS We retrospectively evaluated 51 patients treated with volar locked plate for articular unstable distal radius fractures from December 2006 to March 2009. Each fracture was evaluated according to the AO classification. The average follow-up was 40.5 months. Radiological measurements were performed considering radial height, radial inclination, volar tilt and ulnar variance, both preoperatively and postoperatively, to estimate the correction value. We examined range of motion (ROM), grip strength with a Jamar(®) dynamometer and Disabilities of the Arm, Shoulder and Hand (DASH) score. The τ Student test was performed for statistical analysis. RESULTS The persistence of articular step-off was assessed in 35.3% of patients. Normal radial inclination (21-25°) was restored in 74.5% of patients (range 15-27.5°). Normal radial height (10-13 mm) was restored in 66.6% of patients (range 6.8-17.3mm). Normal volar tilt (7-15°) was achieved in 90.2% of patients (range 3-17°). Normal ulnar variance (0.7-1.5mm) was restored in 86.3% of patients (range 0.7-4.1mm). There was a statistically significant difference between the preoperative and postoperative radiographic values (p<0.01). The majority of patients showed complete recovery of ROM, with no statistically significant difference (p>0.05) in extension, flexion, supination and pronation compared with the contralateral hand. Eight patients who had postoperative volar tilt and/or ulnar variance out of range had a statistically significant difference (p<0.05) in ROM compared with the non-operated side. At final follow-up, all patients had a statistically significant difference (p<0.05) in grip strength compared with the contralateral side, even with good strength values. The mean DASH score was 12.2 (range 0-61). DISCUSSION AND CONCLUSION Our experience suggests that ulnar variance and volar tilt are the most important radiographic parameters to be restored to obtain good functional outcome in distal radius fracture. Small variations of other radiographic parameters seem to not affect the final outcome at minimum 3 years' follow-up.
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Hoare CP, Dickson DR, Armstrong DJ, Nuttall D, Watts AC. Internal fixation for treating distal radius fractures in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kumar S, Chopra R, Sehrawat S, Lakra A. Comparison of treatment of unstable intra articular fractures of distal radius with locking plate versus non-locking plate fixation. J Clin Orthop Trauma 2014; 5:74-8. [PMID: 25983474 PMCID: PMC4085365 DOI: 10.1016/j.jcot.2014.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/24/2014] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Unstable intra articular fractures of distal radius are frequently being managed with open reduction and internal fixation. Of late in some biomechanical studies locking plates have been shown to be better in terms of maintenance of radiological parameters in comparison to non-locking plates. We conducted this study to know whether this biomechanical superiority of locking plates is converted in to better clinical outcomes. MATERIALS AND METHODS A study was conducted in 60 patients (30 in each group) with unstable intra articular fractures of distal radius who were treated by open reduction and internal fixation with locking plates and non-locking plates. Patients were evaluated for radiological parameters (intra articular step off, radial height, radial tilt, volar tilt) and functional parameters (flexion, extension, radial deviation, ulnar deviation, pronation, supination grip strength) at two year follow up. Overall outcome was evaluated by scoring systems of Gartland and Werley and modified Green O' Brien. RESULTS The change in radiological parameters from immediate post op to latest at two year in locking plate group was not significant for radial height, radial tilt, volar tilt, but ulnar variance whereas in non-locking plate there was significant change in radial height, volar tilt, ulnar variance but no significant change in radial inclination. In clinical and functional outcome no significant difference was found at two year follow up. CONCLUSIONS Locking plates maintain the radiological parameters better than non-locking plates but functional outcome are same for both plates at two year after surgery.
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Affiliation(s)
- Sunil Kumar
- Senior Resident, Central Institute of Orthopaedics, V.M.M.C. & Safdarjung Hospital, New Delhi, India,Corresponding author. A-15 Safdarjung Hospital Staff Quarters, Kidwai Nagar West, New Delhi, India. Tel.: +91 (0) 9350480283.
| | - R.K. Chopra
- Professor, Central Institute of Orthopaedics, V.M.M.C. & Safdarjung Hospital, New Delhi, India
| | - Sunil Sehrawat
- Senior Resident, Central Institute of Orthopaedics, V.M.M.C. & Safdarjung Hospital, New Delhi, India
| | - Akshay Lakra
- Senior Resident, Department of Orthopaedics, M.A.M.C. & Lok Nayak Jai Prakash Hospital, New Delhi, India
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Patel SP, Rozental TD. Management of Osteoporotic Patients with Distal Radial Fractures. JBJS Rev 2014; 2:01874474-201405000-00001. [DOI: 10.2106/jbjs.rvw.m.00113] [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]
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Evans S, Ramasamy A, Deshmukh SC. Distal volar radial plates: how anatomical are they? Orthop Traumatol Surg Res 2014; 100:293-5. [PMID: 24662604 DOI: 10.1016/j.otsr.2013.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/28/2013] [Accepted: 11/24/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fractures of the distal radius are common, with volar locking plates being increasingly used in their treatment. They aim to provide stable internal fixation and are designed to mirror the natural anatomy. Current volar plate designs incorporate a volar cortical angle (VCA) of 25 degrees. HYPOTHESIS The aim of this study is to determine whether the VCA in uninjured distal radii corresponds accurately with modern volar plate designs. MATERIALS AND METHODS A retrospective radiological analysis utilizing Computed Tomography scans to assess the VCA of 100 distal radii. Each distal radius was subjected to 3 measurements of the VCA in the sagittal plane. RESULTS One hundred patients were identified (67 male, 33 female; mean age 37.4 years). The mean VCA was 32.9 degrees (S.D.±5.14 degrees). The VCA in male patients was significantly greater than in females (33.6 vs 31.5 degrees; P=0.04). There was a statistically significant difference between the lateral VCA and medial VCA (32.2 vs 34.3 degrees, P=0.02). DISCUSSION Our study clearly demonstrates that the VCA measured in the distal radius is significantly greater than the volar angulation incorporated within modern plate design. Given that the aim of ORIF is to anatomically reconstruct the distal radius, our study highlights that this may not be possible with current plates. LEVELS OF EVIDENCE Level IV Retrospective case series.
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Affiliation(s)
- S Evans
- Department of Trauma and Orthopaedics, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom.
| | - A Ramasamy
- Department of Trauma and Orthopaedics, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom; The Royal British Legion Centre for Blast Injury Studies, Imperial College London, South Kensington, London SW7 2BW, United Kingdom
| | - S C Deshmukh
- Department of Trauma and Orthopaedics, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
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Pillukat T, Schädel-Höpfner M, Windolf J, Prommersberger KJ. [Complex fragmentation of the distal radial articular surface. Reconstruction with subchondral Kirschner wires and bone grafts]. Unfallchirurg 2014; 116:617-23. [PMID: 22706651 DOI: 10.1007/s00113-012-2182-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Complex fragmentation of the distal radial articular surface often results in three major problems: some fragments are too small for stabilisation by standard plates or screws; in addition, substantial loss of articular surfaces and metaphyseal/subchondral bony defects frequently occur. MATERIAL AND METHODS To solve these problems the following strategy was developed: the fixation of small articular fragments was performed by small K-wires that were placed subchondrally and countersunk in the bone. In case of lost articular surfaces a silicone foil was inserted intra-articularly to induce a cartilage-like tissue. Bony defects were replaced by iliac crest bone grafts. Additional stability was achieved by dorsal and volar plate fixation or bridge plating. RESULTS An average of 53° of extension, 44° of flexion, 74° of pronation, and 66° of supination were achieved. The grip strength was an average of 61% of that in the contralateral limb. The average radiographic measurements were -5° of palmar inclination, 21° of ulnar inclination, and 0 mm of positive ulnar variance. A good or excellent functional result was achieved for five of seven wrists according to the rating system of Gartland and Werley. According to the modified Mayo Wrist Score four of five wrists achieved a good and one a fair result.The DASH Score averaged 19 (6-59) points. CONCLUSIONS The applied treatment resulted in stable, mobile wrists with reasonable alignment and nearly even articular surfaces. The functional results were similar to those reported by other authors for less complex distal radius fractures. This strategy seems to be a rational approach to the reconstruction of severely comminuted intra-articular fractures of the distal radius.
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Affiliation(s)
- T Pillukat
- Rhönklinikum, Salzburger Leite 1, 97616, Bad Neustadt a.d. Saale, Deutschland.
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Shahid MK, Robati S. The epidemiology and outcome of open distal radial fractures. J Orthop 2014; 10:49-53. [PMID: 24403749 DOI: 10.1016/j.jor.2013.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mohammad Kamran Shahid
- Department of Orthopaedics, Edinburgh Royal Infirmary, Edinburgh EH16 4SA, United Kingdom
| | - Shibby Robati
- Department of Orthopaedics, Edinburgh Royal Infirmary, Edinburgh EH16 4SA, United Kingdom
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Schweizer A, Fürnstahl P, Nagy L. Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides. J Hand Surg Am 2013; 38:2339-47. [PMID: 24189159 DOI: 10.1016/j.jhsa.2013.09.023] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions. METHODS Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AO-type C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data. RESULTS In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes. CONCLUSIONS Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Andreas Schweizer
- Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland.
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Bentohami A, Bijlsma TS, Goslings JC, de Reuver P, Kaufmann L, Schep NWL. Radiological criteria for acceptable reduction of extra-articular distal radial fractures are not predictive for patient-reported functional outcome. J Hand Surg Eur Vol 2013. [PMID: 23186862 DOI: 10.1177/1753193412468266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess the association between arm-specific disability measured with the QuickDASH questionaire and radiological criteria in patients with extra-articular distal radial fractures. A consecutive series of 385 patients were initially treated non-operatively for an extra-articular distal radial fracture and 257 (69 %) patients were included in the study. In 203 of these patients (78%) the quality of radiographic reduction was judged to be adequate by radiological parameters, which included dorsal tilt, radial inclination, and radial shortening. In 54 patients (22%) the quality of radiographic alignment was judged to be inadequate. We observed no effect of radiographic parameters on the functional outcome. Female sex and longer duration of follow-up (>35 months) were the only independent prognostic factors significantly associated with a worse QuickDASH score.
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Affiliation(s)
- A Bentohami
- Department of Surgery, Spaarne Hospital, Hoofddorp, The Netherlands.
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Fixation of distal radius fractures in adults: a review. Orthop Traumatol Surg Res 2013; 99:216-34. [PMID: 23518070 DOI: 10.1016/j.otsr.2012.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/26/2012] [Accepted: 03/22/2012] [Indexed: 02/02/2023]
Abstract
In patients for whom function is a priority, anatomic reduction and stable fixation are prerequisites for good outcomes. Several therapeutic options exist, including orthopedic treatment and internal fixation with pins (intra- and extrafocal), external fixation which may or may not bridge the wrist, and different internal fixation techniques with dorsal or palmar plates using or not, locking screws. Arthroscopy may be necessary in case of articular fracture. In the presence of significant metaphyseal bone defects, filling of the comminution with phosphocalcic cements provides better graft stability. The level of evidence is too low to allow recommending one type of fixation for one type of fracture; and different fixation options to achieve stable reduction exist, each with its own specific complications. With the new generations of palmar plate, secondary displacement is becoming a thing of the past.
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Abstract
Fixation of distal radius fractures via locking plates is an increasingly popular method. However, these plates include variety of complications, such as flexor and extensor tenosynovitis, tendon injury and intra articular screw or peg penetration. Although they offer superior stability and early mobility, if used improperly; they may cause serious complications related to the implant. Proper use of the implant with strict adherence to the fixation principles and close follow up of patients are very important in order to decrease the rate and severity of complications.
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Affiliation(s)
- Tulgar Toros
- Orthopaedic Surgeon: Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Turkey
| | - Tahir Sadık Sügün
- Orthopaedic Surgeon: Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Turkey.
| | - Kemal Özaksar
- Orthopaedic Surgeon: Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Turkey
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Abstract
Distal radius fractures are an increasingly prevalent upper extremity injury, especially among elderly patients. While treatment guidelines for the acute bony injury have been well documented, treatment of the underlying metabolic bone disease has been less commonly discussed in the orthopedic literature. Distal radius fractures in the elderly patient should be considered a sentinel event for injuries associated with greater morbidity and mortality, such as hip fracture. Management of fracture-related factors, such as osteoporosis and increased fall risk following a distal radius fracture, may prevent the mortality and morbidity of future injuries. This review highlights both the fracture-specific and medical goals of treatment in the elderly patient with a distal radius fracture.
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Volar plating for distal radius fractures--do not trust the image intensifier when judging distal subchondral screw length. Tech Hand Up Extrem Surg 2013; 16:169-72. [PMID: 22914000 DOI: 10.1097/bth.0b013e31825f7c5a] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of the volar plate to treat distal radius fractures is increasing but despite the theoretical advantages of a volar approach there have been reports of extensor tendon ruptures due to prominent screw tips protruding past the dorsal cortex. The valley in the intermediate column between Lister tubercle and the sigmoid notch of the distal radius makes it difficult to rely on fluoroscopy to judge screw length. Our aim was to quantify the dimensions of this valley and to demonstrate the danger of relying on intraoperative image intensification fluoroscopy to determine lengths of distal screws. METHODS AND RESULTS We measured the depth of this valley in the intermediate column of the distal radius in 33 patients with computed tomographic (9 patients) or magnetic resonance image (24 patients) scans of the wrist. There was a consistent valley in all images examined [average 1.8 mm (95% confidence interval, 1.6-2.0 mm)]. Thirty-nine percent of wrists had a valley depth of at least 2 mm. CONCLUSIONS Standard lateral views or rotation of the forearm to obtain oblique views does not identify prominent screw tips; and whatever the rotation of the forearm, screw tips protruding beyond dorsal cortex may look as if it is within the bone when in fact it is out. When drilling we suggest noting the depth at which the drill bit just penetrates dorsal cortex and routinely downsize the distal screw length by 2 mm. We caution against relying on flourosocopy when judging the length of the distal subchondral screws.
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Abstract
There has been a surge in the operative management of distal radius fractures. Closed reduction, external fixation, and open reduction with internal fixation each have advantages and disadvantages. The purpose of this review is not to provide the clinician with an algorithm for treatment of distal radius fractures. These fractures span an extensive spectrum of severity across age groups and demographics. Fortunately, the surgeon holds a vast array of options to provide care for patients with distal radius fractures. The choice of fixation or conservative care resides in the personality of the fracture and the needs of the patients.
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Affiliation(s)
- Joshua G Bales
- Hand Surgery Specialists, Inc, 538 Oak Street, Cincinnati, OH 45219, USA.
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Hattori Y, Doi K, Estrella EP, Chen G. ARTHROSCOPICALLY ASSISTED REDUCTION WITH VOLAR PLATING OR EXTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR FRACTURES OF THE DISTAL RADIUS IN THE ELDERLY PATIENTS. ACTA ACUST UNITED AC 2011; 12:1-12. [PMID: 17613178 DOI: 10.1142/s021881040700333x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 02/06/2007] [Indexed: 11/18/2022]
Abstract
Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treated with arthroscopically assisted reduction combined with volar plating or external fixation. The patients were followed up for an average of 24.9 ± 16.1 months. The average score was 80.1 ± 10.5 according to the modified system of Green and O'Brien. Eight patients had an excellent result, 11 had a good result, seven had a fair result, and two had a poor result. Twenty-three patients were able to return to their previous activities level or occupation without any restriction. On the basis of these results, we concluded that arthroscopically assisted reduction combined with volar plating or external fixation is one of the useful options for the treatment of a displaced intra-articular fracture of the distal radius in elderly patients who are physiologically young or active.
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Affiliation(s)
- Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan.
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Osada D, Tamai K, Iwamoto A, Fujita S, Saotome K. DORSAL PLATING FOR COMMINUTED INTRA-ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS. ACTA ACUST UNITED AC 2011; 9:181-90. [PMID: 15810104 DOI: 10.1142/s0218810404002194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Accepted: 09/22/2004] [Indexed: 11/18/2022]
Abstract
Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry® plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23°, volar tilt 7°, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5° during follow-up in ten patients. Use of dorsal Symmetry® plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.
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Affiliation(s)
- D Osada
- Department of Orthopaedics, Dokkyo University School of Medicine, Tochigi 321-0293, Japan.
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Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 2011; 36:1135-41. [PMID: 21712136 DOI: 10.1016/j.jhsa.2011.04.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Dorsal plating of distal radius fractures with traditional 2.5-mm-thick plates is associated with extensor tendon complications. Consequently, volar locking plates have gained widespread acceptance. A new generation of 1.2- to 1.5-mm, low-profile dorsal plates was designed to minimize tendon irritation. This study examines the complication rates of low-profile dorsal plates compared with volar locking plates. METHODS We identified patients with distal radius fractures treated between September 2002 and June 2006 by low-profile dorsal or volar locking plates. Information pertaining to 7 categories of complications (hardware discomfort and pain, tendon irritation/rupture, failure of reduction, infection, complex regional pain syndrome, stiffness, and neuropathy/hypersensitivity) was collected. Complications were defined as any postoperative plating complications requiring additional surgical intervention, whereas those that only caused patient discomfort were considered secondary problems. RESULTS We included 100 patients, comprising 104 plating cases (57 dorsal, 47 volar), in this study. Overall length of follow-up was 44 ± 21 months (range, 12-80 mo). A total of 18 patients (8 dorsal, 10 volar) experienced complications, whereas 47 (25 dorsal, 22 volar) had secondary reports. Three dorsal and 4 volar patients had complete plate removals. Three dorsal and no volar plates had screw removals only. One volar plate (no dorsal plates) had a major tendon rupture (flexor pollicis longus); 3 dorsal and 3 volar plates resulted in tendon irritation complications, and 4 dorsal and 3 volar plates had secondary problems from tendon irritation. None of the above measures approached statistical significance. Volar cases were associated with significantly more neuropathic complications than dorsal cases. CONCLUSIONS Dorsal low-profile plates are not associated with significantly more tendon irritation or rupture complications. However, volar plating is associated with a higher rate of neuropathic complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Chou YC, Chen ACY, Chen CY, Hsu YH, Wu CC. Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am 2011; 36:974-81. [PMID: 21549526 DOI: 10.1016/j.jhsa.2011.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 02/20/2011] [Accepted: 02/21/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical outcomes of dorsal and volar locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. METHODS We treated 41 consecutive patients who had sustained AO C3 dorsally comminuted fractures of the distal radius with 2.4-mm titanium locking plates between 2006 and 2008. Patients in group 1 (n = 22) were treated with dorsal locking plates, and those in group 2 (n = 19) with volar locking plates. We evaluated clinical outcomes at an average of 37 months and performed statistical analysis using the Mann-Whitney U test and Fisher's exact test. RESULTS No significant difference was noted between the 2 groups in terms of radial inclination, volar tilt, and ulnar variance. At the 3- and 6-month follow-up, group 1 showed better clinical results with respect to wrist extension, grip strength, and Gartland and Werley score, whereas group 2 showed better wrist flexion during this period. The range of motion and grip strength progressively leveled out between the 2 groups, and no significant differences were observed at the 9- and 12-month assessments. One patient in group 1 had short-term complex regional pain syndrome, and 4 patients in group 2 had temporary median nerve numbness. CONCLUSIONS Treatment with dorsal or volar locking plates can provide satisfactory radiographic and functional outcomes for AO type C3 dorsal comminuted distal radius fractures. The dorsal plate group showed an earlier recovery of wrist extension, grip strength, and functional score at the 3- and 6-month follow-up owing to direct reduction as well as fragmental-specific fixation of the dorsal fracture fragments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ying-Chao Chou
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Jakubietz MG, Gruenert JG, Jakubietz RG. The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures. J Orthop Surg Res 2011; 6:24. [PMID: 21600042 PMCID: PMC3115902 DOI: 10.1186/1749-799x-6-24] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 05/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraarticular distal radius fractures can be treated with many methods. While internal fixation with angle stable implants has become increasingly popular, the use of bone graft substitutes has also been recommended to address comminution zones and thus increase stability. Whether a combination of both methods will improve clinical outcomes was the purpose of the study METHODS The study was thus conducted as a prospective randomized clinical trial. 39 patients with unilateral, intraarticular fractures of the distal radius were included and randomized to 2 groups, one being treated with internal fixation only, while the second group received an additional bone graft substitute. RESULTS There was no statistical significance between both groups in functional and radiological results. The occurrence of complications did also not show statistical significance. CONCLUSIONS No advantage of additional granular bone graft substitutes could be seen in this study. Granular bone graft substitutes do not seem to provide extra stability if dorsal angle stable implants are used. Dorsal plates have considerable complication rates such as extensor tendon ruptures and development of CRPS.
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Affiliation(s)
- Michael G Jakubietz
- Department of Trauma-, Hand-, Plastic and Reconstructive Surgery, University of Wuerzburg, Wuerzburg, Germany.
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Abstract
INTRODUCTION Fractures of the distal radius are among the most common fractures seen. They encompass a myriad of presentations and fracture patterns that often benefit from various open reduction and internal fixation techniques-including volar plating, dorsal plating, radial plating, intramedullary nailing, and fragment-specific fixation. In order to obtain optimal reduction of these fractures, surgeons require a thorough understanding of the anatomy and various surgical exposures. ANATOMY The distal radius is surrounded by a soft tissue envelope rich in vascularity and cutaneous innervation. The osseous surface consists of two articular surfaces and three cortical sides covered almost entirely by soft tissue. SURGICAL APPROACHES Approaches to the distal radius can be broadly divided into volar, radial, and dorsal. Visualization of the articular surface can be accomplished best arthroscopically. Arthroscopy can be performed alone or in conjunction with other open approaches to the distal radius. SUMMARY This article will review the pertinent anatomy and various surgical approaches in order to facilitate the surgeon's ability to safely expose a distal radius fracture.
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Affiliation(s)
- Asif M. Ilyas
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA 19107 USA
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Huard S, Leclerc G, Sergent P, Serre A, Gasse N, Lepage D, Jeunet L, Garbuio P, Obert L. Fractures du radius distal à déplacement dorsal : corrélation entre scores fonctionnels, qualité de réduction et type de fixation. ACTA ACUST UNITED AC 2010; 29:366-72. [DOI: 10.1016/j.main.2010.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/24/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Fractures of the distal radius are among the most common fractures in orthopedic practice. The purpose of our study was to explore the advantages and disadvantages of two methods of treatment for this type of fracture. METHODS One hundred thirteen fractures of the distal radius have been operated; 49 fractures were treated with an external fixator and 64 fractures by internal fixation using a "pi" plate. The mean follow-up was 12 months. Clinical evaluation was performed using the modified Gartland and Werley's Functional Scoring System. Radiographic evaluation was performed using the modified Lidstrom Radiographic Scoring System. RESULTS Clinical results were similar between the two groups of patients (p = 0.46). Radiographic parameters were superior in the group of patients treated with open reduction and internal fixation (p = 0.028). CONCLUSIONS Final functional results are comparable between external fixation and dorsal "pi" plating.
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Esparragoza-Cabrera L, Del Cerro-Gutiérrez M, De las Heras-Sánchez J, Sáez-Martínez D, Rojo-Manaute J, Vaquero-Martin J. Open reduction and internal fixation of unstable dorsally displaced distal radius fractures using a fixed-angle volar plate with locking screws. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1988-8856(09)70195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Esparragoza-Cabrera L, Del Cerro-Gutiérrez M, De las Heras-Sánchez J, Sáez-Martínez D, Rojo-Manaute J, Vaquero-Martin J. Reducción abierta y fijación interna de fracturas inestables del radio distal desplazadas dorsalmente: resultados al emplear placa volar de ángulo fijo con tornillos bloqueados. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2009.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Koenig KM, Davis GC, Grove MR, Tosteson ANA, Koval KJ. Is early internal fixation preferred to cast treatment for well-reduced unstable distal radial fractures? J Bone Joint Surg Am 2009; 91:2086-93. [PMID: 19723984 DOI: 10.2106/jbjs.h.01111] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the treatment of distal radial fractures, physicians often advocate internal fixation over cast treatment for potentially unstable fracture patterns, citing the difficulties of successful nonoperative treatment and a decrease in patient tolerance for functional deficiencies. This study was performed to evaluate whether early internal fixation or nonoperative treatment would be preferred for displaced, potentially unstable distal radial fractures that initially had an adequate reduction. METHODS A decision analytic model was created to compare early internal fixation with use of a volar plate and nonoperative management of a displaced, potentially unstable distal radial fracture with an acceptable closed reduction. To identify the optimal treatment, quality-adjusted life expectancy was estimated for each management approach. Data from the literature were used to estimate rates of treatment complications (e.g., fracture redisplacement with nonoperative treatment) and of treatment outcomes. Mean health-state utilities for treatment outcomes of painless malunion, functional deficit, and painful malunion were derived by surveying fifty-one adult volunteers with use of the time trade-off method. Sensitivity analysis was used to determine which model parameters would change the treatment decision over a plausible range of values. RESULTS Early internal fixation with volar plating was the preferred strategy in most scenarios over the ranges of parameters available, but the margins were small. The older patient (mean age, 57.8 years) who sustains a distal radial fracture can expect 0.08 more quality-adjusted life years (29.2 days) with internal fixation compared with nonoperative treatment. Sensitivity analysis revealed no single factor that changed the preferred option within the reported ranges in the base case. However, the group of patients sixty-five years or older, who had lower disutility for painful malunion, derived a very small benefit from operative treatment (0.01 quality-adjusted life year or 3.7 days) and would prefer cast treatment in some scenarios. CONCLUSIONS Internal fixation with use of a volar plate for potentially unstable distal radial fractures provided a higher probability of painless union on the basis of available data in the literature. This long-term gain in quality-adjusted life years outweighed the short-term risks of surgical complications, making early internal fixation the preferred treatment in most cases. However, the difference was quite small. Patients, especially those over sixty-four years old, who have lower disutility for the malunion and painful malunion outcome states may prefer nonoperative treatment.
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Affiliation(s)
- Karl M Koenig
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009; 91:1837-46. [PMID: 19651939 DOI: 10.2106/jbjs.h.01478] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the recent trend toward internal fixation of distal radial fractures, few randomized trials have examined whether volar plate fixation is superior to other stabilization techniques. The purpose of the present study was to compare (1) open reduction and internal fixation with use of a volar plate and early mobilization with (2) percutaneous fixation and casting or external fixation for the treatment of dorsally displaced unstable extra-articular and simple intra-articular fractures of the distal part of the radius, with a specific emphasis on early functional recovery. METHODS A prospective randomized study was performed at two institutions. Forty-five consecutive patients with a displaced, unstable fracture of the distal part of the radius were randomized to closed reduction and pin fixation (n = 22) or open reduction and internal fixation with a volar plate (n = 23). Clinical and radiographic assessments were conducted at six, nine, and twelve weeks after surgery and at one year. Outcome was measured on the basis of range of motion; grip and pinch strength; and Disabilities of the Arm, Shoulder and Hand scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was performed. RESULTS Patients in the open reduction and internal fixation group had superior Disabilities of the Arm, Shoulder and Hand scores at six, nine, and twelve weeks. At six weeks, the average Disabilities of the Arm, Shoulder and Hand score was 27 in the open reduction and internal fixation group as compared with 53 in the closed reduction and pin fixation group (p < 0.01). At nine and twelve weeks, patients in the open reduction and internal fixation group continued to have lower scores (17 compared with 39 [p < 0.01] and 11 compared with 26 [p = 0.01], respectively). At one year, there was no significant difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand scores. Patients in the open reduction and internal fixation group had greater range of motion and strength than patients in the closed reduction and pin fixation group at six and nine weeks, and more patients in the open reduction and internal fixation group were very satisfied with the overall wrist function and motion. Eight complications occurred, two in the open reduction and internal fixation group and six in the closed reduction and pin fixation group. CONCLUSIONS Both closed reduction with percutaneous pin fixation and open reduction with internal fixation with use of a volar plate are effective methods for the treatment of dorsally displaced, unstable, extra-articular or simple intra-articular fractures of the distal part of the radius. Better functional results can be expected in the early postoperative period in association with open reduction and internal fixation, and this form of treatment should be considered for patients requiring a faster return to function after the injury.
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Affiliation(s)
- Tamara D Rozental
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA.
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