Peri-Implant Distal Radius Fracture: Proposal of a New Classification

Peri-implant distal radius fracture due to car collision

Peri-implant fractures have gained increasing importance in orthopedics as the number of surgical procedures involving orthopedic implants rises globally. These fractures pose a significant challenge in terms of diagnosis, treatment, and postoperative management. They manifest as stress fractures distal to the implant site. Developing an effective treatment strategy involves evaluating multiple influencing factors. This article presents a rare case of a peri-implant distal radius fracture in a 63-year-old man, with no comorbidities, resulting from a car accident, classified as C1U in the Michele D'Arienzo system. The surgical intervention included plate fixation for the radius and wire fixation for the ulna. The wire was used for ulna instead of a plate, due to skin injuries, with good results. As life expectancy rises and individuals remain active in their elder years, the incidence of peri-implant fractures is expected to increase. Factors such as the implant type, surgeon's approach, and patient-specific elements may influence peri-implant fracture occurrence. The widespread use of plate fixation for distal radius fractures may also contribute to a parallel increase in such fractures. Providing detailed context and specific case presentation allows better understanding and implications for clinical practice.

Assessment of the relationship between the return to work and the severity of work-related upper limb injuries using the whole person impairment

PURPOSE

Upper limb disorders are one of the most common and important types of occupational injuries. Besides, identifying the factors influencing return to work following these injuries is essential to reduce the dimensions of the problem. In this study, we investigated the return to work and associated factors following occupational injuries leading to upper limb impairment.

METHODS

In this retrospective cohort study, the rate of return to work and associated factors were assessed in 256 workers with work-related upper limb injury referred to a teaching hospital from March 2011 to December 2018. The inclusion criterion was a history of occupational injury resulting in upper limb impairment, and exclusion criteria included the presence of simultaneous impairment in other organs, congenital or non-occupational limb defects as well as patients with incomplete information in their medical records. Individuals' records, including age at the time of injury, gender, date of injury, marital status, education, level of amputation and injury, whole person impairment (WPI) and physiotherapy (prescribed by the physician) were reviewed. The WPI was calculated to assess the extent of the injury. All analyzes were performed by SPSS version 25.0.

RESULT

The rate of return to work was 54.3%, in which 51.8% for the same job and 48.2% for a new job. The main factors associated with non-return to work were more days off work (p = 0.001), higher injury severity (p = 0.001), and dominant hand injury (p = 0.034).

CONCLUSION

The number of days off work, the WPI, and dominant hand injury are the most important determinant in returning to work. In addition, increased job satisfaction and support from co-workers and employers are work-related factors that can lead to an increased return to work.

Is the Postoperative Outcome after Intraarticular Distal Radius Fracture Influenced by Age and Gender? A PROM Study

BACKGROUND

Although the most common fracture of the human body, so far, only few data concerning gender-specific outcomes after distal radius fracture exist. Typically, elderly women suffer from DRF due to a low-energy fall because of osteoporosis. The aim of this study was to analyze the outcome after a surgically treated intraarticular DRF with the help of patient-reported outcome measurement (PROM) and with special regard to gender and age impact.

PATIENTS AND METHODS

It is a retrospective case-control study in which all patients with an intraarticular DRF were enrolled. The control group was composed of healthy volunteers. Munich Wrist Questionnaire (MWQ) was used as Patient Related Outcome Measurement (PROM) for analyzing the outcome. Moreover, age, gender, handedness, fracture classification and follow-up interval were detected. The functional outcome of the fracture group was compared to a healthy control group. Analyses of gender, age and handedness-specific results compared to the healthy control groups were performed as well.

RESULTS

197 patients with distal radius fracture could be enrolled in the study (134 were female and 63 were male). Women (mean age 62 years) were significantly older than men (mean age 50 years). The control group comprised 110 healthy subjects, 71 females (mean age 56 years) and 39 males (mean age 53 years). The whole fracture group had significantly lower MWQ scores compared to the control group (p < 0.001). The male fracture group (90.6 ± 12.4) and the female fracture group (90.8 ± 11.4) had a significantly worse outcome compared to the corresponding control group (p < 0.001 male and p = 0.034 female). Although significantly younger, the male patients had a similar outcome compared to the female patients.

DISCUSSION

Even elderly patients can reach the preoperative level after operative treatment of an intraarticular distal radius fracture. Although significantly younger than the female patients, men have significantly worse functional outcomes compared to their control and cannot perform better than the significantly older female patients. Gender might influence the outcome as well; however, age seems to have a greater impact on the outcome than gender.

Quantitative Assessment of the Restoration of Original Anatomy after 3D Virtual Reduction of Long Bone Fractures

Background: The purpose of this study was to demonstrate the usefulness of 3D image-based virtual reduction by validating the evaluation criteria according to guidelines suggested by the AO Surgery Reference. Methods: For this experiment, 19 intact radial ORTHObones (ORTHObones radius, 3B Scientific, Germany, Hamburg) without any fractures were prepared. All ORTHObones with six cortical marking holes (three points on the distal part and three points on the proximal part) were scanned using a CT scanner twice (before/after intentional fracture of the ORTHObone). After the virtual reduction of all 19 ORTHObones, accuracy evaluations using the four criteria (length variation, apposition variation, alignment variation, Rotation Variation) suggested in the AO Surgery Reference were performed. Results: The mean (M) length variation was 0.42 mm, with 0.01 mm standard deviation (SD). The M apposition variation was 0.48 mm, with 0.40 mm SD. The M AP angulation variation (for alignment variation) was 3.24°, with 2.95° SD. The M lateral angulation variation (for alignment variation) was 0.09°, with 0.13° SD. The M angle of axial rotation was 1.27° with SD: 1.19°. Conclusions: The method of accuracy evaluation used in this study can be helpful in establishing a reliable plan.