Pronator sparing plate osteosynthesis in distal radius fractures: early functional outcome

Thanks to modern anatomic stable angle plate and screw designs in distal radius fractures, early mobilization is possible and pronation torque of the wrist is more important in early recovery. Pronator sparing plate osteosynthesis of the distal radius is a relatively new approach. A short overview of the technique is given with some tips and tricks. The objective of the study is to investigate whether pronator sparing approach to distal radius fractures gives better pronation force or grip force in the postoperative rehabilitation. Two randomly assigned groups of 30 patients with dorsally displaced unstable wrist fractures, operated with or without pronator sparing plate osteosynthesis, were retrospectively evaluated. Early postoperative grip force, pronator force and swelling were compared to the contralateral side. The pronator force on 3 weeks and 6 weeks was significantly higher in the "pronator sparing" group, respectively 57% and 80% of the contralateral side compared with 43% and 67% in the "non sparing" group. Also swelling was significant less in the pronator sparing group. There was no significant difference in grip force between the two groups. Pronator sparing plate osteosynthesis in distal radius fractures seems to give better pronation force and less swelling in early recovery after volar plate osteosynthesis. This technique seems not to have beneficial results on grip force.

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

INTRODUCTION

The direct anterior approach (DAA) is an increasingly popular technique for performing total hip arthroplasty (THA). This muscle-sparing approach may yield functional benefits. However, DAA has been associated with an increased risk incidence (RI) of intra- and postoperative complications.

MATERIALS AND METHODS

A systematic review of the published literature was conducted to document the cumulative RI of intra- and postoperative complications, as well as the presence of a learning curve in subjects undergoing THA with a DAA. Study selection and data extraction were carried out independently in duplicate. A Bayesian zero-inflated random-effect model was used to calculate pooled estimates for the different endpoints.

RESULTS

Thirty-eight studies (6485 patients) were analysed. RIs of 0.8 % [95 % confidence interval (CI): 0.4-1.6 %] and 0.5 % (95 % CI: 0.3-0.9 %) were found for intra-operative trochanter and femoral fractures, respectively, and of 0.9 % (95 CI: 0.3-2.6 %) for postoperative transient lateral cutaneous femoral nerve (LCFN) impairment. A clear RI for early revisions (2.1 %; 95 % CI: 1.4-2.8 %) and other surgical re-interventions (1.3 %; 95 % CI: 0.7-1.9 %) was present, but these values do not differ from reported RIs for THA overall. The RI for dislocation was low (0.6 %; 95 % CI: 0.4-0.9 %) compared with the reported literature.

CONCLUSIONS

DAA is a technically demanding procedure, with outcomes possibly indicative of surgeon learning curve. A risk for intra-operative fractures and LCFN is evident, although the risk for other adverse effects is comparable to those with other approaches.

Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases

The direct anterior approach for total hip arthroplasty has gained popularity throughout the last decade. Early reports showed successful results with rapid functional recovery and low dislocation rates. However there is some concern about the high number of complications induced by the technique. The aim of this study was to examine the early radiological outcome and perioperative complications in a consecutive series of 300 total hip arthroplasties performed through a minimal invasive anterior approach with the aid of a positioning table. We observed 9(3%) intra-operative complications : two femoral perforations, 4 calcar fractures and 3 greater trochanter fractures. There were 42 (14%) postoperative complications and 20 (6.7%) patients required a surgical re-intervention. Our major finding was early peri-prosthetic femoral fracture in 5 patients, not noticed during surgery. The dislocation ratio (2 cases, 0.66%) was low. The complication ratio decreased throughout our series, but statistical significance could not be shown (p = 0.26). Surgeons should be aware of the high risk of occult intra-operative fractures when starting with this technique.