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张 鹏, 贾 波, 陈 逍, 王 宇, 黄 伟, 赖 人, 王 志, 熊 建, 王 天. [Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:578-581. [PMID: 32541995 PMCID: PMC7433416 DOI: 10.19723/j.issn.1671-167x.2020.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture. METHODS In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus. RESULTS The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group. CONCLUSION The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.
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Affiliation(s)
- 鹏 张
- 北京大学人民医院创伤救治中心,北京 100044 Department of Trauma Center, Peking University People’s Hospital, Beijing 100044, China
- 国家创伤医学中心,北京 100044 National Center for Trauma Medicine, Beijing 100044, China
| | - 波 贾
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 逍堃 陈
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 宇 王
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 伟 黄
- 北京大学人民医院创伤救治中心,北京 100044 Department of Trauma Center, Peking University People’s Hospital, Beijing 100044, China
- 国家创伤医学中心,北京 100044 National Center for Trauma Medicine, Beijing 100044, China
| | - 人杰 赖
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 志伟 王
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 建 熊
- 国家创伤医学中心,北京 100044 National Center for Trauma Medicine, Beijing 100044, China
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 天兵 王
- 北京大学人民医院创伤救治中心,北京 100044 Department of Trauma Center, Peking University People’s Hospital, Beijing 100044, China
- 国家创伤医学中心,北京 100044 National Center for Trauma Medicine, Beijing 100044, China
- 北京大学人民医院创伤骨科,北京 100044 Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
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Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schättin S, Hausner T, Leixnering M. Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year. Arch Orthop Trauma Surg 2020; 140:843-852. [PMID: 32221705 DOI: 10.1007/s00402-020-03411-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Distal radius fractures (DRF) are the most common fractures of the upper extremities and incidence is expected to continue rising as life expectancy increases. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF. Main aim of this study was to investigate correlation between radiological and clinical outcome in patients stabilized by palmar locking plate with a minimum follow-up of one year. METHODS A total of 524 patients with DRF, stabilized using palmar angular stable locking plate fixation were included in the study. Of these, 117 patients had to be excluded and another 177 were not accessible. The study group thus compromised 230 patients who returned for the follow-up investigation and were followed-up clinically and radiologically with a mean follow-up interval of 20 months. Outcome was evaluated using pain, range of motion (ROM) and grip strength parameters. In addition, self-assessment by patients was registered on the QuickDASH, PRWE and Mayo Score. The immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off. RESULTS Bivariant correlation analysis showed a significant correlation between ulnar variance and QuickDASH (r = 0.18, p = 0.01), grip strength (r = - 0.18, p = 0.04) and Mayo Score (r = - 0.23, p = 0.001). No significant differences could be found between an unacceptable (> 2 mm) and acceptable (< 2 mm) ulnar variance in respect of pain, ROM, grip strength and patient-reported outcome measurements. Age, gender, additional fracture to the ulnar styloid, or type of postoperative immobilization showed no significant or clinical important impact on the final patient-reported outcome. No significant differences in incidence of complications, ROM or loss of reduction could be found in any patients over or under 65 years of age. CONCLUSIONS Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment and results in a good clinical and radiological outcome with low complication rate. Ulnar variance showed a significant correlation to grip strength, QuickDASH and Mayo Score, but an unacceptable ulnar variance (> 2 mm) was not associated with a worse clinical important outcome. Age (< 65/> 65 years), gender and type of immobilization had no impact on the complication rate or in the final functional or radiological outcome.
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Affiliation(s)
- Stefan Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - A Pichler
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - S Schättin
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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The Relationship of Volar Plate Position and Flexor Tendon Rupture: Should We Question the Validity of the Soong Classification? Plast Reconstr Surg 2020; 146:581-588. [PMID: 32459734 DOI: 10.1097/prs.0000000000007080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors sought to determine the reliability of the Soong classification, which relates the position of the implant to the watershed line of the distal radius, for predicting flexor tendinopathy in distal radius fractures treated with volar plate fixation. METHODS Medical records were reviewed, including demographics, fracture and operative characteristics, tendon-related complications, and radiographic outcomes. Six hundred fifty-nine distal radius fractures were reviewed with a mean duration of clinical follow-up of 12.9 ± 0.7 months. RESULTS The incidence of isolated flexor tendinopathy and tendon rupture was 0.9 and 0.3 percent, respectively. The Soong classification failed to independently predict flexor tendon rupture or tendinopathy. Fractures classified as inadequately reduced were significantly associated with Soong grade 0 or grade 2, whereas adequately reduced fractures were significantly associated with Soong grade 1. CONCLUSION The Soong classification is not the sole predictor of flexor tendinopathy and may be viewed as a reflection of the overall appropriateness of fracture reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Zucchi B, Mangone M, Agostini F, Paoloni M, Petriello L, Bernetti A, Santilli V, Villani C. Movement Analysis with Inertial Measurement Unit Sensor After Surgical Treatment for Distal Radius Fractures. Biores Open Access 2020; 9:151-161. [PMID: 32461820 PMCID: PMC7247043 DOI: 10.1089/biores.2019.0035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 01/01/2023] Open
Abstract
Inertial measurement unit (IMU) has recently been used to evaluate a movement of a body segment to provide accurate information of movement's characteristics. IMU systems have been validated to successfully measure joint angle during upper limb range of motion (ROM). The study aimed to retrospectively evaluate, using an IMU, the ROM recovery of the wrist after surgical treatment for distal-radius fractures with Kirschner wire fixation (KWF) or with volar plate fixation (VPF) and screws. To assess pain in the wrist joint, muscle-fatigue (MF), and functional difficulties in activities of daily living, we evaluated the patients through patient-related wrist evaluation questionnaire (PRWE) scale, disability of the arm, shoulder and hand (DASH) scale, Hand Grip Strength (HGS), and surface electromyography (EMG). We used a single IMU composed of three-axis gyroscope, a three-axis accelerometer, and a magnetometer. We calculated the value of ROM as a percentage with respect to the unaffected wrist. We also recorded surface-EMG signals over biceps brachialis, flexor carpi radialis (FCR), extensor carpi radialis (ECR), and pronator teres muscles. Forty patients were recruited for our study. Ulnar deviation (UD) was significantly higher for VPF than for KWF (p = 0.017); supination was significantly higher for VPF than for KWF (p = 0.031). The percentage of decay of the median frequency of FCR of volar plate was significantly higher than KWF. The HGS of KWF was significantly higher than VPF. In literature, there were no significant differences between the two types of treatment at long-term follow-up. Our results demonstrate a superior efficacy of VPF in terms of ROM improvement in UD and supination, but for these patients, muscle fatigue is greater than the KWF group. Based on the data available, VPF is similar to KWF for the treatment of distal radius fractures. The IMU sensor could be used in the future to evaluate ROM after surgery during patient's rehabilitation and to compare the effects with stratified analysis regarding age and fracture type, paralleled with cost-effectiveness analysis.
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Affiliation(s)
- Benedetta Zucchi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Paoloni
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Luisa Petriello
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Valter Santilli
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Ciro Villani
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
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Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures. Arch Orthop Trauma Surg 2020; 140:611-621. [PMID: 32193677 DOI: 10.1007/s00402-020-03365-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 02/09/2023]
Abstract
Distal Radius fractures (DRF) are one of the most common injuries in the upper extremity and incidence is expected to rise due to a growing elderly population. The complex decision to treat patients operatively or conservatively depends on a large variety of parameters which have to be considered. No unanimous consensus has been reached yet, which operative approach and fixation technique would produce the best postoperative functional results with lowest complication rates. This article addresses the available evidence for indications, approaches, reduction, and fixation techniques in treating DRF.
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García-Cepeda I, Aguado-Maestro I, De Blas-Sanz I, Quintanilla-García A, García-Alonso M. Radiological results of surgical management of fracture of the distal radius treated with volar locking plates. Injury 2020; 51 Suppl 1:S42-S47. [PMID: 32113738 DOI: 10.1016/j.injury.2020.02.106] [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: 12/03/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Distal radius fracture (DRF) is the most common upper extremity fracture. The incidence of complications after surgical treatment still remains high. The objective of our study was to assess functional and radiological results of DRF treated with volar locking plate. METHODS We conducted a retrospective study including DRF treated by open reduction and internal fixation with a volar locking plate during a period of 8 years (2010-2018). Data were collected from clinical records and included patient demographics, fracture characteristics, radiological parameters (radial inclination, palmar tilt, ulnar variance, articular step-off), range of motion (ROM), complications and reinterventions. RESULTS A total of 170 patients (63.5% female) met the inclusion criteria with a mean age of 55.9 years [24.1-83.7; 13.76]. High energy injuries were more frequent in younger patients (25.56% vs 3.95%; p < 0.0001). AO classification was: 2R3A: 23.5%, 2R3B: 24.1% and 2R3C: 52.4%. Time until surgery was 8.5 days, longer in extraarticular fractures (AO-2R3A: 12.22 days, AO-2R3B: 7.97 days, AO-2R3C: 7.04 days, p = 0.018). Younger patients had better radial inclination (excellent in 85.1% vs 59.21%, p = 0.001) and radial shortening (excellent in 100% vs 88.15%, p = 0.001). ROM was: flexion 63° [0-90°; 19.73], extension 57.67° [5-90°; 21.61], pronation 78.94° [40-90°] and supination 81.76° [38-90°; 8.87]. We found a weak correlation between ROM in flexion-extension and radial shortening (r = 0.218; p = 0.001) and articular step-off (r = -0.269; p = 0.002). We had 39 complications (21.18% of patients). 10.6% of patients needed a re-operation, being the most frequent hardware removal (6.5%) and tendinous disruptions repairs (2.4%). Reintervention rate was higher in younger patients (14.9% vs 5.3%; p = 0.042), complete articular fractures (AO-2R3A: 2.5%; AO-2R3B: 7.3%; AO-2R3C: 15.7%; p = 0.037) and high energy injuries (8.4% vs 22.2%; p = 0.044). Patients undergoing reintervention had a decreased flexion-extension (94.44° vs 123.83°, p = 0.007). CONCLUSION Radial shortening and articular step-off seem the most important predictors for postoperative range of motion. Worse radiological outcomes are observed in complete articular fractures and those affecting elder population. Although radiological and functional results are good or excellent in most of cases, the incidence of complications and need for reintervention still remains noticeable. Re-operations were more frequent in younger patients, complete articular fractures and high energy injuries, and it worsened functional outcomes.
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Affiliation(s)
- I García-Cepeda
- Traumatology and Orthopaedic Surgery Department, Hospital Universitario del Río Hortega, C Dulzaina 2, Valladolid 47009, Spain
| | - I Aguado-Maestro
- Traumatology and Orthopaedic Surgery Department, Hospital Universitario del Río Hortega, C Dulzaina 2, Valladolid 47009, Spain.
| | - I De Blas-Sanz
- Traumatology and Orthopaedic Surgery Department, Hospital Universitario del Río Hortega, C Dulzaina 2, Valladolid 47009, Spain
| | - A Quintanilla-García
- Traumatology and Orthopaedic Surgery Department, Hospital Universitario del Río Hortega, C Dulzaina 2, Valladolid 47009, Spain
| | - M García-Alonso
- Traumatology and Orthopaedic Surgery Department, Hospital Universitario del Río Hortega, C Dulzaina 2, Valladolid 47009, Spain
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Nanno M, Kodera N, Tomori Y, Takai S. Volar Locking Plate Fixation for Intra-Articular Distal Radius Fractures with Volar Lunate Facet Fragments Distal to the Watershed Line. J NIPPON MED SCH 2020; 87:24-31. [PMID: 31611505 DOI: 10.1272/jnms.jnms.2020_87-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Standard volar plating of distal radius fractures may not adequately fix the volar lunate facet (VLF) fragment, which can result in volar carpal subluxation. We hypothesized that the size of VLF fragments distal to the watershed line might affect reduction loss after distally placed volar locking plate fixation for intra-articular distal radius fracture and examined if the presence of small displaced VLF fragments was a risk factor for reduction loss. METHODS Twenty-seven hands of 27 patients with intra-articular distal radius fractures with VLF fragments distal to the watershed line were treated by using Acu-Loc 2 volar distal radius locking plate fixation. RESULTS At final follow-up, the mean Mayo Performance Score was 90.9, and the mean Quick Disabilities of Arm, Shoulder, and Hand score was 13.6. On radiography, 5 patients had a reduction loss of >2 mm in ulnar variance from immediately postoperatively to final follow-up (group 1), while 27 had no reduction loss (group 2). The mean longitudinal, transverse, and anteroposterior lengths and joint surface area of the VLF fragment were significantly smaller in group 1 than in group 2. Three-dimensional computed tomography revealed that the fracture patterns of the radiocarpal and distal radioulnar joints in group 1 were mainly volar-displaced VLF fragments. CONCLUSIONS By stabilizing fragments, distally placed volar locking plate fixation effectively treated intra-articular distal radius fractures with VLF fragments distal to the watershed line. However, the presence of small displaced VLF fragments may increase the risk of reduction loss in ulnar variance.
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Affiliation(s)
| | - Norie Kodera
- Department of Orthopedic Surgery, Nippon Medical School
| | - Yuji Tomori
- Department of Orthopedic Surgery, Nippon Medical School
| | - Shinro Takai
- Department of Orthopedic Surgery, Nippon Medical School
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Pulos N, DeGeorge BR, Shin AY, Rizzo M. The Effect of Radial Shaft Dorsal Screw Prominence in Volar Locking Plate Fixation of Distal Radius Fractures. Hand (N Y) 2020; 15:271-275. [PMID: 30081647 PMCID: PMC7076618 DOI: 10.1177/1558944718793171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The purpose of this study was to determine whether prominent radial shaft screws in volar locked plating of distal radius fractures increase the risk of tendon irritation, tendon rupture, or hardware removal. Methods: Patients who underwent volar locked plating of distal radius fractures from April 2002 to March 2016 with at least 6 months of follow-up were evaluated. Variables examined included demographics, extensor tendon irritation, extensor tendon rupture, and hardware removal. The most prominent cortical screws on postoperative lateral radiographs were identified and measured from the dorsal cortex of the radial shaft to the tip of the screw. Results: In all, 261 distal radius fractures in 255 patients were identified. Thirty-nine patients (14.9%) underwent subsequent hardware removal at a mean 15.8 ± 18.6 months. Nine patients (3.45%) were found to have clinically significant extensor tendon irritation including one patient (0.38%) with extensor tendon rupture. The average screw was 1.48 mm proud of the dorsal radial cortex. In all, 22.6% of screws were greater than 2 mm proud. Comparing patients who underwent hardware removal with those who did not, there was no statistically significant difference in mean screw prominence or proportion of patients with screws greater than 2 mm. There was no statistically significant difference between shaft screw prominence and extensor tendon irritation. Conclusions: The effect of dorsal screw prominence of radial shaft screws is not significant. This study does not support the downsizing of prominent screws 2 mm or less.
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Affiliation(s)
| | | | | | - Marco Rizzo
- Mayo Clinic, Rochester, MN, USA,Marco Rizzo, Department of Orthopaedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Dennison DG, Blanchard CL, Elhassan B, Moran SL, Shin AY. Early Versus Late Motion Following Volar Plating of Distal Radius Fractures. Hand (N Y) 2020; 15:125-130. [PMID: 30009627 PMCID: PMC6966284 DOI: 10.1177/1558944718787880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Distal radius fractures are common, and the trend in fixation has included the use of locked volar plating. The duration of splinting required after surgery and the effect splinting has upon outcome of the wrist are not clear. Our aim was to compare outcome of patients treated with early versus late motion protocol after volar plating. Methods: Thirty-three patients with distal radius fractures were prospectively and randomly enrolled into an early versus late motion study including volar plating of the distal radius fracture. Early motion included an active and passive wrist motion protocol by 14 days after surgery and delayed motion was initiated at 5 weeks. Fractures were defined as intra-articular and extra-articular, and those with, and without, ulnar styloid fracture. Motion and outcome scores (Disabilities of the Arm, Shoulder and Hand [DASH]/patient-rated wrist evaluation [PRWE]), and strength were measured through 1 year. Results: Wrist motion, DASH, and PRWE scores were only significantly different at 6 weeks with no significant differences at any later time points up to 1 year. One patient had complex regional pain syndrome (CRPS) and one had adhesive capsulitis in the late motion group. Conclusions: Following locked volar plating of distal radius fractures, early motion favored earlier return of motion along with lower DASH, PRWE, and pain scores within first 6 weeks. Although the late motion group had delayed recovery, there were no long-term significant differences in motion, strength, outcome, or pain scores. The 2 cases with complications (CRPS and adhesive capsulitis) did occur in the late motion group and may implicate late motion with these problems.
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Affiliation(s)
- David G. Dennison
- Mayo Clinic, Rochester, MN, USA,David G. Dennison, Assistant Professor,
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester,
MN 55906, USA.
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Martin DP, Park AG, Jamison D, Jones CM, Ilyas AM. Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius. J Hand Surg Am 2019; 44:1093.e1-1093.e8. [PMID: 30898463 DOI: 10.1016/j.jhsa.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This biomechanical study compared the stability of volar locking plates (VLPs) and locking fragment-specific (LFS) dorsal and radial styloid plates for the fixation of dorsal (AO 23-B2) and radial styloid (AO 23-B1) shear fractures of the distal radius, respectively. METHODS Two groups of 6 composite radii were fixed with a VLP or an LFS dorsal plate over a simulated dorsal shear fracture. Two additional groups of 6 radii received the same VLP or an LFS radial plate to fix a radial styloid fracture. Each plated radius was tested under cyclic axial compression by a servohydraulic testing machine that recorded axial displacement per cycle. Construct stiffness was calculated from the slope of the force-displacement curve. RESULTS In the dorsal shear fracture model, the dorsal LFS plate exhibited less displacement than the VLP (0.32 ± 0.04 vs 0.43 ± 0.07 mm, respectively) and showed greater average stiffness (645 ± 64 vs 433 ± 88 N/mm, respectively). Plate type was responsible for 53.1% of the variation in displacement and 68.6% of the variation in stiffness. In the radial styloid fracture model, variations due to number of cycles elapsed and plate type were similar for displacement and stiffness in both groups. The average stiffness during cyclical nondestructive testing was 566 ± 45 and 573 ± 60 N/mm for VLP and LFS radial plating groups, respectively. CONCLUSIONS For AO 23-B2 (dorsal rim) fractures, the dorsal LFS plates exhibited significantly less displacement and greater stiffness in axial loading than VLPs. For AO 23-B1 (radial styloid) fractures, the VLP displayed similar displacement and stiffness to the radial LFS plates. CLINICAL RELEVANCE All constructs tested could be expected to withstand axial compressive forces typical of early postoperative rehabilitation.
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Affiliation(s)
- Dennis P Martin
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Andrew G Park
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - David Jamison
- Mechanical Engineering Department, Villanova University, Villanova, PA
| | - Christopher M Jones
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Bergsma M, Board J, Doornberg JN, Sierevelt I, Rickman M, Jaarsma RL, Obdeijn MC. MRI Study on the Distance between the Distal Radius and the Flexor and Extensor Tendons: Is There Any Room for Error/Hardware? J Wrist Surg 2019; 8:470-476. [PMID: 31815061 PMCID: PMC6892652 DOI: 10.1055/s-0039-1693053] [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: 02/06/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
Purpose This study aims to quantify the distances between the cortex of the distal radius and flexor and extensor tendons. Methods We analyzed 50 magnetic resonance images (MRI) of intact wrist without pathology. The distances between the volar cortex and the flexor pollicis longs (FPL), index flexor digitorum profunduns (FDPi), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) were measured at the level of the watershed line and 3- and 6-mm proximal to this level. The distances between the dorsal cortex and the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), extensor indicis proprius (EIP), and the extensor digitorum communis (EDC) were measured at the level of Lister's tubercle and 5-mm distal to this level. Analysis was descriptive. Results At the watershed line, the FPL, FDPi, FDP, and FDS were located at an average of 3.1, 2.4, 3.6, and 5.1 mm, respectively, volar to the volar cortex. The distances of the FDP and FDS increased at 3-mm proximal to the watershed line and increased for all four tendons at 6-mm proximal to the watershed line. Dorsally, at Listers' tubercle the ECRL, ECRB, EPL, EIP, and EDC were identified at an average of 0.7, 0.5, 0.5, 2.6, and 3.2 mm, respectively, dorsal to the dorsal cortex of the distal radius. At 5-mm more distal, these tendons were located on average 1.2, 1.0, 0.7, 1.9, and 1.8 mm, respectively, dorsal to the dorsal cortex. Conclusion On the volar side, on average there is enough room for a volar plate when staying proximal to the watershed line. On the dorsal side, there is virtually no room for protruding screws as physical anatomical space is limited to a maximum of 0.7 mm from cortex to the closest tendon (the FDP), with screw increments being 2 mm. Level of Evidence This is a Level II Study.
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Affiliation(s)
- Minke Bergsma
- Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery/Department of Plastic Reconstructive and Hand Surgery, Asterdam Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
| | - Jemara Board
- Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
| | - Job N. Doornberg
- Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery/Department of Plastic Reconstructive and Hand Surgery, Asterdam Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
| | - Inger Sierevelt
- Speciaized Centre of Orthopedic Research and Education, Amstelveen, the Netherlands
| | - Mark Rickman
- Department of Orthopaedic Trauma/Orthopaedics & Trauma Research Group, The Royal Adelaide Hospital, Adelaide, Australia
| | - Ruurd L. Jaarsma
- Department of Orthopaedic & Trauma Surgery, Medical Centre/Flinders University, Adelaide, Australia
| | - Miryam C. Obdeijn
- Department of Orthopaedic Surgery/Department of Plastic Reconstructive and Hand Surgery, Asterdam Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
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Walch A, Erhard L, Vogels J, Pozzetto M, Gibert N, Locquet V. Ultrasound Evaluation of the Protector Role of the Pronator Quadratus Suture in Volar Plating. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2785-2791. [PMID: 30779196 DOI: 10.1002/jum.14968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
The main complication of volar locking plates for distal radius fractures is flexor tendon rupture. The flexor pollicis longus (FPL) is the most commonly ruptured. Repair of the pronator quadratus (PQ) is one of the ways to prevent tendon rupture. The main purpose of this series was to evaluate the role of PQ repair after volar plating to prevent flexor tendon rupture using ultrasound (US). This work was a mono-operator prospective series of 20 consecutive patients with volar locking plates for distal radius fracture between September 2014 and May 2015. The PQ was repaired in all patients. A clinical, ultrasound, and perioperative evaluation of the flexor tendon was performed by this same surgeon. There was no flexor tendon rupture or tenosynovitis. There were no type A cases, which are characterized by contact between the plate and the FPL, and mostly type C cases, which are characterized by no contact between the plate and the FPL on US imaging. The suture of the PQ was sustainable over time when we removed the plate. Pronator quadratus repair is one of the ways to prevent flexor tendon rupture after volar plating. The outward-running suture is an effective technique for repairing the PQ. Ultrasound may be helpful during follow-up to detect asymptomatic flexor tendon irritation.
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Affiliation(s)
- Arnaud Walch
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - Lionel Erhard
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - Jerome Vogels
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - Marc Pozzetto
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - Nicolas Gibert
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
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Öztürk A, Bilgetekin YG, Çatma MF, Akdoğan M, Atilla HA, Ersan Ö. Dengesiz Distal Radius Kiriklarinin Volar Plaklama İle Tedavisi Sonrasinda Kötü Sonuçlarin Belirteçleri; Retrospektif Klinik Analiz. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.547982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Salibian AA, Bruckman KC, Bekisz JM, Mirrer J, Thanik VD, Hacquebord JH. Management of Unstable Distal Radius Fractures: A Survey of Hand Surgeons. J Wrist Surg 2019; 8:335-343. [PMID: 31404192 PMCID: PMC6685781 DOI: 10.1055/s-0038-1675792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/08/2018] [Indexed: 01/16/2023]
Abstract
Background Length of immobilization after operative fixation of unstable distal radius fractures and management in elderly patients is an area of debate. Purpose The purpose of this study is to delineate common practices of fellowship-trained hand surgeons and how they compare with current evidence-based protocols. Methods Surveys were distributed to American Society for Surgery of the Hand members on preferred methods of fixation, postoperative immobilization, and variations in treatment of elderly patients with unstable distal radius fractures. Responses were analyzed in comparison to a literature review. Subgroups were compared with regard to training, practice type, and years in practice. Results Four-hundred eighty-five surveys were analyzed. Volar fixed-angle plating was the most common choice of fixation (84.7%). Patients are most often immobilized for 1 to 2 weeks (40.0%) with range of motion (ROM) therapy begun most commonly between 1 and 4 weeks (47.2%). The majority of surgeons do not treat fractures differently in patients more than 65 years old. Physicians with more than 20 years of experience were significantly more likely to begin wrist ROM sooner with volar plating versus other fixation techniques compared with physicians with less than 20 years of experience (40.7% vs. 34.2%, respectively). Also, physicians in academic-only practices were more likely to immobilize patients for a shorter time after volar plating compared with those in privademics. Conclusion Volar fixed-angle plating is the dominant fixation method for unstable distal radius fractures among fellowship-trained hand surgeons. Elderly patients are not treated more conservatively and rigid immobilization after operative fixation remains the treatment of choice despite current evidence-based protocols.
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Affiliation(s)
- Ara A. Salibian
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Karl C. Bruckman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Jonathan M. Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Joshua Mirrer
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Vishal D. Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Jacques H. Hacquebord
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York
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Lee C, Pereira C, Zoller S, Ghodasra J, Yamaguchi K, Rough J, Sugi M, Benhaim P. Feasibility and Reliability of Open Reduction Internal Fixation in Delayed Distal Radius Fracture Management. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Boretto JG, Zaidenberg EE, Gallucci GL, Sarme A, De Carli P. Comparative Study of Internal Fixation of the Ulna and Distal Ulna Resection in Patients Older Than 70 Years With Distal Radius and Distal Metaphyseal Ulna Fractures. Hand (N Y) 2019; 14:540-546. [PMID: 29463126 PMCID: PMC6760079 DOI: 10.1177/1558944718760000] [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: 11/16/2022]
Abstract
Background: Acute management of fractures of the distal ulna that are associated with fractures of the distal radius remains difficult, particularly in the elderly. Methods: In this study, we investigated whether internal fixation of the distal ulna is associated with a higher rate of complications than resection of the distal ulna in patients older than 70 years. Twenty-four consecutive patients were included in this study, 12 of whom had undergone open reduction and internal fixation (ORIF) of the distal ulna, and 12 who had undergone distal ulna resection. Patients were retrospectively assessed for range of motion, grip strength, pain, and radiographic appearance. The functional outcome was evaluated by the Mayo Wrist Score. Complications were classified according to the Classification of Surgical Complications. Results: There were no differences in patient demographics between the 2 groups, except patient age. Clinical evaluation showed no difference at follow-up; however, there were significantly more complications associated with ORIF compared with resection. Conclusions: The results from our study show that women older than 70 years with fracture of the distal radius and distal ulna have a higher rate of complications if ORIF of the distal ulna is performed. Patients should be warned, by surgeons, of this in cases where ORIF of the distal ulna is suggested.
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Affiliation(s)
- Jorge G. Boretto
- Hospital Italiano de Buenos Aires,
Argentina,Jorge G. Boretto, Hand and Upper Extremity
Department, Instituto de Ortopedia y Traumatología “Dr. Prof. Carlos
Ottolenghi,” Hospital Italiano de Buenos Aires, Buenos Aires, C1199ACK,
Argentina.
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First Place Award: A radiographic analysis of closed reduction and casting of distal radial fractures with consideration of candidacy. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000779] [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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Abstract
PURPOSE OF REVIEW To provide an overview of emerging fixation constructs and materials used in the operative management of distal radius fractures. RECENT FINDINGS The indications, advantages, and disadvantages of relatively new implants and devices used to treat distal radius fractures are discussed. These include the intramedullary nail, intramedullary cage, radiolucent volar locking plate, distal radius hemiarthroplasty, and bone graft substitutes. The spectrum of distal radius fracture patterns may make it impossible to depend on a single device for fixation, and surgeons managing distal radius fractures should be adept at using various surgical approaches, techniques, and hardware systems. Additional studies demonstrating the cost-effectiveness, biomechanical properties, and clinical outcomes will be useful in determining the utility of the described techniques.
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Affiliation(s)
- Abdo Bachoura
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, G114, Philadelphia, PA 19107 USA
| | - Eon K. Shin
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 1203 Langhorne-Newtown Road, Suite 335, Langhorne, PA 19047 USA
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Yamazaki H, Hayashi M, Miyaoka S, Hashimoto S, Kitamura Y, Isobe F, Kato H. Venous perfusion assist system has no additional effect compared to simple elevation on post-operative edema in patients with distal radial fracture treated with volar locking plate fixation: A randomized controlled trial. J Orthop Sci 2019; 24:441-446. [PMID: 30522925 DOI: 10.1016/j.jos.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/05/2018] [Accepted: 11/14/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND While limb elevation and other methods for reducing hand edema are commonly used in clinical practice, alternative methods, such as compression and venous perfusion assist system (VPAS), have emerged. This study compared the efficacy of VPAS to limb elevation in decreasing hand edema after surgery for distal radial fracture (DRF) treated by a volar locking plate (VLP). METHODS A randomized controlled trial was conducted in 102 patients to compare VPAS and elevation methods for edema reduction following VLP fixation for DRF. Changes in edema were measured using the tape measure method along with other parameters on the next day and at one, three, six, and 12 weeks postoperatively. RESULTS There were no significant differences in edema reduction or other factors between the VPAS and elevation groups at any measurement point. CONCLUSIONS VPAS appears to confer no measurable advantage over management with elevation for edema reduction after VLP fixation of DRF. TRIALS REGISTRY This study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000015640).
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Affiliation(s)
- Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto, 390-8510, Japan.
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Shunsuke Miyaoka
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto, 390-8510, Japan
| | - Shun Hashimoto
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto, 390-8510, Japan
| | - You Kitamura
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto, 390-8510, Japan
| | - Fumihiro Isobe
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto, 390-8510, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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Minimally invasive internal fixation for extra-articular distal radius fracture: Comparison between volar plate and intramedullary nail. Orthop Traumatol Surg Res 2019; 105:409-415. [PMID: 30711303 DOI: 10.1016/j.otsr.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are numerous internal fixation techniques for distal radius fracture, using pins, plates or nails. Some authors have developed minimally invasive procedures. The aim of the present study was to compare two minimally invasive internal fixation techniques for unstable extra-articular distal radius fracture in women over 50 years of age: volar plate (minimally invasive plate osteosynthesis: MIPO), and intramedullary nail. HYPOTHESES The main study hypothesis was that the incision scar left by minimally invasive internal fixation is smaller using MIPO than an intramedullary nail. The secondary hypotheses were that the two techniques do not differ in terms of pain, functional score, strength, range of motion and radiologic indices. MATERIAL AND METHOD The series comprised nineteen A2.2 and one A2.1 fractures in 20 female patients with a mean age of 72 years. The first 10 (group 1) received minimally invasive internal fixation of the distal radius by MIPO, and the other 10 (group 2) by intramedullary nail locked onto the distal radius epiphysis and diaphysis. RESULTS The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail (mean, 14.3mm vs. 32.8mm). Some of the secondary hypotheses were also confirmed: there were no differences between the two techniques in terms of pain at 6 months, QuickDASH, PRWE (Patient-Reported Wrist Evaluation), range of motion or ulnar variance; two were not confirmed: pain at 6 weeks was less with intramedullary nails, and palmar slope was better with MIPO. DISCUSSION AND CONCLUSION The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail. In conclusion, the present findings showed that internal fixation of unstable extra-articular fracture in over 50-year-olds gave better clinical results at 6 weeks using an intramedullary nail, while MIPO required smaller incision. LEVEL OF EVIDENCE III, retrospective study.
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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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Investigating the minimum distance between the finger flexor tendons and distal radius during wrist and finger positions in healthy people. J Med Ultrason (2001) 2019; 46:353-359. [PMID: 30840213 DOI: 10.1007/s10396-019-00935-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Rupture of the flexor pollicis longus (FPL) and index flexor digitorum profundus (FDP2) tendons often occurs after locking plate fixation for distal radius fracture. This study aimed to determine the shortest tendon-radius distances of different hand positions. METHODS Fifty-nine hands of 30 healthy volunteers were studied. Distances between the FPL or FDP2 and distal radius were calculated in six wrist positions: 30° palmar flexion, neutral, 30° dorsiflexion, 60° dorsiflexion, maximum dorsiflexion, and 40° ulnar deviation with three finger positions (full extension and flexion of fingers, full flexion of the thumb or index finger, and full extension of the other four fingers). The shortest distance between the FPL or FDP2 and distal radius was noted. RESULTS The shortest distance between the FPL and distal radius was during maximum wrist dorsiflexion with isolated thumb flexion. The distance between the FDP2 and distal radius was shortest with all-finger flexion in 30° wrist dorsiflexion. CONCLUSIONS It is necessary to measure the distance between the FPL and distal radius in maximal wrist dorsiflexion with full flexion of the isolated thumb, as the shortest distance was observed with flexion of the isolated thumb. On the contrary, we recommend measuring the distance between the FDP2 and distal radius in 30° wrist dorsiflexion with flexion of all fingers.
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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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Saving J, Enocson A, Ponzer S, Mellstrand Navarro C. External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures-A 3-Year Follow-Up of a Randomized Controlled Study. J Hand Surg Am 2019; 44:18-26. [PMID: 30420192 DOI: 10.1016/j.jhsa.2018.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/14/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if a volar locking plate (VLP) is superior to external fixation (EF) 3 years after surgery for unstable, dorsally displaced, distal radius fractures caused by low-energy injury in patients 50 to 74 years of age. METHODS During 2009 to 2013, 140 patients with an unstable dorsally displaced distal radius fracture were randomized to either VLP or EF. One hundred eighteen patients (EF 56, VLP 62) were available for a 3-year follow-up. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 3 years. Secondary outcomes were Patient-Related Wrist Evaluation (PRWE) score, EuroQol-5 Dimensions (EQ-5D) score, range of motion (ROM), grip strength, and radiological signs of osteoarthritis (OA) at 3 years. Moreover, reoperations and minor complications during the first 3 years were recorded. RESULTS There were no differences regarding DASH, PRWE, EQ-5D, ROM or grip strength. The reoperation rate was 21% (13 of 62) in the VLP group compared with 14% (8 of 56) in the EF group. The OA rate was 42% (25 of 59) in the VLP group compared with 28% (15 of 53) in the EF group. CONCLUSIONS Three years after surgery for unstable dorsally displaced distal radius fractures, the clinical and radiological results for VLP and EF were comparable. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Jenny Saving
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Södersjukhuset Hospital, Stockholm, Sweden.
| | - Anders Enocson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Södersjukhuset Hospital, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
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Piolanti N, Poggetti A, Nucci AM, Nesti A, Marchetti S, Parchi PD, Scaglione M. The 50 most cited articles about wrist surgery. Orthop Rev (Pavia) 2018; 10:7715. [PMID: 30662683 PMCID: PMC6315303 DOI: 10.4081/or.2018.7715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 11/23/2022] Open
Abstract
The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic “wrist surgery” in the subject category ‘‘Orthopaedics’’. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category “orthopaedics”. Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. “Distal Radius Fractures” was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors who would like to improve their research in wrist and hand surgery and make their publications more citable and appreciated by the scientific community.
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Affiliation(s)
- Nicola Piolanti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Andrea Poggetti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Anna Maria Nucci
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Agnese Nesti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Stefano Marchetti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Paolo Domenico Parchi
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Michelangelo Scaglione
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
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Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 2018; 138:1773-1782. [PMID: 30341694 DOI: 10.1007/s00402-018-3051-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Distal radius fractures (DRF) are the most common fractures of the upper extremities. The incidence is expected to continue rising in the next years due to the increased life expectancy. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF with a complication rate of 8-39% reported in the literature. Main aim of this study was to investigate the incidence of complications after DRF stabilization using palmar angular stable locking plate. METHODS A retrospective medical records review conducted from January 2013 to December 2016 included a total of 392 patients with DRF, that were stabilized using palmar angular stable locking plate and showed a minimum follow-up of 3 months. The group comprised 259 female and 133 male patients with a mean follow-up interval of 11 months (range 3-52 months). All recorded complications were documented. Range of motion (ROM) in extension, flexion, supination, pronation, radial- and ulnar deviation of the last follow-up was noted. Age was divided into younger than 65 years (< 65 years) and older than 65 years (≥ 65 years). The primary, immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off. RESULTS A total of 51 (13%) early and 17 late (4%) complications were recorded in 392 patients. The most common complications included carpal tunnel syndrome (3%), complex regional pain syndrome (3%) and loss of reduction (2%). Of the 68 complications, only 25 (6%) were directly related to the plate. 73% of all complications occurred in AO type C fractures. Patients without complications showed a significantly better ROM in extension, flexion, pronation and supination than patients with complications. No significant differences in incidence of complications, ROM or loss of reduction could be found between patients over and under 65 years of age. Gender and type of immobilization showed no significant influence on the complication rate. CONCLUSIONS Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment. In the majority of the cases a good clinical and radiological outcome with no complications was documented. Gender and type of immobilization had no impact on the complication rate and an age over 65 years is not associated with an increased risk for complications or restricted ROM.
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77
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Kwon BC, Lee JK, Lee SY, Hwang JY, Seo JH. Morphometric Variations in the Volar Aspect of the Distal Radius. Clin Orthop Surg 2018; 10:462-467. [PMID: 30505415 PMCID: PMC6250957 DOI: 10.4055/cios.2018.10.4.462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/23/2018] [Indexed: 11/06/2022] Open
Abstract
Background Significant discrepancy exists between anatomical plate designs and the anatomy of the native distal radius, which may be attributable to considerable morphometric variations in the volar aspect of the distal radius. We aimed to evaluate the degree of variability in the morphometry of the distal radius and identify factors associated with this variability. Methods We measured the volar surface angle (VSA) of the intermediate and lateral columns and the volar surface width (VSW) in the distal radius from three-dimensional computed tomography scans acquired from 81 cadaveric forearms. These morphometric parameters were compared between the lateral and intermediate columns, between males and females, and between Koreans and Caucasians. Caucasian morphometric data were obtained and pooled from the previous studies. The coefficient of variation was used to assess the variability of the parameters and Cohen's d to estimate the effect size of the difference between groups. Results The average VSA of the lateral column was 22° ± 6°, and that of the intermediate column was 29° ± 8° in Koreans (p < 0.001). The variability was high for both VSAs. The VSA of the intermediate column was significantly larger in males than in females (p < 0.001) and in Caucasians than in Koreans (p < 0.001). The average VSW of distal radius was 30 ± 3 mm at the watershed line, and it became narrower proximally. The VSW was significantly larger in males than in females (p < 0.001) and in Koreans than in Caucasians (p < 0.001). The effect sizes of the difference for the VSA and VSW between sexes, races and columns were medium to large. Conclusions Considerable variability exists in the morphometry of the volar distal radius, with sex, race, and column as contributing factors. These results suggest that surgeons should carefully choose an anatomical volar locking plate with appropriate angulation characteristics for each patient to achieve patient-specific alignment of the distal radius.
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Affiliation(s)
- Bong Cheol Kwon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Joon Kyu Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Suk Yoon Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Yeun Hwang
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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Murase T. Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument. J Hand Surg Asian Pac Vol 2018; 21:133-9. [PMID: 27454626 DOI: 10.1142/s2424835516400051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius.
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Affiliation(s)
- Tsuyoshi Murase
- 1 Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
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79
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Drobetz H, Black A, Davies J, Buttner P, Heal C. Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates. World J Orthop 2018; 9:203-209. [PMID: 30364833 PMCID: PMC6198296 DOI: 10.5312/wjo.v9.i10.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.
METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.
RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.
CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.
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Affiliation(s)
- Herwig Drobetz
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Alyce Black
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
| | - Jonathan Davies
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Petra Buttner
- Tropical Health Solutions PTY Ltd, Townsville 4810, Queensland, Australia
- Centre for Chronic Disease Prevention, James Cook University, Cairns 4878, Queensland, Australia
| | - Clare Heal
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, Townsville 4810, Queensland, Australia
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80
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Fowler TP, Fitzpatrick E. Simultaneous Fractures of the Ipsilateral Scaphoid and Distal Radius. J Wrist Surg 2018; 7:303-311. [PMID: 30174987 PMCID: PMC6117171 DOI: 10.1055/s-0038-1641719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Background Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches. Purpose This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously. Materials and Methods Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Patient demographics, injury mechanism, scaphoid and distal radius fracture pattern, treatment approach, and radiographic healing were studied. Results Twenty-three patients were identified. Nineteen of the 23 (83%) were males, and 19 of 23 (83%) of the injury mechanisms were considered high energy. Twenty-two of the 23 (96%) scaphoid fractures were nondisplaced, all treated with screw fixation. Most distal radius fractures were displaced and comminuted, 17 of 23 (74%) were intra-articular. All distal radius fractures were treated surgically with internal and/or external fixation. Three patients were lost to follow-up. Average follow-up of the remaining 20 was to 19.8 weeks. Nineteen of the 20 (95%) scaphoids healed, one scaphoid went on to nonunion with avascular necrosis. All 20 radius fractures healed, 16 of 20 (80%) in anatomic alignment. Conclusion Ipsilateral fractures of the distal radius and scaphoid are rare and are usually result of high-energy mechanisms. The scaphoid fracture is usually a nondisplaced fracture at the waist. The distal radius fracture pattern varies but most are displaced and comminuted. The union rate of the scaphoid is high, even if subjected to radiocarpal distraction required for distal radius management. Level of Evidence Therapeutic level IV study.
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Affiliation(s)
- Timothy P. Fowler
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Elizabeth Fitzpatrick
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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81
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Loisel F, Kielwasser H, Faivre G, Rondot T, Rochet S, Adam A, Sergent P, Leclerc G, Obert L, Lepage D. Treatment of distal radius fractures with locking plates: an update. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1537-1542. [DOI: 10.1007/s00590-018-2274-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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Salas C, Brantley JA, Clark J, Taha MR, Myers OB, Mercer D. Damage in a Distal Radius Fracture Model Treated With Locked Volar Plating After Simulated Postoperative Loading. J Hand Surg Am 2018; 43:679.e1-679.e6. [PMID: 29426604 PMCID: PMC6035079 DOI: 10.1016/j.jhsa.2017.12.019] [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: 09/17/2016] [Revised: 11/22/2017] [Accepted: 12/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE "Damage" is an engineering term defining a period between a state of material perfection and the onset of crack initiation. Clinically, it is a loss of fixation due to microstructural breakdown, indirectly measured as a reduction of stiffness of the bone-implant construct, normalized by the cross-sectional area and length of the bone. The purpose of this study was to characterize damage in a cadaver model of extra-articular distal radius fracture with dorsal comminution treated using 2-column volar distal radius plates. METHODS Ten matched distal radii were randomly divided into 2 groups: group I specimens were treated with a volar distal radius plate with an independent, 2-tiered scaffold design; group II specimens (contralateral limbs) were treated with a volar plate with a single-head design for enhanced ulnar buttressing. Specimens were cyclically loaded to simulate a 6-month postoperative load-bearing period. We report damage after a defined protocol of cyclical loading and load to failure simulating a fall on an outstretched hand. RESULTS Group II specimens experienced more damage under cyclic loading conditions than group I specimens. Group I specimens were stiffer than group II specimens under load-to-failure conditions. Ultimate force at failure in group I and group II specimens was not different. Specimens failed by plate bending (group I, n = 6/10; group II, n = 2/10) and fracture of the lunate facet (group I, n = 4/10; group II, n = 8/10). CONCLUSIONS Group I specimens had less screw cutout at the lunate facet than group II specimens under cyclic loading as indicated by lower damage measures and fewer facet fractures during load-to-failure testing. The overall strength of the construct is not affected by plate design. CLINICAL RELEVANCE Microstructural damage or a loss of fixation due to an overly rigid volar plate design may cause malunion or nonunion of fracture fragments and lead to bone-implant instability.
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Affiliation(s)
- Christina Salas
- Department of Orthopaedics and Rehabilitation at the University of
New Mexico,Department of Mechanical Engineering at the University of New
Mexico,Center for Biomedical Engineering at the University of New
Mexico
| | - Justin A. Brantley
- Department of Orthopaedics and Rehabilitation at the University of
New Mexico,Center for Biomedical Engineering at the University of New
Mexico
| | - James Clark
- Department of Orthopaedics and Rehabilitation at the University of
New Mexico
| | | | - Orrin B. Myers
- Department of Internal Medicine at the University of New
Mexico
| | - Deana Mercer
- Department of Orthopaedics and Rehabilitation at the University of
New Mexico
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83
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Wilson J, Viner JJ, Johal KS, Woodruff MJ. Volar Locking Plate Fixations for Displaced Distal Radius Fractures: An Evaluation of Complications and Radiographic Outcomes. Hand (N Y) 2018; 13:466-472. [PMID: 28691543 PMCID: PMC6081777 DOI: 10.1177/1558944717717505] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A volar locking plate (VLP) is the most frequently used form of implant used for open reduction and internal fixation of distal radius fractures. They are known to have a complication rate of up to 27%. We hypothesized that plate design could influence complication rates. METHODS We performed a review of patients undergoing VLP fixation for distal radius fracture. A total of 228 patients underwent fixation with the Distal Volar Radial Anatomical (DVR) plate; 388 patients underwent fixation with the VariAx plate. Independent observers performed blinded case note and radiographic review, to assess for the quality of reduction, and complications for the inserted VLP. RESULTS Mean time to surgery was 6.0 days; mean follow-up was 17.5 weeks. Mean age was 56.5 years. The quality of reduction was classified as anatomical (46%), good (36.3%), moderate (13.0%), or poor (3.9%). Complications were identified in 109 patients (17%). Plate prominence was seen in 133 patients (21%). The DVR plate was less prominent ( P < .001) and had better overall radiographic appearances ( P = .025). Flexor tendon complications were related to plate prominence ( P = .005). Inferior reduction was associated with increased time to surgery ( P = .020). CONCLUSIONS This study highlights the importance of prompt surgery, effective fracture reduction, and careful plate positioning to avoid volar prominence.
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Affiliation(s)
- James Wilson
- Lancashire Teaching Hospitals NHS
Foundation Trust, Preston, UK
| | - Jeremy J. Viner
- Lancashire Teaching Hospitals NHS
Foundation Trust, Preston, UK,Jeremy J. Viner, 14 Haddon Grove, Timperley,
Altrincham, Cheshire, WA15 6SA, United Kingdom.
| | - Kavan S. Johal
- Lancashire Teaching Hospitals NHS
Foundation Trust, Preston, UK
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84
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Erhart S, Toth S, Kaiser P, Kastenberger T, Deml C, Arora R. Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 2018; 138:879-885. [PMID: 29696363 DOI: 10.1007/s00402-018-2925-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In case of distal radius fractures (DRF) the distal fragment generally displaces either dorsally or volarly. Scientific literature however, seldom differentiates between volarly and dorsally displaced DRFs when reporting results. It is no clear, if the direction of displacement has an influence on the clinical and radiological outcome. This study was intended to evaluate the influence of displacement direction in adult patients with surgically treated Colles or Smith type fractures. PATIENTS AND METHODS After a mean follow up (FU) time of above 5 years, 50 patients who underwent open reduction and internal fixation for DRFs (25 Smith type fractures, 25 Colles type fractures) were included. Upon FU, standard X-rays and a clinical evaluation as well as evaluation scores were raised and analysed. RESULTS Clinical evaluation showed no difference between the Colles and the Smith group. Radiologic and clinical results for the Colles group showed diminished flexion compared to the healthy wrist, decreased radial inclination and dorsal tilt during FU and progression of osteoarthritis. For the Smith group decreased grip strength compared to the healthy wrist and osteoarthritis-progression was found. For both groups there was no correlation between radiologic values, grip strength, arthrosis grading, disability of arm, shoulder and hand score and patient rated wrist evaluation score. DISCUSSION Decreased flexion in combination with a decreased dorsopalmar tilt might hint towards a mechanical inhibition in the Colles group. Altogether, the study showed good clinical outcome with satisfactory radiological result. As all patients showed arthrosis progression, the fracture per se is to be seen as a prearthrotic factor. It still remains unclear which measures could be taken to prevent this.
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Affiliation(s)
- S Erhart
- Department for Trauma Surgery, Tirol Kliniken, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - S Toth
- Department for Trauma Surgery, Tirol Kliniken, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - P Kaiser
- Department for Trauma Surgery, Tirol Kliniken, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - T Kastenberger
- Department for Trauma Surgery, Tirol Kliniken, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - C Deml
- Department for Trauma Surgery, Tirol Kliniken, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - R Arora
- Department for Trauma Surgery, Tirol Kliniken, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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85
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Roebke AJ, Martin AS, Sarmast Z, Fisk E, Goyal KS. Lift-Off Screw Results in Accurate Sagittal Tilt Correction in a Distal Radius Fracture Model. J Hand Surg Am 2018; 43:523-528. [PMID: 29559327 DOI: 10.1016/j.jhsa.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/18/2017] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the accuracy of a distal-first open reduction internal plate fixation technique in achieving correction of volar tilt in dorsally angulated distal radius fractures. METHODS Twenty foam radius models were divided evenly into groups N (normal) and O (osteoporotic). Dorsally angulated extra-articular distal radius fractures were then created. Group O underwent further modification to simulate an osteoporotic model. After static pinning in various degrees of dorsal angulation, opaque fiducial markers were placed and fluoroscopy was used to measure prereduction volar tilt. A variation of the distal-first plate application technique was used where a lift-off screw (LOS) was placed in the proximal most locking hole and propped the proximal aspect of the plate by the screw's length. The LOS length corresponded to the volar tilt correction needed. After fracture reduction using this technique, we measured the volar tilt again. We then compared the actual volar tilt correction with what was predicted based on the LOS length used. We also compared the tilt correction accuracy in the normal and osteoporotic models. RESULTS Prereduction tilt ranged from 3° to 52° of dorsal tilt from normal (10° volar tilt). Corresponding LOSs ranged from 5 to 42 mm in length. Tilt correction correlated with screw length in a linear fashion (R = 0.9). The mean difference between actual and predicted tilt correction for a given screw length was 0.5° ± 3.0°, and the mean absolute difference was 2.4° ± 1.7° for all specimens. There was no difference between normal and osteoporotic models. CONCLUSIONS Prereduction dorsal tilt can be accurately corrected within a few degrees of the goal by using the distal-first technique with an LOS. The LOS length can be calculated, and this technique can potentially be used with any distal radius periarticular locking plate with locking options in the shaft. CLINICAL RELEVANCE A technique that provides accurate tilt correction would be of benefit to surgeons treating distal radius fractures with volar plates.
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Affiliation(s)
- Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Adam S Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Zubair Sarmast
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Erica Fisk
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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86
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Abstract
Injuries to the hands and wrist are common in athletes. Injuries include acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains. Complications in the treatment of sports injuries of the hand and wrist may be divided into 2 categories: incorrect or delayed diagnosis and iatrogenic injury related to treatment. This article highlights common sports injuries of the hand and wrist and their complications, and includes tips for successful management.
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Affiliation(s)
- Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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87
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Kwak JM, Jung GH. Biologic plating of unstable distal radial fractures. BMC Musculoskelet Disord 2018; 19:117. [PMID: 29655367 PMCID: PMC5899831 DOI: 10.1186/s12891-018-2046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/11/2018] [Indexed: 12/01/2022] Open
Abstract
Background Volar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction. Methods Thirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25–83 years), and the mean follow-up period was 47.5 months (range, 36–84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS). Results All wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from − 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75–100). Conclusion Our experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Gu-Hee Jung
- Department of orthopaedic surgery, Gyeongsang national university, college of medicine and Gyeongsang national university Changwon hospital, 555 Samjungja-Dong, Changwon-si, 642-160, Republic of Korea.
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88
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Abstract
Distal radius fractures are one of the most commonly treated fractures in the United States. The highest rates are seen among the elderly, second only to hip fractures. With the increasing aging population these numbers are projected to continue to increase. Distal radius fractures include a spectrum of injury patterns encountered by general practitioners and orthopedists alike. This evidence-based review of distal radius fractures incorporates current and available literature on the diagnosis, management, and treatment of fractures of the distal radius.
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Affiliation(s)
- Benjamin M Mauck
- Department of Orthopaedic Surgery, Campbell Clinic Orthopaedics, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Colin W Swigler
- PGY4, Orthopaedic Surgery Residency, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
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89
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Tordjman D, Hinds RM, Yang SS, Capo JT. Radial Shaft Convergence in Distal Radius Fractures: Diagnosis and Treatment. Tech Hand Up Extrem Surg 2018; 22:19-25. [PMID: 29462074 DOI: 10.1097/bth.0000000000000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Radial shaft convergence in distal radius fractures is often misdiagnosed. This common deformation is often associated with a radial translation of the distal fragment. This parameter has to be corrected because of the increased risk of distal radioulnar joint instability due to detensioning of the distal interosseous membrane if there is an associated triangular fibrocartilage complex lesion. A new radiologic sign for diagnosis of proximal radius convergence during distal radius fracture is presented as well as technical tips for correction of this deformity.
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Affiliation(s)
- Daniel Tordjman
- Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Richard M Hinds
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases
| | - S Steven Yang
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases
| | - John T Capo
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases
- RWJ Barnabas Health-Jersey City Medical Center, Jersey City, NJ
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90
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The status of triangular fibrocartilage complex after the union of distal radius fractures with internal plate fixation. INTERNATIONAL ORTHOPAEDICS 2018; 42:1917-1922. [PMID: 29476211 DOI: 10.1007/s00264-018-3793-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Distal radius fractures are associated with a high incidence of triangular fibrocartilage complex (TFCC) tears. This study aims to evaluate the status of TFCC after the healing of distal radius fractures, and its clinical significance. METHODS Wrist arthroscopies were performed on 43 distal radius fractures, with an average age of 54 years old. RESULTS Twenty-six complete tears and 15 partial healed tears were noted. Five out of eight patients with intact TFCC tears had neither signs nor symptoms, while eight patients with TFCC tears had no complaint. While no association was found between ulnar wrist pain and TFCC tears, there was association between DRUJ instability and TFCC tears and fovea tears. The function outcome did not differ with respect to the integrity of TFCC. CONCLUSIONS A large majority of TFCC tears remained unhealed after the union of distal radius fractures. However, not all patients with tear were symptomatic.
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Zhang P, Jia B, Chen XK, Wang Y, Huang W, Wang TB. Effects of surgical and nonoperative treatment on wrist function of patients with distal radius fracture. Chin J Traumatol 2018; 21:30-33. [PMID: 29429777 PMCID: PMC5961765 DOI: 10.1016/j.cjtee.2017.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/15/2017] [Accepted: 11/25/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To study the effects of surgical and nonoperative treatment on wrist function in patients with distal radius fracture. METHODS In total, 97 patients treated for distal radius fracture in the Department of Orthopedic Trauma at the People's Hospital of Peking University from Jan. 2010 to Jun. 2016 were selected for outpatient follow-up, including manipulative reduction and dorsal splint fixation in 24 cases, bivalve cast fixation in 19 cases and open reduction and internal fixation in 54 cases. Evaluation was based on Sartiento's modification of the Gartland and Werley score. Efficacy was assessed with wrist pain as the focus. RESULTS The wrist function scores of the surgical group were better than nonoperative groups. There was no significant difference in wrist function scores between the dorsal splint group and the bivalve cast group. The ulnar wrist pain incidence had no significant difference in surgical and nonoperative groups. The displace rate in dorsal splint group was higher than other groups. CONCLUSION The overall effect of surgical treatment of distal radius fracture is better than nonoperative treatment. The ulnar wrist pain incidence has no significant difference in these groups. Dorsal splint fixation is more prone to displace than bivalve cast fixation.
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92
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Fu Q, Zhu L, Yang P, Chen A. Volar Locking Plate versus External Fixation for Distal Radius Fractures: A Meta-analysis of Randomized Controlled Trials. Indian J Orthop 2018; 52:602-610. [PMID: 30532300 PMCID: PMC6241055 DOI: 10.4103/ortho.ijortho_601_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Volar locking plate (VP) and external fixation (EF) are the two most commonly used methods for treating distal radius fractures. The aim of this study was to identify which of the two treatments leads to better outcomes (clinically and radiographically) with fewer complications. MATERIALS AND METHODS A metaanalysis was performed. All available randomized controlled trials (RCTs) which compared the clinical results of VP to EF were obtained and the reported means and standard deviations were extracted to perform data synthesis. RESULTS A total of 9 published RCTs with 776 patients fulfilled all inclusion criteria. Data analysis revealed that VP gives better clinical results in the early postoperative period in terms of disabilities of the arm, shoulder, and hand (DASH) scores (3 and 6 months), grip strength (3 months), flexion, extension, and supination (3 months). VP is also advantageous over EF regarding the DASH scores, maintenance of ulnar variance, and total and mild surgical complications at 12 months. CONCLUSIONS This meta analysis supports the use of VP in treating distal radius fractures.
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Affiliation(s)
- Qiang Fu
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lei Zhu
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Peng Yang
- Department of Orthopedics, The 455th Hospital of Chinese People's Liberation Army, Shanghai, China
| | - Aimin Chen
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China,Address for correspondence: Dr. Aimin Chen, Department of Orthopedic Trauma Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China. E-mail:
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93
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Gurbuz Y, Kucuk L, Gunay H, Ozaksar K, Sugun TS, Bilge O. Comparison of ultrasound and dorsal horizon radiographic view for the detection of dorsal screw penetration. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:448-450. [PMID: 29092760 PMCID: PMC6197555 DOI: 10.1016/j.aott.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/01/2017] [Accepted: 10/12/2017] [Indexed: 10/30/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficiency of dorsal tangential fluoroscopy and ultrasonography in detecting dorsal screw penetration in distal radius volar locking plate applications. METHODS Ten cadaveric forearms were operated. The distal four screws were protruded 0, 1 and 2 mm into each of the second, third and fourth dorsal compartments of distal radius. Dorsal horizon views were taken using fluoroscopy. Each radiographic image was evaluated by two orthopedic surgeons who are blinded to procedure. Sonographic evaluations were performed by an orthopedic surgeon blinded to the procedure. Both dorsal horizon view and ultrasonography assessments were noted by the evaluators whether the tip of the screw penetrated or not the dorsal cortex for each compartment. RESULTS No significant difference was observed on correct detection of 0 mm, 1 mm and 2 mm screw penetrations at second and third compartments. In the fourth compartment, there was no difference with 0 mm and 2 mm penetrations but correct detection accuracy of 1 mm screw penetration was 87% in ultrasonography group and 71% in dorsal horizon view group. CONCLUSIONS The accuracy of ultrasonography on 1 mm penetration at the fourth compartment is better than dorsal horizon view. However, dorsal horizon view and ultrasonography accuracy is similar for the other compartments and penetration levels. Ultrasonography is a reliable and effective procedure for detection of dorsal screw penetrations. LEVEL OF EVIDENCE Level III, Diagnostic study.
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94
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The role of brachioradialis release during AO type C distal radius fracture fixation. Orthop Traumatol Surg Res 2017; 103:1099-1103. [PMID: 28782697 DOI: 10.1016/j.otsr.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/21/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, whether this common procedure makes the reduction and fixation easier and affects the elbow function has not been fully understood. HYPOTHESIS Brachioradialis (BR) release during volar plate fixation for type C distal radius fractures makes internal reduction and fixation easier, and it does not adversely affect wrist or elbow function. MATERIAL AND METHODS A total of 74 patients treated with 2.4mm volar locking compression column plate (VCP) were analyzed for type C distal radius fractures prospectively. The patients were divided into two groups, group A with BR release and group B without BR release. The two groups were compared in terms of "internal reduction and fixation time" during the operation, wrist and elbow function including the scores of Gartland and Werley (G-W), Patient-related wrist evaluation score (PRWE), Mayo Elbow Performance Score (MEPS), the Disabilities of the arm, shoulder, and hand (DASH) and a Visual analog scale (VAS) for pain at 6 and 12 months postoperatively. The radial inclination angle, palmar tilt angle and ulnar variance were also measured from the radiographs. RESULTS According to the follow-up of the 74 patients, no significant differences were observed between the two groups on MEPS, DASH, G-W, PRWE, VAS and radiological outcomes at 6 and 12 months postoperatively. Mean time of reduction and internal fixation was significantly shorter in group A than that in group B. CONCLUSION Release of the BR for type C distal radius fractures facilitated the surgical procedure and did not adversely affect elbow and wrist function. LEVEL OF EVIDENCE II, prospective comparative study.
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95
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Stoops TK, Santoni BG, Clark NM, Bauer AA, Shoji C, Schwartz-Fernandes F. Sensitivity and Specificity of Skyline and Carpal Shoot-Through Fluoroscopic Views of Volar Plate Fixation of the Distal Radius: A Cadaveric Investigation of Dorsal Cortex Screw Penetration. Hand (N Y) 2017; 12:551-556. [PMID: 29091485 PMCID: PMC5669327 DOI: 10.1177/1558944716677336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Volar plate fixation of distal radius fractures can result in soft tissue injuries. Abnormal contour of the dorsal cortex of the distal radius provides difficulties in discerning screw penetration on standard radiographs. The skyline and carpal shoot-through views are additional views to improve dorsal cortex visibility. We report on the sensitivity and specificity of determining screw protrusion with these views. METHODS Seven fresh frozen cadavers were instrumented with a distal radius volar locking plate. Initial screw length was determined by depth gauge measurement. A dorsal dissection of the wrist was performed to detect screw penetration. Protruding screws were documented and replaced with screws of the appropriate length and deemed as baseline. Screws were then sequentially lengthened by 2 and 4 mm. Skyline and carpal shoot-through views were obtained at baseline, 2 mm, and 4 mm. The images were randomized and compiled into an untimed survey asking orthopedic surgeons to determine whether screws were penetrating through the dorsal cortex. RESULTS Based on depth gauge measurements, 4 out of 44 (9.1%) volar plate locking screws penetrated the dorsal cortex, as confirmed with dorsal dissection. Sensitivities for the skyline and carpal shoot-through views were 75% and 86% ( P ≤ .001), respectively, for 2-mm protrusions, and 76% and 89% ( P ≤ .001), respectively, for 4-mm screw protrusions. Specificities were 85% and 84% for the skyline and shoot-through views, respectively. CONCLUSIONS We believe that the carpal shoot-through view has utility and can be implemented to augment standard intraoperative views, and may decrease the incidence of screw protrusion resulting in soft tissue injuries.
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Affiliation(s)
- T. Kyle Stoops
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA,T. Kyle Stoops, Foundation for Orthopaedic Research and Education, 13020 North Telecom Parkway, Tampa, FL 33637, USA.
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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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Abe Y, Tokunaga S, Moriya T. Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications? Hand (N Y) 2017; 12:561-567. [PMID: 29091491 PMCID: PMC5669324 DOI: 10.1177/1558944716675129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use. METHODS Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky's plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures. RESULTS Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures. CONCLUSIONS The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.
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Affiliation(s)
- Yoshihiro Abe
- Chiba Rosai Hospital, Ichihara, Japan,Yoshihiro Abe, Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16 Tatumidai-higashi, Ichihara 290-0003, Japan.
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98
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Brown B, Koval K, Langford J, Bhullar IS. Novel Management for Distal Radius Fracture after Trauma. Am Surg 2017. [DOI: 10.1177/000313481708300820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bryan Brown
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
| | - Kenneth Koval
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
| | - Joshua Langford
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
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Cha SM, Shin HD, Hwang SJ. Temporary ipsilateral stiff shoulder after operative fixation of distal radial fractures. J Shoulder Elbow Surg 2017; 26:923-930. [PMID: 28526422 DOI: 10.1016/j.jse.2017.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/22/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was conducted to identify variables affecting the development of temporary stiff shoulder after operative fixation for distal radial fractures (DRF). MATERIALS AND METHODS The study retrospectively analyzed 167 patients who had undergone internal fixation using volar locking plate for DRF between 2010 and 2013. Group 1 was denoted as the "normal group," and group 2 was denoted as the "stiff shoulder group." Basic demographic factors evaluated included age, sex, bone mineral density (BMD), and the dominancy. Also investigated were radiologic variables, including concurrent fractures of the styloid process, positive ulnar variances, classification of DRF, and morphologic type of the distal radioulnar joint. Finally, the type of plate, methods used for postoperative protection, and time of union were analyzed. RESULTS Group 1 consisted of 114 patients, and group 2 consisted of 53 patients. On overall univariate analysis, BMD, hand dominancy, and the protective methods after plating were significantly different between the 2 groups. On multivariate analysis, a lower BMD and injury on the nondominant side were significant factors for shoulder stiffness. Stiffness was significantly higher in patients with a mean BMD < -2.6 than in patients with a mean BMD ≥ -2.6. At the final follow-up, all of the 53 patients in group 2 were relieved of the symptoms of a stiff shoulder. CONCLUSIONS A lower BMD and injury on the nondominant distal radius were distinct factors for the development of a stiff shoulder after operative fixation in DRF. Fortunately, nonoperative treatments, such as stretching exercises/injections, were useful for the relief of these symptoms in the short-term follow-up.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
| | - Sung Jin Hwang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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Mahylis JM, Burwell AK, Bonneau L, Marshall LM, Mirarchi AJ. Drill Penetration Injury to Extensor Tendons: A Biomechanical Analysis. Hand (N Y) 2017; 12:301-306. [PMID: 28453347 PMCID: PMC5480667 DOI: 10.1177/1558944716668824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about extensor tendon failure following drill injury at the time of volar plate fixation. Our goals were to analyze extensor tendon injury following simulated drill penetration, and change in tendon displacement during cyclic loading following simulated drill penetration injury. METHODS Extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons were harvested from 9 fresh frozen cadaveric arms. Eighteen EPL and 18 ECRB samples were created from harvested tendons. Drill penetration injury was performed in either a continuous or an oscillating mode. Injured tendons were subjected to 1200 cycles at 1- to 15-kg cyclic load at a frequency of 1 Hz, and analyzed for failure at drill sites and change in displacement throughout the testing cycle. RESULTS Ten EPL samples and 16 ECRB samples completed testing without failure. Tendon type (ECRB, EPL), mode of injury (continuous, oscillating), and location (proximal, distal) did not affect tendon displacement during loading. A single EPL tendon failed following continuous drill penetration injury. Extensor carpi radialis brevis samples had a mean change in displacement of 2.8 (standard deviation [SD]: 1.5 mm) and 5.9 mm (SD: 4.7 mm) for oscillating and continuous modes, respectively. Six EPL samples had a mean change in displacement of 4.7 (SD: 2.7 mm) and 4.3 mm (SD: 1.8 mm) for oscillating and continuous modes, respectively. CONCLUSIONS Complete extensor tendon failure due to drill penetration was rare. Drill mode did not affect the degree of elongation. Increasing cyclic loading of extensor tendons after drill injury caused modest extensor tendon elongation.
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Affiliation(s)
| | | | | | | | - Adam J. Mirarchi
- Oregon Health & Science University, Portland, USA
- Adam J. Mirarchi, Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Mail Code OP-31, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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