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Gutiérrez-Espinoza H, Araya-Quintanilla F, Cuyul-Vásquez I, Gutiérrez-Monclus R, Reina-Gutiérrez S, Cavero-Redondo I, de Arenas-Arroyo SN. Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3697. [PMID: 36834390 PMCID: PMC9965012 DOI: 10.3390/ijerph20043697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF). METHODS We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs. RESULTS Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at -4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications. CONCLUSIONS Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.
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Affiliation(s)
| | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago 7510157, Chile
| | - Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco 4780000, Chile
| | | | - Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 7500912, Chile
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Asmara AAGY, Karna MB, Meregawa PF, Deslivia MF. Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials. Rev Bras Ortop 2022; 57:899-910. [PMID: 36540735 PMCID: PMC9757966 DOI: 10.1055/s-0042-1754379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH ( p = 0.18) and PRWE ( p = 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of Evidence Level I.
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Affiliation(s)
- Anak Agung Gede Yuda Asmara
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia,Endereço para correspondência Anak Agung Gede Yuda Asmara Orthopedics and Traumatology Department, Faculty of Medicine, Udayana University, Sanglah General HospitalJl, Kesehatan no.1, BaliIndonesia
| | - Made Bramantya Karna
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Putu Feryawan Meregawa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Maria Florencia Deslivia
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
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Fares AB, Childs BR, Polmear MM, Clark DM, Nesti LJ, Dunn JC. Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review. J Hand Surg Am 2021; 46:627.e1-627.e8. [PMID: 33573844 DOI: 10.1016/j.jhsa.2020.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal radius fractures. METHODS A literature search performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 206 articles, 12 of which met inclusion criteria, accounting for 310 patients. Included articles contained the results of DBP for treatment of distal radius fractures with reported outcomes between 1988 and 2018. Data were pooled and analyzed focusing on patient demographics, as well as 3 primary outcomes of complications, range of motion (ROM), and Disabilities of the Arm, Shoulder, and Hand (DASH) and QuickDASH scores. RESULTS Average age was 55 years, median follow-up was 24 months, and the most common use was in comminuted (92%) intra-articular (92%) distal radius fracture caused by fall (58%), or motor vehicle collision or motorcycle collision (27%). A minority of patients had open fractures (16%) and most were cases of polytrauma (65%). Median time from placement to DBP removal was 17 weeks (mean, 119 days). At final follow-up, mean wrist ROM was 45° flexion, 50° extension, 75° pronation, and 73° supination. Mean DASH score was 26.1, and mean QuickDASH score was 19.8. The overall rate for any complication was 13%; the most common was hardware failure (3%) followed by symptomatic malunion or nonunion (3%), and persistent pain after hardware removal (2%). CONCLUSIONS Dorsal bridge plating was found to be used most commonly in intra-articular, comminuted distal radius fractures with overall functional wrist ROM, moderate patient-reported disability, and a 13% complication rate at follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Austin B Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX.
| | - Benjamin R Childs
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Michael M Polmear
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - DesRaj M Clark
- Department of Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Leon J Nesti
- Department of Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
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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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Van Oijen GW, Vegt PA, Hagenaars T, Van Lieshout EMM, Verhofstad MHJ. Outcome after treatment of distal radius fractures in the elderly using the IlluminOss ® System. Eur J Trauma Emerg Surg 2020; 47:1129-1136. [PMID: 31950234 PMCID: PMC8321991 DOI: 10.1007/s00068-019-01289-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
Purpose Distal radius fractures are very common and account for approximately 17% of all fractures treated. Multiple treatment methods are available to treat these fractures, both operative and nonoperative. This study aimed at evaluating the functional and clinical outcomes after treatment of distal radius fractures with the IlluminOss® System in adult patients. Methods A retrospective case series was performed in a single-level two-trauma center. All consecutive adult patients with a distal radius fracture, treated with the IlluminOss® System between 01 August 2012 and 15 August 2015, were included in this study. Baseline patient characteristics and clinical data were retrospectively extracted from the medical records. Radial inclination, volar/dorsal tilt, ulnar variance, and radial length were measured on the latest available standard radiographs. In addition, patients were prospectively subjected to physical examination and were asked to complete the Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Short Form-36 questionnaires. Results Twenty-six patients with 31 distal radius fractures were included. The median age at time of trauma was 77 years and 96% were females. Five patients developed a total of seven complications. Due to persisting pain one reoperation was performed, removing a small prominent part of the implant. Both patient-reported outcome scores and radiographic results were good to excellent. Conclusions The IlluminOss® System is a feasible option to treat distal radius fractures with seemingly good clinical and functional outcome. One out of seven complications required surgical intervention. These outcomes justify more detailed prospective research.
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Affiliation(s)
- Guido W Van Oijen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Paul A Vegt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Tjebbe Hagenaars
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Xu J, Zhang G, He Z, Zhong S, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00795-w. [PMID: 31641940 PMCID: PMC7026237 DOI: 10.1007/s13246-019-00795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/10/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022]
Abstract
To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1-4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.
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Affiliation(s)
- Jing Xu
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Zaopeng He
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Shizhen Zhong
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Yongshao Chen
- Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Chunrong Wei
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Yudong Zheng
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Wei Li
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
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Chen ACY, Cheng CY, Weng CJ, Chou YC. Intramedullary nailing and plating osteosynthesis in the correction of post-traumatic deformity in late-diagnosed distal radius fractures: a retrospective comparison study. BMC Musculoskelet Disord 2019; 20:236. [PMID: 31113405 PMCID: PMC6530186 DOI: 10.1186/s12891-019-2605-1] [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: 08/15/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Various surgical modalities are available for correction of deformity in late-diagnosed distal radius fractures. This study compared surgical outcomes between intramedullary nailing and plating osteosynthesis in open-wedge osteotomy. Methods We retrospectively reviewed 47 unilateral distal radius fractures that underwent open-wedge osteotomy at more than 4 weeks after injury between 2006 and 2011. A locally resected exuberant callus was used as the bone graft. Two types of fixation were used: intramedullary nail in 22 patients (group A) and locking plate in 25 patients (group B). Radiographic analysis including radial height, radial inclination, and volar tilt were performed preoperatively and 2-year postoperatively. The Modified Mayo Wrist Score (MMWS) was used for functional evaluation and a 10-point visual analog scale (VAS) for residual pain assessment. Patient satisfaction was self-reported as a 5-point scale. Radiographic data, functional outcomes, and surgical complications were compared between the two groups. Results All fractures achieved bone union without major complications. The MMWS averaged 84.8 ± 9.7 in group A and 85.2 ± 8.4 in group B, without significant differences (p = 0.436). Instead, significant differences were found in mean wrist flexion (73.6 ± 7.9 vs. 69.6 ± 7.8 degrees; p = 0.042), patient satisfaction (3.6 ± 1.1 vs. 2.9 ± 1.2; p = 0.034), postoperative radial height (11.6 ± 2.6 vs. 10.2 ± 3 mm; p = 0.039) and inclination (20.8 ± 2.8 vs. 17.7 ± 4.1 degrees; p = 0.004), and implant-related complications (9% vs. 36%; p = 0.03). There were no significant differences in other assessment items including postoperative grip strength, pain scale, supination/pronation/extension, volar tilt, correction angles of all three parameters, and general complication rate. Four patients in group A (18%) and 2 in group B (8%) experienced postoperative paresthesia of the surgical hand; no significant difference was noted. All except one patient in group B had full recovery of neurological symptoms. Conclusions Open-wedge osteotomy with either an intramedullary nail or locking plate fixation yielded encouraging radiographic and functional outcomes. Intramedullary nail fixation may facilitate restoration of radial height and inclination with better wrist flexion, less implant-related complications, and greater patient satisfaction.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China. .,Chang Gung University College of Medicine, Taoyuan City, Taiwan.
| | - Chun-Ying Cheng
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chun-Jui Weng
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ying-Chao Chou
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Rancy SK, Malliaris SD, Bogner EA, Wolfe SW. Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant. J Wrist Surg 2018; 7:358-365. [PMID: 30349747 PMCID: PMC6196090 DOI: 10.1055/s-0038-1669438] [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: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
| | - Stephanie D. Malliaris
- Division of Hand and Upper Extremity Surgery, Denver Health Medical Center, University of Colorado School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Eric A. Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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9
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Calbiyik M. Fixation of unstable distal radius fractures by using expandable Intramedullary nailing system in adult patients. Pak J Med Sci 2018; 34:198-203. [PMID: 29643907 PMCID: PMC5857012 DOI: 10.12669/pjms.341.14239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To present our experience on intramedullary nailing device Sonoma Wrx (Sonoma Orthopedic Products Inc., Santa Rosa, CA, USA) used for internal fixation of extra-articular or simple intra-articular distal radius fractures in adult population. Methods This study was conducted from February 2011 to October 2016. A total of 48 patients (mean age 47.3±5.6 years, 35.4% females) with distal radius fracture, who underwent intramedullary distal radius fixation by using Sonoma Wrx were included in this retrospective study. Clinical outcome measures (range of motion [ROM], visual analog scale [VAS]), functional outcomes (Disabilities of the Arm, Shoulder and Hand [DASH] score and Gartland-Werley score), radiographic scores (Stewart score) and parameters (radial inclination, volar tilt, radial height, radio-ulnar variance) and complications were evaluated. Results The total surgery time was 24.3±2.3 minutes. Patients were followed up for 24.7±3.4 weeks. Complete fracture union was obtained at 5.5±0.9 weeks. The postoperative low VAS pain score (1.6±0.93) and high ROM values (76.7° for extension, 78.5° for supination, 80.1° for flexion, and 82.3° for pronation) indicated a very good clinical outcome. DASH score of 8.3±1.5 and Gartland-Werley score of 2.8±4.1 showed good functional outcome. The radiographic Stewart score was 1.0±1.2. Radial inclination, volar tilt, and radial height significantly increased (p<0.001), and radio-ulnar variance decreased (p=0.001) with surgery. No postoperative complication was recorded in 40 patients (83.3%). Conclusions Sonoma Wrx, which is an expansible intramedullary elastic locking distal radius nail, offers a good alternative technique for internal fixation of unstable distal radius fractures with the advantage of minimum soft-tissue dissection and related postoperative complications.
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Affiliation(s)
- Murat Calbiyik
- Murat Calbiyik, Department of Orthopedics and Traumatology, Hitit University, Faculty of Medicine, Corum, Turkey
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Wakasugi T, Shirasaka R, Kawauchi T, Fujita K, Okawa A. Complications of Intramedullary Fixation for Distal Radius Fractures in Elderly Patients: A Retrospective Analysis Using McKay's Complication Checklist. J Hand Surg Asian Pac Vol 2018; 23:71-75. [PMID: 29409407 DOI: 10.1142/s2424835518500091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intramedullary fixation for distal radius fractures is reported to be free of hardware irritation and less invasive than other fixation methods. Some specific complications associated with intramedullary fixation, such as radial nerve sensory neuritis, have been reported, but no study has focused on the complication rates of intramedullary fixation for distal radius fractures in the elderly population. Furthermore, no studies have analyzed common complications, such as carpal tunnel syndrome and flexor tenosynovitis including trigger finger, among patients with distal radius fractures treated by intramedullary fixation based on a comprehensive complication checklist. METHODS We reviewed the medical records of 52 elderly patients with distal radius fractures treated with intramedullary nail fixation. We investigated the postoperative complications in these patients using McKay's complication checklist. RESULTS 5 patients experienced radial nerve sensory disorder, and one patients developed carpal tunnel syndrome. All neurological symptoms resolved spontaneously, and these neurological complications were categorized as mild. Further, 3 patients developed trigger finger at the A1 pulley and needed triamcinolone injections for symptomatic relief. There were no tendinous complications around the implanted hardware. All tendinous complications were categorized as moderate complications and resolved with steroid injection therapy. Among skeletal complications, 1 case of postoperative volar displacement resolved with good functional outcome without the need for corrective osteotomy. This was considered a mild complication. The total complication rate was 19.2%. All complications were categorized as mild or moderate, and no patients experienced severe complications that needed further surgery such as hardware removal. CONCLUSIONS Intramedullary fixation for distal radius fractures was free from tendinous complications such as tenosynovitis and tendon ruptures around the implant, which are frequently caused by volar locking plate fixation. However, this less invasive technique could not avoid common complications such as trigger finger and carpal tunnel syndrome associated with distal radius fractures.
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Affiliation(s)
- Takuma Wakasugi
- * Department of Orthopedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Ritsuro Shirasaka
- * Department of Orthopedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Toshiyuki Kawauchi
- * Department of Orthopedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Koji Fujita
- † Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- † Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Efficiency of fragment specific fixation plates in the treatment of comminuted distal radial fractures. INTERNATIONAL ORTHOPAEDICS 2017; 41:1763-1769. [DOI: 10.1007/s00264-017-3516-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/14/2017] [Indexed: 11/26/2022]
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Laing TA, Sierakowski A, Elliot D. Management of painful scar-tethered cutaneous nerves of the upper limb. HAND SURGERY & REHABILITATION 2017; 36:208-214. [PMID: 28465200 DOI: 10.1016/j.hansur.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
We report the results of treatment by division and proximal relocation of 44 painful, scar-tethered cutaneous nerves of the upper limb in 22 patients. In all patients, neuropathic pain had developed either following surgery or trauma, but without apparent direct nerve injury. The mean duration of pain symptoms prior to relocation was 17 (range 7-44) months. Adequate treatment involved relocation of 35 nerves at a first operation for each of the 22 patients, with six patients requiring further surgery to relocate 9 nerves. At a minimum follow-up of 6 months, nerve relocation resulted in complete resolution of all forms of pain at the primary site in 21/22 (95%) patients and no pain or hypersensitivity at the final relocation site in 19 of the 22 patients (86%).
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Affiliation(s)
- T A Laing
- Hand Surgery Department, St Andrew's Centre for plastic surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom.
| | - A Sierakowski
- Hand Surgery Department, St Andrew's Centre for plastic surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - D Elliot
- Hand Surgery Department, St Andrew's Centre for plastic surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom
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Zhang B, Chang H, Yu K, Bai J, Tian D, Zhang G, Shao X, Zhang Y. Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:2161-2169. [DOI: 10.1007/s00264-017-3460-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
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Wang J, Zhang L, Ma J, Yang Y, Jia H, Ma X. Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials. J Hand Surg Eur Vol 2016; 41:543-52. [PMID: 26858306 DOI: 10.1177/1753193415625606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We conducted a meta-analysis of randomized controlled trials that compared the use of intramedullary nails and volar locking plates in distal radial fractures. PubMed, EMBASE and the Cochrane Collaboration Central database were used to find randomized controlled trials that met the eligibility criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality and analysed the data with RevMan 5.1 software. No statistically significant differences were detected in the disability of the arm, shoulder and hand and the Gartland and Werley scores, radiographic parameters, wrist range of motion, grip strength, total complication rate and incidence of tendon rupture between the two groups. However, carpal tunnel syndrome occurred less often after intramedullary nailing. The two fixation methods achieved equal clinical, functional and radiological outcomes for primary fixation of the indicated types of distal radial fractures. LEVEL OF EVIDENCE Therapeutic/LevelI.
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Affiliation(s)
- J Wang
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - L Zhang
- Health Management Center, Beichen Hospital, Tianjin, China
| | - J Ma
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - Y Yang
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - H Jia
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - X Ma
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
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