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Nwosu C, Rodriguez K, Zeng S, Klifto KM, Klifto CS, Ruch DS. Complications Following Volar Locking Plate Fixation of Distal Radius Fractures in Adults: A Systematic Review of Randomized Control Trials. J Hand Surg Am 2023; 48:861-874. [PMID: 37552141 DOI: 10.1016/j.jhsa.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of this study was to assess the incidence of postoperative complications following volar locking plate (VLP) fixation of distal radius fractures (DRFs). METHODS A search using keywords and subject headings to represent the concepts of volar plating and radius fractures was generated. Databases such as MEDLINE (Ovid), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCO) were searched from inception to November 24, 2021, for randomized controlled trials that reported complications following DRF treated with VLP. Inclusion criteria were studies with adult patients (aged ≥18 years) randomized to VLP fixation without other concomitant surgical interventions, with a minimum follow-up of 3 months. Study sample characteristics and post-surgical complications were extracted. The Cochrane Risk of Bias tool was used to evaluate quality of evidence. RESULTS Of the 4,059 articles identified using the search strategy, 1,778 titles/abstracts and 856 full-text articles were screened for inclusion, of which 35 articles were included for data extraction. Overall, 1,419 patients with a DRF were randomized to VLP fixation. The mean age was 60.3 years. The overall complication rate was 30.8% following VLP fixation, with 12.4% being major complications. The most common complications were median nerve-related (7.1%) and hardware removal (6.8%), secondary to other complications. Tenosynovitis was the most common tendon-related complication (3.4%). Other complications included complex regional pain syndrome (2.4%), malunion (1.3%), superficial wound infections (1.9%), and tendon rupture (1.3%). CONCLUSIONS A meta-analysis of high-quality studies that discuss the complications after VLP fixation for DRF showed an overall complication rate of 30.8%. VLP may be related to more hardware-related complications than those previously reported. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Chinemerem Nwosu
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | | | - Steven Zeng
- Duke University School of Medicine, Durham, NC
| | - Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
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2
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Stiehm M, Rinas I, Helfrich L, Martin H, Leuchter M, Fischer DC, Schmitz KP, Mittlmeier T. Development of a testing device for external wrist bridging dynamic fixators used for distal radius fractures. Clin Biomech (Bristol, Avon) 2023; 108:106056. [PMID: 37556921 DOI: 10.1016/j.clinbiomech.2023.106056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Stabilization of extra-articular distal radius fractures by wrist joint bridging (WB) dynamic fixation allows for early motion of the wrist, but relies on exact positioning of the device. In fact, physiological movement appeared to be compromised with even distinctly aberrant positioning of such device. To investigate this issue in more detail, we developed an in-vitro testing apparatus suitable for assessing the forces required for flexion and extension of the wrist. METHODS The experimental set-up enables the transmission of the translational movement of the traverse of a universal testing machine into the main physiological movement (flexion and extension) of the wrist. An external WB dynamic fixator was assembled to an artificial saw bone wrist model prior and after performing a wedge-shaped osteotomy on the distal radius about 1.5 cm proximal to the joint line, i.e. generation of a fracture model. The functionality of the fixator was evaluated under either condition and the effect of misalignment of the external WB dynamic fixator was quantified by purposeful violation of the manufacture's instructions. Results were statistically analyzed using the generalized linear mixed model. FINDINGS Significantly higher loading was noted as the degree of misalignment increased. The normalized force was significantly higher at a misalignment of 20° compared to 10° (10°: 4.13; 20°: 6.93, P < 0.001). INTERPRETATION The proposed set-up turned out to allow highly reproducible and sensitive recording of the reaction forces during flexion and extension of the wrist and thus is feasible for the evaluation and comparison of different external WB devices.
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Affiliation(s)
- Michael Stiehm
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany.
| | - Ingmar Rinas
- Department of Traumatology, Hand- and Reconstructive Surgery, Rostock University Medical Centre, Rostock, Germany
| | - Levke Helfrich
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Heiner Martin
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Matthias Leuchter
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Klaus-Peter Schmitz
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Thomas Mittlmeier
- Department of Traumatology, Hand- and Reconstructive Surgery, Rostock University Medical Centre, Rostock, Germany
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Roberts T, Kocialcowski C, Cowey A. Dorsal bridging plates for the treatment of high and low energy distal radius fractures. J Clin Orthop Trauma 2022; 35:102048. [PMID: 36340961 PMCID: PMC9634010 DOI: 10.1016/j.jcot.2022.102048] [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: 05/03/2022] [Revised: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Distal radius fractures are common and treatment of complex fracture pattens can be challenging. We assessed functional outcomes, radiographic analysis, and complications of 26 distal radius fractures treated with dorsal bridging plate (DBP) at a mean of 14 months post plate removal (6-34 months). Radiographic parameters were measured pre- and post-operatively and patient reported wrist evaluation scores, patient reported wrist range of movement and satisfaction scores. Mean post-operative total PRWE was 26 (range 0-76) and mean wrist mobility 52° flexion (range 10°-85°) and 50° extension (range 10°-85°). Mean post-operative patient satisfaction score was 89% (range 50-100%). Four patients developed complications (one EPL rupture and three developed CRPS). DBP can reliably restore distal radius anatomy and is associated with good functional outcome scores, return of functional range of wrist movement and high levels of patient satisfaction. Level of Evidence III.
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Affiliation(s)
- Tobias Roberts
- Corresponding author. Trauma & Orthopaedic Department, St. George's Hospital, London, SW17 0QT, UK.
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Dang LHN, Nguyen BL, Le HP, Nguyen TT, Le NTN. Experience of Kapandji technique in treating Colles' fracture in central region of Vietnam. SICOT J 2022; 8:41. [PMID: 36169336 PMCID: PMC9517728 DOI: 10.1051/sicotj/2022040] [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: 06/14/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Extra-articular fractures of the distal radius, known as Colles’ fractures, are very common. The optimal management of Colles’ fracture is still controversial. The Kapandji technique is one option for orthopedic surgeons to maintain reduced fractures, however, the effectiveness of this method is no clear consensus. This study aims to access Colles’ fracture treatment by the Kapandji technique with our experiences. Methods: This prospective study of 33 patients treated with three K-wires intra-focal fractures by the Kapandji procedure for Colles’ fractures at Hue University of Medicine and Pharmacy Hospital in Vietnam between February 2017 and May 2019. The functional outcome of the patients was assessed by the demerit score system of Gartland and Werley, and the quality of reduction was elevated on radiographic as well at 3, 6, 12, and 24 weeks postoperative. Results: 33 patients’ mean age is 54.64 ± 18.00; After 24 weeks of postoperative follow-up, 78.79% presented excellent, 21.21% good, and there are not any fair or poor cases on the functional outcome. All patients achieved complete fracture union at 12 weeks postoperative. The average immediate postoperative radial length was 9.85 mm, the radial inclination was 20.64°, and the volar tilt was 9.2°. Conclusion: The study emphasizes that the Kapandji technique in Colles’ fracture treatment is simple and possible to bring a satisfactory outcome and fast recovery.
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Affiliation(s)
- Le Hoang Nam Dang
- Department of Anatomy-Surgical Training, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Ba Luu Nguyen
- Department of Anatomy-Surgical Training, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hong Phuc Le
- Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thanh Thao Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nghi Thanh Nhan Le
- Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Nho JH, Jang BW, An CY, Yoo JH, Song S, Cho HB, Kim SH, Kim SI, Jung KJ, Kim B. General versus Brachial Plexus Block Anesthesia in Pain Management after Internal Fixation in Patients with Distal Radius Fracture: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159155. [PMID: 35954509 PMCID: PMC9368435 DOI: 10.3390/ijerph19159155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022]
Abstract
Distal radius fractures (DRFs) are very common injuries associated with aging, and the number of fractures is increasing with the increase in the elderly population. General anesthesia or brachial plexus block (BPB) is required for fracture fixation, and acute postoperative pain control is necessary after operation. Early pain control can improve patient satisfaction and functional outcomes. In this study, we report the clinical differences in postoperative pain, according to the method of anesthesia (general anesthesia versus brachial plexus block). Volar plating was used to treat 72 patients older than 60 years who had comminuted DRF. Patients were randomized to either group A (36 patients), who underwent general anesthesia, or group B (36 patients), who underwent BPB. We compared these two groups prospectively for acute postoperative pain using a visual analog scale (VAS) at 2, 4, 6, 12, and 24 h after surgery. The VAS scores of each group were: 6.8 ± 2.5 in general anesthesia and 0.5 ± 2.3 in BPB at 2 h, postoperatively; 6.5 ± 2.4 in general anesthesia and 0.5 ± 2.4 in BPB anesthesia at 4 h, postoperatively; 5.2 ± 2.4 in general anesthesia and 1.5 ± 2.4 in BPB anesthesia at 6 h, postoperatively; 4.5 ± 2.5 in general anesthesia and 3.4 ± 2.7 in BPB anesthesia at 12 h, postoperatively; and 3.5 ± 2.5 in general anesthesia and 3.2 ± 2.7 in BPB anesthesia at 24 h, postoperatively. DRF patients with BPB anesthesia showed a lower VAS score than those subjected to general anesthesia in early postoperative period. As a result, the effect of BPB anesthesia on acute pain management after surgery was excellent, which resulted in a lower pain score compared with general anesthesia in DRF patients undergoing volar plating.
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Affiliation(s)
- Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.-H.N.); (C.Y.A.)
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi 39371, Korea
- Correspondence:
| | - Chi Young An
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.-H.N.); (C.Y.A.)
| | - Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.H.Y.); (S.S.); (H.B.C.); (S.H.K.); (S.I.K.)
| | - Sanghoon Song
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.H.Y.); (S.S.); (H.B.C.); (S.H.K.); (S.I.K.)
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.H.Y.); (S.S.); (H.B.C.); (S.H.K.); (S.I.K.)
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.H.Y.); (S.S.); (H.B.C.); (S.H.K.); (S.I.K.)
| | - Soon Im Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea; (J.H.Y.); (S.S.); (H.B.C.); (S.H.K.); (S.I.K.)
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea;
| | - Byungsung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Bucheon 14584, Korea;
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Falk SSI, Mittlmeier T, Gradl G. Residual dorsal displacement following surgery in distal radial fractures: A cause for trouble? Eur J Trauma Emerg Surg 2022; 49:843-850. [PMID: 35881150 PMCID: PMC10175380 DOI: 10.1007/s00068-022-02061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Distal radius fractures have great impact on activities of daily living of affected patients. Repeatedly, a non-anatomic restoration of the volar tilt can be observed in a minimum of 20% in postoperative X-ray control examinations. Hence, the question arises whether the achieved reduction is functionally acceptable, or whether a further attempt should be made to improve the surgical outcome. METHODS The data presented here originate from a prospective analysis including three therapy studies on surgical treatment options for fractures of the distal radius between 2004 and 2011. For this study, the participants were divided into two groups: The first group represents the cases with non-anatomical restoration of the volar tilt with - 5° to 5°. The second group contains patients with an anatomical volar tilt between 6° and 15°. RESULTS A total of 624 patients were screened according to the inclusion criteria. Radiological evaluation showed consolidation of all fractures. The mean volar tilt as measured in standard x-rays of the wrist was 0° and 8°, respectively. The range of wrist motion in relation of the healthy opposite side was comparable in all directions (for example comparison group 1: Ext/Flex 94/94%; group 2: Ext/Flex 93/93%). Functional assessment of postoperative midterm results employing the Castaing and Gartland & Werley scores 2.3 years after surgery did not reveal significant differences between both groups. CONCLUSION According to the available data, a volar tilt in the range of - 5° to 5° can be tolerated intraoperatively without any risk of loss of function regarding the patient's manual abilities.
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Affiliation(s)
- Steffi S I Falk
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany.
| | - Thomas Mittlmeier
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany
| | - Georg Gradl
- Munich Municipal Hospital Group, Clinic of Trauma, Orthopaedic, Hand and Reconstructive Surgery, Clinic Harlaching, Sanatoriumsplatz 2, 81545, Munich, Germany
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Meng H, Xu B, Xu Y, Niu H, Liu N, Sun D. Treatment of distal radius fractures using a cemented K-wire frame. BMC Musculoskelet Disord 2022; 23:591. [PMID: 35725465 PMCID: PMC9208138 DOI: 10.1186/s12891-022-05550-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This retrospective study included an alternative treatment for types A2, A3, and B1 distal radius fractures using percutaneous fixation with a cemented K-wire frame. METHODS From January 2017 to January 2020, 78 patients with distal radius fractures were treated with percutaneous internal fixation using a cemented K-wire frame. There were 47 male patients and 31 female patients. The fractures were classified into types A2 (n = 10), A3 (n = 46), and B1 (n = 22). X-rays were taken immediately after surgery and after the bone had healed. Wrist function was assessed using the Mayo Wrist Score (90-100, excellent; 80-90, good; 60-80, satisfactory; < 60, poor). Patient satisfaction was assessed using the 10-cm visual analog scale. RESULTS Neither fixation failure nor K-wire migration was found (P > 0.05). Osteomyelitis was not observed in this series. All patients achieved bone healing after a mean of 4.5 weeks (range, 4 to 8 weeks). Follow-up lasted a mean of 27 months (range, 24 to 33 months). The mean score of wrist function was 97 (range, 91 to 100). Among them, 66 results were excellent and 12 results were good. The mean patient satisfaction was 10 cm (range, 8 to 10 cm). CONCLUSIONS Percutaneous fixation with cemented K-wire frame is a safe and preferred choice for the treatment of types A2, A3, and B1 distal radius fractures. The frame provides support to prevent wire migration. The fixation technique is a minimally invasive procedure that is easy to perform. LEVEL OF EVIDENCE Therapeutic study, Level IVa.
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Affiliation(s)
- Hongyu Meng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050000, Hebei, China.,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050000, Hebei, China
| | - Bin Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050000, Hebei, China.,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050000, Hebei, China
| | - Yi Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Haiyun Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Ning Liu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050000, Hebei, China. .,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050000, Hebei, China. .,Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Donglei Sun
- Central Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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Beyer J, Wynkoop E, Liu J, Ebraheim NA. Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies. J Wrist Surg 2021; 10:440-457. [PMID: 34631298 PMCID: PMC8489996 DOI: 10.1055/s-0041-1723793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.
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Affiliation(s)
- Julia Beyer
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Emily Wynkoop
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Jiayong Liu
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Nabil A. Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
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Gou Q, Xiong X, Cao D, He Y, Li X. Volar locking plate versus external fixation for unstable distal radius fractures: a systematic review and meta-analysis based on randomized controlled trials. BMC Musculoskelet Disord 2021; 22:433. [PMID: 33980198 PMCID: PMC8117612 DOI: 10.1186/s12891-021-04312-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background The outcomes for volar locking plate (VLP) and external fixation (EF) in distal radius fracture cases remain controversial. The current study of randomized controlled trials (RCTs) aimed to assess VLP and EF, which might benefit distal radius fracture cases. Methods RCTs comparing VLP and EF in distal radius fracture cases, until 18 March 2020, were systematically reviewed and summarized. The functional and radiographic outcomes, together with complications, for distal radius fracture cases, were evaluated. Results In total, 12 studies comprising 1205 distal radius fracture cases were included. The VLP group had observed lower disability in the arm shoulder and hand score (DASH) at 3rd, 6th, and 12th -month post-operation, with the mean differences (MDs) of − 10.43 (95 % CI = − 15.77 to − 5.08, P < 0.01), − 3.48 (95 % CI = − 6.37 to − 0.59, P = 0.02), and − 4.13 (95 % CI = − 6.94 to − 1.33, P < 0.01), respectively. The VLP group also had lower visual analog scale scores (VAS) compared to the EF group, with MDs of − 0.10 (95 % CI = − 0.18 to − 0.03, P < 0.01) for the former at 6th -month post-operation. Also, the EF group exhibited better grip strength than that in the VLP group, with MD of 12.48 (95 % CI = 7.00–17.95, P < 0.01) at the 3rd month and 4.54 (95 % CI = 0.31–8.76, P = 0.04) at 6th month. No significant differences in radiographic outcomes were observed between the VLP and EF groups (P > 0.05). The VLP group had a lower complication rate than that in the EF group. Conclusions VLP had a lower DASH score and VAS score but with lower grip strength. No significant differences in radiographic outcomes were observed. VLP had a lower complication rate than that of EF. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04312-7.
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Affiliation(s)
- Qi Gou
- Department of Orthopedics, The First People's Hospital of Longquanyi District, 610100, Chengdu, China
| | - Xiong Xiong
- Department of Orthopedics, The First People's Hospital of Longquanyi District, 610100, Chengdu, China
| | - Dan Cao
- Department of Anesthesiology, The First People's Hospital of Longquanyi District, 610100, Chengdu, China
| | - Yuanliang He
- Department of Orthopedics, The First People's Hospital of Longquanyi District, 610100, Chengdu, China.
| | - Xu Li
- Department of Orthopedics, The First People's Hospital of Longquanyi District, 610100, Chengdu, China.
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Maccagnano G, Noia G, Vicenti G, Baglioni M, Masciale MR, Cassano GD, Vitiello R, Moretti B, Pesce V. Volar locking plate versus external fixation in distal radius fractures: A meta-analysis. Orthop Rev (Pavia) 2021; 13:9147. [PMID: 33936574 PMCID: PMC8082167 DOI: 10.4081/or.2021.9147] [Citation(s) in RCA: 4] [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: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 02/08/2023] Open
Abstract
The purpose of this meta-analysis is to evaluate the efficacy of plate or external fixator treatments in distal radius fractures, based not only on clinical and radiographic parameters but on Health Related Quality of Life (HRQOL) parameters. The Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) guidelines were followed when conducting this systematic review. The Revised Assessment of Multiple Systematic Reviews (RAMSTAR) checklist was additionally consulted in order to ensure a high-quality methodological process, encompassing such elements as an ‘a priori’ design, independent reviews and comprehensive search. The literature search was carried out on PubMed, MEDLINE and Scopus. The search terms used were “Radius fracture AND osteosynthesis”, “Wrist fracture AND external fixator” and “Wrist fracture AND plate”. Two reviewers independently screened titles, abstracts and full texts. To determine inter-reviewer agreement, a k score was calculated after each screening state. Of the 5753 studies collected through the initial databases search, two studies were included in the final meta-analysis (125 treated with external fixator vs 132 with volar plate). There was a substantial inter-reviewer agreement as to the title (0.73; 95% confidence interval, 0.67-0.79) abstract (0.65; 95% CI, 0.46-0.83) and fulltext screening stages (0.89; 95%CI, 0.67-1). The meta-analysis reported a mean difference equal to 0.00 (95%CI= -0.05 – 0.05), in accordance with I2= 0% and p test for the heterogeneity value=0.089. This meta analysis confirms and quantifies that the two techniques are superimposable as regards the quality of life reported by patients at least one year of follow-up.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia.,University of Foggia
| | - Giovanni Noia
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia
| | - Giovanni Vicenti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Marco Baglioni
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Maria Rosa Masciale
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Giuseppe Danilo Cassano
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | | | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Vito Pesce
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia.,University of Foggia
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11
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Ilizarov ligamentotaxis versus volar locked plating in the management of AO type C2/C3 distal radius fractures-a prospective non-randomised comparative trial. Musculoskelet Surg 2021; 106:279-290. [PMID: 33712965 DOI: 10.1007/s12306-021-00704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aims of this study were to compare radiological and functional outcomes of Ilizarov ligamentotaxis and locked volar plating in comminuted intra-articular distal radius fractures (AO type C2/C3) using a non-randomised superiority trial. METHODS A total of 72 patients with AO C2/C3 distal radius fractures were allotted into Ilizarov ligamentotaxis (n = 30) and locked volar plating (n = 42) groups based on patient preference. Primary outcome was the ability to achieve and stably maintain acceptable radiological parameters (post-operative, 6 weeks, 3 months, 12 months), and secondary outcome was functional scoring (at 12 months). RESULTS All patients completed the study. All fractures united uneventfully. Plating was superior to Ilizarov in restoring ulnar variance (100% versus 80%, p value 0.004), but Ilizarov was superior to plating in restoring volar tilt (as opposed to neutral tilt, 83.3% versus 47.8%, p value 0.002). Both groups were comparable in restoring radial height, radial inclination and intra-articular reduction and stably maintaining all five parameters over long term. There was a statistically significant difference between the two groups with regard to mean ulnar variance (plating superior) and volar tilt (Ilizarov superior) at all stages of follow-up, whereas radial height and radial inclination were comparable at all points. There was no significant change of all radiological parameters over a follow-up period. At the end of one year, DASH score was slightly better (not clinically appreciable) in the Ilizarov group (8.47 versus 13.61, p value 0.03), but Gartland and Werley scores were comparable between both groups. Mean duration of external fixation in the Ilizarov group was 43.07 ± 8.94 days. Apart from five cases of pin site infections, there were no complications. CONCLUSION Ilizarov ligamentotaxis is a comparable option to locked volar plating in achieving radiological restoration and clinical function in comminuted intra-articular distal radius fractures, AO types C2 and C3. Restoration of ulnar variance needs utmost care while performing Ilizarov ligamentotaxis. Ilizarov comes with the disadvantages of reduced patient preference, pin site infections, need for removal of external fixator and slightly slower return to activity. TRIAL REGISTRATION NUMBER CTRI/2018/08/015549 LEVEL OF EVIDENCE: Level III, Non-randomised prospective trial.
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12
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Lawson A, Naylor JM, Buchbinder R, Ivers R, Balogh ZJ, Smith P, Xuan W, Howard K, Vafa A, Perriman D, Mittal R, Yates P, Rieger B, Smith G, Adie S, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Beattie S, Mulford J, Incoll I, Kale M, Schick B, Li T, Higgs A, Oppy A, Harris IA. Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA Surg 2021; 156:229-237. [PMID: 33439250 DOI: 10.1001/jamasurg.2020.5672] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance The burden of injury and costs of wrist fractures are substantial. Surgical treatment became popular without strong supporting evidence. Objective To assess whether current surgical treatment for displaced distal radius fractures provided better patient-reported wrist pain and function than nonsurgical treatment in patients 60 years and older. Design, Setting, and Participants In this multicenter randomized clinical trial and parallel observational study, 300 eligible patients were screened from 19 centers in Australia and New Zealand from December 1, 2016, until December 31, 2018. A total of 166 participants were randomized to surgical or nonsurgical treatment and followed up at 3 and 12 months by blinded assessors. Those 134 individuals who declined randomization were included in a parallel observational cohort with the same treatment options and follow-up. The primary analysis was intention to treat; sensitivity analyses included as-treated and per-protocol analyses. Intervention Surgical treatment was open reduction and internal fixation using a volar-locking plate (VLP). Nonsurgical treatment was closed reduction and cast immobilization (CR). Main Outcomes and Measures The primary outcome was the Patient-Rated Wrist Evaluation score at 12 months. Secondary outcomes were Disabilities of Arm, Shoulder, and Hand questionnaire score, health-related quality of life, pain, major complications, patient-reported treatment success, bother with appearance, and therapy use. Results In the 300 study participants (mean [SD] age, 71.2 [7.5] years; 269 [90%] female; 166 [81 VLP and 85 CR] in the randomized clinical trial sample and 134 [32 VLP and 102 CR] in the observational sample), no clinically important between-group difference in 12-month Patient-Rated Wrist Evaluation scores (mean [SD] score of 19.8 [21.1] for VLP and 21.5 [24.3] for CR; mean difference, 1.7 points; 95% CI -5.4 to 8.8) was observed. No clinically important differences were found in quality of life, wrist pain, or bother at 3 and 12 months. No significant difference was found in total complications between groups (12 of 84 [14%] for the CR group vs 6 of 80 [8%] for the VLP group; risk ratio [RR], 0.53; 95% CI, 0.21-1.33). Patient-reported treatment success favored the VLP group at 12 months (very successful or successful: 70 [89%] vs 57 [70%]; RR, 1.26; 95% CI, 1.07-1.48; P = .005). There was greater use of postoperative physical therapy in the VLP group (56 [72%] vs 44 [54%]; RR, 1.32; 95% CI, 1.04-1.69; P = 0.02). Conclusions and Relevance This randomized clinical trial found no between-group differences in improvement in wrist pain or function at 12 months from VLP fixation over CR for displaced distal radius fractures in older people. Trial Registration http://anzctr.org.au identifier: ACTRN12616000969460.
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Affiliation(s)
| | - Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Zsolt J Balogh
- John Hunter Hospital, Newcastle, Australia.,University of Newcastle, Newcastle, Australia
| | | | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Arezoo Vafa
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | - Rajat Mittal
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | | | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, Australia
| | - Sam Adie
- St George and Sutherland Hospitals, Sydney, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | - Kim Latendresse
- Nambour General Hospital, Nambour, Australia.,Sunshine Coast University Hospital, Nambour, Australia
| | | | | | | | | | | | - Richard Page
- University Hospital Geelong, Barwon Health, Geelong, Australia.,Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University, Geelong, Australia
| | - Sally Beattie
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University, Geelong, Australia
| | | | - Ian Incoll
- University of Newcastle, Newcastle, Australia.,Gosford and Wyong Hospitals, Gosford, Australia
| | | | | | - Trent Li
- Prince of Wales Hospital, Sydney, Australia
| | | | - Andrew Oppy
- Royal Melbourne Hospital, Melbourne, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
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13
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Woolnough T, Axelrod D, Bozzo A, Koziarz A, Koziarz F, Oitment C, Gyemi L, Gormley J, Gouveia K, Johal H. What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res 2021; 479:348-362. [PMID: 33165042 PMCID: PMC7899542 DOI: 10.1097/corr.0000000000001524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many acceptable treatment options exist for distal radius fractures (DRFs); however, a simultaneous comparison of all methods is difficult using conventional study designs. QUESTIONS/PURPOSES We performed a network meta-analysis of randomized controlled trials (RCTs) on DRF treatment to answer the following questions: Compared with nonoperative treatment, (1) which intervention is associated with the best 1-year functional outcome? (2) Which intervention is associated with the lowest risk of overall complications? (3) Which intervention is associated with the lowest risk of complications requiring operation? METHODS Ten databases were searched from inception to July 25, 2019. Search and analysis reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Included studies were English-language RCTs that assessed at least one surgical treatment arm for adult patients with displaced DRFs, with less than 20% loss to follow-up. We excluded RCTs reporting on patients with open fractures, extensive bone loss, or ipsilateral upper extremity polytrauma. Seventy RCTs (n = 4789 patients) were included. Treatments compared were the volar locking plate, bridging external fixation, nonbridging external fixation, dynamic external fixation, percutaneous pinning, intramedullary fixation, dorsal plating, fragment-specific plating, and nonoperative treatment. Subgroup analyses were conducted for intraarticular fractures, extraarticular fractures, and patients with an average age greater than 60 years. Mean (range) patient age was 59 years (56 to 63) and was similar across all treatment groups except for dynamic external fixation (44 years) and fragment-specific plating (47 years). Distribution of intraarticular and extraarticular fractures was approximately equal among the treatment groups other than that for intramedullary fixation (73% extraarticular), fragment-specific plating (66% intraarticular) [13, 70], and dorsal plating (100% intraarticular). Outcomes were the DASH score at 1 year, total complications, and reoperation. The minimum clinically important different (MCID) for the DASH score was set at 10 points. The analysis was performed using Bayesian methodology with random-effects models. Rank orders were generated using surface under the cumulative ranking curve values. Evidence quality was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology. Most studies had a low risk of bias due to randomization and low rates of incomplete follow-up, unclear risk of bias due to selective reporting, and high risk of bias due to lack of patient and assessor blinding. Studies assessing bridging external fixation and/or nonoperative treatment arms had a higher overall risk of bias while studies with volar plating and/or percutaneous pinning treatment arms had a lower risk of bias. RESULTS Across all patients, there were no clinically important differences in terms of the DASH score at 1 year; although differences were found, all were less than the MCID of 10 points. Volar plating was ranked the highest for DASH score at 1 year (mean difference -7.34 [95% credible interval -11 to -3.7) while intramedullary fixation, with low-quality evidence, also showed improvement in DASH score (mean difference -7.75 [95% CI -14.6 to -0.56]). The subgroup analysis revealed that only locked volar plating was favored over nonoperative treatment for patients older than 60 years of age (mean difference -6.4 [95% CI -11 to -2.1]) and for those with intraarticular fractures (mean difference -8.4 [95% CI -15 to -2.0]). However, its clinical importance was uncertain as the MCID was not met. Among all patients, intramedullary fixation (odds ratio 0.09 [95% CI 0.02 to 0.84]) and locked volar plating (OR 0.14 [95% CI 0.05 to 0.39]) were associated with a lower complication risk compared with nonoperative treatment. For intraarticular fractures, volar plating was the only treatment associated with a lower risk of complications than nonoperative treatment (OR 0.021 [95% CI < 0.01 to 0.50]). For extraarticular fractures, only nonbridging external fixation was associated with a lower risk of complications than nonoperative treatment (OR 0.011 [95% CI < 0.01 to 0.65]), although the quality of evidence was low. Among all patients, the risk of complications requiring operation was lower with intramedullary fixation (OR 0.06 [95% CI < 0.01 to 0.85) than with nonoperative treatment, but no treatment was favored over nonoperative treatment when analyzed by subgroups. CONCLUSION We found no clinically important differences favoring any surgical treatment option with respect to 1-year functional outcome. However, relative to the other options, volar plating was associated with a lower complication risk, particularly in patients with intraarticular fractures, while nonbridging external fixation was associated with a lower complication risk in patients with extraarticular fractures. For patients older than 60 years of age, nonoperative treatment may still be the preferred option because there is no reliable evidence showing a consistent decrease in complications or complications requiring operation among the other treatment options. Particularly in this age group, the decision to expose patients to even a single surgery should be made with caution. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Taylor Woolnough
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Daniel Axelrod
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Anthony Bozzo
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Frank Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Colby Oitment
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Lauren Gyemi
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Jessica Gormley
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Kyle Gouveia
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
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14
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Zhang F, Yang Y, Zhang H, Luo X. A comparative study protocol of external fixation versus volar plate in treating distal radius fracture. Medicine (Baltimore) 2020; 99:e23231. [PMID: 33327243 PMCID: PMC7738129 DOI: 10.1097/md.0000000000023231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The superiority of the open reduction and internal fixation (ORIF) and external fixation remains uncertain owing to the limited sample size involved in the literature. This retrospective cohort research was implemented for the comparison of the efficiency of ORIF and external fixation utilizing the locked volar plating in treating the intra-articular fractures of distal radius. We hypothesized that compared with the external fixation, ORIF can improve the functional scores and reduce complications. METHODS We conducted a retrospective and single-center cohort trial that was approved by institutional review committee of Gansu Provincial Hospital. From June 2016 to July 2018, in our experiment, 178 patients with intra-articular fractures of the distal radius were recruited. Inclusion criteria in this cohort study were designed as follows: the age of patients is between 18 and 65 years, the patients with American Society of Anesthesiologists level I-III, and with the AO-type C3 or C2 fractures of distal radius confirmed by computed tomography scans, the patients with radiographic clinical follow-up for 1 year or >1 year. The patients participating in the trial would be divided into 2 groups: the patients treated via the external fixation and the patients treated by the ORIF utilizing volar plate. The main functional results were the grip strength and the range of motion of wrist. Radiographic measurement and complications were also evaluated in our study. RESULTS This study protocol will guide and clarify our assignments, and the final outcomes and conclusion will further enrich the clinical knowledge in the literature. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6116).
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15
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Kotsougiani-Fischer D, Choi JS, Oh-Fischer JS, Diehm YF, Haug VF, Harhaus L, Gazyakan E, Hirche C, Kneser U, Fischer S. ICF-based multidisciplinary rehabilitation program for complex regional pain syndrome of the hand: efficacy, long-term outcomes, and impact of therapy duration. BMC Surg 2020; 20:306. [PMID: 33256710 PMCID: PMC7708143 DOI: 10.1186/s12893-020-00982-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Complex regional pain syndrome (CRPS) is a rare but feared complication in hand surgery. Although multimodal therapy concepts are recommended, there is only low evidence on efficacy of such approaches. Furthermore, recommendations regarding therapy duration are lacking. Aim of this study was to validate the efficacy of an International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation concept for treatment of CRPS of the hand and to find correlations between therapy duration and outcome measures. Methods Patients with CRPS of the hand after occupational trauma that underwent an ICF-based rehabilitation program between 2010 and 2014 were included in this retrospective study. Besides demographic data, outcomes included pain (VAS), range of motion assessed by fingertip-to-palm-distance (PTPD) and fingernail-to-table-distance (FTTD) as well as strength in grip, 3-point pinch and lateral pinch. All measures were gathered at admission to and discharge from inpatient rehabilitation therapy as well as at follow-up. Statistical analysis included paired t-test, ANOVA and Pearson's correlation analysis. Results Eighty-nine patients with a mean age of 45 years were included in this study. Duration of rehabilitation therapy was 53 days on average. All outcomes improved significantly during rehabilitation therapy. Pain decreased from 6.4 to 2.2. PTPD of digit 2 to 5 improved from 2.5, 2.8, 2.6, and 2.3 cm to 1.3, 1.4, 1.2, and 1.1 cm, respectively. FTTD of digit 2 to 5 decreased from 1.5, 1.7, 1.5, and 1.6 cm to 0.6, 0.8, 0.7, and 0.7 cm, respectively. Strength ameliorated from 9.5, 3.7, 2.7 kg to 17.9, 5.6, 5.0 kg in grip, lateral pinch, and 3-point pinch, respectively. Improvement in range of motion significantly correlated with therapy duration. 54% of patients participated at follow-up after a mean of 7.5 months. Outcome measures at follow-up remained stable compared to discharge values without significant differences. Conclusion The ICF-based rehabilitation concept is a reliable and durable treatment option for CRPS of the hand. Range of motion improved continuously with therapy duration and thus may serve as an indicator for optimum length of therapy.
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Affiliation(s)
- D Kotsougiani-Fischer
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - J S Choi
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - J S Oh-Fischer
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Y F Diehm
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - V F Haug
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - L Harhaus
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - E Gazyakan
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - C Hirche
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - U Kneser
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - S Fischer
- BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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16
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Suwanno P, Omokawa S, Nakanishi Y, Kira T, Tanaka Y. Safe zone of pin insertion for nonbridging external fixators in distal radial fractures: MRI analysis. J Orthop Sci 2020; 25:1003-1007. [PMID: 31959381 DOI: 10.1016/j.jos.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/07/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Of the anatomical reduction and fixation methods used to treat distal radius fracture, non-bridging external fixation has the advantage of enabling early wrist motion. The surgical technique relies on successful placement of the pin in individual fracture fragments. The present study aimed to identify the safe zone of pin insertion for a non-bridging external fixator into the distal radius that avoids metal impingement of extensor tendons. METHODS The width and length of the septal attachments of the extensor retinaculum were measured on axial MR images of 62 wrists. RESULTS The 2-3 septum was the widest and longest, with a width of 2-7 mm and a location 0-36 mm proximal to the wrist joint. The width of the 1-2 septum was 2-6 mm, and was widest at 10 mm proximal to the joint. The 1-2 septum was triangular-shaped, while the 2-3 septum was oval-shaped. The 3-4 and 4-5 septa had narrow attachments and were adequate for pin insertion (with a pin 1-2 mm in width) at a position less than 8 mm proximal to the wrist. The width of the 1 R septum (radial to the 1st septum) was 2-6 mm at the radiovolar aspect of the wrist. CONCLUSIONS There were two safe pin insertion sites; the first was safe at the distal aspect only (8-10 mm proximal to the wrist) and included the 1-2, 3-4, and 4-5 septa, while the second was safe from 0 mm to 32-38 mm proximal to the wrist and included the 1 R and the 2-3 septa. The 1 R septum had adequate size for use as a new pin insertion site that aligns in the internervous plane and has minimal risk of superficial radial nerve injury.
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Affiliation(s)
- Pormes Suwanno
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University 15 Karnjanavanich Rd., Hat Yai, Songkhla, 90110, Thailand
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yasuaki Nakanishi
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tsutomu Kira
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh Z, Smith P, Mittal R, Xuan W, Howard K, Vafa A, Yates P, Rieger B, Smith G, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Hau R, Mulford J, Incoll I, Kale M, Schick B, Higgs A, Oppy A, Perriman D, Harris I. A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan. Trials 2020; 21:651. [PMID: 32669121 PMCID: PMC7364640 DOI: 10.1186/s13063-020-4228-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p < 0.05. Sensitivity analyses will be conducted to assess for differences in intention-to-treat, per-protocol and as-treated analyses. Sensitivity analyses will also be conducted to assess selection bias by evaluating differences in participants between the randomised and observational study arms, and for bias relating to any missing data. An economic analysis will be conducted separately if surgery is shown to provide superior outcomes to a level of clinical significance. Discussion This statistical analysis plan describes the analysis of the CROSSFIRE study which aims to provide evidence to aid clinical decision-making in the treatment of distal radius fractures in older patients. Trial registration CROSSFIRE was approved by The Hunter New England Human Research Ethics Committee (HNEHREC Reference No: 16/02/17/3.04). Registered on 22 July 2016 with The Australian and New Zealand Clinical Trials Registry (ANZCTR Number; ACTRN12616000969460). This manuscript is based on v.11 of the statistical analysis plan. A copy of v.11, signed by the chief investigator and the senior statistician is kept at the administering institution.
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Affiliation(s)
- Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia. .,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Monash University, Melbourne, VIC, Australia.,Cabrini Institute, Melbourne, VIC, Australia
| | - Rebecca Ivers
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Paul Smith
- Canberra Hospital, Canberra, ACT, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Kirsten Howard
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Arezoo Vafa
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Piers Yates
- Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, NSW, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | - Kim Latendresse
- Nambour Hospital and Sunshine Coast University Hospital, Nambour, QLD, Australia
| | - James Wong
- Westmead Hospital, Sydney, NSW, Australia
| | | | | | | | - Phong Tran
- Western Health, Melbourne, VIC, Australia
| | - Richard Page
- University Hospital Geelong, Barwon Health, Geelong, NSW, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | - Michael Kale
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | | | | | - Andrew Oppy
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.,Liverpool Hospital, Sydney, NSW, Australia
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18
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Li J, Rai S, Tang X, Ze R, Liu R, Hong P. Fixation of delayed distal radial fracture involving metaphyseal diaphyseal junction in adolescents: a comparative study of crossed Kirschner-wiring and non-bridging external fixator. BMC Musculoskelet Disord 2020; 21:365. [PMID: 32517675 PMCID: PMC7285434 DOI: 10.1186/s12891-020-03404-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Conservative treatment remains the preferred choice for distal radius fracture in children. However, loss of reduction is problematic, especially in an older child. Crossed Kirschner-wires is widely used to treat distal radius fracture in adolescents. This study aimed to compare the application of crossed Kirschner-wiring (KW) and non-bridging external fixator (EF) for the treatment of delayed distal radial fracture involving metaphyseal diaphyseal junction (MDJ) in adolescents. Methods Between January 2012 to January 2017, 146 (male = 101, female = 45) patients in EF group and 117 (male = 76, female = 41) in KW group, were reviewed retrospectively. Preoperative data were collected from the hospital database, and postoperative clinical outcomes data were collected during the follow-up visits. We used SPSS for data analysis. Results There existed no significant difference between EF and KW regarding sex, body weight, fracture side, duration from injury to surgery. The duration of surgery was significantly shorter in EF (30.5 ± 6.1 min) than the KW group (44.6 ± 9.4 min), P < 0.001. The number of intraoperative X-ray images was significantly lower in EF (6.5 ± 1.1) than KW (11.8 ± 2.3), P < 0.001. The incidence of tendon irritation is significantly higher in the KW (19.7%) than the EF group (0%), P < 0.001. The residual angulation on the AP view was higher in KW (3.8 ± 2.3, degrees) than the EF group (2.5 ± 1.6, degrees), P < 0.001. The volar tilting is better in EF (6.6 ± 1.1, degrees) than the KW group (1.0 ± 1.5, degrees), P < 0.001. However, the functional outcomes of the wrist showed no significant difference between EF and KW group, P = 0.086. Conclusion The EF was superior to KW in the treatment of radial MDJ fractures in adolescents. The EF displayed shorter duration of surgery, less tendon irritation, and better radiographic outcomes than the KW. However, the cost-effect analysis remains to be investigated, because the EF is more expensive than KW.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Renhao Ze
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ruikang Liu
- First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Liu Y, Bai YM. Efficacy of non-bridging external fixation in treating distal radius fractures. Orthop Surg 2020; 12:776-783. [PMID: 32343053 PMCID: PMC7307264 DOI: 10.1111/os.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the efficacy of non‐bridging external fixation in treating distal radius fractures (DRF) and its effect on wrist joint function. Methods The medical records of 207 patients who were treated for DRF between May 2008 and April 2017 in our hospital (age, 18.0–70.0 years; 99 males and 108 females) were retrospectively analyzed. All patients had evident wrist trauma and the diagnosis of DRF was confirmed by imaging tests. A total of 101 patients received bridging external fixation (control group), whereas another 106 received non‐bridging external fixation (study group). At 12 weeks after the procedure, the treatment effect was measured using the Dienst scoring system (rating scale: ≤3 points, excellent; 4–7 points, good; 8–11 points, fair; >12 points, poor), and the wrist joint function was evaluated by Gartland and Werley classification (rating scale: 0–2 points, excellent; 3–8 points, good; 9–20 points, fair; >21 points, poor); meanwhile, the radial length, radial inclination, and palmar tilt were examined by X‐ray. Follow‐up visits were conducted once every 2 weeks for 6 months, and the incidences of complications in the two groups within 6 months after operation were recorded, including incision infection, Kirschner wire loosening, delayed fracture healing, and arthritis. Results There were no differences in the sex ratio, mean age, mean injury period, Arbeitsgemeinschaft fur osteosynthesefragen classification, and cause of fracture between the two groups (all P > 0.05). In terms of the treatment effects, the study group had a higher percentage of excellent results (P < 0.001) and lower percentages of fair and poor results (P = 0.002, P = 0.001) than the control group 12 weeks after treatment, while both groups had similar percentages of good results (P = 0.109). In terms of the score of the wrist joint function, the study group had a higher proportion of excellent result than the control group 12 weeks after treatment (P = 0.029), whereas no intergroup differences in the proportion of good, fair, and poor results were observed (all P > 0.05). After follow‐up for 6 months, the incidences of incision infection, Kirschner wire loosening, delayed fracture healing, and arthritis, as well as the total complication rate were found to be similar between the two groups (all P > 0.05). Conclusions Using non‐bridging external fixation for treating DRF allows some level of wrist movement during the early stage of fixation, effectively maintains the radial length, radial inclination, and palmar tilt, and achieves better outcomes than bridging external fixation.
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Affiliation(s)
- Ying Liu
- Operating Room, Cangzhou People's Hospital, Cangzhou, China
| | - Yu-Ming Bai
- The Second Department of Orthopaedics, Cangzhou Central Hospital, Cangzhou, China
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20
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Graham JG, Penna S, Fletcher D, Kwok M, Aita DJ, Takei TR, Beredjiklian PK. Outcomes of Open Reduction and Internal Fixation of Bilateral Fractures of the Distal Radius. J Hand Microsurg 2019; 11:117-120. [PMID: 31413497 PMCID: PMC6692159 DOI: 10.1055/s-0039-1688512] [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: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 10/26/2022] Open
Abstract
Background Bilateral distal radius fracture (DRF) is an uncommon injury. We described the outcomes of 10 consecutive cases of bilateral DRF treated with open reduction and internal fixation (ORIF) at our institution. Materials and Methods We retrospectively searched our electronic medical records data for all patients 18 years of age or older treated surgically for bilateral DRF over a 6-year period (2011-2016). Patient demographics, fracture classification, fixation method, postoperative complications, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire scores, wrist range of motion (ROM), and radiographic measurements of X-rays at final follow-up were collected and analyzed. Results Ten patients (8 women; 2 men; mean age: 63 years) with 20 fractures were assessed. A volar approach for ORIF was used in 90% of cases. Six of 20 (30%) wrists experienced postoperative complications and required hardware removal. Mean QuickDASH score was 24.8 at final follow-up. On average, ROM reached 58-degree extension, 52-degree flexion, 75-degree pronation, and 75-degree supination. Mean measurements of radial shortening, radial inclination, and volar tilt taken from final postoperative radiographs were 1.3 mm, 21.2 degrees, and 7.8 degrees, respectively. Conclusion In bilateral DRF treated with concomitant ORIF, functional outcomes, recovery of wrist ROM, and restoration of radiographic parameters are comparable to those seen in patients with ipsilateral DRF.
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Affiliation(s)
- Jack G. Graham
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Sreeram Penna
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Daniel Fletcher
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Moody Kwok
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Daren J. Aita
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - T. Robert Takei
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Pedro K. Beredjiklian
- Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Interventions for Distal Radius Fractures: A Network Meta-analysis of Randomized Trials. J Am Acad Orthop Surg 2019; 27:e596-e605. [PMID: 31232797 DOI: 10.5435/jaaos-d-18-00424] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The distal radius is the second most commonly fractured bone in the elderly population. Several approaches for management exist including both surgical and nonsurgical treatments. Evidence for alternative approaches remains inconclusive and often conflicting. METHODS Electronic database searches were conducted to identify randomized trials that (1) enrolled adults with a distal radius fracture; (2) compared external fixation, intramedullary nailing, K-wires, plaster casting (PC), or plate fixation (PF) to one of the other treatments listed; and (3) reported on a functional outcome that categorized patients as "excellent" and "good" or reported fracture healing complication (loss of reduction, malunion, delayed union, nonunion, and refracture). Data were synthesized using a Bayesian network meta-analysis. Odds ratios (ORs) with 95% credible intervals (CrIs) using a random-effects model were calculated. RESULTS Thirty-eight trials were included. Total sample sizes ranged from 30 to 461 patients. Although no differences were noted between treatments at 3 months, PF was ranked the highest for improving functional outcomes at 6 and 12 months, and it demonstrated a statistically significant difference compared with PC at 12 months (OR = 4.27; 95% CrI, 1.07 to 15.12). For reduction in fracture healing complications, PF was ranked the highest again, showing significantly more favorable results relative to the four other interventions: OR = 0.25 (95% CrI, 0.07 to 0.86) versus external fixation, OR = 0.09 (95% CrI, 0.02 to 0.36) versus K-wire, OR = 0.01 (95% CrI, 0.00 to 0.03) versus PC, and OR = 0.00 (95% CrI, 0.00 to 0.35) versus intramedullary nailing. CONCLUSIONS A network meta-analysis of randomized trials revealed that open reduction and internal fixation with a plate offers the best results for adult patients with a distal radius fracture, in terms of early and sustained functional recovery and a reduction in fracture healing complications. Determining whether one approach to PF or plate design is superior requires further study.
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22
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Roh YH, Gong HS, Baek GH. Prognostic Value of Pain Sensitization During Early Recovery After Distal Radius Fracture in Complex Regional Pain Syndrome. PAIN MEDICINE 2019; 20:1066-1071. [PMID: 30412230 DOI: 10.1093/pm/pny184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the influence of pain sensitization in the early recovery of distal radius fractures (DRFs) on the occurrence and prognosis of complex regional pain syndrome (CRPS) type I. METHODS We enrolled 58 patients who were diagnosed with CRPS I based on Budapest criteria within six months after sustaining DRF; they were age- and gender-matched with 58 patients with DRF who did not have CRPS I. We commonly measured patients' pressure pain thresholds (PPTs) in the forearm and administered a Pain Sensitivity Questionnaire (PSQ) when patients complained of pain with numeric rating scale ≥4 at three-month follow-up. Participants were followed up three, six, and 12 months after injury, and the symptoms and sign of CRPS were evaluated at each follow-up. RESULTS Patients with CRPS I were more likely to have sustained high-energy injuries, had severe fractures, and had significantly higher PSQ scores and lower PPTs than the age- and gender-matched controls. At 12 months after injury, CRPS symptoms improved in 52% (30/58) of patients who had been diagnosed with CRPS I at three months after injury. The initial degree of pain sensitization and high-energy injury were associated with persistence of CRPS symptoms up to 12 months after initial injury. CONCLUSIONS Patients with CRPS I after DRF exhibited significantly higher pain sensitization in the early post-trauma period, and the degree of initial pain sensitization and high-energy injuries were associated with prolonged CRPS I signs and symptoms up to one year after initial injury.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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23
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Alter TH, Sandrowski K, Gallant G, Kwok M, Ilyas AM. Complications of Volar Plating of Distal Radius Fractures: A Systematic Review. J Wrist Surg 2019; 8:255-262. [PMID: 31192050 PMCID: PMC6546498 DOI: 10.1055/s-0038-1667304] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023]
Abstract
Background In recent years, there has been an increased utilization of volar locking plate fixation of distal radius fractures (DRFs). However, reported long-term complication rates with this technique remain unclear. Purpose The purpose of this systematic review was to investigate the pooled incidence of complications associated with volar locking plating of DRF. Methods A search of the Scopus database was performed from 2006 through 2016. Studies were considered eligible if they had a diagnosis of a DRF and were treated with a volar locking plate with an average of 12 months or longer follow-up. Results The literature search yielded 633 citations, with 55 eligible for inclusion in the review (total n = 3,911). An overall complication rate of 15% was identified, with 5% representing major complications requiring reoperation. The most common complication types identified included nerve dysfunction (5.7%), tendon injury (3.5%), and hardware-related issues (1.6%). Conclusion Nerve complications were reportedly higher than tendon and hardware-related complications combined. However, despite varying complication rates in the literature, this systematic review reveals an overall low complication rate associated with volar locking plating of DRF.
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Affiliation(s)
- Todd H. Alter
- Department of Hand and Wrist Surgery, Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristin Sandrowski
- Department of Hand and Wrist Surgery, Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory Gallant
- Department of Hand and Wrist Surgery, Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Moody Kwok
- Department of Hand and Wrist Surgery, Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Department of Hand and Wrist Surgery, Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania
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Mellstrand Navarro C, Brolund A, Ekholm C, Heintz E, Hoxha Ekström E, Josefsson PO, Leander L, Nordström P, Zidén L, Stenström K. Treatment of radius or ulna fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and current practice. PLoS One 2019; 14:e0214362. [PMID: 30921377 PMCID: PMC6438530 DOI: 10.1371/journal.pone.0214362] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 03/12/2019] [Indexed: 01/31/2023] Open
Abstract
Background The objective of the present study was to evaluate effectiveness, complications and cost-effectiveness of any surgical or non-surgical treatment for radius or ulna fractures in elderly patients. Secondary objectives were to analyze present treatment traditions of distal radius fractures (DRF) in Sweden and to calculate resource usage for its treatment. Methods and findings The assessment contains a systematic review of clinical and health economic studies comparing treatment options for radius or ulna fractures. The results regarding the effectiveness of the treatments are summarized in meta-analyses. In addition, the assessment contains a cost analysis for different treatment options commonly used for DRF care, and an analysis of registry data on the incidence and treatment of DRF. In total 31 randomized controlled trials were included in meta-analyses. When comparing functional outcome for plate fixation versus non-surgical treatment for DRF, there were no clinically important differences at one-year follow-up (mean difference [MD], -3.29, 95% CI, -7.03; 0.44). Similar results were found when comparing plating and percutaneous methods with respect to functional outcome (standardized mean difference [SMD], -0.07, 95% CI, -0.21; 0.07) and grip strength (MD, -3.47, 95% CI, -11.21; 4.28). There were no differences for minor complications, (risk difference [RD], -0.01, 95% CI, -0.07; 0.05) whereas major complications were less common for the percutaneous group, (RD, 0.02, 95% CI, 0.02; 0.03). Given the low number of studies, the evidence above was rated as moderate certainty. The cost for plate fixation versus plaster cast was estimated to 1698 compared to 137 US dollars. For DRF, plate fixation increased in Sweden between 2005 and 2013, and was the most common surgical method in 2013. Conclusions Surgical treatment of moderately displaced distal radius fractures in elderly patients offers no clear benefit compared to non-surgical treatment. Plating procedures have become more common during the second millennium and involve higher costs and higher risk of major complications than percutaneous options.
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Affiliation(s)
- Cecilia Mellstrand Navarro
- Department of Hand Surgery, Karolinska Institute, Institution for Clinical Research and Education, Södersjukhuset Hospital, Stockholm, Sweden
- * E-mail:
| | - Agneta Brolund
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Mölndal, Sweden
| | - Emelie Heintz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emin Hoxha Ekström
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | | | - Lina Leander
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå, Sweden
| | - Lena Zidén
- Department of Health and Rehabilitation, The Sahlgrenska Academy at the University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Karin Stenström
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
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25
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Raj M, Gill S, Singh S, Rajpoot A, Mittal A, Yadav N. Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/jotr.jotr_11_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Gouk CJC, Bindra RR, Tarrant DJ, Thomas MJE. Volar locking plate fixation versus external fixation of distal radius fractures: a meta-analysis. J Hand Surg Eur Vol 2018; 43:954-960. [PMID: 29228851 DOI: 10.1177/1753193417743936] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This meta-analysis evaluates reported outcomes of volar locking plates versus external fixation for management of distal radius fractures. A comprehensive literature search was carried out using PubMed, embase, MEDLINE, and the Cochrane Library. Multiple outcomes were analysed: study characteristics, objective/subjective outcome measures, radiographic parameters, and complication rates. Nine studies containing 780 participants met the outlined inclusion criteria. Disabilities of the arm, shoulder, and hand scores significantly favoured volar locking plates, but only at 3 months was the difference clinically meaningful. Grip strength, extension, and supination were better in the volar locking plates group in the early post-operative period, but were similar at 12 months. Ulnar variance was better restored by volar locking plates. The volar locking plates group was associated with higher re-operation rate, and the external fixation group had a higher infection rate. Current literature suggests that volar locking plates can provide better subjective scores and radiographic parameters, especially in the first 3 months, but may be associated with a higher re-operation rate.
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Affiliation(s)
- Conor J C Gouk
- 1 Gold Coast University Hospital, Southport, Gold Coast, QLD, Australia
| | - Randip R Bindra
- 1 Gold Coast University Hospital, Southport, Gold Coast, QLD, Australia.,2 Griffith University School of Medicine, Gold Coast, QLD, Australia
| | - Drew J Tarrant
- 1 Gold Coast University Hospital, Southport, Gold Coast, QLD, Australia
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Guzzini M, Lupariello D, Lanzetti RM, Mazza D, Ferretti A. Preliminary experience with triangular CarboFix "Piccolo" Distal Radius Plate in wrist fractures. Clinical and radiological results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 90:61-66. [PMID: 30715000 PMCID: PMC6503389 DOI: 10.23750/abm.v90i1-s.7697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
Abstract
Background and aim o the work: In the recent last years there was a diffusion of new radiolucent plates for the treatment of distal radius fractures. The aim of our study is to evaluate the clinical and radiological outcomes at 12-month-follow-up for the treatment of distal radius fracture with the new triangular CarboFix “Piccolo” Distal Radius Plate. Methods: All consecutive patients aged from 18 or over, who were treated for unstable distal radius fracture with a volar CarboFix “Piccolo” Distal Radius Plate with triangular design between September 2015 and May 2016, have been included in the study. From the original 28 patients, 6 patients were lost to the follow up or did not meet the inclusion criteria and 22 were available for the study. The 22 patients were prospectively reviewed with dynamometric, radiographic and clinical evaluations (ROM, VAS, Quick DASH). Results: The mean follow-up was 15.7 months. All fractures healed, and radiographic union was observed at an average of 5 weeks. All patients have recovery of R.O.M. comparable to the contralateral at the final follow up; with no significant difference (p>0.05) as regards extension, flexion, ulnar deviation, radial deviation, supination and pronation comparing to the unaffected arm. At final follow-up, no patients had a statistically significant difference (p>0.05) of grip strength, comparing to the contralateral side. The mean Quick DASH was 9.3 and the mean VAS score was 2.3. Conclusion: The most important finding of the present study was that the triangular CarboFix “Piccolo” Distal Radius Plate showed good clinical and radiological results in the treatment of distal radial fractures. These results are comparable to those achieved with conventional plates. (www.actabiomedica.it)
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Wang J, Lu Y, Cui Y, Wei X, Sun J. Is volar locking plate superior to external fixation for distal radius fractures? A comprehensive meta-analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:334-342. [PMID: 30497657 PMCID: PMC6204453 DOI: 10.1016/j.aott.2018.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/01/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other. Methods The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs. Results A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = −6.12, 95%CI = −12.07–0.17; CS: MD = −6.43, 95%CI = −12.53–0.3), ulnar variance (RCT: MD = −0.81, 95%CI = −1.25–0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10–0.65; CS: RR = 0.15, 95%CI = 0.06–0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs. Conclusions VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs. Level of evidence Level 1, Therapeutic study.
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Hevonkorpi TP, Launonen AP, Huttunen TT, Kannus P, Niemi S, Mattila VM. Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 - too many patients are yet operated on? BMC Musculoskelet Disord 2018; 19:70. [PMID: 29499673 PMCID: PMC5834887 DOI: 10.1186/s12891-018-1983-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Although optimal treatment of distal radius fractures is controversial, surgery has gained popularity. The purpose of this study was to evaluate recent trends in the surgical treatment of distal radius fractures in Finns aged 50 years or more. Methods A nationwide hospital discharge register-based study was conducted among all patients 50 years of age or older who had a surgically treated distal radius fracture in Finland between 1998 and 2016. The number and rate of different surgical procedures were calculated per 100,000 person-years. Results Altogether 21,965 surgically treated distal radius fractures were identified. During the study period the rate of percutaneous pinning and external fixation diminished while the rate of plate fixation significantly increased. The rate of operative treatment increased continually from 1998 to 2008 whereupon the peak of the incidence was achieved. After 2008, the rate of operative treatment of distal radius fracture remained quite constant, ranging between 61.1 and 67.8 per 100,000 person-years. Conclusions Plate fixation has almost completely replaced both external fixation and percutaneous pinning in the surgical treatment of distal radius fractures in Finland. Despite growing evidence for less invasive treatment options in elderly patients, operative treatment of distal radius fracture is still rather popular today.
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Affiliation(s)
- Teemu P Hevonkorpi
- Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland. .,School of Medicine, University of Tampere, Tampere, Finland.
| | - Antti P Launonen
- Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland
| | - Pekka Kannus
- School of Medicine, University of Tampere, Tampere, Finland.,Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Seppo Niemi
- Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics at Karolinska University Hospital, Karolinska Institutet, Solna and Huddinge, Sweden
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Peng F, Liu YX, Wan ZY. Percutaneous pinning versus volar locking plate internal fixation for unstable distal radius fractures: a meta-analysis. J Hand Surg Eur Vol 2018; 43:158-167. [PMID: 29064312 DOI: 10.1177/1753193417735810] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This meta-analysis compared outcomes between percutaneous pinning/wiring and open reduction internal fixation (ORIF) with locking plates for treatment of unstable distal radius fractures. Medline, Cochrane, EMBASE, and Google Scholar were searched through December 30, 2015. Twenty randomised controlled trials (RCTs) and non-randomised two-arm studies were included. Outcomes included scores of Disabilities of the Arms, Shoulders and Hands (DASH), visual analogue scale (VAS) pain, and patient rated wrist evaluation (PRWE) score, as well as range of motion (ROM) and complication incidence. ORIF/plating was associated with lower DASH scores but longer procedure time, while there was no difference between the two methods with respect to VAS pain score and PRWE score. The overall incidence of complications, including complex regional pain syndrome, was higher with pinning/wiring, though the incidence of carpal tunnel syndrome and nerve defects was not different. Supination and grip strength were better with ORIF. Radiographically, ulnar variation was greater with pinning/wiring. These results suggest that ORIF/plating is the preferred method of managing unstable distal radius fractures. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Fei Peng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuan-Xiang Liu
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen-Yu Wan
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
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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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Stinton SB, Graham PL, Moloney NA, Maclachlan LR, Edgar DW, Pappas E. Longitudinal recovery following distal radial fractures managed with volar plate fixation. Bone Joint J 2017; 99-B:1665-1676. [PMID: 29212691 DOI: 10.1302/0301-620x.99b12.bjj-2017-0348.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022]
Abstract
AIMS To synthesise the literature and perform a meta-analysis detailing the longitudinal recovery in the first two years following a distal radius fracture (DRF) managed with volar plate fixation. MATERIALS AND METHODS Three databases were searched to identify relevant articles. Following eligibility screening and quality assessment, data were extracted and outcomes were assimilated at the post-operative time points of interest. A state-of-the-art longitudinal mixed-effects meta-analysis model was employed to analyse the data. RESULTS The search identified 5698 articles, of which 46 study reports met the selection criteria. High levels of disability and impairment were reported in the immediate post-operative period with subsequently a rapid initial improvement followed by more gradual improvement for up to one year. The results highlight that the period associated with the greatest physical recovery is in the first three months and suggest that the endpoint of treatment outcomes is best measured at one year post-surgery. CONCLUSION Clinically meaningful improvements in outcomes can be expected for 12 months, after which progress plateaus and reaches normal values. This paper adopted a novel approach to meta-analyses in that the research question was of a longitudinal nature, which required a unique method of statistical analysis. Cite this article: Bone Joint J 2017;99-B:1665-76.
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Affiliation(s)
- S B Stinton
- Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East St, O204, Lidcombe NSW 2141, Australia, and Westmead Private Physiotherapy Services, 16 Mons Rd, Westmead NSW 2145, Australia
| | - P L Graham
- Macquarie University, 12 Wally's Walk, Building E7A, Level 6, Macquarie University, NSW 2109, Australia
| | - N A Moloney
- Macquarie University, 75 Talavera Road, Macquarie Park, NSW 2113, Australia
| | - L R Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia QLD 4072, Australia
| | - D W Edgar
- Fiona Stanley Hospital, Fiona Wood Foundation and The University of Notre Dame Australia, 11 Robin Warren Drive, Murdoch, WA 6150, Australia, Fiona Wood Foundation, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia, and The University of Notre Dame Australia, 19 Mouat Street, Fremantle WA 6160, Australia
| | - E Pappas
- Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East St, O204, Lidcombe NSW 2141, Australia
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Medici A, Meccariello L, Rollo G, De Nigris G, Mccabe SJ, Grubor P, Falzarano G. Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes? Injury 2017; 48 Suppl 3:S30-S33. [PMID: 29025606 DOI: 10.1016/s0020-1383(17)30654-x] [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] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes. METHODS Thirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females). Patient assessment included visual analogic scale of pain (VAS), the subjective Mayo Wrist Score (MWS), electromyograms (EMG) at 3 month and 6 months from the day of injury and complications. All patients had the same physiotherapy treatment algorithm following surgery. Patient follow up took place at 1 month, 3, 6, and 12 months. RESULTS A the T12 month follow up point the VAS average was 0.8 (range 0-3) in ORIF + CTR group compared to 1.2 (range 0-3) in the ORIF and NOT CTR. The MWS average was 98.7 (range 95-100) in ORIF + CTR group versus 97.6 (range 95-100) in ORIF no CTR group. There was no statistical significance (p > 0.5) between the two groups during the follow up period. Patients in the sixth month of ORIF + CTR had no suffering of the median nerve, while 31.58% of patients in ORIF and no CTR found to have carpal tunnel syndrome. CONCLUSIONS Routine release of the transverse carpal ligament at the time of fracture fixation may reduce the incidence of postoperative median nerve dysfunction.
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Affiliation(s)
- Antonio Medici
- Department of Orthopedics and Traumatology, Gaetano Rummo Hospital, Benevento, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giancarlo De Nigris
- Department of Orthopedics and Traumatology, Gaetano Rummo Hospital, Benevento, Italy
| | | | - Pedrag Grubor
- Orthopedics and Traumatology, Klinical Center University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Gaetano Rummo Hospital, Benevento, Italy
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Gary C, Shah A, Kanouzi J, Golas AR, Frey JD, Le B, Hacquebord J, Thanik V. Carpal Tunnel Syndrome Following Corrective Osteotomy for Distal Radius Malunion: A Rare Case Report and Review of the Literature. Hand (N Y) 2017; 12:NP157-NP161. [PMID: 28511570 PMCID: PMC5684953 DOI: 10.1177/1558944717708053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although median nerve neuropathy and carpal tunnel syndrome (CTS) are known complications of both untreated and acutely treated distal radius fracture, median neuropathy after correction of distal radius malunion is not commonly reported in hand surgery literature. We describe a patient with severe CTS after corrective osteotomy, open reduction internal fixation (ORIF) with a volar locking plate (VLP), and bone grafting for distal radius malunion. METHODS We report a case of severe acute CTS as a complication of corrective osteotomy with bone grafting for distal radius malunion. RESULTS The patient was treated with surgical exploration of the median nerve and carpal tunnel release. CONCLUSION The authors report a case of acute CTS after ORIF with VLP for a distal radius malunion warranting surgical exploration and carpal tunnel release. Treatment teams must be aware of this potential complication so that the threshold for reoperation is low and irreversible damage to the median nerve is prevented.
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Affiliation(s)
- Cyril Gary
- Yale University, School of Medicine, Division of Plastic Surgery, New Haven, CT, USA
| | - Ajul Shah
- New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA,Ajul Shah, Department of Plastic Surgery, New York University, 307 E. 33rd Street, New York, NY 10016, USA.
| | - Jack Kanouzi
- Yale University, School of Medicine, Division of Plastic Surgery, New Haven, CT, USA
| | - Alyssa R. Golas
- New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA
| | - Jordan D. Frey
- New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA
| | - Brian Le
- New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA
| | - Jacques Hacquebord
- New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA
| | - Vishal Thanik
- New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA
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Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures. Plast Reconstr Surg 2017; 139:717e-724e. [DOI: 10.1097/prs.0000000000003076] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fixation of intra-articular fractures of the distal radius using intramedullary nailing: a randomized trial versus palmar locking plates. Injury 2016; 47 Suppl 7:S25-S30. [PMID: 28040073 DOI: 10.1016/s0020-1383(16)30850-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Proposed benefits of intramedullary techniques include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial was that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of intra-articular fractures of the distal radius. METHODS We conducted a single-centre, prospective randomized matched-pairs trial. Patients with intraarticular distal radius fractures with metaphyseal comminution and a sagittal fracture line (AO 23 C2.1) were randomized to receive volar locking plate fixation (n = 14) or intramedullary nailing (n = 14). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks and 2 years after the operation. RESULTS There were no significant differences between groups in terms of range of motion, grip strength or the level of pain at eight weeks. At the final follow up, patients in the nail group had regained more extension than in the plate group (98% of the unaffected side vs. 94%, this however, did not reach significance). Reduction was maintained in both groups; however volar tilt and ulnar variance were significantly better in the plate group. There was no significant difference in the complication rate between groups. CONCLUSION The present study suggests that intramedullary nail fixation is a reasonable alternative to volar plate fixation for the treatment of intra-articular distal radius fractures and both techniques can yield reliably good results.
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[Complex regional pain syndrome following distal fractures of the radius : Epidemiology, pathophysiological models, diagnostics and therapy]. Unfallchirurg 2016; 119:732-41. [PMID: 27488541 DOI: 10.1007/s00113-016-0217-x] [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: 12/27/2022]
Abstract
The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. Decisive for the diagnostics are a detailed patient medical history and a clinical hand surgical, neurological and pain-related examination with confirmation of the Budapest criteria. Among the types of apparatus used for diagnostics, 3‑phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.
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Abstract
Complications following any form of distal radius fixation remain prevalent. With an armamentarium of fixation options available to practicing surgeons, familiarity with the risks of newer plate technology as it compares with other conventional methods is crucial to optimizing surgical outcome and managing patient expectations. This article presents an updated review on complications following various forms of distal radius fixation.
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Affiliation(s)
- Dennis S Lee
- Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232, USA.
| | - Douglas R Weikert
- Orthopaedic Surgery and Rehabilitation, Hand and Upper Extremity Center, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 3200, Nashville, TN 37232, USA
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Zhang Q, Liu F, Xiao Z, Li Z, Wang B, Dong J, Han Y, Zhou D, Li J. Internal Versus External Fixation for the Treatment of Distal Radial Fractures: A Systematic Review of Overlapping Meta-Analyses. Medicine (Baltimore) 2016; 95:e2945. [PMID: 26945405 PMCID: PMC4782889 DOI: 10.1097/md.0000000000002945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although a serious of meta-analyses have been published to compare the effects of internal versus external fixation (IF vs EF) for treating distal radial fractures (DRF), no consensus was obtained.B y performing a systematic review of overlapping meta-analyses comparing IF versus EF for the treatment of distal radial fractures, we attempted to evaluate the methodology and reporting quality of these meta-analyses, interpret the source of discordant results, and therefore determine the dominant strategy for the treatment of distal radial fractures based on the best evidence currently. An electronic databases search was conducted in MEDLINE, Embase, and Cochrane library to retrieve meta-analyses comparing IF versus EF for treating DRF. Reference lists of relevant literatures were also screened manually to retrieve additional ones. Two investigators independently assessed the eligibility of retrieved articles using predefined inclusion and exclusion criteria. All characteristics as well as outcome variables including functional outcomes, range of motion, radiological results, and complication rates with relevant heterogeneity information presented in each included study were extracted. Heterogeneity was thought to be significant when I² > 50%. We adopted the Oxford Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) Instrument to assess the methodological quality of every included study, and applied the Jadad decision algorithm to select studies with more likely reliable conclusions. A total of 8 studies met the inclusion criteria. The AMSTAR scores ranged from 5 to 9 with a median of 7.75. Following the Jadad algorithm, the meta-analyses with most reliable results can be selected based on the search strategies and application of selection. Finally, 2 meta-analyses with most RCTs and highest AMSTAR scores were selected in this systematic review of overlapping meta-analysis. The best available evidence suggested that compared with EF, IF was significantly associated with lower Disabilities of the Arm, Shoulder and Hand (DASH) scores, better rehabilitation of volar tilt and radial inclination, and lower infection rate at 1-year follow-up. Therefore, we could conclude that internal fixation is superior to external fixations for the treatment of distal radial fractures.
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Affiliation(s)
- Qingyu Zhang
- From the Department of Orthopedics (QZ, ZL, JL), Qilu Hospital, Shandong University, Jinan, Shandong; Department of Orthopedics (FL, BW, DZ, JD, YH), Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong; and Department of Joint Surgery (ZX), Heze Municipal Hospital, Heze, Shandong, China
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Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures: A systematic review and meta-analysis. J Orthop Sci 2016; 21:24-31. [PMID: 26686771 DOI: 10.1016/j.jos.2015.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 08/18/2015] [Accepted: 10/10/2015] [Indexed: 02/09/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis was conducted to compare the relative effectiveness of bridging external fixation and non-bridging external fixation for distal radius fractures treatment. METHOD Relevant literature were comprehensively searched using the PubMed, Springer Link, Karger Medical and Scientific Publishers, Chinese Biomedical Database (CBM) and Chinese National Knowledge Infrastructure (CNKI) databases without any language restrictions. STATA Version 12.0 software and Comprehensive Meta-analysis 2.0 were applied. RESULTS A total of 905 patients with distal radius fracture from six eligible cohort studies were selected for statistical analysis. Our meta-analysis results indicate that the non-bridging cases had a higher risk of pin track infection, rupture of the extensor pollicis longus and nerve injury than the bridging cases. Subgroup analysis stratified by country indicated non-bridging patients showed evidence of an increased risk of pin track infection and higher risk of rupture of the extensor pollicis longus compared with the patients treated with bridging external fixation in the UK population. The follow-up results showed flexion degree of patients treated with non-bridging external fixation was slightly better than that of patients treated with bridging external fixation (P < 0.05). CONCLUSION There is evidence in our systematic review and meta-analysis to support that bridging external fixation can reduce the incidence of pin tract infections and nerve injury compared to non-bridging external fixation, but have no significant difference in other complications and the recovery of wrist joint function. Bridging external fixation could therefore be a better choice in patients with distal radius fractures.
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Qiu WJ, Li YF, Ji YH, Xu W, Zhu XD, Tang XZ, Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities. Sci Rep 2015; 5:15318. [PMID: 26549312 PMCID: PMC4637827 DOI: 10.1038/srep15318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
Abstract
In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined.
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Affiliation(s)
- Wen-Jun Qiu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yi-Fan Li
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yun-Han Ji
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Wei Xu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Xiao-Dong Zhu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Xian-Zhong Tang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Huan-Li Zhao
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Gui-Bin Wang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yue-Qing Jia
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Shi-Cai Zhu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Feng-Fang Zhang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Hong-Mei Liu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
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Brogren E, Petranek M, Atroshi I. Cast-treated distal radius fractures: a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density. Arch Orthop Trauma Surg 2015; 135:927-33. [PMID: 25935132 DOI: 10.1007/s00402-015-2220-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We hypothesized that treating distal radius fractures with cast only or closed reduction and cast is associated with high malunion risk and that the risk is higher in patients with low bone mineral density (BMD). MATERIALS AND METHODS We prospectively studied 130 patients aged 40 years or older with distal radius fractures treated with cast only (87 patients) or closed reduction and cast (43 patients). Radiographs were obtained before treatment, after reduction (in the closed reduction group), and at 1 year. We measured calcaneal BMD with DXA scanner and calculated T scores. We calculated radiological changes from baseline (initial radiographs in cast only and post-reduction radiographs in closed reduction patients) to 1 year. We assessed the relationship between BMD status (normal, osteopenia or osteoporosis) and baseline-to-1-year worsening in volar tilt, ulnar variance, and radial inclination with analysis of covariance adjusting for baseline radiological values. We used receiver operating characteristic (ROC) analysis to determine the ability of T scores to distinguish patients with severe malunion (dorsal tilt >25° and/or ulnar variance ≥5 mm) from those with less severe or no malunion. RESULTS In both treatment groups, baseline radiological variables had deteriorated at 1 year, more in the closed reduction group. Compared to patients with normal BMD, those with osteoporosis had significantly greater worsening in volar tilt and radial inclination but did not differ in ulnar variance worsening. Severe malunion was found in 34 fractures (26 %, 15 in cast only group); T scores had a modest ability in distinguishing severe malunion (area under ROC curve 0.67, 95 % CI 0.56-0.78, p = 0.003). CONCLUSIONS Closed reduction and cast is not an effective treatment for distal radius fractures if radiological graphic outcomes are considered. There is a higher risk of malunion involving dorsal and radial tilt in patients with osteoporosis. Calcaneal BMD measurement may have some benefit in predicting the risk of severe malunion.
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Affiliation(s)
- Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströmsgatan 5, 20502, Malmö, Sweden,
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Igeta Y, Naito K, Sugiyama Y, Obata H, Aritomi K, Kaneko K, Obayashi O. Distal radius fracture after proximal row carpectomy. Int J Surg Case Rep 2015; 7C:165-7. [PMID: 25623755 PMCID: PMC4336416 DOI: 10.1016/j.ijscr.2015.01.026] [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: 10/14/2014] [Revised: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 12/03/2022] Open
Abstract
We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. The DRF is needed wrist range of motion. Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes with it.
Introduction We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. Presentation of case The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar locking plate. No postoperative complication developed, the Mayo score was excellent at 6 months after surgery, and the daily living activity level recovered to that before injury. Discussion Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. Conclusion The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes due to PRC.
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Affiliation(s)
- Yuka Igeta
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Kiyohito Naito
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan; Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo113-8421, Japan.
| | - Yoichi Sugiyama
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Hiroyuki Obata
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Kentaro Aritomi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo113-8421, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo113-8421, Japan
| | - Osamu Obayashi
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
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Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg 2014; 134:1775-81. [PMID: 25311113 DOI: 10.1007/s00402-014-2094-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Wrist fracture is considered a typical initiating trauma for complex regional pain syndrome type I (CRPS I). However, few studies have comprehensively evaluated factors associated with the occurrence of CRPS I after the surgical treatment of a distal radius fracture (DRF). This study evaluates the factors influencing the occurrence of CRPS I after the surgical treatment of a DRF. METHODS A total of 477 patients with a DRF who had been treated surgically were enrolled in this prospective observational study. Patients were followed for 6 months after surgery, and CRPS I was diagnosed using the Budapest diagnostic criteria for research. The factors assessed for the development of CPRS I were age, gender, the body mass index, the type of fracture, the energy of trauma, the number of trial reductions, the type of surgery, and the duration of immobilization. A multivariate logistic regression analysis was conducted to identify independent predictors of the occurrence of CRPS I. RESULTS Among the 477 patients, 42 (8.8 %) satisfied the Budapest criteria for CRPS I within 6 months of surgery. Female patients developed CRPS I more frequently, and the patients who developed CRPS I were older and more likely to sustain a high energy injury or have a comminuted fracture. According to the multivariate analysis, female patients and those with a high energy trauma or severe fracture type were significantly more likely to develop CRPS I (p = 0.02, 0.01, and 0.01, respectively). CONCLUSIONS High energy injuries, severe fractures, and the female gender contribute to the development of CRPS I after the surgical treatment of DRF. The results have important implications for physicians who wish to identify patients at high risk for CRPS I after operative fixation for DRF and instigate treatment accordingly.
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Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthop Traumatol 2014; 15:265-70. [PMID: 25193416 PMCID: PMC4244555 DOI: 10.1007/s10195-014-0317-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 08/07/2014] [Indexed: 11/29/2022] Open
Abstract
Background The objective of the study was to compare the efficacy of external fixation and volar plating on the functional parameter of displaced intra-articular (Cooney’s type IV) distal end radius fractures using the Green and O’Brien scoring system. Materials and methods This prospective randomized study comprised 68 patients treated with external fixation and 42 patients treated with volar locking plates. The patients were followed up at 6 months and 1 year after surgery. The assessment of pain, range of motion, grip strength and activity were assessed at each follow-up visit and scored according to the Green and O’Brien scoring system. Results At 1 year after surgery, we observed that external fixation showed significantly better results than volar locking plates using the Green and O’Brien scores for range of motion (22.0 ± 4.77 vs 19.89 ± 5.05), grip strength (19.91 ± 5.4 vs 16.89 ± 4.4) and final outcome (87.36 ± 11.62 vs 81.55 ± 11.32). No difference was found in pain and activity between these two groups of patients. Patients aged <50 years treated with external fixation showed excellent results (final score (91.57 ± 9.01) at 1 year follow-up. Conclusion External fixation showed superiority over volar locked plating after 1 year of surgery. Level of evidence IV.
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Affiliation(s)
- Rajeev Shukla
- Department of Orthopedics, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, 453555, India,
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Distal radial fractures. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li-hai Z, Ya-nan W, Zhi M, Li-cheng Z, Hong-da L, Huan Y, Xiao-xie L, Pei-fu T. Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials. J Surg Res 2014; 193:324-33. [PMID: 25255722 DOI: 10.1016/j.jss.2014.06.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 05/07/2014] [Accepted: 06/09/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The choice between volar locking plates (VLP) and external fixation (EF) for unstable distal radius fractures have not reached a consensus. The meta-analysis of randomized controlled trials was performed to compare VLP with EF to determine the dominant strategy. MATERIALS AND METHODS Meta-analysis was performed with a systematic search of studies conducted by using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. The randomized controlled trials that compared VLP with EF was identified. Characteristics, functional outcomes, radiological results, and complications were manually extracted from all the selected studies. RESULTS Six studies encompassing 445 patients met the inclusion criteria. There was significant difference between two procedures in disabilities of the arm shoulder and hand scores at 3,6, and 12 mo, visual analogue scale at 6 mo, grip strength at 3 mo, supination at 3 and 6 mo, extension at 3 mo, ulnar variance at 12 mo, and reoperation rate at 12 mo, postoperatively. However, there was no significant difference between flexion, pronation, radial deviation, and ulnar deviation at all follow-up points postoperatively and overall complications at 12 mo, postoperatively. CONCLUSIONS EF had less reoperative rate due to complications, however, VLP had advantages in functional recovery in the early period after surgery, but two methods had similar functional recovery at 12 mo, postoperatively. Clinician should make the treatment decision with great caution for the patients who sustained unstable distal radial fractures.
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Affiliation(s)
- Zhang Li-hai
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Wang Ya-nan
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, P.R. China; School of Medicine, Nankai University, Tianjin, P.R. China
| | - Mao Zhi
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Zhang Li-cheng
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Li Hong-da
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Yan Huan
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Liu Xiao-xie
- Rehabilitation Medicine Center, Chinese PLA General Hospital, Beijing, PR China
| | - Tang Pei-fu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, P.R. China.
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Esenwein P, Sonderegger J, Gruenert J, Ellenrieder B, Tawfik J, Jakubietz M. Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 2013; 133:1155-62. [PMID: 23660964 DOI: 10.1007/s00402-013-1766-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Palmar plate fixation of unstable distal radial fractures is quickly becoming the standard treatment for this common injury. The literature reporting complications consists mainly of isolated case reports or small case series. METHOD Between February 2004 and December 2009 palmar plate fixation was performed in 665 cases. The overall complication rate was 11.3 % (75 complications). Revision surgery was necessary in 10 % (65 procedures). RESULTS The reasons for revision surgery were: postoperative median nerve compression (22 patients) and secondary dislocation (9 patients). An ulna shortening osteotomy for ulnar impingement syndrome was necessary in eight cases. Intraarticular screw placement occurred in three patients. There were two flexor pollicis longus, one finger flexor and three extensor pollicis longus tendon ruptures. Posttraumatic compartment syndrome of the forearm requiring fasciotomy occurred in four cases. There were three cases of infection. Nonoperative treatment was necessary in nine patients, who developed a complex regional pain syndrome. Hardware failure occurred in three cases. Hardware removal was performed in 232 (34 %) cases. CONCLUSION Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.
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Affiliation(s)
- P Esenwein
- Department of Hand, Plastic and Reconstructive Surgery, Cantonal Hospital, 9007, St. Gallen, Switzerland.
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