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Verstreken A, Michielsen J, Vanhees M. A proposal for name-tagging three-dimensional distal radial fracture fragments based on preliminary results. J Hand Surg Eur Vol 2024:17531934241265681. [PMID: 39169758 DOI: 10.1177/17531934241265681] [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] [Indexed: 08/23/2024]
Abstract
Melone introduced a classification system for distal radial fractures, emphasizing the intra-articular patterns. We explore the significance of key part fragments and introduce a three-dimensional fracture tagging system based on an updated version of Melone's concept.
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Affiliation(s)
- Andreas Verstreken
- University of Antwerp, Medical and Healthcare Science, Antwerp, Belgium
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium
| | - Jozef Michielsen
- University of Antwerp, Medical and Healthcare Science, Antwerp, Belgium
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium
| | - Matthias Vanhees
- University of Antwerp, Medical and Healthcare Science, Antwerp, Belgium
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium
- Department of Orthopedic Surgery, AZ Monica, Antwerp, Belgium
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2
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Krimmer H, Wolters R. [Diagnostics and classification of distal radius fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:413-418. [PMID: 38581459 DOI: 10.1007/s00113-024-01425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
Fractures of the distal radius show a wide spectrum of different fracture patterns. Although standard X‑ray images are sufficient for extra-articular fractures, the exact analysis of intra-articular fractures requires the use of computed tomography (CT) with coronal, sagittal and axial sectional images. The classification is based on the Working Group for Osteosynthesis Questions (AO) criteria. The treatment strategy can be more precisely defined by a CT-based classification. Special attention must be paid to the presence of the key corners, as they have a high risk for primary or secondary dislocation if they not adequately stabilized.
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Affiliation(s)
- Hermann Krimmer
- Zentrum für Handchirurgie, St. Elisabethen-Klinikum Ravensburg, St. Martinusstr. 113, 88212, Ravensburg, Deutschland.
| | - Roman Wolters
- Zentrum für Handchirurgie, St. Elisabethen-Klinikum Ravensburg, St. Martinusstr. 113, 88212, Ravensburg, Deutschland
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3
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Zhang J, Yao X, Song Y, Yin P. Establishment and preliminary evaluation of CT-based classification for distal radius fracture. Sci Rep 2024; 14:9673. [PMID: 38671052 PMCID: PMC11053106 DOI: 10.1038/s41598-024-60416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
Establish a new classification system of distal radius fracture based on computed tomographic (CT), and evaluate its reliability and reproducibility preliminarily, and provide a new theoretical reference for clinicians to use the clinical classification system. The imaging data and clinical data of 204 inpatients with distal radius fracture during 6 years from January 1, 2014 to January 1, 2019 in orthopaedic department were analyzed retrospectively and classified based on CT. Three observers evaluated the image data of 48 randomly selected cases based on CT at different time nodes of T1 and T2. Cohen's kappa was used to calculate the consistency. At the last follow-up, patients' Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), and VAS scores were collected. Among 204 cases, there were 12 cases of type 1, including 6 cases of type 1-D, 4 cases of type 1-V and 2 cases of type 1-R. There were 6 cases of type 2, including 2 cases of type 2-DV, 2 cases of type 2-DR and 2 cases of type 2-VR. There were 186 cases of type 3, including 32 cases of type 3-0, 127 cases of type 3-1 and 27 cases of type 3-2. There was no significant difference in DASH, PRWE and VAS scores among all types (P > 0.05). The results of interobserver reproducibility were kappa = 0.985, ICC = 0.984 in the first evaluation, kappa = 0.986, ICC = 0.986 in the second evaluation. The results of intraobserver reproducibility were O1 = 0.991, O2 = 0.991, O3 = 0.989 respectively. The new classification system of distal radius fracture based on CT has theoretical and practical significance for incision selection, fracture reduction and internal fixation. 123 classification system is clear, comprehensive, easy to understand and remember. Moreover, it has higher interobserver reliability and intraobserver reproducibility than other systems reported at present.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedics, The Affiliated Hospital of Innermongolia Medical University, Hohhot, 010010, China.
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100038, China.
| | - Xiaoke Yao
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu, 610041, Sichuan, China
| | - Yanan Song
- National Engineering Laboratory for Medical Big Data Application Technology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Peng Yin
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, 100020, China.
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4
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Haydel AL, Roubion RC, Graphia CT, Cloud CE, Leonardi C, Marrero CE. Preoperative Computed Tomography Scan in Distal Radius Fractures and the Effect on Preoperative Planning. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:141-145. [PMID: 38903840 PMCID: PMC11185880 DOI: 10.1016/j.jhsg.2023.10.012] [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: 09/24/2023] [Accepted: 10/28/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose It is unclear whether computed tomography (CT) scans alter the surgical plan when ordered before surgery for fixation of intra-articular distal radius fractures (DRFs). The purpose of this study was to determine whether a preoperative CT scan alters the planned approach (PA) or planned fixation strategy (PFS) for open reduction internal fixation of intra-articular DRFs. Methods Radiology records were retrospectively reviewed by one trauma surgeon and two hand surgeons for 33 intra-articular DRFs that met the inclusion criteria and previously underwent open reduction internal fixation. Surgeons were initially provided only preoperative radiographs; they were asked for their PA and PFS. Three months later, each surgeon was provided with the same preoperative radiographs as well as a CT scan. They were asked for their PA and PFS and to grade the usefulness of CT for each fracture. Results The overall probability of having the same PA and PFS between the two presentations was 70.6% and 70.9%, respectively. There was a significant difference in opinion on the usefulness of the CT scan among the surgeons (P < .001). Conclusions This study suggests that ordering a CT scan for preoperative planning of open reduction internal fixation for an intra-articular DRF does not affect the approach or fixation strategy in the majority of cases, regardless of how useful a CT scan was determined to be by the surgeon. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Adam L. Haydel
- Department of Orthopaedics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA
| | - Ryan C. Roubion
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, MI
| | - Cristina T. Graphia
- Department of Orthopaedic Surgery and Rehabilitation Services, The University of Chicago, Chicago, IL
| | - Corinne E. Cloud
- Department of Orthopaedics, Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, OH
| | - Claudia Leonardi
- Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA
| | - Christopher E. Marrero
- Department of Orthopaedics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA
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van Veelen NM, Babst R, Link BC, van de Wall BJM, Beeres FJP. [Distal radius fracture-tactic and approach]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:352-369. [PMID: 37395767 DOI: 10.1007/s00064-023-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 07/04/2023]
Abstract
OBJECTIVE The aim of surgical treatment is fracture healing with restored alignment, rotation, and joint surface. Stable fixation allows for functional postoperative aftercare. INDICATIONS Displaced intra- and extra-articular fractures which either could not be adequately reduced or in which a secondary displacement is to expected due to instability criteria. The following factors are considered instability criteria: age > 60 years, female, initial dorsal displacement > 20°, dorsal comminution, radial shortening > 5 mm, palmar displacement. CONTRAINDICATIONS The only absolute contraindication is if the patient is deemed unfit for surgery due to concerns regarding anesthesia. Old age is a relative contraindication, as it is currently debated whether older patients benefit from the operation. SURGICAL TECHNIQUE The surgical technique is guided by the fracture pattern. Palmar plating is most commonly performed. If the joint surface needs to be visualized, a dorsal approach (in combination with another approach or alone) or arthroscopically assisted fixation should be chosen. POSTOPERATIVE MANAGEMENT In general, a functional postoperative regime can be carried out after plate fixation with mobilization without weightbearing. Short-term splinting can provide pain relief. Concomitant ligamentous injuries and fixations, which are not stable enough for functional aftercare (such as k‑wires) require a longer period of immobilization. RESULTS Provided the fracture is reduced correctly, osteosynthesis improves functional outcome. The complication rate ranges between 9 and 15% with the most common complication being tendon irritation/rupture and plate removal. Whether surgical treatment holds the same benefits for patients > 65 years as for younger patients is currently under debate.
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Affiliation(s)
- Nicole M van Veelen
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz.
| | - Reto Babst
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz
- Fakultät für Gesundheitswissenschaften und Medizin, Universität Luzern, Frohburgstrasse 3, 6002, Luzern, Schweiz
| | - Björn-Christian Link
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz
| | - Bryan J M van de Wall
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz
| | - Frank J P Beeres
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz
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Bowers M, Gruenberger E, Jardaly AH, Wood M, Ko A, D'Almeida S, Rubin TA. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-Specific Fixation. J Wrist Surg 2023; 12:500-508. [PMID: 38213565 PMCID: PMC10781579 DOI: 10.1055/s-0043-1761286] [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: 07/06/2022] [Accepted: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t -Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion ( p = 0.08), extension ( p = 0.33), supination ( p = 0.35), or pronation ( p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.
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Affiliation(s)
- Mitchell Bowers
- Department of Orthopaedics, Vanderbilt University, Nashville, Tennessee
| | - Eric Gruenberger
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Achraf H. Jardaly
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Madison Wood
- Medical College of Georgia, Medical College of Georgia, Augusta, Georgia
| | - Andrew Ko
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Stacey D'Almeida
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Todd A. Rubin
- Hand and Upper Extremity Surgery Department, Hughston Clinic Orthopaedics, TriStar Centennial Medical Center, Nashville, Tennessee
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Wieschollek S, Knie C, Megerle K. Cone-beam computed tomography in the treatment of distal radius fractures. HANDCHIR MIKROCHIR P 2023; 55:174-185. [PMID: 37307810 DOI: 10.1055/a-2055-2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Cone-beam computed tomography (CBCT) is a relatively new imaging technique in hand surgery. Being the most common fractures in adults, distal radius fractures are of special importance not only to hand surgeons. The quantity alone calls for fast, efficient and reliable diagnostic procedures. Surgical techniques and possibilities are progressing, especially regarding intra-articular fracture patterns. The demand for exact anatomic reduction is high. There is an overall consensus regarding the indication for preoperative three-dimensional imaging and it is frequently used. Typically, it is obtained by multi-detector computed tomography (MDCT). Postoperative diagnostic procedures are usually limited to plain x-rays. Commonly accepted recommendations regarding postoperative 3D imaging are not yet established. There is a lack of relevant literature. In case of an indication for a postoperative CT scan, it is generally also obtained by MDCT. CBCT for the wrist is not widely used as yet. This review focuses on the potential role of CBCT in the perioperative management of distal radius fractures. CBCT allows for high-resolution imaging with a potentially lower radiation dose compared with MDCT, both with and without implants. It is easily available and can be operated independently, thus being time-efficient and making daily practice easier. Due to its many advantages, CBCT is a recommendable alternative to MDCT in the perioperative management of distal radius fractures.
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Affiliation(s)
- Stefanie Wieschollek
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
| | - Careen Knie
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
| | - Kai Megerle
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
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Kotsalis G, Kotsarinis G, Ladogianni M, Fandridis E. Three Column Fixation Through a Single Incision in Distal Radius Fractures. J Wrist Surg 2023; 12:232-238. [PMID: 37223379 PMCID: PMC10202585 DOI: 10.1055/s-0042-1749162] [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: 09/26/2021] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
Purpose The purpose of this study was to evaluate the clinical and functional results of 67 patients with distal radius fracture (DRF), treated with a modified surgical technique that allows three-column fixation through the same palmar approach. Patients and Methods Between 2014 and 2019, we treated 67 patients using a particular surgical technique. All patients suffered DRF, classified using the universal classification system. Two different intervals were developed palmary: the first ulnarly to the flexor carpi radialis tendon for direct visualization of the distal radius and the second one radially to the radial artery for direct visualization of the styloid process. An anatomic volar locking compression plate was applied to all patients. The radial styloid process was fixed and stabilized either with Kirschner-wires or an anatomic plate through the same incision. Functional results were evaluated based on the Disabilities of the Arm, Shoulder and Hand and Mayo wrist scores. Range of motion and grip strength of the injured wrist were statistically compared with the opposite side. Results The mean follow-up was 47 months (13-84). All fractures were united, and all patients recovered to the preinjury level of activity. The mean flexion-extension range was 73.8° to 55.2° and the supination-pronation range 82.8° to 67°. No infection or nonunion occurred. No major complications were reported. Conclusion Open reduction and internal fixation, under specific indications, is the best treatment option in DRF. The described technique provides excellent visualization to the distal radius surfaces and allows the internal fixation of the radial columns through the same skin incision. Therefore, it can constitute an efficient choice in the treatment armamentarium of DRF.
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Affiliation(s)
- Giannis Kotsalis
- First Department of Orthopedics, General Hospital of Athens G. Gennimatas, Greece
| | - Georgios Kotsarinis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - Maria Ladogianni
- Department of Upper Limb and Microsurgery , KAT General Hospital, Athens, Greece
| | - Emmanouil Fandridis
- Department of Upper Limb and Microsurgery , KAT General Hospital, Athens, Greece
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Miró JI, Bensi AG, Rodríguez GLG, Clembosky G. Minimally Invasive Fixation with Dorsal Suspension Button and Volar Plate in Distal Radius Fractures with Dorsal Die Punch Fragments: A Preliminary Study. J Wrist Surg 2023; 12:161-169. [PMID: 36926206 PMCID: PMC10010901 DOI: 10.1055/s-0042-1749161] [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: 08/19/2021] [Accepted: 03/08/2022] [Indexed: 10/17/2022]
Abstract
Objective The objective of the study is to analyze the clinical and radiological results obtained using a minimally invasive fixation technique with a volar locking plate and a suspension system with a dorsal button in distal articular radius fractures with dorsal comminution. Materials and Methods Six patients with distal radius fractures, between 19 and 68 years of age, were included in the study. Mean follow-up was of 15 weeks. Range of motion (ROM) in flexion, extension, radial deviation, ulnar deviation, pronation, supination, the strength in kilograms, and values on the Visual Analog Scale (VAS), Disabilities of Arm, Shoulder and Hand (DASH), and Mayo Wrist Score (MWS) scales were evaluated at 4, 8, and 12 weeks postoperative. Correction of anteroposterior diameter of the radius and concordance between postoperative anteroposterior diameter and the contralateral wrist diameter were evaluated radiologically. Results The following mean values were obtained at 12 weeks postoperative: ROM in flexion: 40.5°, ROM in extension: 49.5°, ROM in radial deviation: 24.5°, ROM in ulnar deviation: 15°, ROM in pronation: 87°, ROM in supination: 89°, strength: 37.5 kg, pain in VAS scale: 2 points, DASH: 54.5 points, and MWS: 67.5 points. At 12 weeks postoperative, the mean correction of anteroposterior diameter was 0.49 mm. The anteroposterior diameter and that of the contralateral wrist were strongly correlated. Conclusion Fixation with the volar locking plate and dorsal suspension button could be considered an alternative to dorsal plate fixation for treatment of distal radius fractures with comminution or associated dorsal die punch fragments.
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Affiliation(s)
- José Ignacio Miró
- Department of Orthopedic Surgery and Traumatology, Santa Ana Hospital of Motril, Granada, Spain
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de Villeneuve Bargemon JB, Soudé G, Levadoux M, Viaud-Ambrosino S, Peras M, Camuzard O. Radiocarpal fracture-dislocation: Review of the literature, new classification and decision algorithm. Orthop Traumatol Surg Res 2023; 109:103547. [PMID: 36638866 DOI: 10.1016/j.otsr.2023.103547] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Radiocarpal fractures and dislocations are rarely described in the literature. However, the consequences at the functional level are severe, with the loss of almost half of the articular amplitude. The most widespread classification is that of Dumontier, which divides the injury into two categories according to the presence or absence of a fracture. Currently, no classification considers fracture-dislocations in a global and multi-tissue manner; therefore, no therapeutic strategy has been reported. METHODS We conducted an exhaustive bibliographic search for cohort or case report articles concerning radiocarpal fracture-dislocations published between 1990 and the present. Only descriptions of the injury were identified (noting the type of fracture, direction of displacement and carpal injuries). RESULTS In all, data were collected from 14 retrospective series and 16 case reports involving 218 patients. Thirty-five and 183 cases involved anterior and posterior displacement, respectively. A fracture of the distal radius was found in 183 cases and 35 cases had a dislocation only, with no significant fracture. Among the posterior displacements, 44 isolated styloid fractures, 62 styloid and posterior marginal fractures, 29 bimarginal fractures (large anterior fragment and small posterior fragment) and 31 fractures of all the fragments described by Medoff with impaction of the central pavement were found. Anterior displacement fractures were found in 17 cases (styloid and/or anterior marginal fracture). We were able to group the different traumatic clinical forms according to a six-category classification. DISCUSSION A review of the literature highlighted three major components in the management of radiocarpal fracture-dislocations: the bone component, the ligament component and the associated intracarpal lesions. These three components were included in our classification and allowed us to accurately describe all types of radiocarpal fracture-dislocations published in the literature. Authors currently agree on management of the bone component but disagree on that of the ligament component. Particular attention should be paid to intracarpal lesions, which lead to poor outcomes if ignored. Based on our biographical research, we propose a management plan for these complex injuries. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand, Wrist and Elbow Surgery, Saint-Roch Private Hospital, 99, avenue Saint-Roch, 83100 Toulon, France; University Institute of Locomotor and Sport (IULS), Pasteur Hospital, 30, voie romaine, 06100 Nice, France.
| | - Guillaume Soudé
- Orthopedic and Traumatology Surgery, Hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint-Roch Private Hospital, 99, avenue Saint-Roch, 83100 Toulon, France
| | - Sébastien Viaud-Ambrosino
- Hand surgery and limb reconstructive surgery, Timone Adult Hospital, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Matthieu Peras
- Department of orthopedic surgery and traumatology, Teaching Naval Hospital Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon France
| | - Olivier Camuzard
- University Institute of Locomotor and Sport (IULS), Pasteur Hospital, 30, voie romaine, 06100 Nice, France
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11
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Relationship Between Carpal Bone Morphology and Distal Radius Fracture Pattern. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1174520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Abstract
Background: In this study, we examined whether carpal bones (lunate, hamate, capitate) morphologies and fourth metecarp-capitate articulation have an effect on the distal radius fracture pattern.
Methods: 206 patients who applied to the emergency department with distal radius fracture between 2016-2020 were included in the study. Preoperative and pre-reduction x-ray films of the patients were examined. Lunate, hamate, capitate morphologies and 4.metacarp articulation analyzed and classified. Distal radius fracture types were classified according to AO and Fernandez. The relationship between carpal bone morphology and distal radius fracture type was analyzed.
Results: This study consisted of 101 men and 103 women. AO fracture types and carpal bone morphologies (lunate joint type according to Viegas, lunate type according to Zapico, capitate morphology, hamate morphology and capitate-4 metacarpal joint morphology) did not differ significantly (p > 0.05). Fernandez fracture types and carpal bone morphologies (lunate joint type according to Viegas, lunate type according to Zapico, capitate morphology, hamatum morphology and capitate-4.metacarp joint morphology) were compared, there was no significant difference (p > 0.05).
Conclusion: As a result, no clear relationship could be demonstrated between carpal bone morphology and distal radius fracture pattern.
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Donndorff AG, Cafruni VM, Bronenberg Victorica P, Gallucci GL, Boretto JG, De Carli P. Description of unusual osteochondral laminar fragment patterns in Distal Radius fractures. Orthop Traumatol Surg Res 2022; 108:103321. [PMID: 35589086 DOI: 10.1016/j.otsr.2022.103321] [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: 03/05/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Distal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. PATIENTS AND METHODS We reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. RESULTS Two main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: Significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI 1.4 to 2.9). DISCUSSION Global prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. LEVEL OF EVIDENCE IV (Observational/Descriptive); Cross sectional study.
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Affiliation(s)
- Agustín Guillermo Donndorff
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Virginia Maria Cafruni
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina
| | - Pedro Bronenberg Victorica
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina.
| | - Gerardo Luis Gallucci
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Guillermo Boretto
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo De Carli
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Gantry-Free High-Resolution Cone-Beam CT: Efficacy for Distal Radius and Scaphoid Fracture Detection and Characterization. Acad Radiol 2022:S1076-6332(22)00486-X. [PMID: 36167629 DOI: 10.1016/j.acra.2022.08.030] [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: 08/14/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Gantry-free cone-beam CT (CBCT) allows for comfortable patient positioning due to an open scanner architecture. Since CBCT without gantry is not yet established for clinical wrist trauma imaging, this study's aim was to investigate its diagnostic value in the preoperative workup of patients with distal radius and scaphoid fractures. METHODS Within a 12-month period, 113 patients with severe wrist trauma underwent both radiography and CBCT with the same gantry-free multi-use scanner before surgery. Two radiologists retrospectively analyzed all datasets for the morphology of distal radius (n = 95) and scaphoid fractures (n = 20). In all 115 wrists (two bilateral injuries), surgical reports served as the standard of reference. RESULTS While accuracy for distal radius fractures was comparable among CBCT and radiographs, the former was superior with regard to scaphoid fractures (Reader 1: 100.0% vs. 75.0%; Reader 2: 100.0% vs. 65.0%). Accuracy for multi-fragmentary radius injuries (100.0% vs. 90.5%; 100.0% vs. 93.7%), and articular affliction (99.0% vs. 84.2%; 100.0% vs. 83.2%) was also higher in CBCT. Regarding scaphoid fractures, CBCT proved superior for diagnosis of proximal pole or waist involvement (100.0% vs. 70.0%; 100.0% vs. 65.0%) and comminuted patterns (100.0% vs. 70.0%; 100.0% vs. 75.0%). Median effective dose of CBCT was as low as 3.65 µSv compared with 0.16 µSv for standard radiography. CONCLUSION Gantry-free CBCT allows for excellent diagnostic accuracy in the assessment of distal radius and scaphoid fracture morphology. Even in patients with limited mobility, very low radiation dose is sufficient to maintain high image quality.
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Hintringer W, Rosenauer R, Quadlbauer S. Computed Tomography and Pathobiomechanical-Based Treatment of Volar Distal Radius Fractures. J Wrist Surg 2022; 11:203-213. [PMID: 35845238 PMCID: PMC9276065 DOI: 10.1055/s-0041-1731819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022]
Abstract
Today, there are various classifications for distal radius fractures (DRF). However, they are primarily based on plain radiographs and do not provide sufficient information on the best treatment option. There are newer classifications that simultaneously consider the pathobiomechanical basis of the fracture mechanism and analysis of computed tomography images. Main determinants of which type of DRFs occurs are the strength/direction of the applied forces on the carpus and radius, and the position of the wrist relative to the radius during the fall. Reconstruction of the mechanism of injury provides information about which anatomic structures are involved, such as torn ligaments, bone fragments, and the dislocated osteoligamentous units. This article attempts to combine and modify current pathobiomechanically oriented classifications with an improved understanding of the "key fragments" to subsequently offer a treatment approach to stabilize these critical fragments through specific types of internal fixation.
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Affiliation(s)
| | - Rudolf Rosenauer
- AUVA Trauma Hospital Lorenz Böhler, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stefan Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
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15
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Ghafoor H, Haefeli M, Steiger R, Honigmann P. Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases. J Wrist Surg 2022; 11:134-144. [PMID: 35478945 PMCID: PMC9038308 DOI: 10.1055/s-0041-1735839] [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: 12/12/2020] [Accepted: 08/03/2021] [Indexed: 10/27/2022]
Abstract
Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III-V.
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Affiliation(s)
- Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Regula Steiger
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Orthopraxis Lusser, Allschwil, Switzerland
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group, University of Basel, Allschwil, Switzerland
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Yin CY, Huang HK, Fufa D, Wang JP. Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study. BMC Musculoskelet Disord 2022; 23:181. [PMID: 35209885 PMCID: PMC8876376 DOI: 10.1186/s12891-022-05108-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/10/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation. METHODS We reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated. RESULTS At minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference. CONCLUSIONS Radius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Cheng-Yu Yin
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Duretti Fufa
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Lüdi S, Kurz C, Deforth M, Ghafoor H, Haefeli M, Honigmann P. Radiological, Clinical and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures. J Hand Surg Am 2022; 48:377-387. [PMID: 35190216 DOI: 10.1016/j.jhsa.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/17/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures. METHODS We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires. RESULTS Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients. CONCLUSION The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Simona Lüdi
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Charlotte Kurz
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Handclinic AG Rüti, Rüti, Switzerland
| | - Manja Deforth
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Mathias Haefeli
- Hand Surgery, Kantonsspital Graubünden, Chur, Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Medical Additive Manufacturing research group, Department of Biomedical Engineering, University of Basel, Switzerland
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18
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Huang YM, Chen CY, Lin KC, Tarng YW, Liao CY, Chang WN. Functional outcomes following fixation of a marginal distal radius fracture with two commonly used volar locking plates: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:18. [PMID: 34980102 PMCID: PMC8725281 DOI: 10.1186/s12891-021-04984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, marginal distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on marginal distal radius fractures. This study compared functional outcomes in patients with marginal distal radius fractures treated with two different implants. Materials and methods A retrospective study was conducted, all patients who received a Synthes 2.4 mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The marginal distal radius fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa’s joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and grip strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius’s volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating marginal distal radius fractures.
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Affiliation(s)
- Yin-Ming Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China. .,Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, Republic of China. .,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan, Republic of China.
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Yih-Wen Tarng
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Ching-Yi Liao
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Wei-Ning Chang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
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Hruby LA, Haider T, Laggner R, Gahleitner C, Erhart J, Stoik W, Hajdu S, Thalhammer G. Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study. Arch Orthop Trauma Surg 2022; 142:1075-1082. [PMID: 33558991 PMCID: PMC9110479 DOI: 10.1007/s00402-021-03801-7] [Citation(s) in RCA: 4] [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] [Received: 10/13/2020] [Accepted: 01/20/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Distal radius fractures account for one-fifth of all fractures in the emergency department. Their classification based on standard radiographs is common practice although low inter-observer reliabilities and superiority of computer tomography (CT) scanning in evaluation of joint congruency have been reported. MATERIALS AND METHODS We retrospectively analyzed 96 displaced distal radius fractures scheduled for open reduction and internal fixation using standard radiographic assessment. The radiographs were classified with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA), Fernandez and Frykman classifications by three observers and inter-rater reliabilities were calculated. Additional CT scanning was performed in all cases and the following parameters were assessed: radiocarpal joint involvement, fracture extent into the radial sigmoid notch, i.e. the distal radio-ulnar joint, comminution of the metaphysis, and concomitant ulnar styloid fracture. The CT scans were used as a reference standard to determine sensitivity and accuracy of standard radiographic assessment in evaluation of distal radius fractures. RESULTS The inter-rater agreement for the AO classification was 35.4%, 68.8% for the Fernandez and 38.5% for the Frykman classification. Fracture extension into the radiocarpal joint was present in 81 cases (84.4%). Sigmoid notch involvement was found in 81 fractures (84.4%). Involvement of both joints was present in 72 cases (75%). The sensitivity of standard radiographs regarding radiocarpal joint involvement was 93.8%. Considering involvement of the distal radio-ulnar joint the false-negative rate using standard radiographs was 61.7% and the test's accuracy for sigmoid notch involvement was 45.8%. CONCLUSION This study demonstrates that involvement of the sigmoid notch is frequently missed in standard radiographs. The presented data support the frequent use of CT imaging to allow the holistic illustration of a fracture's complexion and to ensure optimal pre-operative planning.
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Affiliation(s)
- Laura A. Hruby
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria ,Department of Orthopedics and Traumatology, Hospital of the St. John of God Brothers Eisenstadt, Johannes von Gott-Platz 1, 7000 Eisenstadt, Austria
| | - Roberta Laggner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Claudia Gahleitner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Jochen Erhart
- Department of Orthopedics and Traumatology, Hospital of the St. John of God Brothers Eisenstadt, Johannes von Gott-Platz 1, 7000 Eisenstadt, Austria
| | - Walter Stoik
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Gerhild Thalhammer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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Morisaki S, Tsuchida S, Oda R, Takahashi K. Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography. Eur J Trauma Emerg Surg 2021; 48:2247-2254. [PMID: 34417629 DOI: 10.1007/s00068-021-01770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The first aim of this study was to investigate the incidence of ulnar styloid fractures (USFs) accompanied by distal radius fractures (DRFs), treated with volar locking plates. The fracture type of DRFs was evaluated by the classifications, based on computed tomography (CT) scan findings. The second aim was to investigate the bone union rate of USFs, depending on the fracture type of DRFs, by comparing union and nonunion groups in the USFs groups. METHODS Between May 2012 and December 2019, 239 consecutive patients with DRFs were treated. Of these patients, 177 DRFs met inclusion criteria. The fracture patterns of the DRFs, based on the classification, using CT scans, which included the AO classification, sagittal angulation, and axial fracture patterns of the articular surface of the distal radius in two-part intra-articular fractures were evaluated. The size of USFs, classified as a tip or base fracture was also investigated. RESULTS The incidence of USFs was significantly higher for AO types A and C than for type B. Analysis of the sagittal angulation of DRFs showed that the incidence of USFs was higher for the extension type than for the flexion type. Axial CT classification of two-part fractures revealed that DRFs with a dorsal fracture line was more frequent than the volar type of DRFs. These results suggested that dorsal displacement of DRFs was associated with a higher incidence of USFs. Finally, the analysis of the bone union rate of USFs revealed that AO classification and sagittal angulation were not correlated with bone union in USFs. However, it was found that a fracture line on the radial side of the radius had a significantly low rate of bone union, compared to a fracture line on the dorsal side. The size of USFs was also not correlated with the bone union rate. CONCLUSIONS The incidence and the bone union rate of USFs have different patterns. The incidence of USFs was higher in the dorsal displacement type of DRFs. However, the bone union rate of USFs was lower for a fracture line on the radial side. Therefore, USFs with DRFs that have a fracture line on the radial side is a candidate for fixation to prevent nonunion.
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Affiliation(s)
| | | | - Ryo Oda
- Saiseikai Shigaken Hospital, Ritto, Japan
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21
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Aita MA, Kaempf R, Biondi BG, Montano GA, Towata F, Rodriguez GLG, Ruggiero GM. Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1730393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AbstractArticular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly.
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Affiliation(s)
| | | | | | | | - Fernando Towata
- Faculdade de Medicina do ABC, Santo André, São Paulo, SP, Brazil
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22
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Biondi M, Poggetti A, Fagetti A, Di Maro A, Bigazzi P, Pfanner S, Lauri G. Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study. Eur J Trauma Emerg Surg 2021; 48:4577-4584. [PMID: 34041552 DOI: 10.1007/s00068-021-01710-3] [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: 01/06/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Volar rim fractures of the distal radius are a spectrum of pathology that must be well identified and treated to achieve good outcomes and avoid surgical failures. New devices of fragment specific fixation have been developed during the last decades to fix this fragment. The purpose of this retrospective study was to evaluate the ability of APTUS® wrist distal radius system to securely fix different types of volar rim fractures. METHODS Patients with at least 1 year of follow-up and a preoperative CT-scan evaluation of the fracture pattern were included in the study. Clinical, radiological and functional outcomes were assessed. RESULTS Sixty-eight patients with an average follow-up of 34, 1 months (12-61) were included in the study. There were no clinical and radiological complications, including loss of reduction, device failure and tendon ruptures. No patients required hardware removal. Wrist range of motion in flexion-extension averaged 96°, while in pronation-supination 144°. At final follow-up mean visual analogue scale pain was 1,8. Questionnaires, as dissabilities of the arm, shouldder and hand (DASH) score and patient-related wrist evolution (PRWE) score were 6,6 and 3 respectively. Grip strenght measured 86% compared to the normal side. CONCLUSION APTUS® wrist presents a versatile set of fragment specific fixation plates able to easily and securely fix all types of volar rim fracture. The system can be used with other devices without any kind of interference between them. When correctly placed and used with the right indications, no late complications can be recorded.
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Affiliation(s)
- Marco Biondi
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Andrea Poggetti
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Agostino Di Maro
- Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Prospero Bigazzi
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sandra Pfanner
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Lauri
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Casari FA, Roner S, Fürnstahl P, Nagy L, Schweizer A. Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series. Arch Orthop Trauma Surg 2021; 141:1425-1432. [PMID: 33715063 PMCID: PMC8295140 DOI: 10.1007/s00402-021-03856-6] [Citation(s) in RCA: 3] [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: 11/10/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intra-articular fractures are associated with posttraumatic arthritis if inappropriately treated. Exact reduction of the joint congruency is the main factor to avoid the development of arthrosis. Aim of this study was to evaluate feasibility of computer-assisted surgical planning and 3D-printed patient-specific instrumentation (PSI) for treatment of distal intraarticular radius fractures. METHOD 7 Patients who suffered a distal intraarticular radius fracture were enrolled in this prospective case series. Preoperative CT-scan was recorded, whereupon a 3D model was computed for surgical planning and design of PSI for surgical navigation. Postoperative accuracy and joint congruency were assessed. Patients were followed-up 3, 6 and 12 months postoperatively. RESULTS Mean follow-up was 16 months. Over all range of motion was restored and flexion, extension and pronation showed significant recovery, p < 0.05. Biggest intraarticular joint step-off and gap reduced from average 2.49 (± 1.04) to 0.8 mm (± 0.44), p < 0.05 and 6.12 mm (± 1.04) to 2.21 mm (± 1.16), p < 0.05. Average grip strength restored (3-16 months) from 20.33 kg (± 7.12) to 39.3 kg (± 19.55) p < 0.05, 100% of the healthy contralateral side. 3D-accuracy for guided fragments was 2.07 mm (± 0.64) and 8.59° (± 2.9) and 2.33 mm (± 0.69) and 12.86° (± 7.13), p > 0.05 for fragments reduced with ligamentotaxis. CONCLUSION Computer-assisted and PSI navigated intraarticular radius fracture treatment is feasible, safe and accurate. The benefits of this method, however, do not outstand the additional effort. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- F. A. Casari
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - S. Roner
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - P. Fürnstahl
- ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - L. Nagy
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - A. Schweizer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
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24
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Flexor tendon complications in distal radius fractures treated with volar rim locking plates. HAND SURGERY & REHABILITATION 2020; 39:511-515. [DOI: 10.1016/j.hansur.2020.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023]
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25
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Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schättin S, Hausner T, Leixnering M. Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year. Arch Orthop Trauma Surg 2020; 140:843-852. [PMID: 32221705 DOI: 10.1007/s00402-020-03411-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Distal radius fractures (DRF) are the most common fractures of the upper extremities and incidence is expected to continue rising as life expectancy increases. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF. Main aim of this study was to investigate correlation between radiological and clinical outcome in patients stabilized by palmar locking plate with a minimum follow-up of one year. METHODS A total of 524 patients with DRF, stabilized using palmar angular stable locking plate fixation were included in the study. Of these, 117 patients had to be excluded and another 177 were not accessible. The study group thus compromised 230 patients who returned for the follow-up investigation and were followed-up clinically and radiologically with a mean follow-up interval of 20 months. Outcome was evaluated using pain, range of motion (ROM) and grip strength parameters. In addition, self-assessment by patients was registered on the QuickDASH, PRWE and Mayo Score. The immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off. RESULTS Bivariant correlation analysis showed a significant correlation between ulnar variance and QuickDASH (r = 0.18, p = 0.01), grip strength (r = - 0.18, p = 0.04) and Mayo Score (r = - 0.23, p = 0.001). No significant differences could be found between an unacceptable (> 2 mm) and acceptable (< 2 mm) ulnar variance in respect of pain, ROM, grip strength and patient-reported outcome measurements. Age, gender, additional fracture to the ulnar styloid, or type of postoperative immobilization showed no significant or clinical important impact on the final patient-reported outcome. No significant differences in incidence of complications, ROM or loss of reduction could be found in any patients over or under 65 years of age. CONCLUSIONS Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment and results in a good clinical and radiological outcome with low complication rate. Ulnar variance showed a significant correlation to grip strength, QuickDASH and Mayo Score, but an unacceptable ulnar variance (> 2 mm) was not associated with a worse clinical important outcome. Age (< 65/> 65 years), gender and type of immobilization had no impact on the complication rate or in the final functional or radiological outcome.
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Affiliation(s)
- Stefan Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - A Pichler
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - S Schättin
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler, European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures. Arch Orthop Trauma Surg 2020; 140:611-621. [PMID: 32193677 DOI: 10.1007/s00402-020-03365-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 02/09/2023]
Abstract
Distal Radius fractures (DRF) are one of the most common injuries in the upper extremity and incidence is expected to rise due to a growing elderly population. The complex decision to treat patients operatively or conservatively depends on a large variety of parameters which have to be considered. No unanimous consensus has been reached yet, which operative approach and fixation technique would produce the best postoperative functional results with lowest complication rates. This article addresses the available evidence for indications, approaches, reduction, and fixation techniques in treating DRF.
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Keuchel-Strobl T, Quadlbauer S, Jurkowitsch J, Rosenauer R, Hausner T, Leixnering M, Pezzei C. Salvage procedure after malunited distal radius fractures and management of pain and stiffness. Arch Orthop Trauma Surg 2020; 140:697-705. [PMID: 32193673 DOI: 10.1007/s00402-020-03369-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/28/2022]
Abstract
Indications for surgical treatment of distal radius fractures (DRF) remain controversial in the literature, especially in elderly patients. Complication rates after operatively treated DRF are low and well documented. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. If conservative treatment fails then salvage procedures are necessary. This review summarizes the therapeutic options available to treat degenerative osteoarthritis after malunited distal radius fractures, regardless of the initial operative or conservative treatment.
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Affiliation(s)
- Tina Keuchel-Strobl
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.
| | - S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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28
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Current management of distal radius fractures and their complications. Arch Orthop Trauma Surg 2020; 140:593-594. [PMID: 32193672 DOI: 10.1007/s00402-020-03366-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/29/2022]
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29
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Abstract
In the recent years, treatment of distal radius fractures (DRF) has advanced considerably. Surgical fixation with palmar angular stable plate has gained popularity, due to a reported lower complication rate when compared to dorsal fixation. The type of trauma or injury, surgical procedure and impaired bone quality are all contributors to complications in DRF. The main aim of this review is to summarize the most common complications and possible therapeutic solutions. In addition, strategies for minimizing these complications will be discussed.
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30
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Abstract
Posttraumatic malunion or secondary dislocation can cause wrist joint incongruency. Uncorrected malalignment increases the risk of secondary degenerative changes and chronic pain. Therefore, early correction using the available fixed-angle devices, cancellous bone grafting only becomes necessary in larger bony defects. Premounting the plate through a palmar approach with regard to the desired correction angles leads to predictable results by precise correction. In case of posttraumatic growth arrest with larger discrepancy of the radius and the ulna, a two-staged procedure is advisable.
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31
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Kastenberger T, Kaiser P, Schmidle G, Schwendinger P, Gabl M, Arora R. Arthroscopic assisted treatment of distal radius fractures and concomitant injuries. Arch Orthop Trauma Surg 2020; 140:623-638. [PMID: 32193675 PMCID: PMC7181439 DOI: 10.1007/s00402-020-03373-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/16/2022]
Abstract
Wrist arthroscopy is mainly used to assist fracture reduction and fixation and to diagnose and treat concomitant injuries mainly to the scapholunate (SL), lunotriquetral (LT) ligament and the triangular fibrocartilage complex (TFCC). Arthroscopy is beneficial in improving anatomical reduction of fracture steps and gaps in intra-articular distal radius fractures (DRFs). Yet, the literature that the functional outcome correlates with the use of arthroscopy, is limited. Non-surgical treatment and immobilization is recommended for Geissler grade I-III Sl-ligament injuries, while open reduction, ligament suture and/or K-wire pinning is mandatory for complete ligament tears according to Geissler grade IV. This manuscript describes the current literature and gives insight into the authors' opinions and practice.
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Affiliation(s)
- Tobias Kastenberger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Peter Kaiser
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Peter Schwendinger
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Markus Gabl
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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