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Chung SR, Chung KC. Recognizing and Treating Unique Distal Radius Fracture Patterns that are Prone to Displacement. Hand Clin 2023; 39:279-293. [PMID: 37453757 DOI: 10.1016/j.hcl.2023.02.004] [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] [Indexed: 07/18/2023]
Abstract
An unstable distal radius fracture is one that is not capable of resisting displacement after initial closed reduction. The challenge in managing distal radius fractures is identifying which fractures are prone to displacement. Currently, there are no standard criteria for assessing the stability of distal radius fractures. The fracture pattern and patient characteristics should be taken into consideration when treating distal radius fractures. This article discusses how to recognize and manage distal radius fractures that are prone to displacement.
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Affiliation(s)
- Sze Ryn Chung
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, 20, College Road, 169856 Singapore
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
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Begum R, Hourston GJM, Bochmann T, Chojnowski AJ. A Systematic 10-Year Review of the Use of Arthroscopy in the Assessment and Treatment of Intercarpal Ligament Injuries Associated with Acute Distal Radius Fracture. J Hand Surg Asian Pac Vol 2022; 27:935-944. [PMID: 36476085 DOI: 10.1142/s2424835522500862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: To review the impact that arthroscopy has made on the assessment and treatment of intercarpal (scapholunate [SL] or lunotriquetral [LT]) ligament injuries associated with acute distal radius fractures (DRF). Methods: A systematic review of EMBASE, MEDLINE and COCHRANE databases for articles published between 2011 and 2021 was performed (PROSPERO ID: CRD42021273293) which included studies reported assessment and outcomes of intercarpal ligament injuries associated with acute DRF. Methodological quality was evaluated. The rate of concomitant injury detection, role of arthroscopy and different clinical outcome assessment measurements used were compared between studies. Results: A total of 20 articles were included with data from 1,346 patients (1,358 wrists). A total of 1,024 intra-articular fractures were included and 294 extra-articular fractures (40 not specified). There was a heterogeneous mix of studies; 10 comparative and 10 non-comparative. Some studies investigated initial assessment findings only, while others assessed radiological outcomes, functional outcomes or both domains over 0.3-99 months. The overall rate of SL ligament injury associated with DRF was 35.3%, while LT ligament injury overall was 18.2%. More frequent were concomitant triangular fibrocartilage complex (TFCC) injuries (44.8%), although this review did not aim to review these. The role of arthroscopy was reviewed, which included assistance in anatomic reduction of the articular surface and systematic inspection of the surrounding soft tissues. Included studies investigated either assessment or assessment and management of intercarpal ligament injury. Meaningful meta-analysis in this heterogeneous group of studies was not possible. Outcomes of comparative studies were described in detail. Conclusions: This review suggests that arthroscopy may have a role in improving reduction of intra-articular DRF and diagnosing and managing soft tissue injuries associated with such fractures. Randomised studies are needed to evaluate whether the detection of intercarpal ligament injury in acute distal radial fractures through arthroscopic assessment alters current management and improves clinical outcome. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Rumina Begum
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - George J M Hourston
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Thomas Bochmann
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Adrian J Chojnowski
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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ÇETİN MÜ, POLAT A, FİDAN F. Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür? CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1087119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared.
Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation.
Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively.
Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.
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Affiliation(s)
| | - Abdulkadir POLAT
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL GAZİOSMANPAŞA TAKSİM HEALTH RESEARCH CENTER
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Shihab Z, Sivakumar B, Graham D, Del Piñal F. Outcomes of Arthroscopic-Assisted Distal Radius Fracture Volar Plating: A Meta-Analysis. J Hand Surg Am 2022; 47:330-340.e1. [PMID: 35168831 DOI: 10.1016/j.jhsa.2021.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 09/06/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The use of wrist arthroscopy to assist fixation of distal radius fractures with volar locking plates (VLPs) has been gaining popularity in recent years; however, there is no consensus on its benefits. This meta-analysis compares outcomes of arthroscopic-assisted VLP to fluoroscopic-assisted VLP in distal radius fractures through a systematic review of the published literature. METHODS A systematic search of publications from databases (Medline, EMBASE, Scopus, and Cochrane) was obtained from inception to May 2020. A random-effects meta-analysis was used to calculate effect sizes. Outcomes included postoperative radiographic reduction (gap, stepoff, radial inclination, volar tilt, and ulnar variance), procedural outcomes (operative time, additional soft tissue injuries and complications), and functional outcomes (range of motion; visual analog scale score; Disabilities of the Arm, Shoulder, and Hand score; Patient-Rated Wrist Evaluation score; Mayo clinic score; and grip strength). RESULTS Six studies, involving 280 patients, met the final inclusion criteria. The meta-analysis for postoperative stepoff was statistically significant, favoring arthroscopic-assisted VLP. In addition, there was greater identification of associated soft tissue injuries, increased wrist extension, and a longer operative duration when performing arthroscopic-assisted VLP fixation. There were no differences in other postoperative radiographic outcomes, complications, or functional outcomes. CONCLUSIONS The current literature suggests that arthroscopic-assisted VLP is a useful adjunct to intra-articular reduction and treatment of associated soft tissue injuries in distal radius fractures. Considerations should include operative time, costs, and the additional training required. Further studies are needed to assess functional outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Zaid Shihab
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Brahman Sivakumar
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Queensland, Australia; Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - David Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, Queensland, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Queensland, Australia; Griffith University School of Medicine and Dentistry, Southport, Queensland, Australia; Departmemt of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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Jung HS, Cho HC, Lee JS. Combined Approach for Intra-articular Distal Radius Fracture: A Case Series and Literature Review. Clin Orthop Surg 2021; 13:529-538. [PMID: 34868503 PMCID: PMC8609214 DOI: 10.4055/cios20291] [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: 11/28/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to classify the possible indications for a combined approach to distal radius fractures (DRFs) by investigating surgical outcomes of patients treated according to our treatment algorithm. Methods A combined approach was performed in 32 patients. Patients who were thought to need a combined approach were classified into three types according to the combined injuries associated with loss of volar cortical buttresses in DRFs. The classifications included the following: type 1, free intra-articular fragments; type 2, distally migrated dorsal fragments located beyond the wrist joint; and type 3, centrally impacted articular fragments and displaced dorsal fragments, not reduced by indirect methods. Results Seven patients had type 1 fractures treated with volar plates and excision of the intra-articular fragments. Fourteen patients had type 2 fractures: 12 were treated with volar plates and excision of dorsal fragments, and 2 with relatively large unstable dorsal fragments were treated with combined volar and dorsal plates. The remaining 11 patients had type 3 fractures treated with combined volar and dorsal plates. At the latest follow-up, the radiographs revealed an average of 16.9° of radial inclination, an average of 4.2° of volar tilt, and an average of 7.5 mm of radial height. According to the Garland and Werley scores, the functional results were excellent for 3 patients, good for 25, and fair for 4. Conclusions The classification system indicated when an additional dorsal approach was needed in unstable DRFs, and it may establish useful guidelines for appropriate surgical decision-making.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Hyung-Chul Cho
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
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Abstract
Wrist arthroscopy in the setting of distal radius fractures allows for direct visualization of the articular surface and treatment of associated soft tissue injuries. Arthroscopic techniques may be used to fine tune reductions with residual articular step-off or gap after an initial reduction attempt and are critical for addressing free articular fragments and die-punch lesions. Surgeon training, experience, and comfort with wrist arthroscopy remains a barrier to widespread adoption of this technique. Level I studies are needed to investigate whether improved articular reduction leads to meaningful clinical differences.
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Mirarchi AJ, Nazir OF. Minimally Invasive Surgery: Is There a Role in Distal Radius Fracture Management? Curr Rev Musculoskelet Med 2021; 14:95-100. [PMID: 33443658 PMCID: PMC7930151 DOI: 10.1007/s12178-020-09689-x] [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] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This review explores minimally invasive surgical techniques for distal radius fractures and guides their use in conjunction with, or as an alternative to, volar locked plating. RECENT FINDINGS Fractures of the lunate facet, die-punch fractures, and marginal articular shear injuries present challenges that cannot be easily addressed with volar plating. The use of external fixation, Kirschner wires, and dorsal bridge plating should all be considered. These techniques, in combination and in addition to volar locked plating, continue to play an important role in fracture management. Arthroscopically assisted surgery with minimally invasive fixation allows for detailed inspection of the radiocarpal joint. Closed treatment and casting continue to play an important role in distal radius fracture care. The role of minimally invasive surgery for distal radius fractures is still being defined. While fixation using a volar locking plate is by far the most common treatment method, other techniques should be considered to improve outcomes and decrease complications.
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Affiliation(s)
- Adam J. Mirarchi
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, USA
| | - Omar F. Nazir
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, USA
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Cornu A, Amouyel T, Chantelot C, Saab M. Clinical, functional and prognostic results after repair of peripheral lesions of the triangular fibrocartilage complex: a retrospective study of 21 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:557-562. [PMID: 33048247 DOI: 10.1007/s00590-020-02805-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main objective of this study was to assess the clinical and functional outcomes of arthroscopic TFCC repair in patients with an isolated Atzei type 1, 2 or 3 lesion or after a distal radius fracture. The secondary objective was to identify which factors could contribute to poor functional outcome. METHODS A retrospective study was conducted from November 2017 to May 2019. The inclusion criteria were patients with an Atzei type 1, 2 or 3 TFCC lesion who underwent arthroscopic repair and with a minimum of 6-month follow-up. Wrist motion, grip and pronation-supination strength were noted. QuickDASH, MMWS and PRWE scores were performed. An analysis was conducted to search for poor outcomes predictive factors (MMWS < 80). RESULTS Twenty-one patients were included with a mean follow-up of 26 months. Seventeen patients (80%) had an Atzei 1 lesion, one (4.8%) had an Atzei 2, and 3 (14%) had an Atzei 3. Wrist motion significantly decreased compared to contralateral. Only pronation and supination were not significant. Grip strength was 73.4% compared to the contralateral (p = 0.002). Mean PRWE was 29.14 (1.5-70.5), QuickDASH was 30.72 (2.3-70.5), and MMWS was 79.3 (35-100). In all patients with a MMWS ≥ 80, none had lunotriquetral lesions when it was the case for 5 of 9 patients with a MMWS < 80 (p = 0.006). Except a story of workplace injury, no other prognosis factor was significant. CONCLUSION Patients with Atzei 1, 2 or 3 TFCC who underwent arthroscopic repair seem to have good outcomes. However, an associated lunotriquetral lesion appears to worsen the functional prognosis.
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Affiliation(s)
- Alexandre Cornu
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France. .,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France.
| | - Thomas Amouyel
- Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
| | - Christophe Chantelot
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France.,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
| | - Marc Saab
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France.,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
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Meaike JJ, Kakar S. Management of Comminuted Distal Radius Fractures: A Critical Analysis Review. JBJS Rev 2020; 8:e2000010. [PMID: 32960024 DOI: 10.2106/jbjs.rvw.20.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Distal radius fractures occur in a bimodal age and sex distribution. Their incidence continues to rise with an increasingly active aging population. The current American Academy of Orthopaedic Surgeons guidelines for operative intervention are radial shortening of >3 mm, dorsal tilt of >10[degrees], or intra-articular displacement or step-off of >2 mm. The method of reduction and fixation should be selected on a case-by-case basis with a focus on patient factors, fracture behavior, surgical proficiency, and functional outcomes.
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Affiliation(s)
- Joshua J Meaike
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Sniderman J, Henry P. Articular reductions - how close is close enough? A narrative review. Injury 2020; 51 Suppl 2:S77-S82. [PMID: 31711651 DOI: 10.1016/j.injury.2019.10.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
Intra-articular fractures are a unique subset of fractures as they involve a varying extent of damage to cartilage. The impact of this articular fracture causes significant microscopic and macroscopic changes, as well as biomechanical irregularities, which can lead to further cartilage damage, and ultimately cascade down the dreaded path to arthritis. It is generally believed that an anatomic reduction of an articular fracture is the necessary goal of treatment for these injuries, however it yet to be delineated how perfect this reduction has to be. A comprehensive literature review was carried out to create a best available evidence guide to the acceptability of upper extremity and lower extremity articular fracture reductions. Ultimately, a perfect anatomic reduction is the best strategy to minimize abnormal loading and wear patterns, however this should be balanced with the realistic factors of each individual case, such as the level of difficulty, joint involved, surgical timing, and patient activity levels.
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Affiliation(s)
- Jhase Sniderman
- Division of Orthopaedic Surgery, University of Toronto, 500 University Ave #602, Toronto, Ontario, M5G 1V7 Canada.
| | - Patrick Henry
- Division of Orthopaedic Surgery, University of Toronto, 500 University Ave #602, Toronto, Ontario, M5G 1V7 Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Center
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