1
|
Holmqvist KJ, Johnson T, Fornander L. The Choice of Osteosynthesis for Distal Radius Fractures: A Matter of Taste, Fracture Instability, or Patient-Related Factors? A Retrospective Study of Functional Outcome in 346 Distal Radius Fractures Operated With Percutaneous Wires or Volar Plate Fixation. Hand (N Y) 2024; 19:481-487. [PMID: 36168306 PMCID: PMC11067849 DOI: 10.1177/15589447221120850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgery with volar locking plate (VLP) for distal radius fractures (DRFs) has become dominant over percutaneous Kirschner wire (K-wire) (PKW) fixation. Not many studies have proved advantages of the VLP and the increasing dominance of the VLP is thus not derived from evidence of superiority but influenced by other factors. METHODS By retrospectively classifying 346 DRFs treated with either PKW or VLP fixation, according to the Buttazzoni classification system, we aimed to investigate the determining factors for choice of surgical method, and by review of the patients' medical records, the functional outcome, duration, and frequentness of the rehabilitation period were correlated to Buttazzoni type and surgical method. RESULTS The odds ratio of having volar plate fixation was negatively correlated to age and positively correlated to a higher Buttazzoni type. We found no clinically significant differences in the functional outcome for different Buttazzoni type of fractures within the VLP and PKW groups, respectively, nor between the 2 methods of surgery for any Buttazzoni type of fracture. CONCLUSION Younger patients and fractures with higher grade of instability were more likely to be treated with VLP than PKW; however, neither fracture instability nor surgical method had any impact on functional outcome.
Collapse
Affiliation(s)
- Karl-Johan Holmqvist
- Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Ted Johnson
- Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Lotta Fornander
- Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
- Department of Orthopedic Surgery, Norrköping, Sweden
| |
Collapse
|
2
|
Gui XY, Cheng ZH, Shi HF, Chen YX, Xiong J, Wang JF, Qiu XS, Zhang ZT. Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution. J Orthop Surg Res 2021; 16:530. [PMID: 34433474 PMCID: PMC8385909 DOI: 10.1186/s13018-021-02641-w] [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: 05/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. MATERIALS AND METHODS Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors' institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. RESULTS A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month's follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. CONCLUSIONS The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. TRIAL REGISTRATION This study has been registered on the ClinicalTrials.gov.
Collapse
Affiliation(s)
- Xue-Yang Gui
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zhao-Hui Cheng
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Hong-Fei Shi
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Yi-Xin Chen
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jun-Fei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Xu-Sheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zi-Tao Zhang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| |
Collapse
|
3
|
Wadsten MÅ, Sjödén GO, Buttazzoni GG, Buttazzoni C, Englund E, Sayed-Noor AS. The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life. J Hand Surg Eur Vol 2018; 43:131-136. [PMID: 28758528 DOI: 10.1177/1753193417721446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Late displacement of distal radius fractures, still in acceptable radiological position after 1-2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10-14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- M Å Wadsten
- 1 Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Sweden
| | - G O Sjödén
- 1 Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Sweden
| | - G G Buttazzoni
- 2 Department of Surgical and Perioperative Sciences (Orthopaedics-Östersund), Umeå University, Sweden
| | - C Buttazzoni
- 2 Department of Surgical and Perioperative Sciences (Orthopaedics-Östersund), Umeå University, Sweden
| | - E Englund
- 3 Department of Research and Development, Västernorrland County, Sundsvall, Sweden
| | - A S Sayed-Noor
- 1 Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Sweden
| |
Collapse
|
4
|
Kleinlugtenbelt YV, Groen SR, Ham SJ, Kloen P, Haverlag R, Simons MP, Scholtes VAB, Bhandari M, Goslings JC, Poolman RW. Classification systems for distal radius fractures. Acta Orthop 2017; 88:681-687. [PMID: 28612669 PMCID: PMC5694815 DOI: 10.1080/17453674.2017.1338066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The reliability of conventional radiography when classifying distal radius fractures (DRF) is fair to moderate. We investigated whether reliability increases when additional computed tomography scans (CT) are used. Patients and methods - In this prospective study, we performed pre- and postreduction posterior-anterior and lateral radiographs of 51 patients presenting with a displaced DRF. The case was included when there was a (questionable) indication for surgical treatment and an additional CT was conducted within 5 days. 4 observers assessed the cases using the Frykman, Fernández, Universal, and AO classification systems. The first 2 assessments were performed using conventional radiography alone; the following 2 assessments were performed with an additional CT. We used the intraclass correlation coefficient (ICC) to evaluate reliability. The CT was used as a reference standard to determine the accuracy. Results - The intraobserver ICC for conventional radiography alone versus radiography and an additional CT was: Frykman 0.57 vs. 0.51; Fernández 0.53 vs. 0.66; Universal 0.57 vs. 0.64; AO 0.59 vs. 0.71. The interobserver ICC was: Frykman: 0.45 vs. 0.28; Fernández: 0.38 vs. 0.44; Universal: 0.32 vs. 0.43; AO: 0.46 vs. 0.40. Interpretation - The intraobserver reliability of the classification systems was fair but improved when an additional CT was used, except for the Frykman classification. The interobserver reliability ranged from poor to fair and did not improve when using an additional CT. Additional CT scanning has implications for the accuracy of scoring the fracture types, especially for simple fracture types.
Collapse
Affiliation(s)
- Ydo V Kleinlugtenbelt
- Department of Orthopaedic and Trauma Surgery, JointResearch Onze Lieve Vrouwe Gasthuis, Amsterdam,Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Deventer,Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada,Correspondence:
| | | | - S John Ham
- Department of Orthopaedic and Trauma Surgery, JointResearch Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Peter Kloen
- Department of Orthopaedic and Trauma Surgery, Academic Medical Centre, Amsterdam
| | - Robert Haverlag
- Department of General and Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Maarten P Simons
- Department of General and Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Vanessa A B Scholtes
- Department of Orthopaedic and Trauma Surgery, JointResearch Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam
| | - Rudolf W Poolman
- Department of Orthopaedic and Trauma Surgery, JointResearch Onze Lieve Vrouwe Gasthuis, Amsterdam
| |
Collapse
|
5
|
Wadsten MÅ, Buttazzoni GG, Sjödén GO, Kadum B, Sayed-Noor AS. Influence of Cortical Comminution and Intra-articular Involvement in Distal Radius Fractures on Clinical Outcome: A Prospective Multicenter Study. J Wrist Surg 2017; 6:285-293. [PMID: 29085730 PMCID: PMC5658209 DOI: 10.1055/s-0037-1601577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/28/2016] [Indexed: 10/19/2022]
Abstract
Aim The purpose of this prospective multicenter study was to test the predictive value of cortical comminution and intra-articular involvement on function and quality of life in distal radius fractures (DRFs) using the Buttazzoni's classification system. Patients and Methods We studied 406 patients between skeletal maturity and 74 years of age with DRF. Fractures with acceptable radiographic alignment were immobilized with a cast. Fractures with nonacceptable radiographic alignment underwent closed reduction and 4 to 6 weeks cast immobilization. Radiographs were obtained after reduction and at 10 to 14 days. Redisplaced fractures were offered surgical treatment. One-year follow-up included grip strength, range of motion (ROM), quickDASH, EQ-5D (including visual analog scale [VAS] for health status), and VAS pain. Results We found no statistically significant differences in QuickDASH, EQ-5D questionnaire, EQ-5D health status VAS, and VAS pain among the Buttazzoni classes. However, initial displacement was associated with worse quickDASH score, worse EQ-5D score, reduced grip strength, and reduced ROM. Dorsal comminution was associated with worse quickDASH score, reduced flexion, and reduced pronation-supination ability. Volar comminution predicted loss of extension, while intra-articular involvement was associated with reduced flexion-extension arc and worse EQ-5D score. There was a significant difference in ROM between noncomminuted and comminuted fracture classes. Conclusion Initial fracture position, type of comminution, and intra-articular involvement influenced the clinical outcome in DRF.
Collapse
Affiliation(s)
- Mats Å Wadsten
- Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden
| | - Gunnar G. Buttazzoni
- Department of Surgical and Perioperative Sciences (Orthopaedics-Östersund), Umeå University, Umeå, Sweden
| | - Göran O. Sjödén
- Department of Surgical and Perioperative Sciences (Orthopaedics- Södersjukhus), Umeå University, Umeå, Sweden
| | - Bakir Kadum
- Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden
| | - Arkan S. Sayed-Noor
- Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Wadsten MÅ, Sayed-Noor AS, Englund E, Buttazzoni GG, Sjödén GO. Cortical comminution in distal radial fractures can predict the radiological outcome. Bone Joint J 2014; 96-B:978-83. [DOI: 10.1302/0301-620x.96b7.32728] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper investigates whether cortical comminution and intra-articular involvement can predict displacement in distal radius fractures by using a classification that includes volar comminution as a separate parameter. A prospective multicentre study involving non-operative treatment of distal radius fractures in 387 patients aged between 15 and 74 years (398 fractures) was conducted. The presence of cortical comminution and intra-articular involvement according to the Buttazzoni classification is described. Minimally displaced fractures were treated with immobilisation in a cast while displaced fractures underwent closed reduction with subsequent immobilisation. Radiographs were obtained after reduction, at 10 to 14 days and after union. The outcome measure was re-displacement or union. In fractures with volar comminution (Buttazzoni type 4), 96% (53 of 55) displaced. In intra-articular fractures without volar comminution (Buttazzoni 3), 72% (84 of 117) displaced. In extra-articular fractures with isolated dorsal comminution (Buttazzoni 2), 73% (106 of 145) displaced while in non-comminuted fractures (Buttazzoni 1), 16 % (13 of 81 ) displaced. A total of 32% (53 of 165) of initially minimally displaced fractures later displaced. All of the initially displaced volarly comminuted fractures re-displaced. Displacement occurred in 31% (63 of 205) of fractures that were still in good alignment after 10 to 14 days. Regression analysis showed that volar and dorsal comminution predicted later displacement, while intra-articular involvement did not predict displacement. Volar comminution was the strongest predictor of displacement. Cite this article: Bone Joint J 2014;96-B:978–83.
Collapse
Affiliation(s)
- M. Å. Wadsten
- Umeå University, Department
of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901
87 Umeå, Sweden
| | - A. S. Sayed-Noor
- Umeå University, Department
of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901
87 Umeå, Sweden
| | - E. Englund
- Sundsvall Hospital, Department
of Research and development, Västernorrland County, 851
86 Sundsvall, Sweden
| | - G. G. Buttazzoni
- Umeå University, Department
of Surgical and Perioperative Sciences (Orthopedics-Östersund), 901
87 Umeå, Sweden
| | - G. O. Sjödén
- Umeå University, Department
of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901
87 Umeå, Sweden
| |
Collapse
|