The role of locking technology in the upper extremity

Plate Fixation of Distal Radius Fractures: What Type of Plate to Use and When?

There are several options for plate fixation of distal radius fractures. Volar plating has broad applicability and consistent outcomes, and thus is the most commonly used plate type. Dorsal plates are advantageous for specific fracture patterns, and can provide direct fracture reduction and buttressing, but may be prominent and can cause tendon irritation. Bridge plates offer an alternative to external fixation while avoiding the complications with prominent hardware, because they span highly comminuted fractures and can be used for immediate weight bearing; however, they require plate removal. Choice of plate fixation should depend on fracture type, patient factors, and surgeon experience.

Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures

BACKGROUND

Total elbow arthroplasty (TEA) and open reduction-internal fixation (ORIF) are 2 viable surgical treatment options for acute, intra-articular distal humeral fractures in elderly patients. Whereas recent systematic reviews and randomized trials have suggested that TEA and ORIF result in similar functional outcome scores, no previous study has assessed the comparative cost-effectiveness between TEA and distal humeral ORIF in this specific demographic.

METHODS

A Markov model was created with the highest-level data available from the literature depicting transitioning health states based on treatment strategies. To populate the quality-of-life data points in the model lacking in the literature, a survey was conducted of patients at 2 referral institutions who underwent TEA or ORIF for acute, intra-articular distal humeral fractures via the European Quality of Life, 5 Domains (EQ-5D) questionnaire at least 2 years postoperatively. Cost data from 2016 for each strategy were used to calculate the comparative cost-effectiveness of TEA versus ORIF.

RESULTS

For patients aged 65 years, the total cost of TEA was $19,407 compared with $20,669 for ORIF. The effectiveness of TEA and ORIF was 8.17 and 7.72, respectively. Overall, the incremental cost-effectiveness ratio of TEA ($2375.76/quality-adjusted life-year) was favored more than ORIF ($2677.26/quality-adjusted life-year).

CONCLUSION

These findings suggest TEA is a slightly more cost-effective procedure than ORIF for most elderly patients who sustain acute, intra-articular distal humeral fractures. Still, the unique limitations, complications, and revision rates for each strategy must be carefully weighed for each patient when making a decision.

Assessment of Intra-articular Screw Penetration During Radial Head and Olecranon Locking Plate Fixation: A Cadaveric Study

BACKGROUND

The purpose of this study is to evaluate the role of radiographic and clinical exams in predicting screw penetration into the proximal radioulnar joint and ulnohumeral joint during open reduction and internal fixation of the radial head and proximal ulna.

METHODS

Olecranon and radial head plates were applied to 15 cadaveric elbows. Screws were assessed for intra-articular joint penetration using both clinical exam and radiographic evaluation. Clinical exam consisted of evaluation for crepitus. Radiographs demonstrating screws positioned near the joint surface were evaluated for penetration by 3 fellowship trained hand surgeons. Elbows were disarticulated and screw prominence was determined and recorded using standardized calipers. The ability of clinical and radiographic exams to correctly predict a breach in the articular surface was determined by calculating sensitivity, specificity, and predictive values. Consideration was given to screw position.

RESULTS

The sensitivity of crepitus was 81.1% for screws in the radial head plate and 72.6% for screws in the olecranon plate. The sensitivity of radiographs was 72.4% for the screws in the radial head plate and 55.0% for screws in the olecranon plate. Correct radiographic assessment of penetration varied but position o-2 on the olecranon plate consistently resulted in the lowest sensitivity of 30.3%.

CONCLUSIONS

The study evaluates sensitivity and specificity of clinical and radiographic means when assessing for articular penetration of screws during olecranon and radial head locking plate fixation. Certain screw locations are more difficult to evaluate than others and may go undetected by standard means of assessment used in a surgical setting.