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Warrender WJ, Wagner DJ, Hoyer RW, Merrell GA, Kleinman WB, Smetana BS. A Cadaveric Comparison of Approaches for Exposure of the Volar Distal Radius: Is There a Utilitarian Approach? Hand (N Y) 2024; 19:44-51. [PMID: 35695337 PMCID: PMC10786120 DOI: 10.1177/15589447221094320] [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: 11/16/2022]
Abstract
BACKGROUND It remains unclear whether exposure for planned fixation of distal radius fractrues is superior with any given approach, and whether a single utilitarian approach exists that permits reliable complete exposure of the volar distal radius. METHODS A cadaveric study was performed using 10 matched specimens. Group 1 consisted of 3 radially based approaches (standard flexor carpi radialis [FCR], standard FCR with radial retraction of FCR and flexor pollicis longus [FPL] tendons, extended FCR). Group 2 consisted of 2 ulnarly based approaches (volar ulnar, extended carpal tunnel). The primary outcome was total width of exposed distal radius at the watershed line. Mann-Whitney U and Wilcoxon rank testing was used to identify differences. RESULTS The standard FCR approach exposed 29 mm (90%), leaving on average 3 mm (10%) of the ulnar corner unexposed. Retracting the FCR and FPL tendons radially allows for an extra 1 mm of volar ulnar corner exposure. Finally, converting to an extended FCR approach provided 100% exposure in all specimens. The volar ulnar exposure however provided exposure to only 9 mm (37%), leaving 20 mm (62.5%) left unexposed radially. The extended carpal tunnel provided exposure to 21 mm (65%), leaving 11 mm (35%) radially unexposed. Differences between each group were statistically significant (P < .05). CONCLUSIONS The extended FCR approach exposed 100% of the volar distal radius in our study and may serve as a utilitarian volar surgical approach for exposure and fixation of distal radius fractures. Additional knowledge of the limitations of alternative approaches can be helpful in surgical planning.
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Muramatsu K, Gandionco JA, Suguitan AA, Tani Y, Iwanaga R, Hashimoto T, Sakai T. Unidirectional Porous β-Tricalcium Phosphate: A New Bone Filling Substitute for Treatment of Distal Radius Fracture in the Elderly Population. J Hand Surg Asian Pac Vol 2020; 25:59-66. [PMID: 32000605 DOI: 10.1142/s2424835520500083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: A new beta-tricalcium phosphate with unidirectional pore structure (UDPTCP), Affinos® (Kurray, Okayama, Japan), has been in clinical use since 2015. To date, there have been only a few clinical studies using this material. We report here the first clinical study for distal radial fracture in the elderly population treated with UDPTCP. Methods: Consecutive patients aged 65 years or older with dorsally displaced unstable fracture of the distal radius (n = 36) were treated operatively in our department. Following reduction of the fracture site, a 7 mm size cube of UDPTCP was placed in the gap of the bony defect and the fracture stabilized with mono-axial or poly-axial type locking plates and screws. Remodeling of the UDPTCP was evaluated by plain radiograph and clinical outcomes were also assessed. Results: UDPTCP was significantly resorbed at 2 months after surgery, both at the center and periphery of the material. Complications were only observed in the post-operative period. Significant correction loss of radial alignment was seen in patients stabilized with poly-axial locking plate. The clinical outcome in all cases was excellent. Conclusions: Block UDPTCP is a safe and convenient material for the treatment of distal radius fracture and is replaced within a suitable time period after grafting into the fracture site. UDPTCP and stable internal fixation is therefore a reliable strategy for restoring and preserving anatomical position, especially in the elderly population.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan.,Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Jessica A Gandionco
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Anthony A Suguitan
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Takahiro Hashimoto
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Dabash S, Potter E, Pimentel E, Shunia J, Abdelgawad A, Thabet AM, Pirela-Cruz M. Radial Plate Fixation of Distal Radius Fracture. Hand (N Y) 2020; 15:103-110. [PMID: 30003806 PMCID: PMC6966286 DOI: 10.1177/1558944718787290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: A radial incision with radial plate fixation for distal radius fracture has historically been avoided due to its risk to the superficial branch of the radial nerve (SBRN). With careful technique, it is possible to avoid injury to the SBRN, thereby minimizing the soft tissue injury associated with other approaches. We compare subjective and objective functional outcomes of radial plate fixation surgeries that we performed with those of dorsal and volar plate fixation in current literature. Methods: Patients at a single center who underwent radial plate fixation for an AO type A or AO type B distal radius fracture between December 2006 and December 2014 were enrolled in the study. Postoperative grip strength and 3-digit pinch strength were measured systematically in the injured and uninjured wrists. Patients also completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire to assess subjective outcomes. Results: Thirty-six patients met our inclusion criteria and had available medical records. Postoperative grip strength in the injured wrist was significantly lowered-68% compared with the uninjured wrist. After subgroup analysis of dominant and nondominant wrist injuries, there was no significant difference in grip strength between injured and uninjured wrists. There was no significant decrease in postoperative 3-digit pinch strength in the injured wrist-89% compared with the uninjured wrist. The mean QuickDASH score for our study participants was 20.9. Conclusions: Radial plate fixation is an effective approach for distal radius fractures. Objective and subjective outcomes are noninferior to those of a dorsal or volar approach.
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Affiliation(s)
- Sherif Dabash
- University of Texas Health Science
Center at Houston, USA,Sherif Dabash, Department of Orthopaedic
Surgery, University of Texas Health Science Center at Houston, 6431 Fannin
Street, Houston, TX 77030, USA.
| | - Eric Potter
- Texas Tech University Health Sciences
Center–El Paso, USA
| | | | - Juan Shunia
- Texas Tech University Health Sciences
Center–El Paso, USA
| | - Amr Abdelgawad
- Texas Tech University Health Sciences
Center–El Paso, USA
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Carrillo F, Roner S, von Atzigen M, Schweizer A, Nagy L, Vlachopoulos L, Snedeker JG, Fürnstahl P. An automatic genetic algorithm framework for the optimization of three-dimensional surgical plans of forearm corrective osteotomies. Med Image Anal 2019; 60:101598. [PMID: 31731091 DOI: 10.1016/j.media.2019.101598] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/19/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022]
Abstract
Three-dimensional (3D) computer-assisted corrective osteotomy has become the state-of-the-art for surgical treatment of complex bone deformities. Despite available technologies, the automatic generation of clinically acceptable, ready-to-use preoperative planning solutions is currently not possible for such pathologies. Multiple contradicting and mutually dependent objectives have to be considered, as well as clinical and technical constraints, which generally require iterative manual adjustments. This leads to unnecessary surgeon efforts and unbearable clinical costs, hindering also the quality of patient treatment due to the reduced number of solutions that can be investigated in a clinically acceptable timeframe. In this paper, we propose an optimization framework for the generation of ready-to-use preoperative planning solutions in a fully automatic fashion. An automatic diagnostic assessment using patient-specific 3D models is performed for 3D malunion quantification and definition of the optimization parameters' range. Afterward, clinical objectives are translated into the optimization module, and controlled through tailored fitness functions based on a weighted and multi-staged optimization approach. The optimization is based on a genetic algorithm capable of solving multi-objective optimization problems with non-linear constraints. The framework outputs a complete preoperative planning solution including position and orientation of the osteotomy plane, transformation to achieve the bone reduction, and position and orientation of the fixation plate and screws. A qualitative validation was performed on 36 consecutive cases of radius osteotomy where solutions generated by the optimization algorithm (OA) were compared against the gold standard solutions generated by experienced surgeons (Gold Standard; GS). Solutions were blinded and presented to 6 readers (4 surgeons, 2 planning engineers), who voted OA solutions to be better in 55% of the time. The quantitative evaluation was based on different error measurements, showing average improvements with respect to the GS from 20% for the reduction alignment and up to 106% for the position of the fixation screws. Notably, our algorithm was able to generate feasible clinical solutions which were not possible to obtain with the current state-of-the-art method.
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Affiliation(s)
- Fabio Carrillo
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zürich, Balgrist Campus, Lengghalde 5, CH-8008 Zurich, Switzerland.
| | - Simon Roner
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
| | - Marco von Atzigen
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zürich, Balgrist Campus, Lengghalde 5, CH-8008 Zurich, Switzerland.
| | - Andreas Schweizer
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
| | - Ladislav Nagy
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
| | - Jess G Snedeker
- Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zürich, Balgrist Campus, Lengghalde 5, CH-8008 Zurich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
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