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Adams AJ, Ilyas AM. Management of Lunate Facet Escape after Distal Radius Fracture Volar Plating: Surgical Technique. J Hand Microsurg 2024; 16:100018. [PMID: 38854386 PMCID: PMC11127541 DOI: 10.1055/s-0043-1761220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
Fractures involving the lunate facet of the distal radius (commonly called the volar ulnar corner or "critical corner") are often difficult to recognize radiographically. "Lunate facet escape" refers to the displacement of this fragment after attempted distal radius fracture closed or open reduction methods. Lunate facet escape can have severe consequences including carpal collapse with pain, instability, and arthritis. Challenges to lunate facet fixation include irregular cortical contour that makes plate fixation difficult, as well as deforming forces by inserting structures. The goal of the management of a distal radius fracture with lunate facet involvement is first identification, then adequate stabilization until osseous healing occurs. However, subsequent lunate facet escape can pose a challenging clinical and surgical dilemma. Here we discuss our preferred approach to treat lunate facet escape after distal radius fracture volar locking plating failure.
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Affiliation(s)
- Alexander J. Adams
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Rothman Opioid Foundation, Philadelphia, Pennsylvania, United States
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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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Galle SE, Harness NG, Hacquebord JH, Burchette RJ, Peterson B. Complications of Radial Column Plating of the Distal Radius. Hand (N Y) 2019; 14:614-619. [PMID: 29484901 PMCID: PMC6759978 DOI: 10.1177/1558944718760861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Distal radius fractures treated with open reduction and internal fixation are commonly stabilized with a volar locking plate; however, more complex fracture patterns may require supplemental fixation with fragment-specific implants. The objective of this study was to evaluate the outcomes of distal radius fractures treated with radial column plates. Methods: A consecutive series of 61 patients who sustained distal radius fractures underwent radial column plating alone or in conjunction with other implants between August 2006 and January 2014. Thirty-one patients returned for follow-up or returned a mailed questionnaire at an average of 4.1 years. The outcomes measures included Visual Analog Scale (VAS); Disabilities of the Arm, Shoulder and Hand (DASH); and Patient-Rated Wrist Evaluation (PRWE) scores. Results: Sixty-one patients with a mean age of 55 years (range, 20-87) met inclusion criteria and were available for follow-up or chart review at an average of 5.2 years (range, 1.6-9.0 years). Seventeen of 61 (28%) underwent radial column plate removal. Twenty patients returned for final follow-up examination, and 11 completed questionnaires via mail. Subjective scores included a mean postoperative VAS of 0.72, DASH score of 17.2, and PRWE score of 15.7. Hardware sensitivity and wrist stiffness were the most common complications at final follow-up. Conclusions: Radial column plating of the distal radius is a safe treatment modality and a valuable adjunct in the setting of complex distal radius fractures, but patients should be counseled that there is a 28% chance that hardware removal may be required. Our retrospective review found evidence of few complications and objective scores consistent with return to normal function.
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Affiliation(s)
| | - Neil G. Harness
- Kaiser Permanente, Anaheim, CA,
USA,Neil G. Harness, Kaiser Permanente Orange
County, Kraemer Medical Office 1, 3460 E. La Palma Avenue, Anaheim, CA 92806,
USA.
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Yang Y, Yin Q, Li D, Rui Y, Wu Y, Ding Y, Jiang Y. A new classification and its value evaluation for intermediate column fractures of the distal radius. J Orthop Surg Res 2018; 13:221. [PMID: 30176895 PMCID: PMC6122768 DOI: 10.1186/s13018-018-0925-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermediate column fractures of the distal radius (ICF) are fractures only or mainly limited to the lunate fossa of the distal radius. There are no classification systems and its value evaluation for ICF in the literature. METHODS According to the characteristics of ICF, ICF were divided into the volar, dorsal, split, collapse, and collapse with split types. Inter- and intra-observer agreements were analyzed with kappa statistics. Seventy-four patients with ICF were retrospectively studied from January 2008 to June 2016. Surgical approach and reduction-fixation method were taken under the guidelines of the classification in 54 patients with displaced fractures, while conservative treatment was taken in 16 patients with non-obvious displaced fractures and 4 patients with displaced fractures who declined surgery. RESULTS The inter- and intra-observer kappa coefficients were 0.875~0.925 and 0.900~0.950, respectively. All patients were followed up for 13~36 months (average, 18.4 months). At the last follow-up, according to Gartland and Werley score of the functional recovery of wrist, all except 3 patients had excellent or good results (the excellent and good rate was 95.95%). CONCLUSION The classification reflects the characteristics of ICF and may provide an important reference for choosing treatment and evaluating prognosis.
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Affiliation(s)
- Ying Yang
- Department of Radiology, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China
| | - Dongchen Li
- Department of Radiology, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China
| | - Yongwei Wu
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China
| | - Yanping Ding
- Department of Radiology, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China
| | - Yan Jiang
- Department of Radiology, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, Wuxi, 214062, China.
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Kwak JM, Jung GH. Biologic plating of unstable distal radial fractures. BMC Musculoskelet Disord 2018; 19:117. [PMID: 29655367 PMCID: PMC5899831 DOI: 10.1186/s12891-018-2046-2] [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: 01/17/2017] [Accepted: 04/11/2018] [Indexed: 12/01/2022] Open
Abstract
Background Volar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction. Methods Thirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25–83 years), and the mean follow-up period was 47.5 months (range, 36–84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS). Results All wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from − 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75–100). Conclusion Our experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Gu-Hee Jung
- Department of orthopaedic surgery, Gyeongsang national university, college of medicine and Gyeongsang national university Changwon hospital, 555 Samjungja-Dong, Changwon-si, 642-160, Republic of Korea.
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Ma Y, Yin Q, Rui Y, Gu S, Yang Y. Image classification for Die-punch fracture of intermediate column of the distal radius. Radiol Med 2017; 122:928-933. [PMID: 28776224 DOI: 10.1007/s11547-017-0797-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to analyze the imaging findings of Die-punch fracture of intermediate column of the distal radius, and to explore the clinical application value of image classification. METHODS The clinical data of 45 patients who were admitted to our hospital from May 2010 to October 2016 were analyzed retrospectively. All patients met the inclusion criteria for Die-punch fracture. X-ray and CT scan were performed to examine the fracture, and the results were assessed by two doctors in a double blind method. Finally, the image classification of Die-punch fracture was formulated. RESULTS According to the imaging features of Die-punch fracture, it was divided into four types: type I (dorsal type, 15 cases), type II (volar type, 8 cases), type III (splitting type, 10 cases), type IV (collapsed type, 12 cases). The accuracy rate of CT was 100% (45/45). The misclassification rate of X-ray was 15.6% (7/45) and the missed diagnosis rate was 11.1% (5/45). CONCLUSIONS CT examination could accurately diagnose Die-punch fracture and perform preoperative image classification.
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Affiliation(s)
- Yunhong Ma
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Ying Yang
- Department of Orthopaedics, Wuxi Hand Surgery Hospital, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
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Gaspar MP, Kho JY, Kane PM, Abdelfattah HM, Culp RW. Orthogonal Plate Fixation With Corrective Osteotomy for Treatment of Distal Radius Fracture Malunion. J Hand Surg Am 2017; 42:e1-e10. [PMID: 28052831 DOI: 10.1016/j.jhsa.2016.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 09/19/2016] [Accepted: 10/23/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To report outcomes of patients with distal radius fracture malunions treated with corrective osteotomy and orthogonal volar and radial "90-90" plate fixation. METHODS We performed a retrospective review of all patients who underwent distal radius corrective osteotomy and 90-90 fixation from January 2008 through December 2014. Demographic data, injury history, prior treatments, and clinical examination values were recorded. Preoperative radiographic measurements were used to classify the type and severity of deformity. The outcomes were patient-reported pain levels, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) functional scores, and radiographic outcomes. Secondary outcomes, including complications and the need for additional surgeries, were also noted. RESULTS Thirty-nine cases (31 extra-articular, 8 combined intra- and extra-articular) were included. At mean postoperative follow-up interval of 4 years, significant improvements were observed clinically in wrist flexion-extension arc, grip strength, pain, and Quick Disabilities of the Arm, Shoulder, and Hand scores. Radiographically, significant postoperative improvements were noted in ulnar variance, radial inclination, intra-articular stepoff, and radial tilt, with volarly and dorsally angulated malunions corrected to 9° and 7° of volar tilt, respectively. Twelve patients (31%) underwent additional surgery, the most common being plate removal in 7 patients, 3 of which involved removal of the radial plate. CONCLUSIONS For patients with symptomatic malunion of the distal radius, corrective osteotomy with 90-90 plate fixation is an effective treatment option for improving pain and restoring function for both volarly and dorsally angulated malunions, including malunions with an intra-articular component. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Michael P Gaspar
- The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA.
| | - Jenniefer Y Kho
- The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA; Division of Orthopedic Surgery, Sutter Gould Medical Foundation, Modesto, CA
| | - Patrick M Kane
- The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Hesham M Abdelfattah
- The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA; Department of Orthopaedic Surgery and Sports Medicine, Temple University Health System, Philadelphia, PA
| | - Randall W Culp
- The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA
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Thiart M, Ikram A, Lamberts RP. How well can step-off and gap distances be reduced when treating intra-articular distal radius fractures with fragment specific fixation when using fluoroscopy. Orthop Traumatol Surg Res 2016; 102:1001-1004. [PMID: 27751844 DOI: 10.1016/j.otsr.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although fragment specific fixation has proved to be an effective treatment regime, it has not been established how successfully this treatment could be performed using fluoroscopy and what the added value of arthroscopy could be. Establish gap and step-off distances after in intra-articular distal radius fractures that have been treated with fragment specific fixation while using fluoroscopy. MATERIAL Forty-four patients with an intra-articular distal radius fracture were treated with fragment specific fixation while using fluoroscopy. METHODS After the treatment of the intra-articular distal radius fracture with fragment specific fixation and the use of fluoroscopy, but before the completion of the surgical intervention, all gap, and step-off distances were determined by using arthroscopy. In addition, the joint was checked for any other wrist pathologies. RESULTS Arthroscopy after the surgical intervention showed that in 37 patients no gap distances could be detected, while in six patients a gap distance of≤2mm was found and in one patient, a gap distance of 3mm. Similarly, arthroscopy revealed no step-off distances in 33 patients, while in 11 patients a step-off distance of≤2mm was found. Although additional wrist pathologies were found in 48% of our population, only one patient needed surgical intervention. Three months after the surgical intervention wrist flexion was 41±10°, wrist extension 51±17°, ulnar deviation 19±10°, radial deviation 32±12° while patients could pronate and supinate their wrist to 85±5° and 74±20°, respectively. CONCLUSION Intra-articular distal radius fractures can be treated successfully with fragment specific fixation and the use of fluoroscopy. As almost all gap and step-off distances could be reduced to an acceptable level, the scope for arthroscopy to further improve this treatment regime is limited. The functional outcome scores that were found 3 months after the surgical intervention were similar to what has been reported in other studies using different treatment option. These findings suggest that fragment specific fixation is a good alternative for treating intra-articular distal radius fractures. As in most cases, only fluoroscopy is needed for fragment specific fixation, this treatment technique is a good treatment option for resource-limited hospitals, setting who do not have access to arthroscopy. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- M Thiart
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - A Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - R P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa.
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Watt AJ, Ching RP, Huang JI. Biomechanical evaluation of metacarpal fracture fixation: application of a 90° internal fixation model. Hand (N Y) 2015; 10:94-9. [PMID: 25767426 PMCID: PMC4349836 DOI: 10.1007/s11552-014-9673-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Complications in metacarpal fracture treatment increase in proportion to the severity of the initial injury and the invasiveness of the surgical fixation technique. This manuscript evaluates the feasibility of minimizing internal fixation construct size and soft tissue dissection, while preserving the advantages of stable internal fixation in a biomechanical model. We hypothesized that comparable construct stability could be achieved with mini-plates in an orthogonal (90/90) configuration compared with a standard dorsal plating technique. METHODS This hypothesis was evaluated in a transverse metacarpal fracture model. Twelve metacarpals were subject to either placement of a 2.0-mm six-hole dorsal plate or two 1.5-mm four-hole mini-plates in a 90/90 configuration. These constructs were tested to failure in a three-point bending apparatus, attaining failure force, displacement, and stiffness. RESULTS Mean failure force was 353.5 ± 121.1 N for the dorsal plating construct and 358.8 ± 77.1 N for the orthogonal construct. Mean failure displacement was 3.3 ± 1.2 mm for the dorsal plating construct and 4.1 ± 0.9 mm for the orthogonal construct. Mean stiffness was 161.3 ± 50.0 N/mm for the dorsal plating construct and 122.1 ± 46.6 N/mm for the orthogonal construct. Mean failure moment was 3.09 ± 1.06 Nm for the dorsal plating construct and 3.14 ± 0.67 Nm for the orthogonal construct. The dorsal plating group failed via screw pullout, whereas the orthogonal failed either by screw pullout or breakage of the plate. CONCLUSIONS When subject to apex dorsal bending, the orthogonal construct and the standard dorsal plate construct behaved comparably. These data suggest that despite its shorter length, lower profile, and less substantial screws, the orthogonal construct provides sufficient rigidity. CLINICAL RELEVANCE This study represents a "proof of concept" regarding the applicability of orthogonal plating in the metacarpal and provides the foundation for minimizing construct size and profile.
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Affiliation(s)
- Andrew J. Watt
- The Buncke Clinic, Department of Plastic Surgery, California Pacific Medical Center, 45 Castro Street, Suite 121, San Francisco, CA 94114 USA
| | - Randal P. Ching
- Department of Mechanical Engineering, University of Washington, Seattle, WA USA
| | - Jerry I. Huang
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA USA
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Gradl G, Mielsch N, Wendt M, Falk S, Mittlmeier T, Gierer P, Gradl G. Intramedullary nail versus volar plate fixation of extra-articular distal radius fractures. Two year results of a prospective randomized trial. Injury 2014; 45 Suppl 1:S3-8. [PMID: 24268189 DOI: 10.1016/j.injury.2013.10.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intramedullary techniques for stabilization of displaced distal radius fractures are now available. Purported benefits include limited soft tissue dissection while affording sufficient stability to allow early wrist motion. The primary null hypothesis of this randomized trial is that there is no significant difference with respect to functional outcome, pain and disability between patients treated with either 2.4-mm volar locking plate fixation or intramedullary nail fixation of unstable dorsally displaced extra-articular fractures of the distal radius. METHODS We conducted a single-centre, parallel-group trial, with unrestricted randomization. Patients with dorsally displaced extra-articular distal radius fractures were randomized to receive volar locking plate (n=72) fixation or intramedullary nailing (n=80). The outcome was measured on the basis of the Gartland and Werley and Castaing score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including volar tilt and ulnar variance. Clinical and radiographic assessment was performed at 8 weeks, 6 months, 1 year and 2 years after the operation. RESULTS There were no significant differences between groups in terms of range of motion, grip strength or the level of pain during the entire follow-up period (p>0.05). There was no significant difference between treatment groups with respect to volar tilt or ulnar variance (p>0.05). There was no significant difference in the complication rate between groups (p>0.05). CONCLUSIONS The present study supports the view that intramedullary nail fixation and volar plate fixation for the treatment of displaced extra-articular distal radius fractures have equivalent radiographic and functional outcomes. LEVEL OF EVIDENCE Level I therapeutic study.
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Affiliation(s)
- Gertraud Gradl
- Department of Trauma and Reconstructive Surgery, Aachen University Medical Center, Pauwelstrasse 30, 52074 Aachen, Germany
| | - Nadja Mielsch
- Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany
| | - Martina Wendt
- Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany
| | - Steffi Falk
- Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany
| | - Thomas Mittlmeier
- Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany
| | - Philip Gierer
- Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany
| | - Georg Gradl
- Department of Trauma- and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
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