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Cakmak MF, Horoz L, Kircil C, Beltir G, Basat HC. Intraoperative assessment of the dorso-ulnar fragment stability with stress fluoroscopy: An observational study. Medicine (Baltimore) 2024; 103:e38509. [PMID: 38875428 PMCID: PMC11175906 DOI: 10.1097/md.0000000000038509] [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] [Received: 04/19/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/16/2024] Open
Abstract
This study aims to investigate the effectiveness of intraoperative stress radiographs in evaluating the stability and fixation adequacy of the dorso-ulnar fragment (DUF) after volar plate application. Sixty-four patients who underwent open reduction and internal fixation due to comminuted distal radius fracture accompanied by DUF between May 2020 and February 2022 were reviewed retrospectively. Two groups were compared, with and without stress radiographs used in addition to routine fluoroscopic imaging during the surgical treatment of distal radius fractures. DUF sizes and fracture classifications were made according to preoperative computed tomography. Displacement of the DUF, dorsal cortex screw penetration, and the number of screws inserted into the DUF were evaluated on immediate postoperative CT scans and direct radiographs. DUF displacement at the patients' last follow-up was significantly higher in the control group (1.62 mm) than in the additional stress fluoroscopy applied group (0.53 mm). It was observed that the amount of displacement increased as the dorso-volar size of the DUF decreased. No significant difference was observed in dorsal cortex screw penetrations between the 2 groups. In the additional stress fluoroscopy applied group, stabilization rates with at least 1 screw over volar-locking plate for DUF were significantly higher (P < .001). Compared to the stress fluoroscopy group, the change in ulnar variance (P < .001) and volar tilt (P < .001) was significantly higher in the control group in the last follow-up radiography. No significant difference was observed between the implant removal rates of both groups. Evaluation of the stability of the DUF with stress radiographs after fixation is an effective method to reveal the need for additional fixation. Dorsal stress radiographs allow dynamic evaluation of fixation strength.
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Affiliation(s)
- Mehmet Fevzi Cakmak
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Levent Horoz
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Cihan Kircil
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Galip Beltir
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Hakki Cagdas Basat
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kirsehir Ahi Evran University, Kirsehir, Turkey
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Ji JQ, Zhang X, Cai T, Chen K, Qian JK, Yuan F, Fan J. Size and fixation options of dorsoulnar fragments in distal radius fractures. Injury 2024; 55:111513. [PMID: 38615576 DOI: 10.1016/j.injury.2024.111513] [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] [Received: 12/08/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE This study aimed to investigate the influence of size and fixation options of dorsoulnar fragments on the clinical outcomes of distal radius fractures (DRFs). METHODS This retrospective analysis was performed on 94 patients with DFR accompanied by dorsoulnar fragments, spanning the period from October 2018 to November 2022. Mean follow-up was 15.5 (range, 12-20) months. Patients were divided into small- (<5 %, n = 28), middle- (5-15 %, n = 50), and large- (>15 %, n = 16) sized groups according to articular involvement of dorsoulnar fragments determined by three-dimensional (3D) computed tomography (CT) modeling. Subdivision also took place for the presence of postoperative fragment displacement (>2 mm) and fixation methods including volar locking plate (VLP), VLP combined with dorsal hollow compression screw (VDS), and VLP combined with dorsal low-profile mini plate (VDP). The radiographic parameters (volar tilt, radial inclination, and radial height) and functional outcome measures of wrist range of motion, wrist function (DASH, PRWE), and wrist pain (VAS) were evaluated and compared between groups. RESULTS Fracture healing was observed in all patients at final follow-up. No instances of dorsoulnar fragment displacement were observed in patients undergoing VDS and VDP treatment and the incidence of the dorsoulnar fragment displacement was 35 % (n = 8) in small-sized group, 21 % (n = 7) in middle-sized group, and 7 % (n = 1) in large-sized group when patients were treated with VLP. In small-sized group, no significant differences were found between patients with and without dorsoulnar fragment displacement in dorsiflexion restriction (10.6 ± 2.8°, 9.1 ± 2.3°, P = 0.159), pronosupination restriction (9.6 ± 2.1°, 8.6 ± 1.7°, P = 0.188), DASH (11.5 ± 4.1, 10.7 ± 3.2, P = 0.562), PRWE (11.9 ± 4.2, 10.6 ± 3.6, P = 0.425), and VAS (1.1 ± 1.1, 0.9 ± 1.0, P = 0.528). In middle-sized combined with large-sized group, the functional outcome measures of dorsiflexion restriction (12.5 ± 3.7°, 9.8 ± 2.9°, P = 0.022), DASH (14.6 ± 5.2, 11.4 ± 3.7, P = 0.030), and PRWE (15.0 ± 4.5, 11.3 ± 3.9, P = 0.016) were superior in patients without dorsoulnar fragment displacement. In patients treated with VLPs, no significant differences were found in dorsiflexion restriction (9.8 ± 2.5°, 10.8 ± 3.5°, 9.4 ± 2.5°, P = 0.299), pronosupination restriction (9.2 ± 1.9°, 10.1 ± 2.8°, 8.9 ± 1.5°, P = 0.200), DASH (11.1 ± 3.5, 12.9 ± 4.3, 11.1 ± 3.6, P = 0.162), PRWE (11.1 ± 3.9, 12.8 ± 4.2, 10.8 ± 3.9, P = 0.188), and VAS (1.0 ± 1.0, 1.4 ± 1.1, 0.9 ± 0.9, P = 0.151) between small-sized, middle-sized, and large-sized groups. In middle-sized group, no significant differences were found in dorsiflexion restriction (10.8 ± 3.5°, 9.4 ± 2.2°, 9.4 ± 2.4°, P = 0.316); pronosupination restriction (10.1 ± 2.8°, 8.8 ± 1.9°, 9.0 ± 2.5°, P = 0.314), DASH (12.9 ± 4.3, 10.3 ± 3.7, 10.5 ± 3.7, P = 0.133), PRWE (12.8 ± 4.2, 10.4 ± 3.8, 10.6 ± 4.1, P = 0.199), and VAS (1.4 ± 1.1, 0.8 ± 0.7, 1.0 ± 1.1, P = 0.201) between subgroups of VLP, VDS, and VDP. No significant differences were found in radiographic parameters between all groups compared. CONCLUSION This study indicated that the strict reduction and fixation of a dorsoulnar fragment might be not essential when its articular involvement was less than 5 %. The volar locking plate (VLP) fixation was commonly effective in treating distal radius fractures accompanied by a dorsoulnar fragment involving over 15 % of the articular surface. Additionally, the use of an additional dorsal hollow compression screw or a dorsal low-profile mini plate can get good wrist function in the early-term follow-up when the dorsoulnar fragment involve 5-15 % of the articular surface.
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Affiliation(s)
- Jia-Qing Ji
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Xin Zhang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Tao Cai
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Kai Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Ji-Kui Qian
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Feng Yuan
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jian Fan
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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Lundqvist E, Olivecrona H, Wretenberg P, Sagerfors M. CT-Based Micromotion Analysis After Locking Plate Fixation of AO Type C Distal Radius Fractures. Indian J Orthop 2023; 57:2031-2039. [PMID: 38026840 PMCID: PMC10673767 DOI: 10.1007/s43465-023-01020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Background Volar locking plate fixation (VLPF) is the most common method for operative fixation of distal radius fractures (DRF). The dorsal ulnar corner (DUC) can be difficult to stabilize as the fragment is small and not exposed when using the volar approach. The purpose of this study was to study fracture fragment migration after VLPF of AO type C DRF, using a volume registration technique of paired CT scans with special focus on the DUC fragment. Materials and Methods This pilot study included ten patients with AO type C DRF, all operated with VLPF. The primary outcome was radiographic outcome. Postoperative and 1-year scans were compared and analyzed. Fragment migration was assessed with CT-based micromotion analysis (CTMA), a software technique used for volume registration of paired CT scans. Results All plates were stable over time. Two patients showed signs of screw movement (0.2-0.35 mm and 0.35- > 1 mm respectively). Postoperative reduction was maintained, and there was no fragment migration at the 1-year follow-up except for one case with increased dorsal tilt. The DUC fragment was found in 8/10 cases, fixated in 7/8 cases, and not dislocated in any case at the 1-year follow-up. Conclusion The CTMA results indicate that variable-angle VLPF after AO type C DRF can yield and maintain a highly stable reduction of the fracture fragments. The DUC fragment remained stable regardless of the number of screws through the fragment. CT volume registration can be a valuable tool in the detailed assessment of fracture fragment migration following volar plate fixation of DRFs.
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Affiliation(s)
- Eva Lundqvist
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Per Wretenberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
| | - Marcus Sagerfors
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
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Li H, Wang D, Zhang W, Xu C, Xiong D, Li J, Zhang L, Tang P. Evaluating the biomechanical performance of Ti6Al4V volar plates in patients with distal radius fractures. Front Bioeng Biotechnol 2023; 11:1141790. [PMID: 36923459 PMCID: PMC10009098 DOI: 10.3389/fbioe.2023.1141790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
Purpose: This study aimed to investigate the biomechanical performance of three Ti6Al4V volar plates with the latest designs using a finite element model. Methods: An AO type 23-A3 distal radius fracture and the models of T plate (2.4 mm LCP Volar Distal Radius Plate), V plate (2.4 mm LCP Two-Column Volar Distal Radius Plate) and π Plate (2.4 mm Volar Rim Distal Radius Plate) (all from Depuy Synthes, West Chester, PA, USA, Ti6Al4V) were built in 3D-matic software. After assembling the internal fixation and fractures, we imported these models into the finite element analysis software (ABAQUS). An axial loading of 100 N was added to the distal end of each model. The displacements of total models and implants, the principal strains and the von Mises stresses in the plates were calculated and compared to capture the biomechanical features of the three plates. Results: The T plate, V plate and π plate represented a model displacement of 0.8414 mm, 1.134 mm and 1.936 mm, respectively. The T plate was with the implant displacement of 0.7576 mm, followed by the V plate (0.8802 mm) and the π plate (1.545 mm). The T plate had the smallest principal strain of 0.23%, the V plate showed an intermediate level of 0.28%, and the π plate had a value of 0.72%. The least peak von Mises stress was observed in the V plate with 263.6MPa, and this value was 435.6 MPa and 1050 MPa in the T plate and π plate, respectively. Conclusion: The biomechanical features of three Ti6Al4V volar locking plates in an AO type 23-A3 fracture were described in our analysis. The T plate and the V plate showed similar biomechanical performance while the π plate represented worse performance than the other two plates.
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Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Dou Xiong
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
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Lundqvist E, Fischer P, Wretenberg P, Krauss W, Sagerfors M. Posttraumatic Arthritis After Combined Plating of Distal Radius Fractures AO Type C: A 7-Year Follow-up of 97 Cases. Hand (N Y) 2022; 17:50S-59S. [PMID: 34490825 PMCID: PMC9793614 DOI: 10.1177/15589447211028991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Volar locking plate fixation is the most common method of operative fixation of distal radius fractures (DRFs). For more complex cases, combined plating is an option for stabilizing intra-articular fragments. The prevalence of posttraumatic arthritis (PA) after an intra-articular DRF, and its relation to patient-reported outcome measures (PROMs), remains unclear. The purpose of this study was to study the prevalence of PA and its correlation to clinical outcome measures. METHODS We evaluated 97 consecutive patients with intra-articular DRF, operated with combined plating, 7 years postoperatively. The primary outcome measure was the prevalence of radiographic PA. Secondary outcome measures included visual analog scale (VAS) pain score, hand grip strength, wrist range of motion (ROM), Patient-Rated Wrist Evaluation (PRWE) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographic examination was performed between 1 and 7 years postoperatively. RESULTS The prevalence of PA was 29% at the 7-year follow-up. No correlation was found between PA and ROM, hand grip strength, PRWE, QuickDASH, VAS pain scores, or radiographic reduction. Median wrist ROM and grip strength were significantly inferior compared with the uninjured side. Hardware removal was performed in 51.5% of cases. There were 2 cases of tendon ruptures. CONCLUSIONS Combined plating can yield a good clinical outcome 7 years postoperatively and a low prevalence of PA. The presence of PA did not correlate to clinical outcome measures or to the accuracy of anatomical reduction 1 year postoperatively. The frequency of tendon ruptures was acceptable, but the high frequency of hardware removal is a concern.
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Affiliation(s)
- Eva Lundqvist
- Örebro University, Sweden
- Örebro University Hospital,
Sweden
| | - Per Fischer
- Örebro University, Sweden
- Karlstad Central Hospital, Sweden
| | - Per Wretenberg
- Örebro University, Sweden
- Örebro University Hospital,
Sweden
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Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases. J Hand Surg Am 2022; 47:813-822. [PMID: 35842329 DOI: 10.1016/j.jhsa.2022.04.018] [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] [Received: 12/09/2021] [Revised: 03/20/2022] [Accepted: 04/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating. METHODS In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score. RESULTS Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group. CONCLUSIONS In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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7
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Hou R. Postoperative Nursing and Functional Rehabilitation of Ultrasound Diagnosis of Lower Rotator Cuff Injury. SCANNING 2022; 2022:8319082. [PMID: 36105551 PMCID: PMC9441379 DOI: 10.1155/2022/8319082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
In order to explore the postoperative nursing effect and functional rehabilitation of rotator cuff repair under ultrasound diagnosis, a method of nursing and rehabilitation functional training for athletes' wrist injury under the assistance of microscopic B-ultrasound was proposed. This study retrospectively analyzed the therapeutic effect of tendon anastomosis in 237 patients with wrist tendon injury, adopted nursing measures such as health education and functional exercise, and observed its clinical effect. The results showed that after 3-6 months of follow-up, all patients had satisfactory recovery of tendon function. Of these, 132 patients recovered well. 84 patients recovered well. The excellent and good rate of patients was 91%. Ultrasound diagnosis of rotator cuff repair combined with functional exercise promotes good recovery of shoulder joint function in patients.
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Affiliation(s)
- Riying Hou
- College of Gerontic Education, Jilin Open University, Changchun, Jilin 130022, China
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Abe S, Shimada T, Murase T, Kuriyama K. Comparison of the Orientation Angles of Volar Locking Plate Distal Ulnar Locking Screw for Distal Radius Fractures. J Hand Surg Am 2022; 47:389.e1-389.e13. [PMID: 34158207 DOI: 10.1016/j.jhsa.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/19/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to measure the angles between the screw and plate in 16 commercially available volar locking plates (VLPs) to determine the fixable intra-articular fragment size. METHODS Ulnar orientation angles (axial plane) and elevation angles (sagittal plane) between the distal ulnar screw and plate were measured for 14 fixed-angle VLPs and 2 variable-angle VLPs. Each VLP was simulated by 2 surgeons to sit distally and ulnarly in 10 normal distal radius models. The distance between the screw and distal/ulnar end of the distal radius on both the volar and dorsal sides, designated as the longitudinal/lateral distance, was measured to identify the fixable size of the 2 intra-articular fragments: volar lunate fragment and dorsoulnar fragment. Relationships between the ulnar orientation angle and dorsal-side lateral length as well as the elevation angle and dorsal-side longitudinal distance were analyzed. RESULTS The ulnar orientation and elevation angles ranged from 6.5° to 16.9° and -5.8° to 34.3°, respectively, for fixed-angle VLPs and -12.5° to 32.2° and 3.1° to 42.1°, respectively, for variable-angle VLPs. The minimal longitudinal distances on the volar side with the fixed- and variable-angle VLPs were 4.3-10.9 mm and 5.8-5.9 mm, respectively. On the dorsal side, the lateral distance negatively correlated with the ulnar orientation angle (R = -0.74), and the longitudinal distance negatively correlated with the elevation angle (R = -0.89). CONCLUSIONS The Depuy Synthes variable-angle VLP provides an advantage for fixating small intra-articular fragments. For fixed-angle VLPs, the Mizuho VLP provides an advantage for fixating small volar lunate fragments. A narrow dorsoulnar fragment can be fixated using a plate with a large ulnar orientation angle, such as the Zimmer Biomet or Mizuho VLP. CLINICAL RELEVANCE The ability of each individual commercially available plate to capture specific intra-articular fragments should be known.
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Affiliation(s)
- Shingo Abe
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
| | - Toshiki Shimada
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Kuriyama
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan
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Hadzhinikolova M, Zderic I, Ciric D, Barcik JP, Enchev D, Baltov A, Rusimov L, Varga P, Stoffel K, Richards G, Gueorguiev B, Rashkov M. Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment - a biomechanical study. BMC Musculoskelet Disord 2022; 23:35. [PMID: 34986819 PMCID: PMC8734044 DOI: 10.1186/s12891-021-04989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.
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Affiliation(s)
- Mariya Hadzhinikolova
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Daniel Ciric
- AO Research Institute Davos, Davos, Switzerland.,Flinders University, Tonsley, South Australia
| | | | - Dian Enchev
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Lyubomir Rusimov
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | | | - Mihail Rashkov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
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Raducha JE, Got CJ. Nuances of Radiographic Assessment of Distal Radius Fractures to Avoid Missed Fragments. Hand Clin 2021; 37:197-204. [PMID: 33892873 DOI: 10.1016/j.hcl.2021.02.002] [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] [Indexed: 02/02/2023]
Abstract
Distal radius fractures, like many articular and periarticular fractures, can make it difficult to determine the true number, location, and orientation of fracture fragments. This article should help the reader work through imaging interpretation starting from the initial, often displaced radiographs to postreduction imaging and determination if further 3-dimensional imaging is necessary.
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Affiliation(s)
- Jeremy E Raducha
- Department of Orthopedics, Brown University, Lifespan Inc, Rhode Island Hospital, Miriam Hospital, 593 Eddy Street, Providence, RI 02905, USA.
| | - Christopher J Got
- Department of Orthopedics, Brown University, University Orthopedics Inc, Lifespan Rhode Island Hospital, Miriam Hospital, 593 Eddy Street, Providence, RI 02905, USA
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Sagerfors M, Lundqvist E, Bjorling P. Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases. J Wrist Surg 2020; 9:388-395. [PMID: 33042641 PMCID: PMC7540645 DOI: 10.1055/s-0040-1712503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Background The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion. Question/Purpose Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intra-articular fractures. The primary outcome was patient-reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients. Conclusion The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managed with volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.
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Affiliation(s)
- Marcus Sagerfors
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Eva Lundqvist
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Patrik Bjorling
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
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Asmar G, Bellity J, Falcone MO. Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:481-490. [PMID: 32955698 DOI: 10.1007/s00590-020-02791-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. MATERIALS AND METHODS This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. RESULTS In the first phase: mean incision size was 32 mm, and mean operative time was 28.5 min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2 months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. CONCLUSION The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.
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Affiliation(s)
- Ghada Asmar
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Jonathan Bellity
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Marc-Olivier Falcone
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France. .,Clinique Internationale du Parc Monceau, 21 rue de Chazelles, 75017, Paris, France.
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Konrads C, Gonser C, Bahrs C. [Fractures of the Distal Radius]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:217-231. [PMID: 32663875 DOI: 10.1055/a-1042-0567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The fracture of the distal radius is the most common human fracture. The optimal management of this injury requires extensive knowledge and skills regarding closed and open reposition maneuvers, plastering and various surgical osteosynthesis techniques. Typical as well as rare accompanying injuries must be recognized and included in the treatment regimen.
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