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Steward A, Semsem S, Currie K, Bentley L, Mineo R, Holliday M, McAnulty K, Master V. The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging. J Med Radiat Sci 2023; 70:380-387. [PMID: 37439053 PMCID: PMC10715354 DOI: 10.1002/jmrs.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION This study illustrates image rejection rates of the lateral wrist x-ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image-repeat decision-making skills existing between radiologists, experienced radiographers and junior radiographers. METHODS A retrospective review was conducted of all rejected lateral wrist x-ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study. RESULTS The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers. CONCLUSIONS This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision-making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.
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Affiliation(s)
| | - Sarah Semsem
- Western HealthFootscrayVictoriaAustralia
- Discipline of Medical Radiation SciencesRMIT UniversityBundooraAustralia
| | - Katie Currie
- Western HealthFootscrayVictoriaAustralia
- School of Medicine, Faculty of HealthDeakin UniversityWaurn PondsAustralia
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Toro-Aguilera Á, Arenas-Romera J, Carrera I, Lamas C. Is ultrasound superior to fluoroscopy in distal radius volar fixation? HAND SURGERY & REHABILITATION 2023; 42:488-491. [PMID: 37499797 DOI: 10.1016/j.hansur.2023.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES In volar distal radius fixation, conventional and additional fluoroscopic views could not be sufficient to assess dorsal screw penetration. Ultrasound (US) has been suggested as a technique to improve this assessment. The objective was to determine the agreement between these two explorations in a clinical study. Quantify time-consuming of intraoperative US was the secondary objective. MATERIAL AND METHODS A prospective descriptive study was performed. Thirty patients with a surgical distal radius fracture were treated with volar fixation by five consultant surgeons in a level I Trauma Centre. Final intraoperative fluoroscopic views: AP, lateral, 20º tilted lateral and Dorsal Tangential views (DTV) were performed assessing for dorsal screw protrusion. Then, ultrasound was performed to reassess dorsal cortex integrity. Those protruding screws were registered and changed. RESULTS A total of 153 screws were examined. Four protruding screws were observed with no multiple protruding screws in the same fixation. Intraoperative ultrasound detected a dorsal screw protrusion in one fixation, assessed as correct by radiological projections. Almost perfect agreement was found between DTV and US examination k = 0.83 (p < 0.001). The mean surgical time was 63 ± 20.3 min while the addition of the ultrasound, supposed an average of 4 ± 1 min more. CONCLUSION Ultrasound did not show a clinically significant improvement in the assessment dorsal screw penetration in distal radius fixation. A high agreement was observed between US and the described fluoroscopic views. The addition of intraoperative US was a non-significant time-consuming procedure.
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Affiliation(s)
- Álvaro Toro-Aguilera
- Trauma Unit. Orthopaedic and Trauma Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Javier Arenas-Romera
- Trauma Unit. Orthopaedic and Trauma Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ion Carrera
- Trauma Unit. Orthopaedic and Trauma Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Lamas
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
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Kim MB, Lee JH, Lee YH. Arc center distance as a novel quantitative radiographic parameter for volar Barton fractures. Arch Orthop Trauma Surg 2022; 142:3765-3770. [PMID: 34739580 DOI: 10.1007/s00402-021-04240-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aims of this study were to investigate conventional radiographic parameters and introduce a novel parameter (arc center distance, ACD) for volar Barton fractures. METHODS Twenty-four cases of volar Barton fracture were retrospectively analyzed. We measured volar tilt angle (VTA), anteroposterior distance (APD), teardrop angle (TDA), and capitate-to-axis-of-radius distance (CARD) on lateral plain radiographs. The ACD was measured on the sagittal images of computed tomography scans. VTAs, APDs, TDAs, and CARDs were compared between the fractured and normal contralateral wrist. The area under the receiver operating characteristic curve was calculated for each parameter. RESULTS TDAs did not differ significantly between the fractured wrists and the controls. On the other hand, VTAs, APDs, and CARDs were all significantly greater in the fractured wrists (mean values were 17.25°, 20.70 mm, and - 3.40 mm, respectively). The area under the curve value was highest (0.943) for the ACD. When a cutoff value of 1.02 mm was used as a threshold, a sensitivity of 100% and specificity of 80.95% were achieved. CONCLUSIONS The mean values of conventional parameters (VTA, APD, TDA and CARD) in volar Barton fractures were presented. The ACD can be useful parameter for quantitatively evaluating volar Barton fractures.
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Affiliation(s)
- Min Bom Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Dae-hak road, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Dae-hak road, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - Young Ho Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Dae-hak road, Jongro-gu, Seoul, 03080, Republic of Korea
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Toro-Aguilera Á, Martínez-Galarza P, Camacho-Carrasco P, Caballero M, Segur JM. Comparative study between fixed-angle and polyaxial screws in distal radius fixation with two volar locking plates. Orthop Traumatol Surg Res 2021; 107:102801. [PMID: 33383184 DOI: 10.1016/j.otsr.2020.102801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/03/2020] [Accepted: 10/30/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION When treating a distal radius fracture with a volar locking plate (VLP), numerous plate-screw designs are available. To date, there is not a screw fastening system with a clear superiority among the others. HYPOTESIS Fixed-angle screws are superior to polyaxial screws in distal radius VLP fixation with respect to screw protrusion and reduction preservation. MATERIAL AND METHODS A prospective cohort study based on eighty patients was performed. The first forty patients were treated by polyaxial VLP (PA group) were the next forty by a fixed-angle VLP (FA group). Fixation was performed by the flexor carpi radialis approach. Screws were placed 2mm shorter than actual measurement and intraoperative AP, lateral and tilt wrist views were done routinely. A computed tomography (CT) was conducted searching for screw protrusion. Loss of reduction was calculated from the difference between post-operative x-rays values and those at the 6-month follow-up. The total follow-up was 12 months with no losses. RESULTS Postoperative CT detected dorsal screw protrusion in 17 patients in PA group and 16 patients in FA group that intraoperative radiographs were assumed as correct (p=0.48). The mean invasion of dorsal cortex was of 2.2mm (1-7mm) for PA group and 2.6mm (1-5mm) for FA group (p=0.70). As from those protruding screws, the mean size was registered founding that fixed-angle screws had protrusions with shorter screws 20 vs. 22mm (p<0.05). Intraarticular screw protrusion was registered in 3 and 2 patients respectively (p>1.0). Experienced loss of reduction in volar tilt (p=0.42), radial inclination (p=0.75) and ulnar variance (p=0.83) were equivalent in both groups while a better preservation of the radial height in the PA group was observed (p<0.05). DISCUSSIONS In terms of screw protrusion rate, both fastening systems where similar. However, fixed-angle group invaded the dorsal cortex with shorter screws. Polyaxial screws were associated with a better preservation of the radial height. Finally, this study reinforces the idea that dorsal and articular screw protrusion is more frequent than we expected. LEVEL OF EVIDENCE II; therapeutic, prospective cohort study.
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Affiliation(s)
- Álvaro Toro-Aguilera
- Department of Orthopaedics and Trauma Surgery, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain; Department of Orthopaedics and Trauma Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
| | - Pablo Martínez-Galarza
- Department of Orthopaedics and Trauma Surgery, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain; Department of Orthopaedics and Trauma Surgery, Hospital de Mollet, Ronda Pinetons, 6, 08100 Mollet del Vallès, Spain
| | - Pilar Camacho-Carrasco
- Department of Orthopaedic and Trauma Surgery, Hospital Clínic. University of Barcelona, c/de Villarroel, 170, 08036 Barcelona, Spain
| | - Miguel Caballero
- Surgery Department Research Registrar, IDIBAPS, University of Barcelona, c/Rosselló, 149-153, 08036 Barcelona, Spain
| | - Josep M Segur
- Department of Orthopaedic and Trauma Surgery, Hospital Clínic. University of Barcelona, c/de Villarroel, 170, 08036 Barcelona, Spain
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Müller SA, Adolfsson L, Baum C, Müller-Gerbl M, Müller AM, Rikli D. Fluoroscopy of the Elbow: A Cadaveric Study Defining New Standard Projections to Visualize Important Anatomical Landmarks. JB JS Open Access 2021; 6:JBJSOA-D-20-00160. [PMID: 34056508 PMCID: PMC8154458 DOI: 10.2106/jbjs.oa.20.00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Despite new 3-dimensional imaging modalities, 2-dimensional fluoroscopy remains the standard intraoperative imaging modality. The elbow has complex anatomy, and defined standard fluoroscopic projections are lacking. Therefore, the aim of this study was to define standard projections of the elbow for intraoperative fluoroscopy. Methods This study consisted of 2 parts. In part I, dissected cadaveric elbows were examined under fluoroscopy, and their radiographic anatomical features were assessed, with focus on projections showing defined anatomical landmarks. In part II, projections from part I were verified on entire cadavers to simulate intraoperative imaging. Standard projections for anteroposterior (AP) and lateral views as well as oblique and axial views were recorded. Results Eight standardized projections could be defined and included 3 AP, 1 lateral, 2 oblique, and 2 axial views. By applying these specific projections, we could visualize the epicondyles, the trochlea with its medial and lateral borders, the capitellum, the olecranon, the greater sigmoid notch, the coronoid process including its anteromedial facet, the proximal radioulnar joint with the radial tuberosity, and the anterior and posterior joint lines of the distal part of the humerus. These standard projections were reliably obtained using a specific sequence. Conclusions Knowledge about radiographic anatomy and standard projections is essential for visualizing important landmarks. With the presented standard projections of the elbow, important anatomical landmarks can be clearly examined. Thus, fluoroscopic visualization of anatomical fracture reduction and correct implant placement should be facilitated. Clinical Relevance This basic science cadaveric study defines fluoroscopic standard projections of the elbow essential for visualization of anatomical landmarks during surgery.
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Affiliation(s)
- Sebastian A Müller
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Lars Adolfsson
- Department of Orthopedic Surgery, Linköping University, Linköping, Sweden
| | - Cornelia Baum
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Andreas M Müller
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
| | - Daniel Rikli
- Department of Orthopedic Surgery (S.A.M., C.B., A.M.M., and D.R.) and Institute of Anatomy (M.M.-G.), University of Basel, Basel, Switzerland
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Stoops TK, Santoni BG, Clark NM, Bauer AA, Shoji C, Schwartz-Fernandes F. Sensitivity and Specificity of Skyline and Carpal Shoot-Through Fluoroscopic Views of Volar Plate Fixation of the Distal Radius: A Cadaveric Investigation of Dorsal Cortex Screw Penetration. Hand (N Y) 2017; 12:551-556. [PMID: 29091485 PMCID: PMC5669327 DOI: 10.1177/1558944716677336] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Volar plate fixation of distal radius fractures can result in soft tissue injuries. Abnormal contour of the dorsal cortex of the distal radius provides difficulties in discerning screw penetration on standard radiographs. The skyline and carpal shoot-through views are additional views to improve dorsal cortex visibility. We report on the sensitivity and specificity of determining screw protrusion with these views. METHODS Seven fresh frozen cadavers were instrumented with a distal radius volar locking plate. Initial screw length was determined by depth gauge measurement. A dorsal dissection of the wrist was performed to detect screw penetration. Protruding screws were documented and replaced with screws of the appropriate length and deemed as baseline. Screws were then sequentially lengthened by 2 and 4 mm. Skyline and carpal shoot-through views were obtained at baseline, 2 mm, and 4 mm. The images were randomized and compiled into an untimed survey asking orthopedic surgeons to determine whether screws were penetrating through the dorsal cortex. RESULTS Based on depth gauge measurements, 4 out of 44 (9.1%) volar plate locking screws penetrated the dorsal cortex, as confirmed with dorsal dissection. Sensitivities for the skyline and carpal shoot-through views were 75% and 86% ( P ≤ .001), respectively, for 2-mm protrusions, and 76% and 89% ( P ≤ .001), respectively, for 4-mm screw protrusions. Specificities were 85% and 84% for the skyline and shoot-through views, respectively. CONCLUSIONS We believe that the carpal shoot-through view has utility and can be implemented to augment standard intraoperative views, and may decrease the incidence of screw protrusion resulting in soft tissue injuries.
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Affiliation(s)
- T. Kyle Stoops
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA,T. Kyle Stoops, Foundation for Orthopaedic Research and Education, 13020 North Telecom Parkway, Tampa, FL 33637, USA.
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Mears SC, Kates SL. A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2. Geriatr Orthop Surg Rehabil 2015; 6:58-120. [PMID: 26246957 DOI: 10.1177/2151458515572697] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.
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Abstract
OBJECTIVES Determining the rate of specific adverse events after volar plating performed for distal radius fractures. DESIGN Retrospective. SETTING University level I trauma center. PATIENTS We searched the electronic database of all surgical procedures performed in our department using the following keywords: distal radius fracture, wrist fracture, and plate fixation. We identified 315 patients, 12 of whom were lost at follow-up. INTERVENTION Volar plate fixation for the treatment of distal radius fractures. MAIN OUTCOME MEASUREMENTS At an average follow-up of 5 years, 303 patients were evaluated through medical records and clinical and radiographic assessment for specific adverse events after volar plate fixation. RESULTS Adverse events were observed in 18 patients (5.9%). Implant-related adverse events, including tendon impairments, intra-articular screws, and screw loosening, were observed in 15 patients (5.0%). Extensor tendon impairments were represented by 5 cases of extensor tenosynovitis and 3 cases of rupture of the extensor pollicis longus due to screws protruding dorsally. Flexor impairments were represented by 2 cases of tenosynovitis and 2 cases of flexor pollicis longus rupture. Screw penetration into the radioulnar joint was observed in 1 case. Loss of reduction was identified in 3 cases. One patient had a deep postoperative infection treated with operative debridement. One patient experienced injury to the median nerve during routine implant removal unrelated to tendon issues. CONCLUSIONS The majority of adverse events after volar plate fixation were due to technical errors in implant placement. In our cohort, tendon impairments were the most frequently observed; among these, extensor tendon impairments were the most represented (50% of all adverse events). All 12 tendon-related adverse events were due to technical shortcomings with implant placement. LEVEL OF EVIDENCE Therapeutic level IV.
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Patel A, Culbertson MD, Lahey P, Semenovski M, Choueka J. Improving accuracy and confidence in distal radius volar plate screw placement through supplemental radiography: examining specialty, education, and experience levels. Hand (N Y) 2013; 8:308-14. [PMID: 24426939 PMCID: PMC3745250 DOI: 10.1007/s11552-013-9528-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to assess the extent to which a supplemental radiographic view increases accuracy and confidence ratings when determining screw placement in volar plating of distal radius fractures for evaluators of different specialties and experience levels. METHODS Thirty-four distal radius fractures treated with volar plate fixation were imaged using standard AP and lateral, and supplemental lateral tilt views. Each case was then evaluated for penetration of distal screw tips into the articular space. Sixty-five physicians then completed a two-phase analysis and survey of these cases. In the first phase, presentation consisted only of AP and lateral views; in the second, the lateral tilt view was added. Participants were asked to determine whether distal screws penetrated the joint and rate their confidence in the determination. Assessments were scored for correctness; changes in accuracy and confidence levels between phases were analyzed using paired t tests. Comparisons between groups were performed by ANOVA. RESULTS Supplementation increased accuracy and confidence in all position, specialty, and experience groups. Confidence scores were significantly higher following evaluation of three views versus two views. Residents exhibited the greatest improvements in accuracy and confidence. For first-phase (standard view) assessments, accuracy scores were significantly better for attendings with less than 10 years post-fellowship experience than those with more. CONCLUSIONS A supplemental view of the distal radius combined with AP and lateral views significantly improves the ability of all evaluators, regardless of specialty or training level, to correctly assess placement of fixation screws. The greatest improvements are seen for resident trainees.
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Affiliation(s)
- Archit Patel
- />Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA
| | - Maya Deza Culbertson
- />Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA
| | - Philip Lahey
- />Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA
| | - Michael Semenovski
- />Department of Anesthesiology & Pain Medicine at St. Elizabeth’s Medical Center, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135 USA
| | - Jack Choueka
- />Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St, Brooklyn, NY 11219 USA
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Rhee PC, Dennison DG, Kakar S. Avoiding and treating perioperative complications of distal radius fractures. Hand Clin 2012; 28:185-98. [PMID: 22554662 DOI: 10.1016/j.hcl.2012.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Numerous methods of treatment are available for the management of distal radius fractures, with modern trends favoring volar fixed-angle distal radius plates. Whatever the method of fixation, recognition, management, and prevention of the known associated complications are essential to achieve a good outcome. This article reviews the common preventable complications that are associated with operative treatment of distal radius fractures, including tendon injuries, inadequate reduction, subsidence or collapse, intra-articular placement of pegs or screws, nerve injuries, complex regional pain syndrome, carpal tunnel syndrome, and compartment syndrome.
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Affiliation(s)
- Peter C Rhee
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Intraoperative imaging of the distal radioulnar joint using a modified skyline view. J Hand Surg Am 2012; 37:503-8. [PMID: 22305825 DOI: 10.1016/j.jhsa.2011.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 12/05/2011] [Accepted: 12/09/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Nonanatomic reduction of the sigmoid notch in distal radius fractures may lead to limited motion, instability, or pain with pronation and supination. Standard radiological projections only poorly capture the sigmoid notch contours in the axial plane. The purpose of this study was to find an intraoperatively feasible radiological projection that will facilitate an axial view of the distal radioulnar joint. METHODS We modified a previously described radiographic projection termed the skyline view for evaluating the distal radius axially. We created intra-articular steps at the sigmoid notch in solid foam forearm models to identify the best of 12 projections using an image intensifier. Four observers scored each projection based on the clarity of the sigmoid notch contour and indicated the presence and location of an intra-articular stepoff. RESULTS The sigmoid notch was best visualized in the modified skyline view with the wrist in extension and 10° to 15° of dorsal forearm angulation relative to the x-ray path. All observers correctly recognized the presence and location of intra-articular steps at the sigmoid notch with this view. The same forearm angulation with the wrist in flexion did not reach equally good visibility of the sigmoid notch. Arm position (wrist flexion, forearm rotation, or forearm angulation) and intra-articular stepoff (none, palmar, or dorsal) were dependent determinates. Elimination of the variable forearm rotation had minimal effect, indicating that forearm rotation is not important for visualization of the sigmoid notch. CONCLUSIONS The modified skyline view for visualization of the distal radioulnar joint in an axial plane allows good visibility of the sigmoid notch and reliable identification of stepoffs. Further cadaver and in vivo studies are required to verify the validity of this method.
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Bukata SV, Digiovanni BF, Friedman SM, Hoyen H, Kates A, Kates SL, Mears SC, Mendelson DA, Serna FH, Sieber FE, Tyler WK. A guide to improving the care of patients with fragility fractures. Geriatr Orthop Surg Rehabil 2011; 2:5-37. [PMID: 23569668 PMCID: PMC3597301 DOI: 10.1177/2151458510397504] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Susan V Bukata
- Corresponding Author: Associate Professor, Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
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