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Dalton JF, Luchetti TJ, Cluts LM, Bhogal SS, Kaufmann RA, Goitz RJ, Fowler JR. Comparison of Patient-Reported Outcomes With or Without Prophylactic Carpal Tunnel Release After Distal Radius Fracture Stabilization. Orthopedics 2023; 46:e362-e368. [PMID: 37052597 DOI: 10.3928/01477447-20230407-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Distal radius fractures (DRFs) are frequently complicated by acute carpal tunnel syndrome (CTS), which, if unrecognized, can cause permanent median neuropathy. Some surgeons recommend "prophylactic" carpal tunnel release (CTR) during open reduction and internal fixation (ORIF) of DRF. Patient-reported outcomes (PROs) and safety data regarding prophylactic vs symptomatic CTR strategies during DRF fixation are lacking. We conducted a retrospective review of two management strategies for DRFs at our institution (2017 to 2019). Group 1 consisted of patients operated on by two surgeons performing ORIF and symptomatic CTR only for acute CTS. Group 2 consisted of patients operated on by a third surgeon performing ORIF and prophylactic CTR on all patients irrespective of median nerve symptoms. The PROs included QuickDASH Wrist and PROMIS physical/mental health preoperatively vs at final follow-up. Demographic information, complications, and return to the operating room were recorded. Group 1 (36 patients) and group 2 (76 patients) were demographically similar. The mechanism of injury was more severe in group 1 (P<.05), but preoperative PROs were similar between the two groups. Eight patients (22.2%) in group 1 had symptomatic CTR for acute CTS. Significant improvement occurred within both groups from preoperative to final follow-up for PROMIS physical function and QuickDASH Wrist scores (P<.05). Intergroup PROs were not significantly different at either time point. One patient in group 1 (2.8%) and 2 patients in group 2 (2.6%) returned to the operating room due to median nerve symptoms (P>.05). A prophylactic CTR strategy is not associated with improved PROs compared with a symptomatic strategy during ORIF of DRF. [Orthopedics. 2023;46(6):e362-e368.].
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U J, Ethiraj P, M U, H S A. Incidence of Carpal Tunnel Syndrome in Distal Radius Fractures Treated by Various Modalities in a Tertiary Care Center: A Single Center Study. Cureus 2023; 15:e35346. [PMID: 36974255 PMCID: PMC10039760 DOI: 10.7759/cureus.35346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Background Distal end radius fractures (DRF), which account for 17.5% of all fractures, are the most frequent fracture seen in emergency rooms. In patients with DRFs, delayed carpal tunnel syndrome (CTS) occurs in about 20% of cases. When patients are treated with DRFs using different modalities, CTS results in poor functional outcomes. Our study aims to identify the prevalence of CTS in DRF patients receiving treatment with various modalities. Materials and methods Two hundred twenty patients with a history of DRFs who were treated by a variety of modalities at R.L. Jalappa Hospital and Research Center between January 2013 and January 2018 are included in this retrospective analysis. The medical records from the department of the hospital's paperwork were used to gather the patient's information and radiographs. The information was gathered, tabulated, and examined. Results In our study, the incidence of CTS in DRF was calculated using a sample size of 220 and found to be 32.73%. The incidence of CTS was shown to be higher in groups with more comminution than less comminution when treatment modalities were analyzed. These groups included closed reduction and internal fixation (CRIF)/open reduction and internal fixation (ORIF) with K wire, external fixation, conservative with the cast, ORIF with variable angle volar locking plate (VAVLP), and ORIF with volar T locking plates (VTLP). Conclusions After DRFs, carpal tunnel syndrome is the most significant consequence limiting functional results, hence preventing it requires considerably more attention and care.
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Bhashyam AR, Kao DS. Surgical Technique for Concurrent Endoscopic Carpal Tunnel Release and Distal Radius Fracture Fixation Using the Flexor Carpi Radialis Approach: A Case Series. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:166-171. [PMID: 35601523 PMCID: PMC9120784 DOI: 10.1016/j.jhsg.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Multiple prior studies have assessed the results of open approaches for concurrent carpal tunnel release with distal radius fracture fixation; however, less is known regarding the feasibility of endoscopic techniques, especially in the setting of high-energy trauma. In this study, we assessed the feasibility and results of concurrent endoscopic carpal tunnel release and distal radius fracture fixation using the flexor carpi radialis approach after high- and low-energy trauma. Methods We performed a retrospective, single-surgeon study of 17 consecutive adult patients (aged >18 years) who underwent open reduction internal fixation of an acute distal radius fracture with concurrent endoscopic carpal tunnel release at a level 1 trauma center between April 2017 and October 2020. Recovery from median nerve dysfunction was assessed from patient charts at routinely scheduled postoperative follow-up visits (at 2 weeks, 4 weeks, 6 weeks, and 12 weeks). Results The transverse carpal ligament could be visualized and released in all patients. All patients had a return of light touch sensibility with or without intermittent paresthesia by 12 weeks after surgery (the median time from surgery to recovery was 19 days [range, 12–82 days]). There were no patient reports or clinical examination evidence of palmar cutaneous branch, recurrent motor branch, or the third common digital nerve injury. Time to recovery was significantly different in the setting of high- versus low-energy trauma (26 days vs 18 days, respectively; P = .02). Conclusions In this study, we demonstrated that concurrent endoscopic carpal tunnel release using the flexor carpi radialis approach for distal radius fracture fixation in the settings of high- and low-energy trauma is safe from major complications and effective at releasing the transverse carpal ligament. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Abhiram R. Bhashyam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
- Corresponding author: Abhiram R. Bhashyam, MD, PhD, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
| | - Dennis S. Kao
- Division of Plastic Surgery, University of Washington, Seattle, WA
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Avoiding Complications in Distal Radius Fractures. J Orthop Trauma 2021; 35:s27-s32. [PMID: 34415879 DOI: 10.1097/bot.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 02/02/2023]
Abstract
Managing fractures of the distal radius is a fundamental skill for orthopaedic surgeons. Given the prevalence of these fractures, complications following operative management are well described and frequently encountered. Surgeons should be observant in the acute phase for emergent conditions such as acute carpal tunnel syndrome. Careful radiographic examination intra-operatively can help prevent delayed complications by identifying surgical errors such as hardware malposition or malreduction. Many problems that arise during the treatment of distal radius fractures are the result of technical errors and can be anticipated.
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Sugiyama Y, Naito K, Miyamoto H, Goto K, Kinoshita M, Nagura N, Iwase Y, Kaneko K. A Survey of the Median Nerve Elasticity after Volar Locking Plate Fixation Using Ultrasound Elastography. J Hand Microsurg 2020; 12:95-99. [PMID: 32788823 DOI: 10.1055/s-0039-1685544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Introduction Median nerve disorder is one of the complications after surgery using volar locking plate (VLP) for distal radius fracture (DRF). In this study, elasticity of the median nerve was quantified using ultrasound elastography (EG) (real-time tissue EG) and compared between the operation and healthy sides in patients after surgery for DRF using VLP. Materials and Methods The subjects of this study were 28 patients (4 males and 24 females; mean age: 58.5 years) who could be followed up for more than 6 months after surgery for DRF and were able to be examined by EG. We evaluated median nerve elasticities on the operation and healthy sides using EG on the final follow-up. Results The median nerve strain ratios were 3.97 ± 2.99 on the operation side and 3.91 ± 1.51 on the healthy side, showing no significant difference in elasticity of the median nerve between the operation and healthy sides. Conclusion Median nerve disorder, which is a complication after surgery with VLP, can be objectively detected using EG capable of evaluating median nerve elasticity externally to detect medial nerve degeneration while degeneration of the median nerve. Thus, EG may be used as a useful diagnostic tool to prevent complications and decide on appropriate timing of VLP extraction.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideaki Miyamoto
- Trauma and Reconstruction Center, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
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Shah KN, Goodman AD, Durand W, Daniels AH, Weiss APC. Acute Carpal Tunnel Syndrome in Inpatients With Operative Distal Radius Fracture. Orthopedics 2019; 42:227-234. [PMID: 31136674 DOI: 10.3928/01477447-20190523-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/26/2019] [Indexed: 02/03/2023]
Abstract
Acute carpal tunnel syndrome (CTS) may occur concomitantly with distal radius fracture (DRF) and is often managed with carpal tunnel release (CTR). Carpal tunnel syndrome may also develop postoperatively after DRF fixation. The authors sought to determine the rate of CTS with DRF, prophylactic CTR, and postoperative development of CTS. Furthermore, they also sought to identify predictors of these. The Nationwide Inpatient Sample database was queried (2002 to 2014) to identify adult inpatients undergoing surgical fixation of DRFs. They were segregated by the presence of CTS and further stratified by the timing of CTR in relation to DRF fixation. Those with a CTS diagnosis undergoing CTR on the same day as or prior to DRF fixation were classified as having CTS concomitantly. Patients undergoing CTR without a CTS diagnosis were considered prophylactically released. Carpal tunnel releases on any day after fracture fixation were considered complications. The authors identified 275,052 inpatients who had fixation of DRFs. Of these, 11,816 patients (4.3%) had CTS concomitantly. A total of 530 patients developed CTS after their DRF fixation (0.3%). Of those without CTS, 4420 patients (1.6%) underwent prophylactic CTR. Male sex, age younger than 50 years, and polytrauma status were associated with concomitant CTS and prophylactic CTR. Age younger than 50 years and polytrauma status were associated with postoperative development of CTS. The authors identified the rate of concomitant CTS, prophylactic CTR, and CTS developing postoperatively in inpatients undergoing DRF fixation. As early recognition and treatment optimizes outcomes after acute CTS, these data draw attention to the high rate of CTS and may be useful to surgeons treating patients with DRFs. [Orthopedics. 2019; 42(4):227-234.].
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Seigerman D, Lutsky K, Fletcher D, Katt B, Kwok M, Mazur D, Sodha S, Beredjiklian PK. Complications in the Management of Distal Radius Fractures: How Do We Avoid them? Curr Rev Musculoskelet Med 2019; 12:204-212. [PMID: 30826959 PMCID: PMC6542871 DOI: 10.1007/s12178-019-09544-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THIS REVIEW Distal radius fractures are one of the most common fractures in the upper extremity. The purpose of this review is to outline common complications that may arise when caring for distal radius fractures and to describe the treatment strategies when faced with such complications. RECENT FINDINGS Tendon complications are not uncommon after distal radius fractures. Recent literature highlights new plating technology for dorsal plating techniques. Moreover, new literature has outlined parameters for flexor tendon complications when using volar locking plates in an effort to avoid flexor tendon irritation and rupture. In summary, it is important to understand the various complications that can arise when treating distal radius fractures in an effort to avoid suboptimal outcomes.
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Affiliation(s)
- Daniel Seigerman
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Kevin Lutsky
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Daniel Fletcher
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Brian Katt
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Moody Kwok
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Donald Mazur
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Samir Sodha
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Pedro K Beredjiklian
- Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
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Earp BE, Mora AN, Floyd WE, Blazar PE. Predictors of Acute Carpal Tunnel Syndrome Following ORIF of Distal Radius Fractures: A Matched Case–Control Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Alter TH, Ilyas AM. Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.18.00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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10
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Systematic review and pooled analysis of the rate of carpal tunnel syndrome after prophylactic carpal tunnel release in patients with a distal radius fracture. HAND SURGERY & REHABILITATION 2018; 37:155-159. [DOI: 10.1016/j.hansur.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/21/2018] [Accepted: 02/27/2018] [Indexed: 01/23/2023]
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Abstract
Carpal tunnel syndrome (CTS) after distal radius fractures can present in 3 forms: acute, transient, and delayed. Acute CTS requires an emergent carpal tunnel release. Many patients with transient CTS after distal radius fracture do not require surgical release of the carpal tunnel once the fracture is repaired. Prophylactic carpal tunnel release in the absence of signs and symptoms of CTS after a distal radius fracture is not indicated. For patients with delayed CTS after a distal radius fracture, all possible causes of nerve compression should be considered and addressed in standard fashion.
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12
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Samson D, Power DM. Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius. J Hand Surg Asian Pac Vol 2017; 22:343-349. [DOI: 10.1142/s021881041750040x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Our aims were to identify iatrogenous injuries to the palmar branch of the median nerve sustained during volar plate fixation of the distal radius, make the clinician aware of this relatively uncommon complication of distal radius fixation, to emphasise common threads in symptomatology and to propose an algorithm for evaluation and management. Methods: Retrospectively interrogating our database over a 5 year period, the case records, neurophysiology records, operative records, therapy records were reviewed. The data was analysed with regard to the grade of surgeon performing the procedure, the site of injury, complexity of the fracture, delay to surgery, implant choice and outcome of the treatment. Variations in nerve anatomy were documented during revision surgery and common themes in symptomatology and clinical presentation were identified. Results: Seven patients with an iatrogenic injury involving the palmar branch of the median nerve associated with volar plate fixation of the distal radius were assessed. The male: female ratio was 1:6 and the mean age of patients was 47.8 years (33-74 years). The initial operative fixation was undertaken by a consultant orthopaedic surgeon at a mean of 7.8 (1-17) days from injury. The mean time from fracture fixation surgery to referral to the peripheral nerve injury service was 8.9 (2-36) months. Six patients presented with pain on attempted wrist extension. Five patients had parasthesia, hyperaesthesia or dysaesthesia in the distribution of the PCBMN. Anaesthesia or hypoaesthesia was present in three patients. Two patients presented with symptoms of complex regional pain syndrome (CRPS) Type 2. Conclusions: Revising relevant anatomy and possible variations as well as careful placements of retractors in the region of the median nerve could bring down these injuries. We propose an algorithm for their management.
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Affiliation(s)
- Deepak Samson
- Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth University Hospital, Edgbaston, UK
| | - Dominic M. Power
- Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth University Hospital, Edgbaston, UK
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13
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[Nerve injuries associated with distal radius fractures]. HAND SURGERY & REHABILITATION 2016; 35S:S75-S79. [PMID: 27890216 DOI: 10.1016/j.hansur.2016.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/26/2015] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
Abstract
Nerve damage is a common complication of distal radius fractures. It may be a result of the injury event or be iatrogenic. It is the source of disability and potential handicap. There is little published data on this topic and no study has validated the strategies needed to prevent or manage these nerve-related complications. There is no consensus on treatment. Prevention requires a good knowledge of the various surgical approaches and rigorous fracture fixation technique. The objective of this article is to take stock of recent data from the scientific literature.
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Gaspar MP, Sessions BA, Dudoussat BS, Kane PM. Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study. J Wrist Surg 2016; 5:241-246. [PMID: 27468377 PMCID: PMC4959898 DOI: 10.1055/s-0036-1581053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The safety of surgical approaches for single- versus double-incision carpal tunnel release in association with distal radius open reduction and internal fixation remains controversial. PURPOSE The purpose of this study was to identify critical structures to determine if a single-incision extension of the standard flexor carpi radialis (FCR) approach can be performed safely. METHODS Nine cadaveric arms with were dissected under loupe magnification, utilizing a standard FCR approach. After the distal radius exposure was complete, the distal portion of the FCR incision was extended to allow release of the carpal tunnel. Dissection of critical structures was performed, including the recurrent thenar motor branch of the median nerve, the palmar cutaneous branch of the median nerve (PCBm), the palmar carpal and superficial palmar branches of the radial artery, and proximally the median nerve proper. The anatomic relationship of these structures relative to the surgical approach was recorded. RESULTS Extension of the standard FCR approach as described in this study did not damage any critical structure in the specimens dissected. The PCBm was noted to arise from the radial side of the median nerve an average of 6.01cm proximal to the proximal edge of the transverse carpal ligament. The PCBm became enveloped in the layers of the antebrachial fascia and the transverse carpal ligament at the incision site, protecting it from injury. The recurrent motor branch of the median nerve, branches of the radial artery and the median nerve proper were not at risk during extension of the FCR approach to release the carpal tunnel. CONCLUSIONS Extension of the standard FCR approach to include carpal tunnel release can be performed with minimal risk to the underlying structures. This exposure may offer benefits in both visualization and extent of carpal tunnel release.
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Affiliation(s)
- Michael P. Gaspar
- Department of Orthopedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Blane A. Sessions
- Department of Orthopedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Bryan S. Dudoussat
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patrick M. Kane
- Department of Orthopedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am 2016; 41:845-54. [PMID: 27342171 DOI: 10.1016/j.jhsa.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/25/2016] [Indexed: 02/02/2023]
Abstract
Distal radius fractures remain among the most common fractures of the upper extremity. The indications for operative management continue to evolve based on outcomes from the most recent clinical studies. Advancements over the past decade have expanded the variety of fixation options available; however, the clinical superiority of a particular treatment modality remains without consensus. Each approach requires the use of unique surgical techniques, and the choice of a particular implant system should be based on the surgeon's familiarity with the implant design and its limitations. As our understanding of the management of distal radius fractures improves, so will our indications for each specific treatment modality.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - J Ryan Hill
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
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16
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Chhabra AB. In Reply. J Hand Surg Am 2016; 41:e111-2. [PMID: 27113710 DOI: 10.1016/j.jhsa.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 02/02/2023]
Affiliation(s)
- A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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17
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Avis D, Power D. Letter Regarding "The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture". J Hand Surg Am 2016; 41:e111. [PMID: 27113711 DOI: 10.1016/j.jhsa.2016.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/05/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Duncan Avis
- Centre for Nerve Injury and Paralysis, Birmingham Hand Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Dominic Power
- Centre for Nerve Injury and Paralysis, Birmingham Hand Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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18
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Abstract
Complications following any form of distal radius fixation remain prevalent. With an armamentarium of fixation options available to practicing surgeons, familiarity with the risks of newer plate technology as it compares with other conventional methods is crucial to optimizing surgical outcome and managing patient expectations. This article presents an updated review on complications following various forms of distal radius fixation.
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Affiliation(s)
- Dennis S Lee
- Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232, USA.
| | - Douglas R Weikert
- Orthopaedic Surgery and Rehabilitation, Hand and Upper Extremity Center, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 3200, Nashville, TN 37232, USA
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19
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Tannan SC, Pappou IP, Gwathmey FW, Freilich AM, Chhabra AB. The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture. J Hand Surg Am 2015; 40:2026-2031.e1. [PMID: 26304737 DOI: 10.1016/j.jhsa.2015.07.001] [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] [Received: 04/17/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the relative benefits of an extended flexor carpi radialis (FCR) (eFCR) approach with prophylactic carpal tunnel release at the time of volar plate osteosynthesis for distal radius fracture via a single incision into the traditional volar Henry (VH) approach. METHODS This was a prospective cohort comparison of preoperative and postoperative median nerve function of 27 patients (15 eFCR and 12 VH) with unilateral, isolated distal radius fractures requiring open reduction internal fixation without preoperative acute carpal tunnel syndrome. Patients were operated on via either the eFCR or VH approach. The validated Levine-Katz Carpal Tunnel Questionnaire (symptom and functional severity scores) was administered and Semmes-Weinstein monofilament and 2-point discrimination testing were conducted preoperatively and at 6 weeks and 3 months postoperatively. Grip and pinch strength were measured at 6 weeks and 3 months. The groups were comparable in terms of age, sex, and fracture type and displacement. RESULTS Comparing across groups, there were no statistically significant differences in any outcome measured preoperatively or postoperatively. The eFCR and VH groups demonstrated significant improvement in functional severity scores, symptom severity, and grip strength. The symptom severity score improved to statistical significance at 6 weeks in the eFCR group and at 3 months in the VH group. CONCLUSIONS In this small comparative study, the eFCR approach was found to be safe and efficacious. There was no increased surgical morbidity, which suggests that this technique can be used safely for all patients undergoing volar plating and not just in cases of concurrent carpal tunnel syndrome. It allows easier retraction of carpal tunnel contents; therefore, it is our preferred approach.
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Affiliation(s)
- Shruti C Tannan
- Department of Plastic Surgery and Orthopaedics, Wake Forest University Medical Center, Winston-Salem, NC
| | - Ioannis P Pappou
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Frank W Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Aaron M Freilich
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Ka-Ho T, Kai-Yiu C, Yat-Fai C, Shun-Chung L, Yuk-Yin C. Locking Plate for AO Type C Intra-articular Distal Radius Fracture: Volar or Dorsal Approach? JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2014. [DOI: 10.1016/j.jotr.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose There is controversy over the outcomes and complications of volar and dorsal plating for the treatment of intra-articular fracture distal radius. Methods From 2008 to 2010, 81 patients with intra-articular fracture distal radius of AO type C1–C3 treated with distal radius locking plates via volar or dorsal approaches were reviewed in our institute. The clinical, radiological, and functional outcomes were evaluated at 6 months after operation. Results The volar approach group showed a significantly better flexion range, flexion-extension arc as well as Green and O'Brien functional score than dorsal approach group. Volar tilting of the distal radius was significantly better in the dorsal group, but that did not contribute to better palmar—flexion range or grip strength. Overall complication rate was similar in both groups. Conclusion The volar approach group demonstrated better range of motion and functional score. The complication rates were similar between the two groups. The volar surgical approach should be adopted in most operative cases of AO type C intra-articular fracture distal radius while the dorsal approach should be reserved for intra-articular fracture with dorsal comminuted fragments.
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Affiliation(s)
- Tsang Ka-Ho
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
| | - Choi Kai-Yiu
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
| | - Chan Yat-Fai
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
| | - Lau Shun-Chung
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
| | - Chow Yuk-Yin
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
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Calleja H, Tsai TM, Kaufman C. Carpal tunnel release using the radial sided approach compared with the two-incision approach. ACTA ACUST UNITED AC 2014; 19:375-80. [PMID: 25155704 DOI: 10.1142/s0218810414500300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We compared carpal tunnel release using a radial sided approach (RCTR) with a two-incision approach with regards to complications, grip strength, and functional outcomes. Retrospective chart review was done and data was collected pre-operatively, and post-operatively at six weeks and three months. A total of 32 and 26 patients were included in the two-incision and RCTR groups respectively. At six weeks, the RCTR group showed an increased grip strength (+32.24%) while the two-incision group was weaker (-6.75%). Both groups showed an increased strength at three months, RCTR at 98.4% while the two-incision group was significantly lower at 38.6% increase. Both techniques provided improvement in outcome scores, with no statistical difference. RCTR was associated with a significantly earlier return of grip strength and had better grip strength at six weeks and three months post-operatively. Both techniques provided symptom relief and good functional outcome.
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Affiliation(s)
- Henry Calleja
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA , University of Louisville, Louisville, Kentucky, USA
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Complications after volar plating of distal radius fractures. J Hand Surg Am 2014; 39:1183-5; quiz 1186. [PMID: 24810935 DOI: 10.1016/j.jhsa.2014.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
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Abstract
Carpal tunnel syndrome is a common condition and is a well-recognized phenomenon following a distal radius fracture. The treating surgeon should be vigilant in noticing the signs and symptoms. If acute carpal tunnel syndrome is noted, then surgical release of the carpal tunnel and fracture fixation should be performed urgently. If early carpal tunnel syndrome findings are noted during distal radius fracture management, all potential causes should be evaluated. Delayed carpal tunnel syndrome presenting after a distal radius fracture has healed is best managed in standard fashion. There is no role for prophylactic carpal tunnel release at the time of distal radius fixation in a patient who is asymptomatic.
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Affiliation(s)
- Genghis E Niver
- Hand and Upper Extremity Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
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25
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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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