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Seok HG, Park WT, Park SJ, Park SG. Small volar fragment in the lunate fossa leads to volar tilt loss after volar plate fixation for AO/OTA type-C distal radius fracture. HAND SURGERY & REHABILITATION 2024; 43:101674. [PMID: 38431044 DOI: 10.1016/j.hansur.2024.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The relationship between volar fragment size and postoperative volar tilt loss in complete articular distal radius fracture is not well known. In this study, we measured precise radiological parameters to help identify other factors that might contribute to volar tilt loss. MATERIAL AND METHODS We retrospectively reviewed the radiological examinations and charts of 256 patients with distal radial fracture who underwent volar locking plate fixation between March 2014 and July 2022. Radiological parameters were measured based on preoperative CT and immediate postoperative radiographs. Univariate and multivariate linear regression analysis was performed to identify relevant factors associated with volar tilt loss following volar locking plate fixation. The receiver operating characteristic curve was used to identify the cutoff value of the independent parameters. RESULTS On univariate analysis, 2 radiologic parameters on preoperative CT (volar fragment length at the lunate fossa, and teardrop angle) and 4 on immediate postoperative X-ray (radial inclination, radial length, capitate shift, and volar tilt) were significantly associated with postoperative volar tilt loss. On multivariate linear regression analysis, the risk of volar tilt loss increased as the capitate moved toward the back of the radial shaft. The cut-off for anteroposterior length in the lunate fossa was 6.5 mm. CONCLUSIONS AO/OTA type-C distal radius fractures with <6.5 mm anteroposterior length in the lunate fossa had significantly higher rates of malunion with dorsal deformity. In addition, preoperative teardrop angle <37.2 ° and immediate postoperative volar tilt <3.7º are also predictors of postoperative volar tilt loss.
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Affiliation(s)
- Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Wook Tae Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Sung-Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea.
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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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Franovic S, Pietroski AD, Druskovich K, Page B, Burdick GB, Fathima B, McIntosh MJ, King EA, Muh SJ. A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:169-177. [PMID: 36974282 PMCID: PMC10039314 DOI: 10.1016/j.jhsg.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To conduct a cost-effectiveness study of nonsurgical and surgical treatment options for distal radius fractures using distinct posttreatment outcome patterns. Methods We created a decision tree to model the following treatment modalities for distal radius fractures: nonsurgical management, external fixation, percutaneous pinning, and plate fixation. Each node of the model was associated with specific costs in dollars, a utility adjustment (quality-adjusted life year [QALY]), and a percent likelihood. The nodes of the decision tree included uneventful healing, eventful healing and no further intervention, carpal tunnel syndrome, trigger finger, and tendon rupture as well as associated treatments for each event. The percent probabilities of each transition state, QALY values, and costs of intervention were gleaned from a systematic review. Rollback and incremental cost-effectiveness ratio analyses were conducted to identify optimal treatment strategies. Threshold values of $50,000/QALY and $100,000/QALY were used to distinguish the modalities in the incremental cost-effectiveness ratio analysis. Results Both the rollback analysis and the incremental cost-effectiveness ratio analysis revealed nonsurgical management as the predominant strategy when compared with the other operative modalities. Nonsurgical management dominated external fixation and plate fixation, although it was comparable with percutaneous fixation, yielding a $2,242 lesser cost and 0.017 lesser effectiveness. Conclusions The cost effectiveness of nonsurgical management is driven by its decreased cost to the health care system. Plate and external fixation have been shown to be both more expensive and less effective than other proposed treatments. Percutaneous pinning has demonstrated more favorable effectiveness in the literature than plate and external fixation and, thus, may be more cost effective in certain circumstances. Future studies may find value in investigating further clinical aspects of distal radius fractures and their association with nonsurgical management versus that with plate fixation. Type of study/level of evidence Economic/decision analysis II.
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Affiliation(s)
- Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | | | | | - Brendan Page
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | - Gabriel B. Burdick
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | - Bushra Fathima
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | | | - Elizabeth A. King
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
| | - Stephanie J. Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
- Corresponding author: Stephanie J. Muh, MD, Division of Hand and Upper Extremity, Department of Orthopaedic Surgery, Henry Ford Health System, West Bloomfield, MI 48202.
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Ghafoor H, Haefeli M, Steiger R, Honigmann P. Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases. J Wrist Surg 2022; 11:134-144. [PMID: 35478945 PMCID: PMC9038308 DOI: 10.1055/s-0041-1735839] [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: 12/12/2020] [Accepted: 08/03/2021] [Indexed: 10/27/2022]
Abstract
Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III-V.
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Affiliation(s)
- Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Regula Steiger
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Orthopraxis Lusser, Allschwil, Switzerland
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group, University of Basel, Allschwil, Switzerland
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5
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Sakamoto S, Doi K, Hattori Y, Al-Bazzaz A, Hayashi K, Sonezaki S. Comminuted Dorsal Ulnar Fragment in Distal Radius Fractures Treated Using the Integrated Compression Screw With a Mini-Plate. J Hand Surg Am 2022; 47:394.e1-394.e6. [PMID: 34674899 DOI: 10.1016/j.jhsa.2021.09.002] [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: 10/07/2020] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
Stabilization for displaced dorsoulnar fragments in distal radius fractures is challenging to treat with conventional volar locking plates alone. The integrated compression screw combined with a volar locking plate has been introduced as an additional tool to stabilize the dorsoulnar fragment and has been reported to work effectively. However, the compression screw is unable to stabilize a comminuted dorsal ulnar fragment; therefore, it is necessary to consider using an additional dorsal plate. We have developed a modified surgical technique to stabilize a comminuted dorsal intra-articular fragment by combining the integrated compression screw with a mini-plate as a washer or a buttress.
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Affiliation(s)
- Sotetsu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan.
| | - Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Abdullah Al-Bazzaz
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Kota Hayashi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Shichoh Sonezaki
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
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Maiello A, Rivera F, Maniscalco P, Colombo M, Di Stefano G, Quattrini F. Tronco-conical locking plate in distal radius fractures. Injury 2022; 53 Suppl 1:S19-S22. [PMID: 33158498 DOI: 10.1016/j.injury.2020.10.084] [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: 07/29/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Volar locked plates represent the most popular fixation technique for distal radius fracture (DRF). However, threaded screw-hole angular stability mechanism has some issues. The purpose of our study is to evaluate clinical and radiological outcome of a tronco-conical locking mechanism for volar plating of DRF. MATERIALS AND METHODS Eighty patients with DRF treated with tronco-conical locking volar plates between May 2013 to December 2017 in two institutions were collected. We analysed clinical and radiological outcomes and peri-operative complications, like loss of reduction, fragment displacement, deformation or implant-related problems and surgical and other general complications. RESULTS 78 patients were available for at final follow-up. The average follow-up period was 11.4 months (range, 6-18 months). All fractures healed within three months. Five cases of final reductions were defined unsatisfying. According to Gartland and Werley's scoring system at final follow up, 36 patients had excellent results, 40 patients had good results, one patient had fair and one patient had poor results. Five complications were observed. No complications were observed during surgical plate removal. CONCLUSION Complications found in our study are not related to tronco-conical locking mechanism and are like those found in the literature. Further studies are needed to evaluate functional results or radiographic parameters of this new type of angular stability mechanism. Tronco-conical locking plate is an attractive alternative threaded screw-hole angular stability mechanism.
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Affiliation(s)
- Alessio Maiello
- Orthopaedic and Trauma Department, S.S. Annunziata Hospital, Savigliano (CN), Italy.
| | - Fabrizio Rivera
- Orthopaedic and Trauma Department, S.S. Annunziata Hospital, Savigliano (CN), Italy
| | - Pietro Maniscalco
- Orthopaedic and Traumatology Department, G. da Saliceto Hospital, Piacenza, Italy
| | | | - Giovanni Di Stefano
- Orthopaedic and Traumatology Department, G. da Saliceto Hospital, Piacenza, Italy
| | - Fabrizio Quattrini
- Orthopaedic and Traumatology Department, G. da Saliceto Hospital, Piacenza, Italy
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Lüdi S, Kurz C, Deforth M, Ghafoor H, Haefeli M, Honigmann P. Radiological, Clinical and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures. J Hand Surg Am 2022; 48:377-387. [PMID: 35190216 DOI: 10.1016/j.jhsa.2021.12.002] [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: 01/04/2021] [Revised: 10/17/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures. METHODS We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires. RESULTS Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients. CONCLUSION The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Simona Lüdi
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Charlotte Kurz
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Handclinic AG Rüti, Rüti, Switzerland
| | - Manja Deforth
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Haval Ghafoor
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland
| | - Mathias Haefeli
- Hand Surgery, Kantonsspital Graubünden, Chur, Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Switzerland; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Medical Additive Manufacturing research group, Department of Biomedical Engineering, University of Basel, Switzerland
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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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Beyer J, Wynkoop E, Liu J, Ebraheim NA. Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies. J Wrist Surg 2021; 10:440-457. [PMID: 34631298 PMCID: PMC8489996 DOI: 10.1055/s-0041-1723793] [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: 06/18/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.
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Affiliation(s)
- Julia Beyer
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Emily Wynkoop
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Jiayong Liu
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Nabil A. Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
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10
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Gui XY, Cheng ZH, Shi HF, Chen YX, Xiong J, Wang JF, Qiu XS, Zhang ZT. Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution. J Orthop Surg Res 2021; 16:530. [PMID: 34433474 PMCID: PMC8385909 DOI: 10.1186/s13018-021-02641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. MATERIALS AND METHODS Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors' institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. RESULTS A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month's follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. CONCLUSIONS The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. TRIAL REGISTRATION This study has been registered on the ClinicalTrials.gov.
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Affiliation(s)
- Xue-Yang Gui
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zhao-Hui Cheng
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Hong-Fei Shi
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Yi-Xin Chen
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jun-Fei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Xu-Sheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zi-Tao Zhang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
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Gui XY, Shi HF, Xiong J, Chen YX, Wang JF, Huang J, Qiu XS, Wang YH. A modified intrafocal pinning technique with three-dimensional planning to facilitate volar plating in dorsally comminuted AO/OTA C2 and C3 distal radius fractures. BMC Musculoskelet Disord 2021; 22:379. [PMID: 33892699 PMCID: PMC8066843 DOI: 10.1186/s12891-021-04265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/14/2021] [Indexed: 01/03/2023] Open
Abstract
Backgrounds Theaim of this study was to assess the efficacy of a modified intrafocal pinningtechnique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures. Methods Intotal 35 AO/OTA type C2 and C3 fractures were finally included.The 3D digital model of the fracture was reconstructed based on preoperative computedtomographic (CT) images, with the displacement of the comminuted dorsalfragment and the intra-articular fragment analyzed for preoperative planning. During operation, amodified intrafocal pinning technique was applied percutaneously from thedorsal aspect of the radius to reduce the collapsed intra-articular fragmentfollowing volar plating. Adequate reduction was confirmed in all of patientsconsidering radial height, radial inclination and volar tilt in postoperativeradiographs. Results No significant fracture re-displacement wasobserved in most of the cases during a mean follow-up period of 17.4 months, exceptfor two patients withthe C3 fracture. All of the patients achieved adequate clinicalROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achievedan excellent (n = 21) or good (n = 12) Gartland and Werley wrist score. Conclusions Ourmodified intrafocal pinning technique with 3D planning contributes to a satisfactoryclinical and radiological outcome in dorsally comminuted intra-articular distalradius fractures fixed with a volar locking plate. Trialregistration Notapplicable because the design of the study is retrospective.
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Affiliation(s)
- Xue-Yang Gui
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Hong-Fei Shi
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
| | - Yi-Xin Chen
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jun-Fei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jie Huang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Xu-Sheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Yin-He Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
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12
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Martin DP, Park AG, Jamison D, Jones CM, Ilyas AM. Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius. J Hand Surg Am 2019; 44:1093.e1-1093.e8. [PMID: 30898463 DOI: 10.1016/j.jhsa.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This biomechanical study compared the stability of volar locking plates (VLPs) and locking fragment-specific (LFS) dorsal and radial styloid plates for the fixation of dorsal (AO 23-B2) and radial styloid (AO 23-B1) shear fractures of the distal radius, respectively. METHODS Two groups of 6 composite radii were fixed with a VLP or an LFS dorsal plate over a simulated dorsal shear fracture. Two additional groups of 6 radii received the same VLP or an LFS radial plate to fix a radial styloid fracture. Each plated radius was tested under cyclic axial compression by a servohydraulic testing machine that recorded axial displacement per cycle. Construct stiffness was calculated from the slope of the force-displacement curve. RESULTS In the dorsal shear fracture model, the dorsal LFS plate exhibited less displacement than the VLP (0.32 ± 0.04 vs 0.43 ± 0.07 mm, respectively) and showed greater average stiffness (645 ± 64 vs 433 ± 88 N/mm, respectively). Plate type was responsible for 53.1% of the variation in displacement and 68.6% of the variation in stiffness. In the radial styloid fracture model, variations due to number of cycles elapsed and plate type were similar for displacement and stiffness in both groups. The average stiffness during cyclical nondestructive testing was 566 ± 45 and 573 ± 60 N/mm for VLP and LFS radial plating groups, respectively. CONCLUSIONS For AO 23-B2 (dorsal rim) fractures, the dorsal LFS plates exhibited significantly less displacement and greater stiffness in axial loading than VLPs. For AO 23-B1 (radial styloid) fractures, the VLP displayed similar displacement and stiffness to the radial LFS plates. CLINICAL RELEVANCE All constructs tested could be expected to withstand axial compressive forces typical of early postoperative rehabilitation.
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Affiliation(s)
- Dennis P Martin
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Andrew G Park
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - David Jamison
- Mechanical Engineering Department, Villanova University, Villanova, PA
| | - Christopher M Jones
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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13
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Yu X, Yu Y, Shao X, Bai Y, Zhou T. Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study. J Orthop Surg Res 2019; 14:271. [PMID: 31455394 PMCID: PMC6712714 DOI: 10.1186/s13018-019-1309-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose This study aimed to compare the radiographic and functional results of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type C2/C3 fracture of distal radius between volar locking plate (VLP) and external fixation (EF). Methods It was a retrospective comparative study. Between January 2015 and March 2018, a total of 62/117 patients who underwent EF (23) or VLP fixation (39) for AO type C2/C3 distal radius fractures were assessed. The follow-up period was at least 12 months. Gartland–Werley scale and the disabilities of the arm, shoulder, and hand (DASH) scale were used to evaluate the overall functional outcomes; wrist range of motion and grip strength were measured. The radiographic parameters included radial inclination, volar tilt, radial length, ulnar variance, and articular step-off. All of the comparisons were performed using SPSS 21.0. Results The mean follow-up time was 17.1 months. At final visit, VLP performed better in wrist flexion (69.7° vs 62.3°, p < 0.001), forearm pronation (73.1° vs 64.8°, p = 0.027) and supination (70.6° vs 63.1°, p = 0.033) than EF, but not different with regard to other kinematic parameters. No significant difference was found between two groups, in term of Gartland-Werley or DASH score (p > 0.05). The ulnar variance and articular step-off was significantly more improved in VLP than EF group, being 0.6 vs 1.6 mm (p = 0.002) and 0.5 vs 1.2 mm (p = 0.007). The overall rate of complications did not differ in both groups (28.2% vs 34.5%) (p = 0.587). Conclusions Compared to EF, VLP fixation showed better performance in wrist mobility, correction of ulnar variance, and improving articular congruence, but with the comparable overall functional outcomes and complication rate.
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Affiliation(s)
- Xiaofei Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yadong Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Xinzhong Shao
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Bai
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tong Zhou
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
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14
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Yu L, Zhang X, Zhang B, Hu C, Yu K, Tian D, Bai Y. Outcomes of volar locking plate (VLP) fixation for treatment of die-punch fracture of the distal radius: A retrospective single-surgeon study. Medicine (Baltimore) 2019; 98:e16796. [PMID: 31415386 PMCID: PMC6831231 DOI: 10.1097/md.0000000000016796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Distal radius fracture involving the lunate facet is a tough issue for surgeons, but currently there is scarcity of data on these injuries. This study aims to evaluate results of volar locking plate (VLP) for treatment of die-punch fractures of the distal radius.Between January 2013 and June 2017, a total of 37 patients with die-punch fractures of the distal radius were admitted and underwent VLP fixation. Clinical and radiographic data on these patients were extracted from their electronic medical records. Preoperative radiographs, CT scanning and 3D reconstruction were used to definitely diagnose this injury. Radiographs taken at immediate postoperation and at last follow-up were analyzed. Data on radial subsidence, articular step-off status, volar tilt, radial inclination, wrist motion range, grip strength and related complications at the final follow-up were documented for analysis. The overall outcomes of the injured limb were evaluated, based on the Gartland and Werley scoring system.The mean radial subsidence was 0.8 mm (0-3.3 mm), and articular step-off finally occurred in 4 patients (10.8%). The mean volar tilt was 9.5° (6°-15°), radial inclination 21° (12°-27°). The mean wrist was 84.2% in flexion of the contralateral uninjured wrist, 87.0% in extension, 92.2% in pronation and 94.5% in supination, respectively. The mean grip strength was 86% (range 56%-108%) of the contralateral un-injured upper limb. Gartland and Werley score demonstrated the excellent and good rate of 83.8%, with excellent result in 21 patients, good in 10, fair in 4 and poor in 2. Incidence of overall complications was 27.0% (10/37), with one requiring surgical intervention.VLP demonstrated its efficacy and safety for treatment of die-punch fractures. Prospective comparative studies with larger sample are required to compare the outcomes among different fixation methods, with expectation of precise and individualized treatment for every patient.Type of study/level of evidence: Therapeutic III.
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Affiliation(s)
- Lili Yu
- Department of Neurology, the 2nd Hospital of Hebei Medical University
| | - Xiong Zhang
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Bing Zhang
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Chunhe Hu
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Kunlun Yu
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Dehu Tian
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yanbin Bai
- Department of Orthopaedic Surgery
- Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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Lans J, Alvarez J, Kachooei AR, Ozkan S, Jupiter JB. Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps. J Wrist Surg 2019; 8:118-123. [PMID: 30941251 PMCID: PMC6443535 DOI: 10.1055/s-0038-1673407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Background The dorsal lunate facet fragment represents part of a complex articular injury of the distal radius and is challenging to reduce through a standard volar approach. We propose reduction through a standard volar approach and intraoperative dorsal lunate facet reduction using a bone forceps. To evaluate the postoperative reduction, we used computed tomography (CT) scan. Methods We retrospectively included 60 patients with a median follow-up of 44 weeks. Fracture reduction was evaluated using pre- and direct postoperative CT scans of the wrist, measuring the articular gap and step of the sigmoid notch. The range of motion was evaluated clinically by the treating physician. Bivariate analysis was performed to compare pre- and postoperative radiographic measurements and to compare wrist range of motion. Results When comparing the injured with the uninjured wrist, there was a significant difference in flexion, extension, pronation, and supination. In 87% of the patients, there was complete radiographic reduction of the fracture. Conclusion This study shows that dorsal ulnar lunate facet fracture fragments in distal radius fractures can be reduced through a standard volar approach with the help of an intraoperative bone reduction forceps. Using wrist CT, we showed that 87% of the patients with a dorsal ulnar lunate facet fragment had a postoperative articular step or gap of <1 mm. Level of Evidence : This is a level IV, therapeutic study.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josefina Alvarez
- Department of Traumatology, British Hospital, Montevideo, Uruguay
| | - Amir R. Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sezai Ozkan
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Comparison of fracture healing and long-term patient-reported functional outcome between dorsal and volar plating for AO C3-type distal radius fractures. Eur J Trauma Emerg Surg 2019; 46:591-598. [PMID: 30810768 DOI: 10.1007/s00068-019-01100-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to evaluate the differences in long-term functional outcome and radiographic fracture healing between volar and dorsally approached comminuted intra-articular distal radius fractures (DRF) (AO C3-type). METHODS A retrospective, age-matched, case-control study with a 1:2 allocation ratio was conducted in 84 patients C3-type DRFs patients who underwent either dorsal locking plating (DLP) group (n = 28) or volar locking plating (VLP) group (n = 56). Standardized wrist radiographs (posterior-anterior and 15° lateral) were assessed immediately postoperative and at final follow. To evaluate for loss of reduction standard radiographic measurements were performed. Fracture healing was assessed radiologically. Patient-reported outcomes were assessed with the patient-related wrist evaluation and the EQ-5D-3L for health-related quality of life. Patient satisfaction was assessed with the use of a numeric analog scale ranging from 0 (not satisfied) to 100 (very satisfied). RESULTS All fractures united within 3 months postoperatively. Average age was 59 ± 12 years. Fifty-five patients (66%) participated in the follow-up survey at an average of 76.6 ± 23.8 months. DLP group showed a significant change in sagittal tilt compared with VLP group (3.4 ± 3.0° vs - 0.4 ± 4.1°, p < 0.001). No significant difference in other radiographic and long-term functional outcome was found between both groups (p > 0.05). CONCLUSION Dorsal locking plating fixation in C3-type DRFs resulted in a minimal, but statistically significant, volar collapse of sagittal tilt compared with volar locking plating fixation. However, this difference in volar collapse did not significantly influence the long-term clinical outcome.
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Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly. INTERNATIONAL ORTHOPAEDICS 2018; 42:2243-2248. [DOI: 10.1007/s00264-018-3903-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Devaux N, Henning J, Haefeli M, Honigmann P. The Retinaculum Flap for Dorsal Fixation of Distal Radius Fractures. J Hand Surg Am 2018; 43:391.e1-391.e7. [PMID: 29618418 DOI: 10.1016/j.jhsa.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
In spite of the more popular volar approach for plating of distal radius fractures (DRFs), there are still indications for dorsal plating and even combined dorsovolar plating in complex DRFs. Dorsal plating carries a concern for complications such as tenosynovitis, extensor tendon adhesions, and delayed extensor tendon ruptures. These risks can be minimized by use of modern low-profile plates and the use of an extensor retinaculum flap to cover the distal plate and screws. We describe the technique of the dorsal retinaculum flap for dorsal plating of DRFs.
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Affiliation(s)
- Noémie Devaux
- Department of Hand Surgery, Kantonsspital, Baselland Liestal, Liestal, Switzerland
| | - Julia Henning
- Department of Hand Surgery, Kantonsspital, Baselland Liestal, Liestal, Switzerland; Department of Plastic and Hand Surgery, Inselspital, Bern, Switzerland
| | - Mathias Haefeli
- Department of Hand Surgery, Kantonsspital, Baden, Switzerland
| | - Philipp Honigmann
- Department of Hand Surgery, Kantonsspital, Baselland Liestal, Liestal, Switzerland.
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Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol 2018; 43:142-147. [PMID: 28870129 DOI: 10.1177/1753193417727139] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Alejandro Lizaur-Utrilla
- 1 Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain.,2 Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Abe Y, Tokunaga S, Moriya T. Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications? Hand (N Y) 2017; 12:561-567. [PMID: 29091491 PMCID: PMC5669324 DOI: 10.1177/1558944716675129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use. METHODS Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky's plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures. RESULTS Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures. CONCLUSIONS The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.
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Affiliation(s)
- Yoshihiro Abe
- Chiba Rosai Hospital, Ichihara, Japan,Yoshihiro Abe, Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16 Tatumidai-higashi, Ichihara 290-0003, Japan.
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21
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Zhang X, Zhao Y, Hu C, Yu K, Bai J, Tian D, Xu Y, Zhang B. Comparative study of type B distal radius fractures with and without lunate facet involvement treated by volar locking plate, an observational study. Int J Surg 2017; 44:317-323. [PMID: 28705590 DOI: 10.1016/j.ijsu.2017.07.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the results of volar locking plate for treatment of type B distal radius fractures involving the lunate facet and compare them with those without involvement in lunate facet. METHOD s: This was a retrospective study. A total of 93 patients with type B distal radius were treated by single volar locking plate between January 2014 and December 2015. Preoperative digital radiographs were used to initially diagnose and further classify this injury according to AO/OTA classification system. CT scanning or reconstruction was used to diagnose the complex or suspicious cases. Patients with lunate facet involvement were defined as group 1 (n = 21) and the remaining without luante facet involvement as group 2 (n = 72). Postoperative immediate radiographs and radiographs at last visit were analyzed. We evaluated clinical outcomes at minimum of 12 months and performed statistical analysis using the SPSS 19.0 software package. RESULTS Bony union was reached in all participants, at the median time of 8 weeks. At the final follow-up, there were no significant difference observed in term of volar tilt and radial inclination between both groups (P, 0.172; 0.514). Articular step-off in group 1 was significantly greater than those of group 2 (P, 0.016). Significant articular step-off (>2 mm) occurred in 4 patients (19.0%) in group 1 and 3 (4.2%) in group 2 (P = 0.044). At 3-months postoperatively, group 1 showed worse results than group 2 for most variables (P < 0.05). At 6-months postoperatively, the differences for wrist flexion, supination, ulnar deviation and VAS in motion remained significant between both groups (P < 0.05). At the last follow-up, no significant differences were observed for any variable (P > 0.05). Five minor complications occurred in group 1 and 11 in group 2, and the difference was not significant (P = 0.346). CONCLUSIONS Patients with distal radius fractures involving lunate facet would obtain more slow recovery, especially for wrist flexion, supination, ulnar deviation and VAS in motion. In addition, patients with lunate facet fractures would be at higher risk of loss of reduction and final articular step-off.
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Affiliation(s)
- Xiong Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Yan Zhao
- Nursing College of Hebei Medical University, Shijiazhuang, Hebei, 050017, PR China.
| | - Chunhe Hu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Kunlun Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Jiangbo Bai
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Dehu Tian
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Yi Xu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Bing Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
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Wichlas F, Tsitsilonis S, Kopf S, Krapohl BD, Manegold S. Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2017; 6:Doc08. [PMID: 28580225 PMCID: PMC5442450 DOI: 10.3205/iprs000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon’s analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon’s decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon’s analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon’s analysis for the surgical approach.
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Affiliation(s)
- Florian Wichlas
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Serafim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Sebastian Kopf
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Björn Dirk Krapohl
- Department for Plastic Surgery and Hand Surgery, St. Marien Hospital, Berlin, Germany
| | - Sebastian Manegold
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
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Yoon JO, You SL, Kim JK. Intra-articular comminution worsens outcomes of distal radial fractures treated by open reduction and palmar locking plate fixation. J Hand Surg Eur Vol 2017; 42:260-265. [PMID: 28196444 DOI: 10.1177/1753193416682943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We studied 50 patients with AO type C2 distal radial fractures and 35 with AO type C3 distal radial fractures treated by open reduction and palmar locking plate fixation. At 3-month clinical assessments, mean wrist flexion arcs, grip strengths and disabilities of the arm, shoulder and hand scores were significantly better for AO type C2 fractures. At 2-year post-operative clinical assessments, mean disabilities of the arm, shoulder and hand scores were significantly better for AO type C2 fractures than for AO type C3 fractures. At 2-year radiographic examinations, anterior angulations, ulnar variances and arthritis grades were also significantly better for AO type C2 fractures. This study showed that AO type C3 distal radial fractures, which have intra-articular comminution, had poorer clinical and radiographic outcomes than AO type C2 fractures, despite open reduction and palmar locking plate fixation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J O Yoon
- 1 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - S L You
- 2 Department of Orthopedic Surgery, Ewha Womans Universtiy Mokdong Hospital, Seoul, South Korea
| | - J K Kim
- 1 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures. Plast Reconstr Surg 2017; 139:717e-724e. [DOI: 10.1097/prs.0000000000003076] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shakir S, Naran S, Neral M, Wollstein R. Titanium versus Stainless-Steel Plating in the Surgical Treatment of Distal Radius Fractures: A Randomized Trial. J Hand Microsurg 2016; 8:155-158. [PMID: 27999458 DOI: 10.1055/s-0036-1593731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022] Open
Abstract
Our purpose was to compare postoperative complications and rate of plate removal in titanium and stainless-steel plating of distal radius fractures (DRF). Patients following DRF were randomly fixed with titanium or stainless-steel plates using the same plating system. Complications, second surgeries, and plate prominence were documented. A total of 41 patients were treated with stainless-steel and 22 with titanium plates. Average follow-up was 60 ± 5.6 months. There was no difference in demographics, fracture characteristics, or follow-up between the groups. Plate prominence was found in 50% of radiographs (mean distance: 1.4 mm). Four titanium plates and three stainless-steel plates were removed (11%). Mean time to plate removal was 18.4 ± 4.6 months. There was no difference in removal rates between the groups. Plate material and prominence, age, fracture comminution and smoking status were not associated with plate removal. Our results support using volar and dorsal plates regardless of the plate material.
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Affiliation(s)
- Sameer Shakir
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Sanjay Naran
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Mithun Neral
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Ronit Wollstein
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Technion Israel Institute of Technology School of Medicine, Haifa, Israel
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Zhang X, Hu C, Yu K, Bai J, Tian D, Xu Y, Zhang B. Volar locking plate (VLP) versus non-locking plate (NLP) in the treatment of die-punch fractures of the distal radius, an observational study. Int J Surg 2016; 34:142-147. [DOI: 10.1016/j.ijsu.2016.08.527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
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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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Disseldorp D, Hannemann P, Poeze M, Brink P. Dorsal or Volar Plate Fixation of the Distal Radius: Does the Complication Rate Help Us to Choose? J Wrist Surg 2016; 5:202-10. [PMID: 27468370 PMCID: PMC4959891 DOI: 10.1055/s-0036-1571842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 12/24/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Internal fixation with plates is a reliable fixation technique for the treatment of distal radius fractures. An ongoing discussion exists whether volar or dorsal plating is the appropriate technique. In clinical practice, volar plate fixation is usually preferred because of the assumed lower complication frequency. However, recent studies with the newer generation low-profile dorsal plates reported lower complication rates. PURPOSE The aim of our study was to evaluate the differences in complication rates between volar and dorsal plate for the treatment of distal radius fractures in adult patients. PATIENTS AND METHODS A total of 214 patients with acute distal radius fractures were included in this retrospective study with a minimum 2 years of follow-up. In total, 123 patients were treated with dorsal plate fixation and 91 patients with volar plate fixation. Our primary study outcome was complication rate. RESULTS The overall risk for complications was 15.4% in the dorsal group and 14.3% in the volar group (p = 0.81). A total of 19 patients had implant removal due to complications: 11 patients in the dorsal group and 8 patients in the volar group (p = 0.97). CONCLUSION There is no preferred plate fixation technique based on these study results. In our opinion, decision for type of plate fixation should be based on fracture type and surgeon's experience with the specific approach and plate types. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- D.J.G. Disseldorp
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P.F.W. Hannemann
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M. Poeze
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P.R.G. Brink
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
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A classification and grading system for Barton fractures. INTERNATIONAL ORTHOPAEDICS 2015; 40:1725-1734. [DOI: 10.1007/s00264-015-3034-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/01/2015] [Indexed: 12/22/2022]
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Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments. Med Sci Monit 2015; 21:2837-44. [PMID: 26391617 PMCID: PMC4588632 DOI: 10.12659/msm.894075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background To compare risk of carpal tunnel syndrome (CTS) in distal radius fracture (DRF) patients after 7 treatments using bridging external fixation (BrEF), non-bridging external fixation (non-BrEF), plaster fixation, K-wire fixation, dorsal plating fixation, volar plating fixation, and dorsal and volar plating by performing a network meta-analysis. Material/Methods An exhaustive search of electronic databases identified randomized controlled trails (RCTs) closely related to our study topic. The published articles were screened, based on predefined inclusion and exclusion criteria, to select high-quality studies for the present network meta-analysis. Data extracted from the selected studies were analyzed using STATA version 12.0 software. Results The literature search and selection process identified 12 eligible RCTs that contained a total of 1370 DRF patients (394 patients with BrEF, 377 patients with non-BrEF, 89 patients with K-wire fixation, 192 patients with plaster fixation, 42 patients with dorsal plating fixation, 152 patients with volar plating fixation, and 124 patients with dorsal and volar plating fixation). Our network meta-analysis results demonstrated no significant differences in CTS risk among the 7 treatments (P>0.05). The value of surface under the cumulative ranking curve (SUCRA), however, suggested that dorsal plating fixation is the optimal treatment, with the lowest risk of CTS in DRF patients (dorsal plating fixation: 89.2%; dorsal and volar plating: 57.8%; plaster fixation: 50.9%; non-BrEF: 50.6%; volar plating fixation: 39.6%; BrEF: 38.4%; K-wire fixation: 23.6%). Conclusions Our network meta-analysis provides evidence that dorsal plating fixation significantly decreases the risk of CTS and could be the method of choice in DRF patients.
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Affiliation(s)
- Huan-Li Zhao
- Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Gui-Bin Wang
- Department of Radiology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Yue-Qing Jia
- Department of Traumatic Orthopedics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Shi-Cai Zhu
- Department of Radiology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Feng-Fang Zhang
- Department of Radiology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, China (mainland)
| | - Hong-Mei Liu
- Department of Surgery, Linyi People's Hospital, Linyi, Shandong, China (mainland)
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Lee JI, Cho JH, Lee SJ. The effects of the Frag-Loc(®) compression screw on distal radius fracture with a displaced dorsoulnar fragment. Arch Orthop Trauma Surg 2015. [PMID: 26204980 DOI: 10.1007/s00402-015-2290-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the radiographic and clinical outcomes of the Frag-Loc(®) compression screw with palmar plate fixation on distal radius fractures that include a displaced dorsoulnar fragment. PATIENTS AND METHODS This retrospective comparative study enrolled 48 patients who had an unstable distal radius fracture and a dorsoulnar fragment that was more than 2 mm displaced and that had involvement of more than one-quarter of the articular surface. Twenty-six of the 48 patients were treated with a palmar locking plate without a Frag-Loc(®) compression screw (group 1) and the other 22 patients were treated with palmar locking plate with a Frag-Loc(®) compression screw to fix the dorsoulnar fragment (group 2). First, we reviewed all pre-surgical computerized tomographic (CT) scans. Second, we used the gap distance between the dorsoulnar and palmar fragment as seen on post-surgical axial and sagittal CT scans to determine outcome. The gap distance was measured at the point of maximum distance perpendicular to the plane of the main fracture line. Clinical outcomes were evaluated based on the patient-rated wrist evaluation (PRWE) score; the disabilities of the arm, shoulder and hand score; wrist active range of motion; and grip strength. RESULTS There were no statistically significant differences in clinical outcome between the two groups. However, there were statistically significant differences in post-surgical gap distance. The mean post-surgical gap distances for group 1 were 1.3 mm (range 0.2-3.8 mm) on axial CT scans and 1.4 mm (range 0.5-2.4 mm) on sagittal CT scans, while the mean post-surgical gap distances for group 2 were 0.7 mm (range 0.7-1.6 mm) and 0.7 mm (range 0.3-1.1 mm). CONCLUSION This study shows that the Frag-Loc(®) compression screw can reduce the gap distance between the dorsoulnar fragment and the distal radius, according to evaluation of post-surgical axial and sagittal CT scans. This result suggests that the Frag-Loc(®) compression screw is an effective and simple treatment option to immobilize a dorsoulnar fragment associated with distal radius fracture.
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Affiliation(s)
- Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
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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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Ikeda K, Osamura N, Tada K. Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius. ACTA ACUST UNITED AC 2014; 19:139-44. [PMID: 24641759 DOI: 10.1142/s0218810414970016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
If fixation of an ulnodorsal fragment in an intra-articular fracture of the distal radius is not stable, it is sometimes caused by dorsal displacement after surgery. Hence, we recommend the volar plate fixation with an additional dorsal approach and fixation of irreducible ulnodorsal fragments using a low-profile dorsal mini plate. The details of the surgical procedure and indications are discussed in this article.
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Affiliation(s)
- Kazuo Ikeda
- Department of Orthopaedic Surgery, Kanazawa Medical Center, Kanazawa 920-8650, Japan
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Distal radial fractures. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu X, Wu WD, Fang YF, Zhang MC, Huang WH. Biomechanical comparison of osteoporotic distal radius fractures fixed by distal locking screws with different length. PLoS One 2014; 9:e103371. [PMID: 25080094 PMCID: PMC4117495 DOI: 10.1371/journal.pone.0103371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/30/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length. Methods A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure. Results Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009), whereas stiffness in group B and C was statistically similar (P = 0.93). Load to clinical failure was significantly less for group A (456.54±78.59 N) compared with groups B (580.24±73.85 N) and C (591.07±38.40 N). Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C. Conclusions The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion.
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Affiliation(s)
- Xiong Liu
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
- Department of Orthopaedics, Shilongboai Hospital (The Eight People’s Hospital of Dongguan), Dongguan, Guangdong, P.R. China
| | - Wei-dong Wu
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
- Department of Orthopaedics, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, P.R. China
| | - Ya-feng Fang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
| | - Mei-chao Zhang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
- * E-mail:
| | - Wen-hua Huang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
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Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures. J Orthop Traumatol 2014; 15:259-64. [PMID: 25027735 PMCID: PMC4244564 DOI: 10.1007/s10195-014-0306-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/20/2014] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to evaluate the complication rates of volar versus dorsal locking plates and postoperative reduction potential after distal radius fractures. Materials and methods For this study 285 distal radius fractures (280 patients/59.4 % female) treated with locked plating were retrospectively evaluated. The mean age of the patients was 54.6 years (SD 17.4) and the mean follow-up was 33.2 months (SD 17.2). The palmar approach was used in 225 cases and the dorsal approach in 60 cases (95 % type C fractures). Results Adequate reduction was achieved with both approaches, regardless of fracture severity. In the dorsal group, the complications and implant removal rates were significantly higher and the operative time was also longer. Conclusions Based on these facts, we advocate the palmar locking plate for the vast majority of fractures. In cases of complex multifragmentary articular fractures where no compromise in reduction is acceptable, and with the biomechanical equality of palmar and dorsal plating remaining unproven, dorsal plating may still be considered. Level of evidence Therapeutic level IV.
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Del Piñal F, Klausmeyer M, Moraleda E, de Piero GH, Rúas JS. Arthroscopic reduction of comminuted intra-articular distal radius fractures with diaphyseal-metaphyseal comminution. J Hand Surg Am 2014; 39:835-43. [PMID: 24674608 DOI: 10.1016/j.jhsa.2014.02.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE In the setting of severely comminuted diaphyseal-metaphyseal fractures of the distal radius, arthroscopic reduction of the joint surface is difficult and often results in shortening and collapse. Yet, several authors have shown the benefits of arthroscopy in articular distal radius fractures. We present a method that safely allows a combination of arthroscopic reduction and rigid fixation and describe the outcomes in a small group of patients. METHODS Four consecutive patients with severely comminuted diaphyseal-metaphyseal articular fractures of the distal radius were treated using the stable reference fragment technique. For all cases, we used an extra-long volar locking plate applied to the diaphysis of the radius. Preoperative computed tomography scanning was used to identify the largest articular fragment. This reference fragment was reduced and stabilized with locking pegs or screws to the volar plate under fluoroscopic guidance. The articular reduction continued arthroscopically, using the reference fragment as a guide. Once the articular reduction was complete, the comminuted metaphysis was addressed and secured to the plate. RESULTS All patients achieved excellent clinical and radiological results. Flexion-extension averaged 124° and pronation-supination averaged 174°. One patient showed minor signs of radiocarpal osteoarthritis on radiographs at 3 years. CONCLUSIONS By securing the reference fragment before addressing the metaphyseal comminution, a stable platform was created. Thus, intra-articular reduction was achieved while maintaining extra-articular alignment. Although the results were excellent, the number of cases was small. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
| | - Melissa Klausmeyer
- Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
| | - Eduardo Moraleda
- Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
| | - Guillermo H de Piero
- Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
| | - Jaime S Rúas
- Instituto de Cirugía Plástica y de la Mano, Private Practice, and Hospital Mutua Montañesa, Santander, Spain
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Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement to assess reporting of observational trials in hand surgery. J Hand Surg Am 2013; 38:1584-9.e2. [PMID: 23845586 PMCID: PMC3989883 DOI: 10.1016/j.jhsa.2013.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To use the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist to critically evaluate the change in quality of observational trial reporting in the Journal of Hand Surgery American between 2005 and 2011. METHODS A cross-sectional analysis of observational studies published in the Journal of Hand Surgery American was designed to sample 2 6-month periods of publication (March 2005 to August 2005 and June 2011 to November 2011). Fifty-one items were extracted from the STROBE statement for evaluation. Overall STROBE compliance rates for articles and specific checklist items were determined. Final compliance percentages from each period were compared by Student t-testing. Changes in item compliance over time were quantified. RESULTS Overall compliance with the STROBE statement was 38% (range, 10%-54%) in 2005 and 58% (range, 39%-85%) for 2011 manuscripts representing a significant improvement. Seventy-five percent or greater of articles (2005/2011) provided the explicit reporting of background (100%/97%), follow-up time (85%/94%), overall interpretation of data (100%/94%), and results of similar studies (95%/89%). Twenty-five percent or less of articles provided the study design in the abstract (10%/20%), a clear description of the study's setting (10%/23%), the handling of missing data (0%/6%), the potential directions of bias (5%/11%), and the use of a power analysis (0%/17%). Eighty-six percent (44/51) of items were more frequently satisfied in 2011 articles than in 2005 publications. Absolute increases in compliance rates of 40% or greater were noted in 10 items (20%) with no worsening in compliance for an individual item over 6%. CONCLUSIONS The overall quality of the reporting of observational trials in the Journal of Hand Surgery American improved from 2005 to 2011. Current observational trials in hand surgery could still benefit from increased reporting of methodological details including the use of power analyses, the handling of missing data, and consideration of potential bias. LEVEL OF EVIDENCE Diagnostic III.
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Dorsal locked plate fixation of distal radius fractures. J Hand Surg Am 2013; 38:1414-22. [PMID: 23751326 DOI: 10.1016/j.jhsa.2013.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/10/2013] [Accepted: 04/23/2013] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are common, and internal fixation for operative management of these injuries is widely accepted. Although use of the volar approach for plate fixation has become more popular, benefits of the dorsal surgical approach include the potential for direct reduction and assessment of articular alignment, evaluation and management of concomitant intrinsic intercarpal ligament injury, and initiation of early range of motion. For certain fracture patterns, dorsal plate fixation is the preferred surgical technique. Improvements in implant design, in particular the use of low-profile dorsal plates, has decreased the rate of complications seen previously with this technique. Here, we provide an overview of the evaluation of patients with distal radius fractures, as well as the surgical indications and contraindications, techniques, and complications after dorsal locked plate fixation of intra-articular distal radius fractures.
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Wei J, Yang TB, Luo W, Qin JB, Kong FJ. Complications following dorsal versus volar plate fixation of distal radius fracture: A meta-analysis. J Int Med Res 2013; 41:265-75. [DOI: 10.1177/0300060513476438] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: A meta-analysis to compare complication rates following volar or dorsal surgical fixation of distal radius fracture. Methods: A detailed search of PubMed®/MEDLINE® was undertaken to identify randomized and nonrandomized controlled trials published before 25 August 2012 that compared volar with dorsal fixation, in patients with distal radius fracture. Results: A quantitative meta-analysis of 12 trials (952 patients) was performed. There was no between-group difference in the overall rate of complications. Volar fixation was associated with significant increases in neuropathy (relative risk [RR] 2.19; 95% confidence intervals [CI] 1.27, 3.76) and carpal tunnel syndrome (RR 4.56; 95% CI 1.02, 20.44), and a reduction in tendon irritation, compared with the dorsal approach (RR 0.38; 95% CI 0.17, 0.86). Conclusions: Dorsal fixation offers a lower risk of neuropathy and carpal tunnel syndrome than the volar approach, but a higher risk of tendon irritation. Patients with a distal radius fracture can expect similar outcomes after volar or dorsal surgery.
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Affiliation(s)
- Jie Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Tu-Bao Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jia-Bi Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Fan-Jing Kong
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
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Twigt B, Bemelman M, Lansink K, Leenen L. Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era. INTERNATIONAL ORTHOPAEDICS 2013; 37:483-8. [PMID: 23307017 DOI: 10.1007/s00264-012-1761-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/14/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE C-type distal radial fractures remain challenging fractures. Currently locking plates are very popular because of their length preserving, stability. A considerable drawback is the high cost. Since 2003 we have been using mini AO plates (2.7 mm) as an alternative. We analysed our results and performed a cost analysis. METHODS Retrospective analysis was performed of all patients operated upon between 2003 and 2008 for C type distal radius fractures. Reduction was achieved with mini AO plates, applied in a buttress fashion, with ligamentotaxis. Rehabilitation consisted of immediate mobilisation. Pre- and postoperative X-rays, operative results and patient charts were reviewed. Furthermore, we prospectively evaluated the functional results using VAS, DASH and Mayo wrist scores. Lastly, we assessed the implant costs and compared them to locking plates. RESULTS Thirty-four patients were treated with a mean age of 49 years. Mean radial shortening improved 2 mm; dorsal and radial angulation improved 23 and 4°, respectively. At consolidation (eight weeks) the average radial shortening was 0.75 mm, a volar angulation of 3°, and 21° of radial angulation. Functional results were excellent, demonstrated by a mean VAS score less than 1, a DASH score of 12 and a Mayo wrist score of 87. Compared to locking plates, there was an overall reduction in material costs of 15,300 Euro. CONCLUSIONS Our technique has excellent biomechanical stability, enabling immediate functional rehabilitation, good anatomical and functional outcome with significantly lower costs.
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Affiliation(s)
- Bas Twigt
- Department of Trauma, University Medical Centre Utrecht, Utrecht, The Netherlands
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Dorsally comminuted fractures of the distal end of the radius: osteosynthesis with volar fixed angle locking plates. ISRN ORTHOPEDICS 2013; 2013:131757. [PMID: 24959352 PMCID: PMC4045357 DOI: 10.1155/2013/131757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/14/2013] [Indexed: 11/17/2022]
Abstract
Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18-61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7-12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31826073d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee YS, Wei TY, Cheng YC, Hsu TL, Huang CR. A comparative study of Colles' fractures in patients between fifty and seventy years of age: percutaneous K-wiring versus volar locking plating. INTERNATIONAL ORTHOPAEDICS 2012; 36:789-94. [PMID: 22159615 PMCID: PMC3311792 DOI: 10.1007/s00264-011-1424-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/09/2011] [Indexed: 01/19/2023]
Abstract
PURPOSE This retrospective study was to compare the clinical outcomes of volar locking plating (VLP) and percutaneous Kirschner wiring (PKW) for the management of displaced Colles type distal radius fractures in patients between 50 and 70 years old. METHODS There were 31 elderly patients with displaced Colles' fractures treated by VLP. We compared them to 31 match-paired patients treated by PKW. The patients were matched according to age (within five years) and sex. All patients were followed up retrospectively for at least 12 months. The functional outcomes and radiological results were compared between the two groups. RESULTS All fractures healed within three months. There were two complications (6.5%) in the PKW group and one complication (3.2%) in the VLP group. At final follow-up, wrist flexion, extension, and ulnar deviation were significantly better in the VLP group compared with the PKW group (all p values<0.05). According to modified Green and O'Brien criteria, the VLP group showed a trend towards increased rate of satisfactory outcome compared with the PKW group (p = 0.09). CONCLUSION For the treatment of displaced Colles' fractures in patients between 50 and 70 years old, both groups had high union rate and low complication rate. However, better functional results can be expected in association with open reduction and volar locking plating.
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Affiliation(s)
- Yih-Shiunn Lee
- Department of Orthopedic Surgery, Lin Shin Hospital, Taichung City, Taiwan
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Tien-Yung Wei
- Department of Obstetrics and Gynecology, Tungs Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Yu-Chieh Cheng
- Departments of Orthopedic Surgery, Tungs Taichung Metroharbor Hospital, No. 699, Sec. 1, Jhongci Rd., Wuci Township, Taichung City, 435 Taiwan
| | - Tzu-Liang Hsu
- Departments of Orthopedic Surgery, Tungs Taichung Metroharbor Hospital, No. 699, Sec. 1, Jhongci Rd., Wuci Township, Taichung City, 435 Taiwan
| | - Chien-Rae Huang
- Department of Orthopedic Surgery, Taipei City Hospital, Heping Branch, Taipei, Taiwan
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