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Miyaoka S, Yamazaki H, Hayashi M, Takahashi J. Implant removal following open reduction and internal fixation for distal radius fracture: A study based on the Diagnosis Procedure Combination database in Japan. J Orthop Sci 2022; 28:645-650. [PMID: 35428544 DOI: 10.1016/j.jos.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/03/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rate of implant removal and the factors influencing its indication in patients with distal radius fracture (DRF) in Japan are unclear. METHODS We retrospectively evaluated the incidence rate of implant removal in a large cohort of DRF patients obtained from the Diagnosis Procedure Combination database in Japan between April 2014 and March 2019. Patient- and hospital-related factors possibly affecting removal rate, including age, sex, annual number of open reduction and internal fixation (ORIF) for DRF procedures per hospital, number of hospital beds, advanced or general care hospital, and hospital location were analyzed as well. Hospital location was classified into three types based on population and population density as 1) large city, 2) local city, and 3) sparse area. RESULTS Implant removal was performed in 3242 (26.3%) of 12,328 DRF patients receiving ORIF. According to multivariate analysis, the significant factors related to a decreased probability of removal were older patients, male, large annual number of ORIF for DRF procedures per hospital, large number of hospital beds, advanced care hospital, and hospital in large city. CONCLUSIONS This study clarified the current implant removal rate and trends following ORIF for DRF in Japan. Both patient- and hospital-related factors significantly impacted the decision for implant removal.
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Affiliation(s)
- Shunsuke Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Honjo 1-5-2, Matsumoto 390-8510, Japan.
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
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Hashimoto S, Yamazaki H, Hayashi M, Isobe F, Miyaoka S, Kitamura Y, Kato H. Radiographic Change in Articular Reduction After Volar Locking Plating for Intra-Articular Distal Radius Fractures. J Hand Surg Am 2020; 45:335-340. [PMID: 31668645 DOI: 10.1016/j.jhsa.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 05/13/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the stability of the articular reduction 12 weeks after intra-articular distal radius fracture (DRF) fixation with a volar locking plate (VLP). METHODS We prospectively assessed for losses in articular reduction, including gap and step, during the 12 weeks following surgery for intra-articular DRF treated with a VLP in 68 wrists. The mean patient age was 62 years (range, 16-88 years). Frontal and lateral digital tomosynthesis, a recently developed form of digital tomography, was employed to measure articular gap and step in the lunate and scaphoid fossa of the radius. The average time between surgery and imaging was 1.2 days (range, 0-2 days) for the first evaluation and 87.0 days (range, 74-105 days) for the second examination. RESULTS The mean gap and step were similar at the first and second examinations: 0.4 mm (SD, 0.8) and 0.3 mm (SD, 0.6) and 0.3 mm (SD, 0.7) and 0.3 mm (SD, 0.5), respectively. CONCLUSIONS There was no change in the alignment of the fragments in cases treated with VLP. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Shun Hashimoto
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan.
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihiro Isobe
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Shunsuke Miyaoka
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Yo Kitamura
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Isobe F, Yamazaki H, Hayashi M, Uchiyama S, Miyaoka S, Kato H. Prospective Evaluation of Median Nerve Dysfunctions in Patients with a Distal Radius Fracture Treated with Volar Locking Plating. J Hand Surg Asian Pac Vol 2019; 24:392-399. [PMID: 31690191 DOI: 10.1142/s2424835519500498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The aim of this study was to identify the risk factors for median nerve dysfunctions after volar locking plate (VLP) fixation for distal radius fracture (DRF). Methods: We prospectively assessed the incidence of median nerve symptoms (MNS) such as numbness, pain, paresthesia, or hypesthesia in the area innervated by the median nerve and evaluated post-operative nerve conduction (NC) in 91 hands of 121 patients after VLP fixation for DRF. Multivariate logistic regression analysis was conducted to identify factors independently associated with MNS and abnormal NC in the injured wrist. Results: There were 18 cases (20%) of MNS on the injured side, 9 hands (10%) of both MNS and abnormal NC, 11 hands (12%) with only abnormal NC, and 9 hands with only MNS. Sensitivity, specificity, and diagnostic accuracy of abnormal NC for diagnosing MNS were 50%, 86%, and 78%, respectively. Four cases did not respond to conservative treatment and received carpal tunnel release concomitantly with plate removal. Logistic regression examination revealed that volar placement of the plate and short stature were significant independent predictors of MNS, while patient age was the sole independent predictor of abnormal NC. Conclusions: Our study demonstrated that plate prominence, short stature, and age were significant independent risk factors for median nerve dysfunctions after VLP fixation for DRF.
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Affiliation(s)
- Fumihiro Isobe
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shunsuke Miyaoka
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Nanno M, Kodera N, Tomori Y, Takai S. Ultrasonographic movement of the flexor pollicis longus tendon before and after removal of a volar plate for the distal radius fracture. J Orthop Surg (Hong Kong) 2019; 26:2309499018760131. [PMID: 29486669 DOI: 10.1177/2309499018760131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare the movement of the flexor pollicis longus (FPL) tendon on the distal radius during wrist and finger motions before and after removal of a volar plate in patients with distal radius fractures using transverse ultrasound and to evaluate the kinematic effects on the FPL by the removal. METHODS Twenty-five patients with distal radius fracture were evaluated quantitatively by transverse ultrasound using coordinates for the movement of the FPL on the distal radius during wrist and finger motions before and after the plate removal. RESULTS At all wrist positions, during finger motion, the FPL moved significantly more palmarly away from the radius after plate removal compared to before. However, the FPL was still situated more dorsoulnarly compared with unaffected side. Moreover, the FPL moved significantly most dorsally both before and after removal at the wrist dorsal flexion position with finger flexion. CONCLUSIONS These findings suggested that any adhesion between the FPL and the pronator quadratus (PQ) muscle was released by removing the plate and that the FPL would approach original tendon movement. Additionally, it is speculated that any remaining atrophy and fibrosis of the PQ may be the reason for more dorsoulnar location of the FPL in the affected side compared with the unaffected one. This ultrasound evaluation may be useful in further understanding the FPL kinematics on the distal radius, and in appropriate treatment of the distal radius fracture with plate fixation for preventing FPL rupture.
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Affiliation(s)
- Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Norie Kodera
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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Sato K, Kikuchi Y, Mimata Y, Murakami K, Takahashi G, Doita M. Volar locking plates not touching the flexor pollicis longus tendon appear as prominences on radiographs: a cadaver study. J Orthop Traumatol 2019; 20:29. [PMID: 31432281 PMCID: PMC6702291 DOI: 10.1186/s10195-019-0536-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background Plate protrusion is a risk factor for flexor pollicis longus (FPL) rupture following volar locking plate (VLP) surgery. However, plate prominence on follow-up radiographs is common. We hypothesised that a VLP that does not touch the FPL tendon can appear as a plate prominence projected over the volar ridge on lateral radiographs. Materials and methods We studied six current designs of widely used plates in formalin-fixed cadavers. Each plate was placed in six cadavers. We analysed 36 different plate–cadaver combinations. The main aim of plate fixation was to position the plate in the most distal position without FPL tendon contact. Radiographs were obtained using fluoroscopy. We evaluated plate prominence from the volar ridge according to the Soong grading system. Results Soong grades 0 (plate did not extend beyond volar ridge), 1 (plate protruded beyond volar ridge) and 2 (plate directly on or located beyond the volar ridge) were observed in 23 (63.9%), 9 (25.0%) and 4 (11.1%) cadavers, respectively. VariAx, DVR and VALCP showed grade 1 prominence, whereas Acu-Loc2, HYBRIX and MODE showed grade 2 prominence. Conclusions Implant protrusion was observed in 36% of plate–cadaver combinations, even if the plate did not touch the FPL. Estimating the risk of FPL rupture using lateral radiographs alone is likely insufficient. Our findings can be applied to accurately identify the presence of implant prominence following VLP surgery.
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Affiliation(s)
- Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Yuki Kikuchi
- Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Kenya Murakami
- Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Gaku Takahashi
- Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
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Kinoshita M, Naito K, Goto K, Sugiyama Y, Nagura N, Obata H, Iwase Y, Kaneko K. Anatomical-positional relationship between the bone structure of the distal radius and flexor pollicis longus tendon using ultrasonography. Surg Radiol Anat 2019; 41:785-789. [PMID: 30879084 DOI: 10.1007/s00276-019-02216-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE In this study, using an ultrasonography, we investigated the positional relationship between the volar bone cortex of distal radius and flexor pollicis longus (FPL) tendon in the distal radius of healthy subjects. METHODS The subjects were 32 healthy volunteers (56 wrists) (Age 32.9 ± 8.5, 16 males and 16 females). Their wrists were imaged by an ultrasonography. The distances between the watershed line (WS) and FPL (A), between the distal margin of pronator quadratus (DMPQ) and FPL (B), between the FPL and volar radial bone cortex at the maximum muscle belly of the PQ muscle right below the sliding region of the FPL tendon (C), and between the WS and DMPQ (D) were measured. RESULTS All these parameters showed a normal distribution. When the correlation among the parameters was investigated, a correlation with an index of the physique, BMI, was noted in A (P < 0.01), B (P < 0.01), and C (P < 0.01), but no correlation was noted only in D (P = 0.59). CONCLUSIONS Our results were suggested that when distal radius fracture is treated with a distal plate placement, the appropriate placement can be achieved by applying about 3 mm additional dissection of soft tissue on the volar bone cortex distal to the DMPQ.
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Affiliation(s)
- Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
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Tokutake K, Iwatsuki K, Tatebe M, Okui N, Mizuno M, Hirata H. Usefulness of CT-based measurement of volar prominence for evaluation of risk of flexor tendon injury following fixation of a distal radius fracture. J Orthop Sci 2019; 24:263-268. [PMID: 30245089 DOI: 10.1016/j.jos.2018.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although some radiographic evaluations of the risk of flexor tendon injury following fixation of a distal radius fracture are useful, these radiographic measurements are limited because of their inability to obtain three-dimensional measurements. We hypothesized that CT-based measurements would be more sensitive indicators for risk estimation than radiography. METHODS We retrospectively evaluated the relationship between plate positioning and the incidence of flexor tendon symptoms based on postoperative radiographic and CT-based measurements in 99 hands that were followed up for more than 12 months. We also compared the reproducibility, diagnostic accuracy, and ability to detect the plate-bone gap between radiographic and CT-based measurements. We also assessed the correlation between the volar prominence and plate-bone gap using CT. Multivariable analysis using stepwise logistic regression was performed to identify factors independently associated with tendon rupture or irritation. RESULTS In single variable analysis, we found that the volar tilt was significantly smaller and the radiographic plate-to-critical line distance (PCL), CT-PCL, and CT-gap were significantly greater in the group with tendon irritation or rupture. Multivariable logistic regression analysis indicated that the CT-based measurement of the volar prominence is a significantly positive independent predictor of tendon rupture or irritation. CONCLUSION CT-based measurement of the volar prominence may be one of the best radiographic predictors of the risk of flexor tendon injury following fixation of a distal radius fracture regardless of the plate type and distal prominence and the extent of rotation. This measurement may assist surgeons when deciding on the need for removal of hardware to decrease the long-term risk of flexor tendon rupture.
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Affiliation(s)
- Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan; Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, 510-8567, Japan.
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahiro Tatebe
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuyuki Okui
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, 510-8567, Japan
| | - Masanori Mizuno
- Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi, 510-8567, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius. J Med Ultrason (2001) 2018; 45:647-651. [DOI: 10.1007/s10396-018-0882-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
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Incidence of tendon rupture following volar plate fixation of distal radius fractures: A survey of 2787 cases. J Orthop 2018; 15:236-238. [PMID: 29657475 DOI: 10.1016/j.jor.2018.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/14/2018] [Indexed: 11/22/2022] Open
Abstract
This study assessed the comprehensive incidence of tendon rupture following volar locking plate (VLP) surgery for a large number of patients with distal radius fractures (DRFs) at multiple facilities in one prefecture, Japan. During the 4-year period, 2787 patients with DRFs underwent fixation using VLP. The overall incidence rates of rupture of the FPL, the extensor pollicis longus, the flexor digitorum profundus of the index finger, and the extensor digitorum communis were 0.35% (10 patients), 0.29% (8 patients), 0.04% (1 patient), and 0.04% (1 patient), respectively.
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Effects of Volar Tilt, Wrist Extension, and Plate Position on Contact Between Flexor Pollicis Longus Tendon and Volar Plate. J Hand Surg Am 2017; 42:996-1001. [PMID: 28927879 DOI: 10.1016/j.jhsa.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 07/05/2017] [Accepted: 08/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Volar plates positioned at, or distal to, the watershed line have been shown to have a higher incidence of attritional rupture of the flexor pollicis longus (FPL). In this study, we aimed to evaluate the effect of wrist extension and volar tilt on the contact between the plate and the FPL tendon in a cadaver model. We hypothesized that, following volar plate application, loss of native volar tilt increases the contact between the FPL and the plate at lower degrees of wrist extension. METHODS A volar locking plate was applied on 6 fresh-frozen cadavers. To determine the contact between the plate and the FPL tendon, both structures were wrapped with copper wire and circuit conductivity was monitored throughout wrist motion. A lateral wrist radiograph was obtained at each circuit closure, indicating tendon-plate contact. Baseline measurements were obtained with plate positioned at Soong grades 0, 1, and 2. An extra-articular osteotomy was made and contact was recorded at various volar tilt angles (+5°, 0°, -5°, -10°, -15°, and -20°) in 3 different plate positions. A blinded observer measured the degree of wrist extension on all lateral radiographs. Data were analyzed using linear mixed-effects regression model. RESULTS Plates placed distal to the watershed line had the most contact throughout wrist range of motion. Significantly, less wrist extension was required for contact in wrists with neutral or dorsal tilt and in distally placed volar plates. Volar tilt, wrist extension, and plate position were 3 independent risk factors determining contact between plate and tendon. CONCLUSIONS Loss of volar tilt, increased wrist extension, and higher Soong grade plate position result in greater contact between wire-wrapped FPL tendon and plate. CLINICAL RELEVANCE The FPL/plate contact chart generated in this study may be used to assess the risk of rupture in the clinical setting.
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A systematic review of volar locking plate removal after distal radius fracture. Injury 2017; 48:2650-2656. [PMID: 29031822 DOI: 10.1016/j.injury.2017.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 08/23/2017] [Accepted: 10/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Indication of volar locking plate (VLP) removal after bony healing of distal radius fracture (DRF) is controversial. Studies with various range of removal rate were reported. The purpose of this systematic review was to investigate the frequency and the reasons of hardware removal over the world. We hypothesized that more frequent VLP removal contribute to better clinical outcomes. METHODS The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of treatment using VLP for DRF. Data collection included hardware removal rate, complication rate, clinical and radiological outcomes. We analyzed correlation between hardware removal rate with clinical and radiological outcomes. RESULTS A total of 3472 articles were screened, yielding 52 studies for final review. The mean hardware removal rate was 9%, ranging from 0 to 100%. The mean removal rate in studies from France, Norway, Japan, and Belgium was as high as 19%. The mean removal rate in studies from the US was low (3%). The most frequent reasons for extraction were routine removal (22%), tendon irritation or tenosynovitis (14%), hardware problem (14%), and patient' request (13%). Although routine removal and patient' request were not counted as complication, correlation between removal rate with complication rate was strong (rho=0.64, p<0.001). Correlations between clinical and radiological outcomes were week except for volar tilt (rho=-0.42, p=0.009). CONCLUSIONS There was a diversity of removal rate and reasons in the studies over the world. High frequent VLP removal did not contribute to better clinical outcomes.
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Shinohara T, Takahashi S, Hirata H. Anterior interosseous nerve palsy mimicking rupture of the index flexor digitorum profundus after volar locking plate fixation of a distal radius fracture. NAGOYA JOURNAL OF MEDICAL SCIENCE 2017; 79:421-425. [PMID: 28878447 PMCID: PMC5577028 DOI: 10.18999/nagjms.79.3.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe the case of a patient with distal radius fracture who became unable to flex the distal interphalangeal joint of the index finger after internal fixation using a volar locking plate. There was palpable crepitus with active thumb motion, and wrist radiographs showed prominence of the volar plate at the watershed line. Therefore, our initial diagnosis was plate-induced closed rupture of the flexor digitorum profundus tendon of the index finger. However, upon surgical removal of the plate, no tendon rupture was found. Magnetic resonance imaging after plate removal showed diffuse increased signal intensity in the index flexor digitorum profundus on T2-weighted fat-suppressed images, which indicated muscle denervation. Based on the above findings, we changed the diagnosis to anterior interosseous nerve palsy with isolated paralysis of the flexor digitorum profundus of the index finger. Finger flexion disability following volar plate fixation of distal radius fracture should always be investigated carefully..
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Affiliation(s)
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Evaluation of flexor pollicis longus tendon attrition using color Doppler imaging after volar plate fixation for distal radius fracture. J Orthop Sci 2017; 22:447-452. [PMID: 28325701 DOI: 10.1016/j.jos.2017.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/16/2016] [Accepted: 01/03/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Early diagnosis of attritional wear of the flexor pollicis longus (FPL) tendon is essential in preventing subsequent tendon rupture. There are currently few objective methods of assessing FPL attrition. We hypothesized that color Doppler imaging could visibly detect FPL tendon attrition, and analyzed our results. METHODS We evaluated ultrasound imaging of the contact between the FPL tendon and a volar locking plate using the real-time B-mode and Doppler waveforms of the FPL tendon using the continuous Doppler wave mode in 40 patients who underwent fixation of the distal volar locking plate for distal radius fracture. Twenty out of 40 patients underwent plate removal surgery after ultrasound evaluation. We also assessed the relationship between the Doppler waveforms and attrition of the FPL tendon in these 20 patients. RESULTS Based on the ultrasound findings (n = 40), we divided Doppler waveforms of the FPL tendon into three categories: type 1, spindle wave; type 2, spindle wave with spike; and type 3, spike wave. There were 23, 11, and six patients with type 1, 2, and 3 waveforms in the affected hand, respectively. There were 37 patients with type 1, three with type 2, and no patient with type 3 waveforms in the contralateral wrist. Of the 20 patients who underwent plate removal, five had type 3 waveforms. We found tendon fraying or partial tears in three of these five patients. In addition, all five patients showed changes to type 1 or 2 waveforms after plate removal. None of the other 15 patients with type 1 or 2 waveforms had any tendon injuries during plate removal. CONCLUSIONS Spike Doppler waveform can indicate abnormal findings, and may be a useful method to predict tendon attrition, because of its visibility. DIAGNOSTIC STUDY Level III evidence.
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Eltorai AEM, Sobel AD, Thomas NP, Daniels AH, Born CT. Current Trends in the Management of Distal Radius Fractures. Orthopedics 2017; 40:145-152. [PMID: 28112784 DOI: 10.3928/01477447-20170117-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023]
Abstract
This article discusses recent reports on distal radius fractures. The keyword "distal radius fracture" was used to query the PubMed database of the US National Library of Medicine. From the resulting list, articles published in the Journal of Hand Surgery (American Volume), the Journal of Hand Surgery (European Volume), and the Journal of Orthopaedic Trauma from April 2014 through December 2015 were reviewed. Related commentaries were also evaluated. Case series of fewer than 5 patients were excluded. The 65 studies and commentaries identified are categorized and summarized. [Orthopedics. 2017; 40(3):145-152.].
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Abstract
Volar plate fixation of unstable distal radius fractures has become the preferred technique by most surgeons for the operative treatment of displaced distal radius fractures. Flexor tendon rupture is a rare but serious complication associated with this operation that is thought to be due to irritation of the flexor tendons over the prominent distal edge of the plate. We describe a novel technique of using the brachioradialis tendon to cover the distal edge of the plate to help prevent tendon irritation and rupture.
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Is there a benefit of proximal locking screws in osteoporotic distal radius fractures? - A biomechanical study. Injury 2016; 47:1631-5. [PMID: 27242328 DOI: 10.1016/j.injury.2016.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/09/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The distal radial fracture is a common fracture and frequently seen in geriatric patients. During the last years, volar plating has become a popular treatment option. While the application of locking screws at the distal fragment is widely accepted, there is no evidence for their use at the radial shaft. MATERIALS AND METHODS In six osteoporotic pairs of matched human cadaver radii an extra-articular model creating an AO 23-A2.1 fracture was employed. Osteosynthesis were performed using the APTUS 2.5 Adaptive TriLock Distal Radius System (Medartis AG) with locking (LS) or non-locking screws (NLS) for proximal fixation. Biomechanical testing was performed in a staircase fashion: starting with 50 cycles at 200N, the load was continuously increased by 50N every 80 cycles up to a maximum force of 400N. Finally, load to failure was analyzed with failure defined as sudden loss of force measured (20%) or major deformation of the radii (10mm). RESULTS At 200N, 250N, 300N, 400N and load to failure, the NLS group showed a higher degree of elastic modulus. In contrast, the LS group showed higher elastic modulus at 350N. Maximum force was higher in the LS group without reaching statistical significance. Reasons for loss of fixation were longitudinal shaft fractures, horizontal peri-implant fractures and distal cutting out. No difference was seen between the two groups concerning the development of the above mentioned complications. CONCLUSION Our study did not show biomechanical superiority for distal radius fracture fixation by using locking screws in the proximal holes in an osteoporotic cadaver study. At load to failure, longitudinal shaft fractures and peri-implant fractures seemed to be a more relevant problem rather than failure of the proximal fixation.
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