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Parry JA, Salimi M, Stacey SC, Mauffrey C. There is no correlation between differences in adverse events and differences in patient-reported outcome measures in orthopaedic trauma randomized controlled trials: A systematic review. Injury 2024; 55:111909. [PMID: 39332228 DOI: 10.1016/j.injury.2024.111909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/21/2024] [Accepted: 09/15/2024] [Indexed: 09/29/2024]
Abstract
INTRODUCTION A recovery without adverse events is a top priority of orthopaedic trauma patients, however many randomized controlled trials (RCTs) are only powered to detect a difference in patient-reported outcome measures (PROMs). While it may be assumed that differences in major adverse event rates between treatment groups will result in differences in PROMs, this has not been established. The purpose of this study was to perform a systematic review of RCTs to evaluate if differences in these outcomes were correlated. METHODS A systematic search was conducted of online databases to identify RCTs in orthopaedic trauma fracture management that reported both major adverse events and PROMs. Adverse events included secondary surgeries or complications that could negatively affect long-term outcomes (nonunion, chronic regional pain syndrome, etc.). The correlation between a difference (p < 0.05) in adverse events and a difference in PROMs was assessed. RESULTS The systematic review yielded 30 RCTs involving 6,769 patients. The primary outcome was a continuous PROM in 70.0 % (21/30). A difference in major adverse events was reported in 23.3 % (7/30) and a difference in PROMs was reported in 6.7 % (2/30). Studies reporting a difference in adverse events, compared to those that did not, were not more likely to report a difference in PROMs (14.3 % (1/7) vs. 4.3 % (1/23); p = 0.42). CONCLUSIONS There was no correlation between differences in adverse event rates and differences in PROMs in orthopaedic trauma RCTs. Investigators should consider powering studies to detect differences in the major adverse events that both patients and surgeons wish to avoid. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States.
| | - Maryam Salimi
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
| | - Stephen C Stacey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
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Perregaard S, Jørgensen RW, Landgren M. Complications After Volar Locking Plate Fixation of Distal Radius Fractures: A Retrospective Study of 822 Patients. J Hand Surg Am 2024; 49:745-750. [PMID: 36697293 DOI: 10.1016/j.jhsa.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/14/2022] [Accepted: 11/02/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE With the current routine use of volar locking plates as the preferred surgical treatment option for distal radius fractures, the purpose of this study was to investigate the incidence of postoperative complications following surgery and, second, investigate the correlation between demographic factors and the risk of complications. METHODS We retrospectively reviewed all patients who had been surgically treated for a distal radius fracture with open reduction and internal fixation using volar plating and screws during a 3-year period. Relevant demographic information and all postoperative complications of the 822 patients eligible for inclusion were recorded, with a mean follow-up time of 2.8 years. RESULTS We identified an overall complication rate of 12.3% (101 of the 822 patients), with 4.8% defined as experiencing major complications and 7.5% defined as experiencing minor complications. The most frequent were complications that led to hardware removal, observed in 2.7% (n = 22) of the patients; wound-related problems that did not require surgical revision, observed in 2.2% (n = 18) of the patients; and carpal tunnel syndrome, observed in 1.9% (n = 16) of the patients. Binary logistic regression modeling showed no correlation between demographic factors and the risk of complications. CONCLUSIONS In conclusion, a low overall complication rate of 12.3% was found. Further, 4.8% of the patients experienced a major complication and 7.5% of the patients experienced a minor complication following open reduction and internal fixation using volar plating of distal radius fractures. Age, sex, fracture type, and time from trauma to surgery were not found to be associated with an increased risk of postoperative complications. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Søren Perregaard
- Department of Orthopedic Surgery, Hand Surgery Unit, Copenhagen University Hospital, Herlev and Gentofte, Gentofte, Denmark
| | - Rasmus Wejnold Jørgensen
- Department of Orthopedic Surgery, Hand Surgery Unit, Copenhagen University Hospital, Herlev and Gentofte, Gentofte, Denmark
| | - Marcus Landgren
- Department of Orthopedic Surgery, Hand Surgery Unit, Copenhagen University Hospital, Herlev and Gentofte, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Bowers M, Gruenberger E, Jardaly AH, Wood M, Ko A, D'Almeida S, Rubin TA. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-Specific Fixation. J Wrist Surg 2023; 12:500-508. [PMID: 38213565 PMCID: PMC10781579 DOI: 10.1055/s-0043-1761286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t -Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion ( p = 0.08), extension ( p = 0.33), supination ( p = 0.35), or pronation ( p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.
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Affiliation(s)
- Mitchell Bowers
- Department of Orthopaedics, Vanderbilt University, Nashville, Tennessee
| | - Eric Gruenberger
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Achraf H. Jardaly
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Madison Wood
- Medical College of Georgia, Medical College of Georgia, Augusta, Georgia
| | - Andrew Ko
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Stacey D'Almeida
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Todd A. Rubin
- Hand and Upper Extremity Surgery Department, Hughston Clinic Orthopaedics, TriStar Centennial Medical Center, Nashville, Tennessee
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Nwosu C, Rodriguez K, Zeng S, Klifto KM, Klifto CS, Ruch DS. Complications Following Volar Locking Plate Fixation of Distal Radius Fractures in Adults: A Systematic Review of Randomized Control Trials. J Hand Surg Am 2023; 48:861-874. [PMID: 37552141 DOI: 10.1016/j.jhsa.2023.04.022] [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: 10/07/2022] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of this study was to assess the incidence of postoperative complications following volar locking plate (VLP) fixation of distal radius fractures (DRFs). METHODS A search using keywords and subject headings to represent the concepts of volar plating and radius fractures was generated. Databases such as MEDLINE (Ovid), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCO) were searched from inception to November 24, 2021, for randomized controlled trials that reported complications following DRF treated with VLP. Inclusion criteria were studies with adult patients (aged ≥18 years) randomized to VLP fixation without other concomitant surgical interventions, with a minimum follow-up of 3 months. Study sample characteristics and post-surgical complications were extracted. The Cochrane Risk of Bias tool was used to evaluate quality of evidence. RESULTS Of the 4,059 articles identified using the search strategy, 1,778 titles/abstracts and 856 full-text articles were screened for inclusion, of which 35 articles were included for data extraction. Overall, 1,419 patients with a DRF were randomized to VLP fixation. The mean age was 60.3 years. The overall complication rate was 30.8% following VLP fixation, with 12.4% being major complications. The most common complications were median nerve-related (7.1%) and hardware removal (6.8%), secondary to other complications. Tenosynovitis was the most common tendon-related complication (3.4%). Other complications included complex regional pain syndrome (2.4%), malunion (1.3%), superficial wound infections (1.9%), and tendon rupture (1.3%). CONCLUSIONS A meta-analysis of high-quality studies that discuss the complications after VLP fixation for DRF showed an overall complication rate of 30.8%. VLP may be related to more hardware-related complications than those previously reported. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Chinemerem Nwosu
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | | | - Steven Zeng
- Duke University School of Medicine, Durham, NC
| | - Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
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Foster BK, Boualam B, Shea RP, Udoeyo IF, Luciani AM, Klena JC, Grandizio LC. Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:638-642. [PMID: 37790835 PMCID: PMC10543772 DOI: 10.1016/j.jhsg.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP). Methods We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT. Results A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures. Conclusions Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs. Level of evidence Prognostic II.
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Affiliation(s)
- Brian K. Foster
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Benchaa Boualam
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - R. Parker Shea
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Idorenyin F. Udoeyo
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - A. Michael Luciani
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Joel C. Klena
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Louis C. Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
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Sagerfors M, Jakobsson H, Wretenberg P, Brus O, Möller M. Treatment and outcome of AO/OTA type C distal radius fractures: 12 199 fractures from the Swedish Fracture Register. Acta Orthop Belg 2023; 89:241-247. [PMID: 37924540 DOI: 10.52628/89.2.11473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The aim of this study was to examine the epidemiology, treatment, and patient-reported outcome of AO/OTA type C distal radius fractures (DRF) using data from a large national fracture register. We used prospectively collected data from the Swedish Fracture Register covering all AO/OTA type C DRFs registered between April 2012 and December 2018. Data on fracture type, epidemiology, trauma-mechanism, and treatment had been recorded by the treating physician. Patients had been sent an outcome questionnaire including EQ-VAS, EQ-5D, and the SMFA at the time of injury and 12 months after. A total of 12 199 cases with AO/OTA type C fracture were identified. AO/OTA type C1 fracture was most common, with 5400 cases, followed by AO type C2 with 4304 and AO/OTA type C3 with 2495. Cast treatment and surgical treatment with volar locking plate fixation were the most common treatments. Patient-reported outcome measures worsened significantly one year after the fracture, and 56% reported moderate problems with pain and discomfort one year after the fracture. Patients treated with a volar plate reported a significantly larger deterioration in EQ-5D outcome compared to patients treated with a cast. No treatment method was found to be superior. A good outcome after a type C fracture is possible, but many patients do not recover completely. Our findings indicate a relatively better self-reported outcome for patients treated with a cast, but as treatment was not randomized the clinical relevance is unclear.
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Huang YM, Chen CY, Lin KC, Lai WY, Lin YY, Fu YJ, Tarng YW. Using Trident distal radial locking plate to fix the fracture of distal radius volar rim. J Chin Med Assoc 2023; 86:426-430. [PMID: 36661280 DOI: 10.1097/jcma.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The volar locking plates have been widely used in a variety of distal radius fractures, but they still have several limitations when dealing with small fragments located around the watershed line with widely reported complications. The volar rim fragments play a critical role in radiocarpal joint stability and failing to secure the volar rim fragment usually results in carpal instability, subluxation, or even dislocation. This study investigates clinical outcomes in the use of a novel implant, the Trident distal radial (TDR) locking plate to treat distal radius fracture with the intermedium column edge (lunate fossa volar rim) fragment involvement. METHODS A retrospective study of 25 patients was conducted, all patients had intermedium column fractures with lunate fossa volar rim involvement and treat with the TDR between January 2016 and December 2019. The clinical assessment outcomes included VAS Pain, PRWE, and DASH scores. Objective measurements included ROM of the injured wrist and grip strength. Final radiographs were used to evaluate radial inclination, volar tilt, ulnar variance, and distal radioulnar joint instability. Secondary operations related to hardware complications were also recorded. RESULTS The outcome revealed that the mean VAS Pain Score was 1.3, mean DASH score was 10.5, and mean PRWE score was 9.3. Objective measurements revealed good ROM recovery and an 89% gripping strength recovery compared with contralateral hand. Radiographic measurements revealed good maintenance of volar tilt, radial inclination, and mean ulnar variance. There were no complications related to the implant and all fracture sites were union. CONCLUSION We believe that the TDR provided more stable fixation among distal radial fractures that predominantly involved the intermedial column and volar rim fragment, and allowing early rehabilitation. We could obtain excellent results in the wrist ROM, gripping power, and Pain Score (VAS).
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Affiliation(s)
- Yin-Ming Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ying Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yih-Wen Tarng
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Fallah Y, Zohrabi K, Shariyate MJ. Persian Fixation - A Novel Surgical Method for Intra-articular Distal Radius Fractures. J Hand Surg Asian Pac Vol 2023; 28:172-177. [PMID: 37120293 DOI: 10.1142/s2424835523500170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background: Intra-articular distal radius fracture treatment options include Kirschner wires (K-wire) fixation, external fixation and plate fixation, however, fixation of small bone fragments in distal radius fractures in a secure and anatomical manner was a challenging issue with several limitations. In this study, we present a novel surgical method that we have called the Persian Fixation for intra-articular distal radius fracture and describe a short-term clinical result. Methods: We described the surgical procedure and clinical result of 15 patients between 2019 and 2020 in whom the Persian Fixation technique was utilised. Through clinical examination and questionnaires, objective and subjective clinical results were determined. Results: At the final follow-up, the mean Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score for our patients was 17.6 ± 12.1, the mean WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) score was 20.7 ± 4.4 and the mean Visual Analogue Scale (VAS) score was 27.8 ± 16.5, indicating a good to excellent clinical result. Conclusions: We recommended the Persian Fixation technique for intra-articular distal radius fractures, which is a low-cost and readily accessible procedure that provides stable fixation of a tiny bone piece. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Yousef Fallah
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kian Zohrabi
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Javad Shariyate
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Jakobsson H, Lundqvist E, Wretenberg P, Sagerfors M. Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome. Arch Physiother 2023; 13:6. [PMID: 36941730 PMCID: PMC10029229 DOI: 10.1186/s40945-023-00159-4] [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: 05/30/2022] [Accepted: 02/21/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS & METHODS This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength. RESULTS Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse. CONCLUSIONS Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.
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Affiliation(s)
- Hugo Jakobsson
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden.
| | - Eva Lundqvist
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
| | - Per Wretenberg
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
| | - Marcus Sagerfors
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
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"Spin" in Plastic Surgery Randomized Controlled Trials with Statistically Nonsignificant Primary Outcomes: A Systematic Review. Plast Reconstr Surg 2023; 151:506e-519e. [PMID: 36442055 DOI: 10.1097/prs.0000000000009937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND "Spin" refers to a manipulation of language that implies benefit for an intervention when none may exist. Randomized controlled trials (RCTs) in other fields have been demonstrated to employ spin, which can mislead clinicians to use ineffective or unsafe interventions. This study's objective was to determine the strategies, severity, and extent of spin in plastic surgery RCTs with nonsignificant primary outcomes. METHODS A literature search of the top 15 plastic surgery journals using MEDLINE was performed (2000 through 2020). Parallel 1:1 RCTs with a clearly identified primary outcome showing statistically nonsignificant results ( P > 0.05) were included. Screening, data extraction, and spin analysis were performed by two independent reviewers. The spin analysis was then independently assessed in duplicate by two plastic surgery residents with graduate-level training in clinical epidemiology. RESULTS From 3497 studies identified, 92 RCTs were included in this study. Spin strategies were identified in 78 RCTs (85%), including 64 abstracts (70%) and 77 main texts (84%). Severity of spin was rated moderate or high in 43 abstract conclusions (47%) and 42 main text conclusions (46%). The most identified spin strategy in the abstract was claiming equivalence for statistically nonsignificant results (26%); in the main text, focusing on another objective (24%). CONCLUSIONS This study suggests that 85% of statistically nonsignificant RCTs in plastic surgery employ spin. Readers of plastic surgery research should be aware of strategies, whether intentional or unintentional, used to manipulate language in reports of statistically nonsignificant RCTs when applying research findings to clinical practice.
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Modest JM, Raducha JE, Schilkowsky RM, Molino J, Got CJ, Katarincic JA, Gil JA. Supplementary Fixation Improves Stability of Intra-Articular Distal Radius Fractures Managed With a Spanning Plate. J Hand Surg Am 2023:S0363-5023(23)00021-7. [PMID: 36792395 DOI: 10.1016/j.jhsa.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Previous studies evaluating weight bearing of distal radius fractures treated through dorsal spanning bridge plates used extra-articular fracture models, and have not evaluated the role of supplementary fixation. We hypothesized that supplementary fixation with a spanning dorsal bridge plate for an intra-articular wrist fracture would decrease the displacement of individual articular pieces with cyclic axial loading and allow for walker or crutch weight bearing. METHODS Thirty cadaveric forearms were matched into 3 cohorts, controlling for age, sex, and bone mineral density. An intra-articular fracture model was fixed with the following 3 techniques: (1) cohort A with a dorsal bridge plate, (2) cohort B with a dorsal bridge plate and two 1.6-mm k-wires, and (3) cohort C with a dorsal bridge plate and a radial pin plate. Specimens were axially loaded cyclically with escalating weights consistent with walker and crutch weight-bearing with failure defined as 2-mm displacement. RESULTS No specimens failed at 2- or 5-kg weights, but cohort A had significantly more displacement at these weights compared with cohort B. Cohort A had significantly more failure than cohort C. Both cohort A and cohort B had significantly more displacement at crutch weight bearing compared with cohort C. The supplementary fixation group had significantly lower displacement at crutch weight-bearing compared with cohort A in all gaps. Survival curves demonstrated the fixation cohort to survive higher loads than the nonfixation group. CONCLUSION There was significantly less displacement and less failure of intra-articular distal radius fractures treated with a spanning dorsal bridge plate and supplementary fixation. Our model showed that either type of fixation was superior to the nonfixation group. CLINICAL SIGNIFICANCE When considering early weight-bearing for intra-articular distal radius fractures treated with a spanning dorsal bridge plate, supplementary fixation may be considered as an augmentation to prevent fracture displacement.
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Affiliation(s)
- Jacob M Modest
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI.
| | - Jeremy E Raducha
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Rachel M Schilkowsky
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Janine Molino
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Christopher J Got
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Julia A Katarincic
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Joseph A Gil
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
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de Villeneuve Bargemon JB, Soudé G, Levadoux M, Viaud-Ambrosino S, Peras M, Camuzard O. Radiocarpal fracture-dislocation: Review of the literature, new classification and decision algorithm. Orthop Traumatol Surg Res 2023; 109:103547. [PMID: 36638866 DOI: 10.1016/j.otsr.2023.103547] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Radiocarpal fractures and dislocations are rarely described in the literature. However, the consequences at the functional level are severe, with the loss of almost half of the articular amplitude. The most widespread classification is that of Dumontier, which divides the injury into two categories according to the presence or absence of a fracture. Currently, no classification considers fracture-dislocations in a global and multi-tissue manner; therefore, no therapeutic strategy has been reported. METHODS We conducted an exhaustive bibliographic search for cohort or case report articles concerning radiocarpal fracture-dislocations published between 1990 and the present. Only descriptions of the injury were identified (noting the type of fracture, direction of displacement and carpal injuries). RESULTS In all, data were collected from 14 retrospective series and 16 case reports involving 218 patients. Thirty-five and 183 cases involved anterior and posterior displacement, respectively. A fracture of the distal radius was found in 183 cases and 35 cases had a dislocation only, with no significant fracture. Among the posterior displacements, 44 isolated styloid fractures, 62 styloid and posterior marginal fractures, 29 bimarginal fractures (large anterior fragment and small posterior fragment) and 31 fractures of all the fragments described by Medoff with impaction of the central pavement were found. Anterior displacement fractures were found in 17 cases (styloid and/or anterior marginal fracture). We were able to group the different traumatic clinical forms according to a six-category classification. DISCUSSION A review of the literature highlighted three major components in the management of radiocarpal fracture-dislocations: the bone component, the ligament component and the associated intracarpal lesions. These three components were included in our classification and allowed us to accurately describe all types of radiocarpal fracture-dislocations published in the literature. Authors currently agree on management of the bone component but disagree on that of the ligament component. Particular attention should be paid to intracarpal lesions, which lead to poor outcomes if ignored. Based on our biographical research, we propose a management plan for these complex injuries. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand, Wrist and Elbow Surgery, Saint-Roch Private Hospital, 99, avenue Saint-Roch, 83100 Toulon, France; University Institute of Locomotor and Sport (IULS), Pasteur Hospital, 30, voie romaine, 06100 Nice, France.
| | - Guillaume Soudé
- Orthopedic and Traumatology Surgery, Hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint-Roch Private Hospital, 99, avenue Saint-Roch, 83100 Toulon, France
| | - Sébastien Viaud-Ambrosino
- Hand surgery and limb reconstructive surgery, Timone Adult Hospital, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Matthieu Peras
- Department of orthopedic surgery and traumatology, Teaching Naval Hospital Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon France
| | - Olivier Camuzard
- University Institute of Locomotor and Sport (IULS), Pasteur Hospital, 30, voie romaine, 06100 Nice, France
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Asmara AAGY, Karna MB, Meregawa PF, Deslivia MF. Outcomes of the Management of Distal Radius Fractures in the Last 5 Years: A Meta-analysis of Randomized Controlled Trials. Rev Bras Ortop 2022; 57:899-910. [PMID: 36540735 PMCID: PMC9757966 DOI: 10.1055/s-0042-1754379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Over the last decades, volar locking plates (VLPs) have been the mainstay treatment for distal radius fractures (DRFs). With the growing body of evidence, we systematically reviewed studies on recent VLP modifications. Methods A systematic search was performed in the PubMed/MEDLINE database for studies published in English in the past five years. The inclusion criteria were randomized controlled trials (RCTs) on the operative treatment of DRFs. We excluded ongoing trials and studies not directly addressing DRF. The primary outcomes assessed were subjective (such as the scores on the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, the Patient-rated Wrist Evaluation [PRWE], the European Quality of Life-5 Dimensions [EQ-5D], the 36-item Short Form Health Survey [SF-36], and the Visual Analog Scale [VAS]) and objective clinical outcomes (the complication rate). Results We identified 29 articles published from 2016 to 2020 with high quality of evidence, except for one, which had evidence of moderate quality. In total, 3,079 DRFs were analyzed in the present study. All studies except one had a greater proportion of female participants, and only in 1 study the mean age of the sample was < 40 years old. There were no significant differences between the VLP and external fixation (EF) in terms of the scores on the DASH ( p = 0.18) and PRWE ( p = 0.77). The VLP alone without pronator quadratus (PQ) repair yielded significantly better outcomes. Conclusion In unstable fractures, the VLP and EF yielded comparable long-term results. There is no clear benefit of adding PQ repair to current the VLP surgical technique. Level of Evidence Level I.
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Affiliation(s)
- Anak Agung Gede Yuda Asmara
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia,Endereço para correspondência Anak Agung Gede Yuda Asmara Orthopedics and Traumatology Department, Faculty of Medicine, Udayana University, Sanglah General HospitalJl, Kesehatan no.1, BaliIndonesia
| | - Made Bramantya Karna
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Putu Feryawan Meregawa
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
| | - Maria Florencia Deslivia
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Udayana University, Sanglah General Hospital, Bali, Indonésia
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14
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Kunes JA, Hong DY, Hellwinkel JE, Tedesco LJ, Strauch RJ. Extensor Tendon Injury After Volar Locking Plating for Distal Radius Fractures: A Systematic Review. Hand (N Y) 2022; 17:87S-94S. [PMID: 35168382 PMCID: PMC9793626 DOI: 10.1177/15589447211068186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Distal radius fractures are common orthopedic injuries. Treatment has varied historically, but volar locking plating currently predominates. Although flexor tendon injury is a well-studied complication of this operation, extensor tendon injury is less well studied. The purpose of this review is to search the literature and present the epidemiology, presentation, and treatment of this complication. The Cochrane, EMBASE, PubMed, and SCOPUS databases were searched for the terms "volar" + "radius" + ("plate" OR "plating") + "extensor." Ninety final studies were included for analysis in this review. The incidence of extensor tendon rupture varies from 0% to 12.5%; the extensor pollicis longus is most commonly ruptured. The presentation and management of extensor tendon injury after injury, intraoperatively, and postoperatively are summarized. Radiographic views are described to detect screw prominence and minimize intraoperative risk. Extensor tendon injury after volar locking plate for distal radius fractures is an uncommon injury with several risk factors including dorsal screw prominence and fracture fragments. Removal of hardware and tendon transfers or reconstruction may be necessary to prevent loss of extensor mechanism.
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15
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ÇETİN MÜ, POLAT A, FİDAN F. Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür? CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1087119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared.
Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation.
Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively.
Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.
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Affiliation(s)
| | - Abdulkadir POLAT
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL GAZİOSMANPAŞA TAKSİM HEALTH RESEARCH CENTER
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16
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Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases. J Hand Surg Am 2022; 47:813-822. [PMID: 35842329 DOI: 10.1016/j.jhsa.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/20/2022] [Accepted: 04/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating. METHODS In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score. RESULTS Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group. CONCLUSIONS In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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17
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Huang YM, Chen CY, Lin KC, Tarng YW, Liao CY, Chang WN. Functional outcomes following fixation of a marginal distal radius fracture with two commonly used volar locking plates: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:18. [PMID: 34980102 PMCID: PMC8725281 DOI: 10.1186/s12891-021-04984-1] [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: 05/18/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, marginal distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on marginal distal radius fractures. This study compared functional outcomes in patients with marginal distal radius fractures treated with two different implants. Materials and methods A retrospective study was conducted, all patients who received a Synthes 2.4 mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The marginal distal radius fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa’s joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and grip strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius’s volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating marginal distal radius fractures.
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Affiliation(s)
- Yin-Ming Huang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China. .,Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, Republic of China. .,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan, Republic of China.
| | - Kai-Cheng Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Yih-Wen Tarng
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Ching-Yi Liao
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
| | - Wei-Ning Chang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan, Republic of China
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18
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Adult Distal Radius Fracture Management. J Am Acad Orthop Surg 2021; 29:e1105-e1116. [PMID: 34288886 DOI: 10.5435/jaaos-d-20-01335] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/18/2021] [Indexed: 02/01/2023] Open
Abstract
Distal radius fractures (DRFs) are some of the most commonly encountered fractures, and the incidence is increasing. Optimal treatment remains controversial. Critical evaluation of the initial imaging is necessary to recognize fracture characteristics and stability. The fracture pattern, injury mechanism, soft-tissue injury, patient characteristics, and surgeon preference are generally taken into consideration when choosing the most appropriate modality. Volar plating has become the workhorse of surgical DRF management but is not without complications. The surgeon should be comfortable using a wide variety of techniques to customize the fixation to the fracture pattern. Recognition of potential dangers and use of intraoperative imaging techniques can mitigate complications. Goals of rehabilitation after the initial treatment of DRF include regaining motion, strength, and ultimately function while managing pain.
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19
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Björk M, Niklasson J, Westerdahl E, Sagerfors M. Self-efficacy corresponds to wrist function after combined plating of distal radius fractures. J Hand Ther 2021; 33:314-319. [PMID: 32088082 DOI: 10.1016/j.jht.2020.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/06/2019] [Accepted: 01/12/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A prospective cohort single-center study. INTRODUCTION Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome. PURPOSE OF THE STUDY The aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture. METHODS Sixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion. RESULTS The group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score. DISCUSSION SE corresponds to wrist function after combined plating of distal radius fractures. CONCLUSION Measurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.
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Affiliation(s)
- Marie Björk
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden
| | - Johan Niklasson
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden
| | - Elisabeth Westerdahl
- Faculty of Medicine and Health, Department of Physiotherapy, Örebro University, Örebro, Sweden
| | - Marcus Sagerfors
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
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20
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Abstract
Despite the popularity and success of volar fixed angle plating, variations in distal radius fracture presentation underscore the importance of understanding different surgical treatment options to maximize patient outcomes. The 3-column theory of wrist mechanics provided the foundation for using a column-specific fixation approach. Implant placement within the ulnar column can be challenging because of anatomical constraints. Some have described "safe zones" for implant position to decrease the potential for tendon impingement. A thorough understanding of the surrounding anatomy can allow fixation decisions based on fracture fragment location. Literature reports have shown excellent results when using fragment specific fixation constructs and similar outcomes when comparing these constructs with volar locked plating. Achieving optimal outcomes in surgically treated distal radius fractures requires the surgeon to be competent along a spectrum of surgical approaches and fixation constructs.
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21
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Abstract
The field of hand surgery continues to evolve in new and exciting directions. Advances in diagnosis and management for common complaints and complex injuries allow higher-level care, while still being cognizant of the cost of health care delivery. Indications and protocols for past paradigm shifts, such as volar locked plating for distal radial fractures, continue to be honed, and the outcomes seen for modern flexor tendon repairs are impressive. Open questions remain, but promising results for scaphoid nonunion surgery and peripheral nerve reconstruction with processed allograft will continue to shed light on these unsolved problems.
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Affiliation(s)
- Travis A Doering
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA.
| | - Benjamin M Mauck
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA
| | - James H Calandruccio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA
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22
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Maccagnano G, Noia G, Vicenti G, Baglioni M, Masciale MR, Cassano GD, Vitiello R, Moretti B, Pesce V. Volar locking plate versus external fixation in distal radius fractures: A meta-analysis. Orthop Rev (Pavia) 2021; 13:9147. [PMID: 33936574 PMCID: PMC8082167 DOI: 10.4081/or.2021.9147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 02/08/2023] Open
Abstract
The purpose of this meta-analysis is to evaluate the efficacy of plate or external fixator treatments in distal radius fractures, based not only on clinical and radiographic parameters but on Health Related Quality of Life (HRQOL) parameters. The Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) guidelines were followed when conducting this systematic review. The Revised Assessment of Multiple Systematic Reviews (RAMSTAR) checklist was additionally consulted in order to ensure a high-quality methodological process, encompassing such elements as an ‘a priori’ design, independent reviews and comprehensive search. The literature search was carried out on PubMed, MEDLINE and Scopus. The search terms used were “Radius fracture AND osteosynthesis”, “Wrist fracture AND external fixator” and “Wrist fracture AND plate”. Two reviewers independently screened titles, abstracts and full texts. To determine inter-reviewer agreement, a k score was calculated after each screening state. Of the 5753 studies collected through the initial databases search, two studies were included in the final meta-analysis (125 treated with external fixator vs 132 with volar plate). There was a substantial inter-reviewer agreement as to the title (0.73; 95% confidence interval, 0.67-0.79) abstract (0.65; 95% CI, 0.46-0.83) and fulltext screening stages (0.89; 95%CI, 0.67-1). The meta-analysis reported a mean difference equal to 0.00 (95%CI= -0.05 – 0.05), in accordance with I2= 0% and p test for the heterogeneity value=0.089. This meta analysis confirms and quantifies that the two techniques are superimposable as regards the quality of life reported by patients at least one year of follow-up.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia.,University of Foggia
| | - Giovanni Noia
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia
| | - Giovanni Vicenti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Marco Baglioni
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Maria Rosa Masciale
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Giuseppe Danilo Cassano
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | | | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari, AOU Consorziale Policlinico, Bari
| | - Vito Pesce
- Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia.,University of Foggia
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Woolnough T, Axelrod D, Bozzo A, Koziarz A, Koziarz F, Oitment C, Gyemi L, Gormley J, Gouveia K, Johal H. What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res 2021; 479:348-362. [PMID: 33165042 PMCID: PMC7899542 DOI: 10.1097/corr.0000000000001524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many acceptable treatment options exist for distal radius fractures (DRFs); however, a simultaneous comparison of all methods is difficult using conventional study designs. QUESTIONS/PURPOSES We performed a network meta-analysis of randomized controlled trials (RCTs) on DRF treatment to answer the following questions: Compared with nonoperative treatment, (1) which intervention is associated with the best 1-year functional outcome? (2) Which intervention is associated with the lowest risk of overall complications? (3) Which intervention is associated with the lowest risk of complications requiring operation? METHODS Ten databases were searched from inception to July 25, 2019. Search and analysis reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Included studies were English-language RCTs that assessed at least one surgical treatment arm for adult patients with displaced DRFs, with less than 20% loss to follow-up. We excluded RCTs reporting on patients with open fractures, extensive bone loss, or ipsilateral upper extremity polytrauma. Seventy RCTs (n = 4789 patients) were included. Treatments compared were the volar locking plate, bridging external fixation, nonbridging external fixation, dynamic external fixation, percutaneous pinning, intramedullary fixation, dorsal plating, fragment-specific plating, and nonoperative treatment. Subgroup analyses were conducted for intraarticular fractures, extraarticular fractures, and patients with an average age greater than 60 years. Mean (range) patient age was 59 years (56 to 63) and was similar across all treatment groups except for dynamic external fixation (44 years) and fragment-specific plating (47 years). Distribution of intraarticular and extraarticular fractures was approximately equal among the treatment groups other than that for intramedullary fixation (73% extraarticular), fragment-specific plating (66% intraarticular) [13, 70], and dorsal plating (100% intraarticular). Outcomes were the DASH score at 1 year, total complications, and reoperation. The minimum clinically important different (MCID) for the DASH score was set at 10 points. The analysis was performed using Bayesian methodology with random-effects models. Rank orders were generated using surface under the cumulative ranking curve values. Evidence quality was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology. Most studies had a low risk of bias due to randomization and low rates of incomplete follow-up, unclear risk of bias due to selective reporting, and high risk of bias due to lack of patient and assessor blinding. Studies assessing bridging external fixation and/or nonoperative treatment arms had a higher overall risk of bias while studies with volar plating and/or percutaneous pinning treatment arms had a lower risk of bias. RESULTS Across all patients, there were no clinically important differences in terms of the DASH score at 1 year; although differences were found, all were less than the MCID of 10 points. Volar plating was ranked the highest for DASH score at 1 year (mean difference -7.34 [95% credible interval -11 to -3.7) while intramedullary fixation, with low-quality evidence, also showed improvement in DASH score (mean difference -7.75 [95% CI -14.6 to -0.56]). The subgroup analysis revealed that only locked volar plating was favored over nonoperative treatment for patients older than 60 years of age (mean difference -6.4 [95% CI -11 to -2.1]) and for those with intraarticular fractures (mean difference -8.4 [95% CI -15 to -2.0]). However, its clinical importance was uncertain as the MCID was not met. Among all patients, intramedullary fixation (odds ratio 0.09 [95% CI 0.02 to 0.84]) and locked volar plating (OR 0.14 [95% CI 0.05 to 0.39]) were associated with a lower complication risk compared with nonoperative treatment. For intraarticular fractures, volar plating was the only treatment associated with a lower risk of complications than nonoperative treatment (OR 0.021 [95% CI < 0.01 to 0.50]). For extraarticular fractures, only nonbridging external fixation was associated with a lower risk of complications than nonoperative treatment (OR 0.011 [95% CI < 0.01 to 0.65]), although the quality of evidence was low. Among all patients, the risk of complications requiring operation was lower with intramedullary fixation (OR 0.06 [95% CI < 0.01 to 0.85) than with nonoperative treatment, but no treatment was favored over nonoperative treatment when analyzed by subgroups. CONCLUSION We found no clinically important differences favoring any surgical treatment option with respect to 1-year functional outcome. However, relative to the other options, volar plating was associated with a lower complication risk, particularly in patients with intraarticular fractures, while nonbridging external fixation was associated with a lower complication risk in patients with extraarticular fractures. For patients older than 60 years of age, nonoperative treatment may still be the preferred option because there is no reliable evidence showing a consistent decrease in complications or complications requiring operation among the other treatment options. Particularly in this age group, the decision to expose patients to even a single surgery should be made with caution. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Taylor Woolnough
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Daniel Axelrod
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Anthony Bozzo
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Frank Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Colby Oitment
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Lauren Gyemi
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Jessica Gormley
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Kyle Gouveia
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
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Combined volar and dorsal plating vs. volar plating of distal radius fractures. A single-center study of 105 cases. HAND SURGERY & REHABILITATION 2020; 39:516-521. [DOI: 10.1016/j.hansur.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
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Sagerfors M, Lundqvist E, Bjorling P. Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases. J Wrist Surg 2020; 9:388-395. [PMID: 33042641 PMCID: PMC7540645 DOI: 10.1055/s-0040-1712503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Background The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion. Question/Purpose Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intra-articular fractures. The primary outcome was patient-reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients. Conclusion The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managed with volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.
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Affiliation(s)
- Marcus Sagerfors
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Eva Lundqvist
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Patrik Bjorling
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
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Meaike JJ, Kakar S. Management of Comminuted Distal Radius Fractures: A Critical Analysis Review. JBJS Rev 2020; 8:e2000010. [PMID: 32960024 DOI: 10.2106/jbjs.rvw.20.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Distal radius fractures occur in a bimodal age and sex distribution. Their incidence continues to rise with an increasingly active aging population. The current American Academy of Orthopaedic Surgeons guidelines for operative intervention are radial shortening of >3 mm, dorsal tilt of >10[degrees], or intra-articular displacement or step-off of >2 mm. The method of reduction and fixation should be selected on a case-by-case basis with a focus on patient factors, fracture behavior, surgical proficiency, and functional outcomes.
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Affiliation(s)
- Joshua J Meaike
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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27
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Abstract
In the recent years, treatment of distal radius fractures (DRF) has advanced considerably. Surgical fixation with palmar angular stable plate has gained popularity, due to a reported lower complication rate when compared to dorsal fixation. The type of trauma or injury, surgical procedure and impaired bone quality are all contributors to complications in DRF. The main aim of this review is to summarize the most common complications and possible therapeutic solutions. In addition, strategies for minimizing these complications will be discussed.
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28
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Sagerfors M, Niklasson J, Pettersson K. Pulp-to-palm distance is associated with inferior short-term outcome after combined plating for distal radius fractures. HAND SURGERY & REHABILITATION 2019; 38:369-374. [PMID: 31568863 DOI: 10.1016/j.hansur.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/29/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
Distal radius fractures (DRF) are the most common fracture in adults. A tool is needed to identify patients who may need extra attention from the physical therapist during the rehabilitation process. The purpose of the study was to examine if pulp-to-palm distance (PTP) 4 weeks postoperatively is associated with wrist function 3 months postoperatively in patients undergoing combined plating for a complex DRF. This prospective study involved 53 patients. PTP was assessed by a physical therapist at the second visit, 4 weeks postoperatively. The 3-month follow-up visit consisted of evaluating the following outcomes: PRWE (Patient-Rated Wrist Evaluation), QuickDASH (Disabilities of the Arm, Shoulder and Hand), VAS pain scores, hand grip strength and wrist range of motion. All patients received the same amount of hand therapy. Patients with zero PTP at 4 weeks postoperative had a significantly better range of motion in wrist extension, flexion, radial deviation, ulnar deviation, hand grip strength and QuickDASH scores compared to patients with a PTP>0cm. VAS pain scores did not differ between the two groups. Patients with zero PTP at 4 weeks postoperative were more likely to have a better wrist function at 3 months postoperative compared to patients with measurable PTP. Based on this study's findings, measuring the PTP distance at 4 weeks postoperative could be useful for identifying patients in need of support during the rehabilitation process after DRF surgery. This could potentially improve the allocation of hand rehabilitation resources; screening patients postoperatively could help to begin relevant interventions.
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Affiliation(s)
- M Sagerfors
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Södra Grev Rosengatan, 70182 Örebro, Sweden.
| | - J Niklasson
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Södra Grev Rosengatan, 70182 Örebro, Sweden.
| | - K Pettersson
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Södra Grev Rosengatan, 70182 Örebro, Sweden.
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29
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Aita MA, Rodrigues FL, Alves KHCR, de Oliveira RK, Ruggiero GM, Rodrigues LMR. Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study. J Wrist Surg 2019; 8:408-415. [PMID: 31579551 PMCID: PMC6773580 DOI: 10.1055/s-0039-1692480] [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: 11/04/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.
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Affiliation(s)
- Marcio Aurelio Aita
- Division of Orthopedic and Trauma—Hand and Microsurgery, Department of Surgery, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fabio Lucas Rodrigues
- Division of Orthopedic and Trauma—Hand and Microsurgery, Department of Surgery, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | | | | | - Luciano Miller Reis Rodrigues
- Division of Orthopedic and Trauma—Hand and Microsurgery, Department of Surgery, Faculdade de Medicina do ABC, Santo Andre, Brazil
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30
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Sagerfors M, Bjorling P, Niklasson J, Pettersson K. Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases. J Wrist Surg 2019; 8:180-185. [PMID: 31192037 PMCID: PMC6546491 DOI: 10.1055/s-0038-1676859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/12/2018] [Indexed: 01/06/2023]
Abstract
Background The distal radius fracture (DRF) is the most common fracture among adults. In recent years, there has been a shift toward volar locking plates in the treatment of DRFs, and this shift has taken place with a low degree of evidence. Question/purposes Can combined volar T-plating and dorsal pi-plating of AO type C fractures yield a good functional and radiographic outcome 1 year postoperatively? Patients and Methods In a retrospective cohort study, we evaluated 102 consecutive patients operated with combined dorsal and volar plating, of whom 80 completed the 1-year follow-up. The DRFs were operated between 2012 and 2013. All cases were AO type C2 and C3 fractures. The primary outcome was functional scoring including radiographic examination. Secondary outcome measures included range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results The median Batra radiographic score was 84.5. Wrist extension was 74% of the uninjured side, flexion was 70%, pronation was 94%, and supination was 90%. The Patient-Rated Wrist Evaluation score was 21 points, and the Disabilities of the Arm, Shoulder, and Hand score was 19.4 points. VAS pain scores were 0 at rest and 3 during activity. Hand grip strength was 80% of the uninjured side. Radiographic outcome did not correspond to a patient-reported outcome. Hardware removal was performed in 15/80 cases. Conclusions We conclude that a good outcome can be expected after combined dorsal and volar plating of DRFs. Radiographic outcome is not necessarily associated with functional outcome 1 year postoperatively. The rate of hardware removal was acceptable. Level of Evidence III.
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Affiliation(s)
- Marcus Sagerfors
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Patrik Bjorling
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Johan Niklasson
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
| | - Kurt Pettersson
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden
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Abstract
Distal radial fractures account for up to 18% of all fractures in patients over 65 years of age, and osteoporosis is a predominant factor in these fractures. Fracture treatment may include closed reduction and casting/splinting, external fixation, and open reduction and internal fixation.
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Affiliation(s)
- John C Wu
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - Carson D Strickland
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James S Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Abstract
PURPOSE OF REVIEW Fragment-specific fixation can be a useful tool in treating distal radius fractures. In order to best utilize these techniques, surgeons require an understanding of the normal anatomy, fracture patterns, approaches, and fixation strategies. RECENT FINDINGS Fragment-specific fixation may be appropriate for certain fracture patterns particularly when monoblock plating techniques are not sufficient. Radial styloid, volar rim, dorsal wall, dorsal-ulnar corner, and impacted intraarticular fragments may be secured with implants designed specifically for each individual fragment. Although more technically demanding, advantages include accurate articular reconstruction, minimal hardware irritation, and reliable functional outcomes.
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Affiliation(s)
- Bryan A Hozack
- Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Rick J Tosti
- Orthopaedic Surgery, Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street Suite G114, Philadelphia, PA, 19107, USA
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Rancy SK, Malliaris SD, Bogner EA, Wolfe SW. Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant. J Wrist Surg 2018; 7:358-365. [PMID: 30349747 PMCID: PMC6196090 DOI: 10.1055/s-0038-1669438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
| | - Stephanie D. Malliaris
- Division of Hand and Upper Extremity Surgery, Denver Health Medical Center, University of Colorado School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Eric A. Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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34
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Affiliation(s)
- Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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35
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Landgren M, Abramo A, Geijer M, Kopylov P, Tägil M. Similar 1-year subjective outcome after a distal radius fracture during the 10-year-period 2003-2012. Acta Orthop 2017; 88:451-456. [PMID: 28290758 PMCID: PMC5499340 DOI: 10.1080/17453674.2017.1303601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - During the last decades, treatment of distal radius fractures (DRFs) has changed, with surgical intervention being more common and with new techniques. We investigated whether this change has influenced the subjective outcome. Here we report, year by year, the 1-year score after a DRF over a 10-year-period, using a patient-reported outcome measure. Patients and methods - Patients aged 18 years or more with a DRF between 2003 and 2012 were prospectively and consecutively registered in a longitudinal outcome database. 1 year after the fracture, all the patients were sent a validated subjective outcome questionnaire, the Disabilities of the Arm, Shoulder, and Hand (DASH). The lower the score (0-100), the better the outcome. Results - Between 2003 and 2012, 3,666 patients (2,833 of them women; mean age 62 (18-98) years) were included. 22% were operated and the rate remained constant over the years. The surgical methods shifted from external fixators (42%) and fragment-specific plates (45%) in 2003, to mainly volar locking plates (65%) in 2012. 70% of the patients responded to the 1-year DASH questionnaire. The median DASH score was 9 (IQR: 2-25) for the cohort, both in surgically treated patients (9 (IQR: 3-25)) and in non-surgically treated patients (9 (IQR 2-27)). Subgroup analysis showed a higher median DASH score for women than for men; for patients with AO type C fractures rather than type B or type A fractures; for patients with external fixation or fragment-specific fixation than for those who underwent surgery using volar locking plates; and for patients who were operated by a general orthopedic surgeon rather than a hand surgeon. Interpretation - The shift in surgical treatment had no influence on the subjective outcome for the cohort.
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Affiliation(s)
- Marcus Landgren
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund;,Correspondence:
| | - Antonio Abramo
- Department of Hand Surgery Malmö, Skåne University Hospital, Malmö
| | - Mats Geijer
- Department of Clinical Sciences, Lund University, and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Philippe Kopylov
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund
| | - Magnus Tägil
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund;,Department of Hand Surgery Malmö, Skåne University Hospital, Malmö
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