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Świta M, Szymonek P, Talarek K, Tomczyk-Warunek A, Turżańska K, Posturzyńska A, Winiarska-Mieczan A. Complex Regional Pain Syndrome after Distal Radius Fracture-Case Report and Mini Literature Review. J Clin Med 2024; 13:1122. [PMID: 38398434 PMCID: PMC10889771 DOI: 10.3390/jcm13041122] [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: 12/31/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field.
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Affiliation(s)
- Michał Świta
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (M.Ś.); (P.S.); (K.T.); (A.P.)
| | - Paweł Szymonek
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (M.Ś.); (P.S.); (K.T.); (A.P.)
| | - Konrad Talarek
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (M.Ś.); (P.S.); (K.T.); (A.P.)
| | - Agnieszka Tomczyk-Warunek
- Laboratory of Locomotor Systems Research, Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Karolina Turżańska
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (M.Ś.); (P.S.); (K.T.); (A.P.)
| | - Agnieszka Posturzyńska
- Department of Rehabilitation and Orthopedics, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (M.Ś.); (P.S.); (K.T.); (A.P.)
| | - Anna Winiarska-Mieczan
- Department of Bromatology and Nutrition Physiology, Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka St. 13, 20-950 Lublin, Poland;
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Abulsoud MI, Mohammed AS, Elmarghany M, Elgeushy A, Elzahed E, Moawad M, Elshal EA, Elhalawany MF, Hassanein YA, Fouad AA, Zakaria AR. Intramedullary Kirschner wire fixation of displaced distal forearm fractures in children. BMC Musculoskelet Disord 2023; 24:746. [PMID: 37735419 PMCID: PMC10512509 DOI: 10.1186/s12891-023-06875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
AIM OF THE WORK This study was designed to highlight internal fixation by intramedullary K-wires for displaced distal forearm fractures among children and analyze the results of this technique. We hypothesize that physis-sparing intramedullary fixation prevents displacement with a lower complication rate. METHODS This prospective case series involving 47 patients was conducted between February 2018 and December 2019. All patients with open physis presented with recent displaced distal forearm fractures were included, and all of them were treated with an intramedullary k-wire fixation for both bones with the assessment of the union rate, union time, suspected complication, radiographic evaluation, and functional outcome. RESULTS The study population consisted of 31 boys (66%) and 16 girls (34%). The mean age of the patients was 10.68 ± 2.728 years (range, 7-15 years). All fractures were united in a median of 6 weeks (range, 4-8 weeks), The functional outcome after 12 months was normal in 42 patients (89.4%), whereas, in five patients (10.6%), the functional parameters were minimally reduced. The median preoperative angulation improved from 36° (range, 24°-52°) preoperatively to 4° (range, 0°-10°) on immediate postoperative radiographs. After 12 months, the median angulation was 2° (range, 0°-7°) (p < 0.001). The angulation of the distal radius immediately after surgery and at the final follow-up was statistically correlated with the functional outcome (p < 0.001 and 0.002, respectively). CONCLUSION This technique provides a good result with less susceptibility to re-displacement and low complication rates. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mohamed I Abulsoud
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Ahmed Saied Mohammed
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Elmarghany
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elgeushy
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ehab Elzahed
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Moawad
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ehab A Elshal
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed F Elhalawany
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yahia A Hassanein
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amr A Fouad
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed R Zakaria
- Department of Orthopedic Surgery, Helwan University, Helwan, Egypt
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Walker LC, O'Connor D, Richards SW, Southgate JJ. The "COVID-19 Approach" to Distal Radius Fracture Management. J Wrist Surg 2023; 12:121-127. [PMID: 36926211 PMCID: PMC10010892 DOI: 10.1055/s-0042-1756496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/28/2022] [Indexed: 10/10/2022]
Abstract
Background In response to the coronavirus pandemic the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines advised treating distal radius fractures (DRFs) non-operatively where possible. Questions/Purpose The aim of this study was to assess whether the coronavirus disease 2019 (COVID-19) pandemic lockdown within the United Kingdom did alter the management of DRFs and whether there was any subsequent change in patient outcome or complication rate. Patients and Methods A retrospective cohort study was performed at a single orthopaedic center within the United Kingdom. The cohort of patients presenting with DRFs during the first lockdown was identified through the virtual fracture clinic database. The cohort of patients from the previous year was also identified for comparison. Data was collected on patient demographics, radiological features of the fractures, management, patient outcome and subsequent complications. Comparisons were then made between the cohorts for each year. Results The pre-COVID cohort had a significantly higher number of patients reviewed in face-to-face clinic appointments ( p = 0.0044) and the mean number of clinic appointments for those patients was significantly higher ( p = 0.0149). There was no significant difference between the cohorts regarding patient complications or any need for return to theater with a minimum 10 month follow-up period. Conclusion Despite comparative numbers and patterns of DRFs as well as no significant difference in the number of injuries requiring orthopaedic intervention, the burden on fracture clinic services was significantly reduced during the COVID pandemic. Encouragingly, this reduction in follow-up has not translated into an increased prevalence of complications or requirement for further surgery. Level of Evidence The level of evidence of the study is level III.
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Affiliation(s)
- Lucy C. Walker
- Department of Trauma and Orthopaedics, Poole Hospital, University Hospitals Dorset, Poole, England
| | - David O'Connor
- Department of Trauma and Orthopaedics, Poole Hospital, University Hospitals Dorset, Poole, England
| | - Simon W. Richards
- Department of Trauma and Orthopaedics, Poole Hospital, University Hospitals Dorset, Poole, England
| | - Jeremy J. Southgate
- Department of Trauma and Orthopaedics, Poole Hospital, University Hospitals Dorset, Poole, England
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Liu J, Mustafa AK, Lees VC, Qian Z, Wei G, Lu X, Jin J, Ren L, Ren L, Wang K. Analysis and validation of a 3D finite element model for human forearm fracture. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3617. [PMID: 35560814 DOI: 10.1002/cnm.3617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
Most researchers have performed finite element (FE) analysis of the human forearm fracture by exploring the strength and load transmission of the bones. However, few studies concentrated a complete simulation of the whole forearm complex including ligaments. This paper aims to investigate the load transmission through the bones, contact stress at the joints and strain in the ligaments by using an elaborate FE model, further validating the fracture condition for human forearm. The interosseous ligament was separated into three regions based on the distance to the proximal and distal ends. The FE simulation results were slightly more or less than a previous experimental data in the literature, but generally provided a close approximation of the bone and ligament behaviors. Compared with the experiment results under different loading conditions, maximum contact stress at the proximal radio ulnar joint (PRUJ) and distal radio ulnar joint (DRUJ) of the simulations was higher with an average of 13.4%, and peak strain in the interosseous ligament (IOL) was lower with an average of 11.0%. Under 10 kg load, the maximum stress in the radius (2.25 MPa) was less than double the value in the ulna (1.43 MPa). Finally, the FE model has been validated with the onset and location of the Colles' fracture in the literature. This study will provide a great benefit in terms of surgical and medical applications related to forearm fracture that require an extensive knowledge of the behavior of the bones and ligaments under various loading conditions.
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Affiliation(s)
- Jing Liu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
- Weihai Institute for Bionics - Jilin University, Weihai, China
| | - Al-Khazraji Mustafa
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Vivien C Lees
- Department of Reconstructive Plastic Surgery, University Hospital South Manchester, Wythenshawe, UK
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
- Weihai Institute for Bionics - Jilin University, Weihai, China
| | - Guowu Wei
- School of Science, Engineering and Environment, University of Salford, Salford, UK
| | - Xuewei Lu
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Jianqiao Jin
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Luquan Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
- Weihai Institute for Bionics - Jilin University, Weihai, China
| | - Kunyang Wang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, China
- Weihai Institute for Bionics - Jilin University, Weihai, China
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Bolam SM, Munro L, Wright M. Poor compliance documenting informed consent in trauma patients with distal radius fractures compared to elective total knee arthroplasty. ANZ J Surg 2022; 92:1831-1838. [PMID: 35588267 PMCID: PMC9543849 DOI: 10.1111/ans.17781] [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: 11/26/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
Background The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Methods Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12‐month period in a single‐centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. Results A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. Conclusions This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritize improving documentation of informed consent for orthopaedic trauma patients to ensure a patient‐centred approach to healthcare.
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Affiliation(s)
- Scott M Bolam
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Leigh Munro
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Wright
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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An Analysis of the Impact of Timing and Technique on Outcomes after Surgery for Distal Radius Fractures: The Wrist and Radius Injury Surgical Trial Collaborative Study. Plast Reconstr Surg 2021; 148:1053-1062. [PMID: 34546187 DOI: 10.1097/prs.0000000000008416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical treatment of closed distal radius fractures varies based on treatment, surgeon schedule, and patient preferences. The authors examined how timing and technique impact surgeon-perceived procedural difficulty and quality of reduction, outcomes, and complications. METHODS This was a retrospective study of participants in the randomized, multicenter Wrist and Radius Injury Surgical Trial with isolated unstable distal radius fractures. Participants were randomized to treatment with a volar locking plate system, closed reduction and percutaneous pinning, or external fixation. The authors analyzed surgeon-perceived procedural difficulty and reduction quality based on time to operation. RESULTS Of 184 participants, 88 underwent surgery less than 7 days after fracture (mean, 4.6 days) and 96 underwent surgery at more than 7 days after fracture (mean, 12.3 days). Surgery performed at more than 7 days was rated more difficult versus surgery at less than 7 days [4.6 versus 3.8 of 10 (1 = easiest); p = 0.05]. When the volar locking plate technique was performed, there was no difference in surgeon-perceived difficulty or reduction quality between the groups; however, surgeons performing closed reduction and percutaneous pinning more than 7 days after injury reported greater procedure difficulty (4.1 versus 2.9; p = 0.05) and poorer reduction quality compared to less than 7 days (7.2 versus 8.1; p = 0.03). Participants who underwent surgery at less than 7 days scored 8 and 7 points greater on the Michigan Hand Outcomes Questionnaire Satisfaction (p = 0.05) and Activities of Daily Living (p = 0.03) domains, respectively. CONCLUSIONS Surgery performed less than 7 days after fracture leads to better surgeon-perceived reduction quality and less procedural difficulty. If surgery cannot be performed before 7 days, the authors recommend patients undergo treatment with the volar locking plate system, given the comparable level of surgeon-perceived procedural difficulty and reduction quality when surgery was performed less than 7 days after injury. CLINICAL QUERSTION/LEVEL OF EVIDENCE Therapeutic, III.
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Samade R, Farrell N, Zaki O, Farrar N, Goyal KS. Outcomes following Distal Radius Fractures with Preexisting Ulnocarpal Abutment. J Wrist Surg 2021; 10:329-334. [PMID: 34381637 PMCID: PMC8328551 DOI: 10.1055/s-0041-1726294] [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: 05/21/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Background Due to the commonality of distal radius fractures (DRFs), the potential impact of ulnocarpal abutment (UA) on patient outcomes is significant, whether it developed after or prior to injury. It is, therefore, important to consider whether preexisting UA has any impact on outcomes after an acute DRF. Questions/Purpose The aims of this study were to determine if differences were present in (1) pain at final follow-up, (2) complications, and (3) unintended operations in patients with DRFs and either without or with preexisting radiographic UA. Methods A single institution retrospective cohort study comparing patients treated either nonoperatively (43 patients) or operatively (473 patients) for DRFs between 5/1/2008 to 5/1/2018 was performed. Data included demographics, prior wrist pain or surgery, ulnar variance, select treatment data, and presence of pain, complication, or unintended operation by final follow-up. Statistical testing used Fisher's exact test and chi-squared test, with a significance level of 0.05. Results The prevalence of preexisting UA was 14.0 and 15.6% in the nonoperatively- and operatively treated groups, respectively. In nonoperatively treated patients without or with UA, no differences in pain (37.8 vs. 33.3%, p = 1.00) or complications were seen (13.5 vs. 50.0%, p = 0.07). A higher unintended operation rate for nonoperatively treated DRFs with UA, compared with those without, UA was seen (5.4 vs. 50.0%, p = 0.01). No differences in pain, complications, or unintended operations were seen between those without and with UA in the operatively treated group. Conclusion Preexisting UA is not associated with pain, complications, or unintended operations after operative treatment of DRFs. Prospective studies further evaluating outcomes in nonoperatively treated DRFs with UA may be beneficial.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nolan Farrell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Omar Zaki
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicholas Farrar
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kanu S. Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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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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Thirty-day Emergency Department Utilization after Distal Radius Fracture Treatment: Identifying Predictors and Variation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2416. [PMID: 31741813 PMCID: PMC6799403 DOI: 10.1097/gox.0000000000002416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/29/2019] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Unplanned hospital visits are costly and may indicate reduced care quality. In this analysis, we aim to investigate the emergency department (ED) utilization for patients 30 days after treatment for a distal radius fracture (DRF) with an emphasis on DRF-related diagnoses of complications and examine nationwide variation in returns to the ED after treatment.
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Kirby E, Sparrow S. A retrospective analysis of the number of therapy visits after distal radius fractures using a new provider-scored clinical severity scale. J Hand Ther 2019; 31:480-485. [PMID: 28711410 DOI: 10.1016/j.jht.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/05/2017] [Accepted: 06/14/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective study. INTRODUCTION Fractures of the distal radius are common as is a postfracture referral to occupational therapy (OT). This article examines factors that cause greater morbidity and a greater number of OT visits. PURPOSE OF THE STUDY This study aims to analyze which of 5 common sequelae of the distal radius fracture is most significant for increasing the number of therapy visits. METHODS Three-hundred Sixty charts were reviewed, and 89 were selected. Multiple regression was used to determine which of our 5 independent variables had the greatest predictive power for the total number of therapy visits. RESULTS The regression model demonstrated significance at P ≤ .01. Total active motion (TAM) of the digits (P ≤ .01) and TAM of the forearm (P ≤ .01) were the only complications that demonstrated statistical significance and a positive relationship with the number of therapy visits. In addition to this, TAM of the forearm and digits showed a strong correlation with the number of therapy visits. TAM of the wrist, pain, and edema had a weak correlation. Patients with high total group score on the clinical severity scale also had a moderate correlation. DISCUSSION The results of the study illustrate the importance of digital contractures on a patient's morbidity, function, and their need for OT visits. CONCLUSION The information from this study is important for the clinician as it identifies patients at risk for increased morbidity and identifies the complications that the clinician may want to stress early in the rehabilitation of that patient. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eric Kirby
- MacNeal Hospital Rehabilitation Department, Berwyn, IL, USA.
| | - Sean Sparrow
- MacNeal Hospital Rehabilitation Department, Berwyn, IL, USA
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A Novel Technique for Correcting Radial Length and Translation in Distal Radius Fractures. Tech Hand Up Extrem Surg 2018; 22:116-119. [PMID: 29975230 DOI: 10.1097/bth.0000000000000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a novel technique in correcting distal radius fractures deformed with significant shortening or coronal plane translation in both the acute or chronic setting. The technique involves using a modified push-pull device to assist the surgeon in correcting length and/or translation of the articular block without the use additional hardware outside of the volar plate.
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Kwak JM, Jung GH. Biologic plating of unstable distal radial fractures. BMC Musculoskelet Disord 2018; 19:117. [PMID: 29655367 PMCID: PMC5899831 DOI: 10.1186/s12891-018-2046-2] [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: 01/17/2017] [Accepted: 04/11/2018] [Indexed: 12/01/2022] Open
Abstract
Background Volar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction. Methods Thirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25–83 years), and the mean follow-up period was 47.5 months (range, 36–84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS). Results All wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from − 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75–100). Conclusion Our experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Gu-Hee Jung
- Department of orthopaedic surgery, Gyeongsang national university, college of medicine and Gyeongsang national university Changwon hospital, 555 Samjungja-Dong, Changwon-si, 642-160, Republic of Korea.
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Xu W, Ni C, Yu R, Gu G, Wang Z, Zheng G. Risk factors for distal radius fracture in postmenopausal women. DER ORTHOPADE 2017; 46:447-450. [DOI: 10.1007/s00132-017-3403-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased because of complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius.
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Affiliation(s)
- Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, The University of Michigan
| | - Alexandra L. Mathews
- Research Assistant, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System
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Abstract
Correct diagnosis of wrist injuries is critical in preventing prolonged pain and dysfunction. Radiographs cannot diagnose a large percentage of injuries. Wrist sprain is considered one of the most common yet most treacherous emergency department (ED) diagnoses because radiographs do not always rule out all acute injuries. Knowledge of the anatomy, normal physical examination findings, and physical examination abnormalities associated with different pathological conditions, is paramount in making the correct diagnosis. This article focuses on the anatomy, diagnosis, and ED management of acute wrist injuries, including fractures and dislocations.
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Affiliation(s)
- Alina Tsyrulnik
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, New Haven, CT 06519, USA.
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Gupta SKV, Mandapalli P. Comparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the Distal End Radius. ACTA ACUST UNITED AC 2015. [DOI: 10.5005/jp-journals-10017-1051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Background
The purpose of this study is to compare between the open reduction and internal fixation (ORIF) using a volar plate and external fixation with K-wire fixation for the treatment of unstable distal radius fractures.
Materials and methods
This investigation was designed to prospectively evaluate the outcomes of similar distal radius fracture patterns treated by ORIF with volar plating vs closed reduction and pinning with external fixation.
Results
Open reduction and internal fixation with volar locking plate group has overall decrease incidence of complications significantly less radial shortening and significantly greater postoperative wrist motion when compared to external fixation.
Conclusion
Use of volar locking plate resulted in a faster recovery of function compared with external fixation. Use of volar locking plate resulted in better anatomical function and grip strength. However, no functional advantage was demonstrated at or beyond 12 weeks or 1 year.
Gupta SKV, Mandapalli P. Comparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the Distal End Radius. The Duke Orthop J 2015;5(1):20-24.
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Kuo LC, Yang TH, Hsu YY, Wu PT, Lin CL, Hsu HY, Jou IM. Is progressive early digit mobilization intervention beneficial for patients with external fixation of distal radius fracture? A pilot randomized controlled trial. Clin Rehabil 2013; 27:983-93. [PMID: 23787939 DOI: 10.1177/0269215513487391] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate whether progressive early digit mobilization resulted in better outcomes for hand stiffness and related functional results, as well as the effects on the bone healing process. DESIGN Prospective, pilot randomized controlled trial. SETTING A university hospital in southern Taiwan. PARTICIPANTS Twenty-two patients with distal radius fracture randomized into two groups: early digit mobilization or control. INTERVENTIONS The intervention group received 45 minutes per treatment session and three sessions per week until the external fixator was removed 6 weeks after fracture. The control group received usual home programmes. After removing fixators, both groups received regular rehabilitation programmes until 12 weeks after surgery. MAIN MEASURES Hand strength, dexterity and functional outcomes were obtained using a dynamometer, Purdue pegboard and self-report assessment, respectively, and X-rays of the distal radius were taken to reveal bone healing 1, 3, 6 and 12 weeks after surgery. A motion tracking system measured various kinematic parameters. RESULTS The recovery rates between the groups showed statistically significant differences in both thumb workspace (81.55% vs. 69.54%, P = 0.04) and finger workspace (89.22% vs. 59.97%, P = 0.03) 12 weeks after injury. However, no statistical differences were found in finger dexterity, strength and self-reported outcomes. The radiographic assessment showed no significant differences between the groups for radial inclination, radial height and volar tilt throughout the examinations. CONCLUSIONS The findings suggest that early rehabilitative intervention for digits is applicable for distal radius fracture treatment, and does not produce additional bone deformities.
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Affiliation(s)
- Li-Chieh Kuo
- 1Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan
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White BD, Nydick JA, Karsky D, Williams BD, Hess AV, Stone JD. Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg Am 2012; 37:2035-40. [PMID: 22943839 DOI: 10.1016/j.jhsa.2012.06.041] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 06/29/2012] [Accepted: 06/29/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the incidence of tendon rupture after nonoperative and operative management of distal radius fractures, report clinical outcomes after tendon repair or transfer, and examine volar plate and dorsal screw prominence as a predictor of tendon rupture. METHODS We performed a retrospective chart review on patients treated for tendon rupture after distal radius fracture. We evaluated active range of motion, Disabilities of Arm, Shoulder, and Hand score, grip strength, and pain score, and performed radiographic evaluation of volar plate and dorsal screw prominence in both the study group and a matched control group. RESULTS There were 6 tendon ruptures in 1,359 patients (0.4%) treated nonoperatively and 8 tendon ruptures in 999 patients (0.8%) treated with volar plate fixation. At the time of final follow-up, regardless of treatment, we noted that patients had minimal pain and excellent motion and grip strength. Mean Disabilities of the Shoulder, Arm, and Hand scores were 6 for patients treated nonoperatively and 4 for those treated with volar plating. CONCLUSIONS We were unable to verify volar plate or dorsal screw prominence as independent risk factors for tendon rupture after distal radius fractures. However, we recommend continued follow-up and plate removal for symptomatic patients who have volar plate prominence or dorsal screw prominence. In the event of tendon rupture, we report excellent clinical outcomes after tendon repair or tendon transfer. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Brian D White
- Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA
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Jhattu H, Klaassen S, Ying C, Hussain MA. Acute carpal tunnel syndrome in trauma. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0732-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schønnemann JO, Hansen TB, Søballe K. Randomised study of non-bridging external fixation compared with intramedullary fixation of unstable distal radial fractures. J Plast Surg Hand Surg 2011; 45:232-7. [DOI: 10.3109/2000656x.2011.613243] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Richard MJ, Wartinbee DA, Riboh J, Miller M, Leversedge FJ, Ruch DS. Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius. J Hand Surg Am 2011; 36:1614-20. [PMID: 21849236 DOI: 10.1016/j.jhsa.2011.06.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 06/25/2011] [Accepted: 06/29/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether there was a difference in complication rates in our patients treated with external fixation versus volar plating of distal radius fractures. We also looked for a difference in radiographic results; in the clinical outcomes of flexion, extension, supination, pronation, and grip strength; and in scores on the visual analog scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. METHODS We reviewed 115 patients with comminuted intrarticular distal radius fractures. Of those patients, 59 were treated with external fixation and 56 with volar plate fixation. Postoperative radiographs, range of motion, and grip strength were measured; DASH and VAS pain questionnaires were administered; and complications were documented. RESULTS The external fixation group had a significantly higher overall complication rate. In the volar plate group, there were more tendon and median nerve complications, but this difference was not significant. Radiographically, the external fixator group demonstrated radial shortening of 0.7 mm, whereas the volar plate group demonstrated 0.3 mm of radial shortening during the postoperative period. There were no significant differences between the groups in the measurement of scapholunate angle or palmar tilt. The mean DASH score at final follow-up was 32 in the external fixation group and 17 in the volar plate group, which was statistically significant. The final VAS scores were statistically different at 3.1 for the external fixation group and 1.1 for the volar plate group. On physical examination, the volar plate group had significantly better arc of motion in pronation-supination and flexion-extension and better grip strength. CONCLUSIONS In the patients we studied, volar plate fixation has an overall decreased incidence of complications and significantly better motion in flexion-extension and supination-pronation compared to external fixation. Volar plate fixation also has less radial shortening than the external fixation group, yet the absolute difference in magnitude of ulnar variance was only 1.4 mm, calling into question the clinical significance of this difference. Patients with volar plating also have better pain and functional outcomes and better grip strength. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Marc J Richard
- Duke University Medical Center, Division of Orthopaedic Surgery, DUMC 3466, Durham, NC 27710, USA
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Wartinbee DA, Miller M, Riboh J. Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10017-1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Background
Much attention has been given recently to the complication profile of volar plate fixation of distal radial fractures. The purpose of this investigation was to compare complication rates among patients with distal radial fractures treated with volar plating versus those treated with external fixation.
Methods
Two parallel series of patients with comminuted intra-articular distal radius fractures were reviewed. 59 patients were treated with external fixation and 56 patients with volar plate fixation. Postoperative radiographs, range of motion, grip strength, DASH scores, and VAS pain questionnaires were analyzed, and complications were described.
Results
The external fixation group had a significantly higher overall complication rate (p = 0.021) than the volar plate fixation group. In the volar plate group, there were more tendon complications and median nerve pathology. Radial shortening was greater in the external fixation group when compared to the volar plate fixation group. DASH scores and VAS scores were significantly higher in the external fixation group. Clinically, the patients in the volar plate fixation group had significantly greater arcs of motion in pronation-supination (p < 0.0001) and flexion-extension (p = 0.002) with a trend towards better grip strength (p = 0.0062).
Conclusions
Volar plate fixation for fractures of the distal radius provides an overall decreased incidence of complications, significantly less radial shortening, and significantly greater postoperative wrist motion when compared to external fixation. Volar plate fixation is also associated with lower VAS scores when compared to external fixation as well as DASH scores that approach statistical significance.
Level of evidence
III (retrospective comparative study).
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Tejwani NC, Takemoto RC, Nayak G, Pahk B, Egol KA. Who is lost to followup?: a study of patients with distal radius fractures. Clin Orthop Relat Res 2010; 468:599-604. [PMID: 19582523 PMCID: PMC2806989 DOI: 10.1007/s11999-009-0968-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 06/22/2009] [Indexed: 01/31/2023]
Abstract
Distal radius fractures are the most common upper extremity fracture, representing one-sixth of all fractures treated in emergency departments nationwide. Beyond the initial reduction and immobilization of these fractures, providing proper followup to ensure maintenance of the reduction and identify complications is necessary for optimal recovery of forearm and wrist functions. We sought to identify the clinical and demographic factors that characterize patients with distal radius fractures who do not return for followup and to assess the underlying causes for their poor followup rates. Compared with patients who were compliant with followup, those lost to followup had lower Physical and Mental Health scores on the SF-36 forms, more often were treated nonoperatively, and more likely had not surpassed secondary education. However, we found no difference between these two groups based on age, gender, mechanism of injury, marital status, or hand dominance. Early identification of patients who potentially are noncompliant can result in additional measures being taken to ensure the patient's return to the treating hospital and physicians. This in turn will prevent complications attributable to lack of followup and allow more accurate assessment of results, thereby improving patient outcomes.
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Affiliation(s)
- Nirmal C Tejwani
- Department of Orthopaedics, NYU Hospital for Joint Diseases, 550 First Avenue, NBV21W37, New York, NY 10016, USA.
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