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Fang PC, Lo TYY, Cheng CY, Wu CT, Chen ACY. Radiographic Analysis in Extra-Articular and Intra-Articular Distal Radius Fractures Treated with Variable-Angle Volar Locking Plate Fixation. J Clin Med 2023; 12:jcm12103494. [PMID: 37240600 DOI: 10.3390/jcm12103494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Different distal radial fracture types have different prognosis after fixation. Our study aim is to evaluate the differences in radiographic parameters by using variable-angle volar locking plate (VAVLP) fixation according to extra-articular and intra-articular distal radial fracture. (2) Methods: There are two groups: extra-articular group (21) and intra-articular group (25). Forearm radiographs immediately after surgery and at 3 months after operation were reviewed for analyzing radial height (RH), ulnar variance (UV), radial inclination (RI), volar tilt (VT), tear drop angle (TDA), distal dorsal cortical distance (DDD), and Soong classification (SC). (3) Results: There were no significant differences in the above parameters between two groups at either immediately post-operative or at 3-month follow-up, except for TDA (p = 0.048). Most patients in both groups were at low risk of flexor tendon rupture, except for two cases. We observed a positive correlation between post-operative DDD and 3-month change in the intra-articular group, but not the extra-articular group. (4) Conclusions: Our study demonstrates that VAVLP fixation is effective in maintaining the stability of most radiographic parameters and reduces the risk of tendon rupture in both extra-articular and intra-articular distal radial fractures. Post-operative DDD can be used to predict the degree of subsequent displacement in patients with intra-articular fractures fixed with VAVLP.
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Affiliation(s)
- Pin-Chieh Fang
- Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Tak-Yu-Yubie Lo
- Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chun-Ying Cheng
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Taoyuan, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chun-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Taoyuan, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
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Mori Y, Takegami Y, Tokutake K, Oka Y, Imagama S. Retrospective Comparative Study of Clinical Outcomes and Cost-Effectiveness with Bone Substitutes on Volar Locking Plate Fixation of Unstable Distal Radial Fractures in the Elderly. J Hand Surg Asian Pac Vol 2023; 28:61-68. [PMID: 36803469 DOI: 10.1142/s2424835523500091] [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: 02/23/2023]
Abstract
Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015-2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001). Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Yusuke Mori
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiharu Oka
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Askin A, Aldemir C, Duygun F, Nabi V. The Relation between the Radial Collapse and the Number of Metaphyseal Screws for Distal Radius Fractures. Malays Orthop J 2022; 16:30-35. [PMID: 36589376 PMCID: PMC9791896 DOI: 10.5704/moj.2211.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The purpose of this study is the evaluation of radial collapse, based on the number of screws used in the metaphyseal region and by distal dorsal distance (DDD) and lunate facet distance (LFD) measurement. Materials and methods Between 2015 and 2019, 60 patients who were being treated with volar locking plates due to isolated distal radius fracture were evaluated. Control radiographs were taken on the first day and at 3rd-, 6th- and 12th-month follow-ups. Distal dorsal cortex distance and lunate facet distance were measured in the lateral radiographs. The number of screws used in the metaphyseal region was also evaluated. According to the number of screws, the amount of collapse was analysed based on both the LFD and the DDD. Results The mean age of patients was 43.5±12.7 years. Thirty-three of the patients included in the study were male and 27 were female, and the minimum follow-up period was one year. According to the mean number of screws, groups were defined as up to 6 screws or 7 screws and above. There was a statistically significant difference between the groups in terms of DDD collapse at the 6th-month and 12th-month follow-ups (p<0.005). It was observed that the radial collapse and decrease in DDD and LFD were lower in plates with seven screws and above. Conclusion Decreases in either DDD or LFD, or radial collapse were observed less in patients who had seven or more metaphyseal screws inserted. These findings might be useful for surgeons treating distal radius fractures to reduce radial collapse.
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Affiliation(s)
- A Askin
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkiye,Corresponding Author: Aydogan Askin, Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Varlik, Kazim Karabekir Cd, 07100 Muratpasa/Antalya, Turkiye Phone: +902422491300
| | - C Aldemir
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - F Duygun
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - V Nabi
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkiye
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Abstract
Ultrasonography (US) is a noninvasive examination modality that is devoid of risk, both for the patient and the surgeon, compared with fluoroscopy. The principle is the same for distal radius and finger fractures: replace the fluoroscopy checks with US checks to reduce the patient's, surgeon's, and surgical team's exposure to radiation. In this article, the authors report their experience of the effectiveness of ultrasound imaging during the fixation of a distal radius and long finger fracture. They also describe equipment needed and surgical procedure.
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Affiliation(s)
- Jean Michel Cognet
- SOS Mains Champagne Ardenne, Médipôle, 1 rue Jules Méline, Bezannes 51430, France.
| | - François Bauzou
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire Carémeau, 4 Rue du Professeur Robert Debré, Nîmes 30029, France
| | - Pascal Louis
- SOS Mains Champagne Ardenne, Médipôle, 1 rue Jules Méline, Bezannes 51430, France
| | - Olivier Mares
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalo-Universitaire Carémeau, 4 Rue du Professeur Robert Debré, Nîmes 30029, France
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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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Abstract
PURPOSE OF REVIEW To provide an overview of emerging fixation constructs and materials used in the operative management of distal radius fractures. RECENT FINDINGS The indications, advantages, and disadvantages of relatively new implants and devices used to treat distal radius fractures are discussed. These include the intramedullary nail, intramedullary cage, radiolucent volar locking plate, distal radius hemiarthroplasty, and bone graft substitutes. The spectrum of distal radius fracture patterns may make it impossible to depend on a single device for fixation, and surgeons managing distal radius fractures should be adept at using various surgical approaches, techniques, and hardware systems. Additional studies demonstrating the cost-effectiveness, biomechanical properties, and clinical outcomes will be useful in determining the utility of the described techniques.
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Affiliation(s)
- Abdo Bachoura
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, G114, Philadelphia, PA 19107 USA
| | - Eon K. Shin
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 1203 Langhorne-Newtown Road, Suite 335, Langhorne, PA 19047 USA
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Kinoshita M, Naito K, Goto K, Sugiyama Y, Nagura N, Obata H, Iwase Y, Kaneko K. Anatomical-positional relationship between the bone structure of the distal radius and flexor pollicis longus tendon using ultrasonography. Surg Radiol Anat 2019; 41:785-789. [PMID: 30879084 DOI: 10.1007/s00276-019-02216-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE In this study, using an ultrasonography, we investigated the positional relationship between the volar bone cortex of distal radius and flexor pollicis longus (FPL) tendon in the distal radius of healthy subjects. METHODS The subjects were 32 healthy volunteers (56 wrists) (Age 32.9 ± 8.5, 16 males and 16 females). Their wrists were imaged by an ultrasonography. The distances between the watershed line (WS) and FPL (A), between the distal margin of pronator quadratus (DMPQ) and FPL (B), between the FPL and volar radial bone cortex at the maximum muscle belly of the PQ muscle right below the sliding region of the FPL tendon (C), and between the WS and DMPQ (D) were measured. RESULTS All these parameters showed a normal distribution. When the correlation among the parameters was investigated, a correlation with an index of the physique, BMI, was noted in A (P < 0.01), B (P < 0.01), and C (P < 0.01), but no correlation was noted only in D (P = 0.59). CONCLUSIONS Our results were suggested that when distal radius fracture is treated with a distal plate placement, the appropriate placement can be achieved by applying about 3 mm additional dissection of soft tissue on the volar bone cortex distal to the DMPQ.
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Affiliation(s)
- Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan
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Lee SK, Chun YS, Shin HM, Kim SM, Choy WS. Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly. Orthop Traumatol Surg Res 2018; 104:883-891. [PMID: 29807188 DOI: 10.1016/j.otsr.2018.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/26/2018] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients. METHODS One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared. RESULTS Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group. CONCLUSION The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients. LEVEL OF EVIDENCE III Therapeutic study.
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Affiliation(s)
- Sang Ki Lee
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea.
| | - Young Sub Chun
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| | - Hyun Min Shin
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| | - Soo Min Kim
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| | - Won Sik Choy
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
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Zhong Z, Wu C, Lin X, Hu H. [Effectiveness comparison between minimally invasive surgery and traditional open reduction internal fixation in treatment of unstable distal radial fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:322-328. [PMID: 29806282 PMCID: PMC8414273 DOI: 10.7507/1002-1892.201711140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of minimally invasive percutaneous internal fixation and traditional open reduction via Henry approach and internal fixation in the treatment of unstable distal radial fractures. Methods Fifty-six patients with unstable distal radial fractures that met the selection criteria between October 2013 and December 2014 were randomly divided into minimally invasive group (26 cases) and traditional group (30 cases). They were treated with oblique T-shaped locking plate internal fixation via minimally invasive percutaneous approach or traditional Henry approach. There was no significant difference in gender, age, side, causes of injury, fracture classification, and time from injury to operation between 2 groups ( P>0.05). The length of incision, operation time, intraoperative blood loss, hospitalization time, and fracture healing time were recorded in 2 groups. The difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation were compared between 2 groups. The visual analogue scale (VAS) score, the percentage of the lateral wrist flexion and extension range, forearm rotation, and the hand grip strength (recorded as FS%, FR%, and HG% , respectively) were compared between 2 groups at 4 weeks and 3 months postoperatively. The wrist function was evaluated through the disability of arm-shoulder-hand (DASH) scores at 3 months postoperatively. Results The length of incision, operation time, intraoperative blood loss, and hospitalization time in minimally invasive group were significantly less than those in traditional group ( P<0.05). The incisions of 2 groups were all achieved primary healing. All patients were followed up 10-16 months (mean, 12.6 months). There was no radial artery injury, screw too long, or screw entering the joint space. In minimally invasive group, 1 patient had the symptoms of median nerve irritation after operation, and recovered completely at 1 month; in traditional group, there were 2 cases of tendon irritation after operation. There was no significant difference in the fracture healing time, the difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation between 2 groups ( P>0.05). At 4 weeks after operation, the VAS score in minimally invasive group was significantly less than that in traditional group, and the FS%, FR%, and HG% were significantly higher than those in traditional group ( P<0.05). There was no significant difference in above indicators between 2 groups at 3 months after operation ( P>0.05). The DASH score in minimally invasive group was significantly less than that in traditional group at 3 months after operation ( t=-5.308, P=0.000). The patient's aesthetic evaluation of postoperative wound in minimally invasive group was better than in traditional group. Conclusion For treatment of unstable distal radial fractures, the metacarpal minimally invasive internal fixation has the advantages of smaller wound, incisional concealment, and quicker recovery of wrist joint.
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Affiliation(s)
- Zeli Zhong
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong Sichuan, 643000,
| | - Chao Wu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Xu Lin
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Haigang Hu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China
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10
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Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am 2016; 41:845-54. [PMID: 27342171 DOI: 10.1016/j.jhsa.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/25/2016] [Indexed: 02/02/2023]
Abstract
Distal radius fractures remain among the most common fractures of the upper extremity. The indications for operative management continue to evolve based on outcomes from the most recent clinical studies. Advancements over the past decade have expanded the variety of fixation options available; however, the clinical superiority of a particular treatment modality remains without consensus. Each approach requires the use of unique surgical techniques, and the choice of a particular implant system should be based on the surgeon's familiarity with the implant design and its limitations. As our understanding of the management of distal radius fractures improves, so will our indications for each specific treatment modality.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - J Ryan Hill
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
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11
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Abstract
This manuscript will provide an overview of how the age and osteoporosis related changes in mechanical properties of bone affect the stability of osteosynthesis constructs, both from a mechanical as well as from a clinical perspective. The manuscript will also address some of the principles of fracture fixation for osteoporotic fractures and discuss applications of osteoporotic fracture fixation at sites typically affected by fragility fractures, namely the distal radius, the proximal humerus, the femur and the spine. The primary aim of operative treatment in elderly individuals is the avoidance of immobilization of the patient. In selected cases conservative treatment might be required. Generally, choice of treatment should be individualized and based on the evaluation of patient-specific, fracture-specific and surgeon-specific aspects. The orthopaedic surgeon plays an essential role in enabling functional recovery by providing good surgery but a multidisciplinary approach is essential in order to support the patient to regain his/her quality of life after fragility fracture. Overall, the therapy of fractures in osteoporotic bone in the elderly requires a multidisciplinary therapeutic acute care concept including treatment of co-morbidities and correct choice of timing, and technique of the operative intervention.
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Affiliation(s)
- Christian von Rüden
- Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical UniversitySalzburg, Austria
| | - Peter Augat
- Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical UniversitySalzburg, Austria.
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