1
|
Avci Ö, Sisman A. Comparison of the cast and volar locking plate in the treatment of intra-articular distal radius fractures in elderly patients over 75 years of age. J Clin Orthop Trauma 2023; 45:102262. [PMID: 37885613 PMCID: PMC10598046 DOI: 10.1016/j.jcot.2023.102262] [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: 05/08/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Background We aimed to compare radiologically and clinically closed reduction circular casting (CRCC) and volar locking plate (VLP) treatment options in elderly patients over 75 years with intraarticular distal radius fracture (DRF). Material and method Elderly patients aged ≥75 years with at least one year of follow-up from the clinic archive who underwent conservative (CRCC) and surgical (VLP) treatment for AO type C DRF were retrospectively included in the study. Thirty-seven patients treated conservatively with CRCC and 31 treated surgically with VLP were compared as two groups. Quick Disability of the Arm, Shoulder, and Hand (QDASH) and Visual Analog scores (VAS) were evaluated functionally. In addition, a rapid assessment of physical activity (RAPA) score evaluation was performed since these patients were elderly. In addition, radiologic findings, wrist range of motion, and complications were evaluated. Results There was no difference between the CRCC and VLP groups regarding QDASH, VAS, and RAPA scores at the last follow up. Radiologically, there were significant differences between the groups regarding radial height, volar tilt, radial inclination and joint stepping. (respectively p= <0.001, p= <0.001, p= <0.001, p= <0.001). Conclusion In elderly patients over 75 years of age with intra-articular DRF, surgical treatment with VLP results in better radiologic results compared to conservative treatment with CRCC, although both treatment options lead to similar results in terms of functional outcomes.
Collapse
Affiliation(s)
- Özgür Avci
- Tavsanli State Hospital, Department of Orthopaedics and Traumatology, Kütahya, 34764, Turkey
| | - Ali Sisman
- Adnan Menderes University Faculty of Medicine, Department of Orthopaedic and Traumatology, 09100, Aydın, Turkey
| |
Collapse
|
2
|
Phan A, Schloemann D, Calderon T, Hammert WC. Using MaxDiff Analysis to Elicit Patients' Treatment Preferences for Distal Radius Fractures in Patients Aged 60 Years and Older. J Hand Surg Am 2023:S0363-5023(23)00120-X. [PMID: 37029035 DOI: 10.1016/j.jhsa.2023.03.004] [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: 08/22/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE The objective of our study was to determine how the attributes of surgical and nonsurgical distal radius fracture (DRF) treatments affect patient treatment preferences. METHODS Two hundred fifty patients aged 60 years and older were contacted from a single-hand surgeon's practice, and 172 chose to participate. We built a series of best-worst scaling experiments for the MaxDiff analysis to determine the relative importance of treatment attributes. Hierarchical Bayes analysis was used to generate individual-level item scores (ISs) for each attribute that together have a total sum of 100. RESULTS One hundred general hand clinic patients without a history of a DRF and 43 patients with a history of a DRF completed the survey. For the general hand clinic patients, the most important attributes to avoid when choosing a DRF treatment (in descending order) were the longer time to full recovery (IS, 24.9; 95% confidence interval [CI]: 23.4-26.3), longer time spent in a cast (IS, 22.8; 95% CI, 21.5-24.2), and higher complication rates (IS, 18.4; 95% CI, 16.9-19.8). Meanwhile, for patients with a history of a DRF, the most important attributes to avoid (in descending order) were a longer time to full recovery (IS, 25.6; 95% CI, 23.3-27.9), longer time spent in a cast (IS, 22.8; 95% CI, 19.9-25.7), and abnormal alignment of the radius on x-ray (IS, 18.3; 95% CI, 15.4-21.3). For both the groups, the least concerning attributes based on the IS were appearance-scar, appearance-bump, and the need for anesthesia. CONCLUSIONS Eliciting patient preferences is a vital component of shared decision-making and advancing patient-centered care. As conceptualized in this MaxDiff analysis, when choosing a DRF treatment, patients mostly want to avoid a longer time to full recovery and a longer time in a cast, whereas patients have the least concern about appearance and need for anesthesia. CLINICAL RELEVANCE Eliciting patient preferences is a vital component of shared decision-making. Our results may provide guidance to surgeons in discussions on the relative benefits of surgical and nonsurgical DRF treatments, by quantifying the most and least important factors to patients.
Collapse
Affiliation(s)
- Amy Phan
- Department of Orthopaedics and Physical Performance, University of Rochester, Rochester, NY
| | - Derek Schloemann
- Department of Orthopaedics and Physical Performance, University of Rochester, Rochester, NY
| | - Thais Calderon
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA
| | | |
Collapse
|
3
|
Shah HA, Martin AR, Geller JS, Iyer H, Dodds SD. Radiographic Outcomes following K-Wire Augmentation of Dorsal Spanning Plate Fixation for Intra-Articular Fractures of the Distal Radius. J Wrist Surg 2022; 11:388-394. [PMID: 36339083 PMCID: PMC9633136 DOI: 10.1055/s-0041-1740401] [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: 04/08/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022]
Abstract
Background Restoration of articular surface alignment is critical in treating intra-articular distal radius fractures. Dorsal spanning plate fixation functions as an internal distraction mechanism and can be advantageous in the setting of highly comminuted fracture patterns, polytrauma patients, and patients with radiocarpal instability. The addition of K-wires to support articular surface reduction potentially augments fracture repair stability. Questions/Purposes We examined the radiographic outcomes and maintenance of reduction in patients with comminuted intra-articular distal radius fractures treated with K-wire fixation of articular fragments followed by dorsal spanning plate application. Patients and Methods We reviewed 35 consecutive patients with complex intra-articular distal radius fractures treated with dorsal spanning plate and K-wire fixation between April 2016 and October 2019. AO classification was recorded: B1 (3), B3 (2), C2 (2), C3 (28). A two-tailed paired t -test was used to compare findings immediately post-dorsal spanning plate surgery and at final follow-up after dorsal spanning plate removal. Results Mean patient age was 43.3 years (19-78 years). Mean follow-up was 7.8 months (SD 4.3 months) from surgery and 2.5 months from pin removal (SD 2.6 months). All patients achieved radiographic union. Radial height (mean interval change (MIC) 0.2 mm, SD 2.2, p = 0.63), articular step-off (MIC 0.1 mm, SD 0.6 mm, p = 0.88), and radial inclination (MIC -1.1 degrees, SD 3.7 degrees, p = 0.10) did not change from post-surgery to final follow-up. Ulnar variance (MIC -0.9 mm, SD 2.0 mm, p = 0.02) and volar tilt (MIC -1.5 degrees, SD 4.4 degrees, p = 0.05) were found to have decreased. Conclusion Dorsal spanning plate augmented with K-wire fixation for comminuted intra-articular distal radius fractures in polytrauma patients allows for immediate weightbearing and maintains articular surface alignment at radiographic union and may provide better articular restoration than treatment with dorsal spanning plate alone. Level of Evidence This is a Level IV , therapeutic study.
Collapse
Affiliation(s)
- Harsh A. Shah
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Anthony R. Martin
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Joseph S. Geller
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Hariharan Iyer
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Seth D. Dodds
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| |
Collapse
|
4
|
Taljanovic MS, Omar IM, Weaver JS, Becker JL, Mercer DM, Becker GW. Posttreatment Imaging of the Wrist and Hand: Update 2022. Semin Musculoskelet Radiol 2022; 26:295-313. [PMID: 35654096 DOI: 10.1055/s-0042-1743538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.
Collapse
Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jennifer S Weaver
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L Becker
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| |
Collapse
|
5
|
Calotta NA, Shores JT, Coon D. Upper-Extremity Venous Thromboembolism Following Operative Treatment of Distal Radius Fractures: An Uncommon but Dangerous Complication. J Hand Surg Am 2021; 46:1123.e1-1123.e7. [PMID: 34001409 DOI: 10.1016/j.jhsa.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius fractures are the most common long bone fracture in the United States, with an estimated incidence of 640,000 cases per year. Operative fixation presents a theoretical risk factor for the development of upper-extremity venous thromboembolism (UE-VTE). Additionally, patients presenting with distal radius fracture commonly have preexisting comorbidities that further increase the risk of UE-VTE. Finally, UE-VTE is considered the highest risk for eventual development of pulmonary embolism. Despite this, scant attention has been paid to studying UE-VTE in this population. The purpose of this study was to measure the incidence of this complication and to identify possible medical factors that increased the risk of developing UE-VTE. METHODS We queried the Truven MarketScan Commercial Claims and Encounters Database for all patients who experienced a distal radius fracture and were subsequently treated with open reduction and internal fixation between 2012 and 2016. Patients were identified using relevant Common Procedural Terminology codes. Demographic and medical variables were tabulated. Our primary outcome was the development of ipsilateral UE-VTE or pulmonary embolism in the first 60 days after surgery. RESULTS The study included 24,494 patients. The mean age was 50.7 years (range, 18-91), and 58% were women. There were 79 cases (0.3%) of UE-VTE and 19 cases of pulmonary embolism in the study population (24.1% of all UE-VTE cases; 0.08% of total sample). Multivariable logistic regression showed that coexisting heart failure and estrogen use were associated with increased risk of UE-VTE. CONCLUSIONS Although uncommon, the development of UE-VTE after open reduction and internal fixation for distal radius fractures is a concerning complication. Coexisting heart failure and estrogen use are associated with increased risk of UE-VTE. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Devin Coon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
6
|
Lv YX, Chen MM, Su CX, Ye HN, Yang J, Li J. Analysis of risk factors associated with flexor pollicis longus injury after volar plating of distal radius fractures. J Int Med Res 2021; 49:3000605211031438. [PMID: 34369195 PMCID: PMC8358517 DOI: 10.1177/03000605211031438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective This study was performed to analyze the risk factors associated with flexor pollicis longus (FPL) attrition or rupture after volar plating of distal radius fractures. Methods Three hundred thirty-eight patients with distal radius fractures were included in this retrospective study. Univariate analysis and multivariate logistic regression analysis were performed to predict risk factors. Results Univariate analysis showed that sex, volar tilt, the Soong grade, the plate-to-critical line distance (PCLD), the plate-to-volar rim distance (PVRD), and the time of plate removal were significantly associated with FPL attrition or rupture. Multivariate logistic regression analysis demonstrated that decreased volar tilt, Soong grade 2, PCLD of >2 mm, PVRD of <3 mm, and plate removal at ≥1 year were the risk factors significantly associated with FPL attrition or rupture. Conclusions Reduced volar tilt, Soong grade 2, PCLD of >2 mm, and PVRD of <3 mm appear to be risk factors that are significantly associated with FPL attrition or rupture. The findings of this study also suggest that the risk of tendon rupture is lower if a Soong grade 2 plate is removed, the PCLD is >2 mm, the PVRD is <3 mm, or reduced volar tilt is achieved earlier (at <1 year).
Collapse
Affiliation(s)
- Yang-Xun Lv
- Department of Orthopedics, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Mang-Mang Chen
- Department of Orthopedics, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Chen-Xian Su
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao-Nan Ye
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jie Yang
- Department of Orthopedics, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Jing Li
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|
7
|
Intelligent Rehabilitation Assistance Tools for Distal Radius Fracture: A Systematic Review Based on Literatures and Mobile Application Stores. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:7613569. [PMID: 33062041 PMCID: PMC7542482 DOI: 10.1155/2020/7613569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Objective To systematically analyze the existing intelligent rehabilitation mobile applications (APPs) related to distal radius fracture (DRF) and evaluate their features and characteristics, so as to help doctors and patients to make evidence-based choice for appropriate intelligent-assisted rehabilitation. Methods Literatures which in regard to the intelligent rehabilitation tools of DRF were systematic retrieved from the PubMed, the Cochrane library, Wan Fang, and VIP Data. The effective APPs were systematically screened out through the APP markets of iOS and Android mobile platform, and the functional characteristics of different APPs were evaluated and analyzed. Results A total of 8 literatures and 31 APPs were included, which were divided into four categories: intelligent intervention, angle measurement, intelligent monitoring, and auxiliary rehabilitation games. These APPs provide support for the patients' home rehabilitation guidance and training and make up for the high cost and space limitations of traditional rehabilitation methods. The intelligent intervention category has the largest download ratio in the APP market. Angle measurement tools help DRF patients to measure the joint angle autonomously to judge the degree of rehabilitation, which is the most concentrated type of literature research. Some of the APPs and tools have obtained good clinical verification. However, due to the restrictions of cost, geographic authority, and applicable population, a large number of APPs still lack effective evidence to support popularization. Conclusion Patients with DRF could draw support from different kinds of APPs in order to fulfill personal need and promote self-management. Intelligent rehabilitation APPs play a positive role in the rehabilitation of patients, but the acceptance of the utilization for intelligent rehabilitation APPs is relatively low, which might need follow-up research to address the conundrum.
Collapse
|
8
|
Bergsma M, Doornberg JN, Hendrickx L, Hayat B, Kerkhoffs GM, Jhadav B, Jaarsma RL, Bain GI. Interpretations of the Term "Watershed Line" Used as Reference for Volar Plating. J Wrist Surg 2020; 9:268-274. [PMID: 32509435 PMCID: PMC7263865 DOI: 10.1055/s-0039-1694719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
Objective The objective of this systematic review is to provide an overview of all interpretations of the definition of the watershed line used in literature. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed for this review. A comprehensive search was performed for definitions of the watershed line given in literature. A total of 32 studies giving an explicit interpretation of the definition of the watershed line or anatomical reference for plate positioning in writing and/or imaging were included. Results In 32 studies, we found eight different landmarks used to refer to the watershed line or correct plate positioning. Five studies used two different soft tissue landmarks. Six different bony landmarks were described in 24 studies. These could further be subdivided into three anatomical interpretations, described in seven studies, in which the term "watershed line" is explained as a distinguishable anatomical line, and two surgical interpretations, described in 15 studies, which are purely reflecting the optimal location of the volar plate. One interpretation of the watershed line described in two studies combined both anatomical and surgical landmarks. Conclusion The (mis)interpretation of the definition of the term "watershed line" as described by Orbay is subject to the type of landmarks and purpose used: soft tissue or bony landmarks and an anatomical or a surgical purpose. A clear distinction can be made between interpretations using bony landmarks, as the true watershed line is defined and definitions using soft tissue landmarks, which might represent the reference points surgeons use in clinical practice.
Collapse
Affiliation(s)
- Minke Bergsma
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Laurent Hendrickx
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Batur Hayat
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Bhavin Jhadav
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
| | - Ruurd L. Jaarsma
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
| | - Gregory I. Bain
- Department of Orthopaedic Surgery Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics and Implants Research Group, Flinders University, Adelaide, Australia
| |
Collapse
|
9
|
Zhang J, Zhuang YQ, Zhou L, Jiang GQ, Zhang YD, Wu J. Sparing the pronator quadratus for volar plating of distal radius fractures: a comparative study of two methods. J Int Med Res 2019; 48:300060519893851. [PMID: 31854221 PMCID: PMC7459187 DOI: 10.1177/0300060519893851] [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] [Indexed: 11/16/2022] Open
Abstract
Objectives The objective of this study was to compare the results of two methods for
sparing the pronator quadratus in volar plating of distal radius
fractures. Methods A total of 110 patients were randomized to volar plating with sparing of the
pronator quadratus either by a transverse incision along the distal border
of the pronator quadratus (Group A, 55 people) or by the brachioradialis
splitting method (Group B, 55 people). The operative and radiation time,
range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand
(DASH) scores, Visual Analog Scale (VAS) scores, and complications were
recorded. Results There were no significant differences in the mean operative time, radiation
time, mean bone union time, or total complication rate between the groups.
We found no significant differences in range of motion, grip strength, VAS
scores, and DASH scores at any of the study intervals between the groups.
Although neurapraxia of the superficial branch of the radial nerve was more
common in Group B than in Group A (6.7% vs. 0%), the difference was not
significant. Conclusions Both methods were efficient approaches for sparing the pronator quadratus and
had similar clinical outcomes, but they had different indications.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| | - Yun-Qiang Zhuang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| | - Long Zhou
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| | - Gang-Qiang Jiang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| | - Ya-Di Zhang
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| | - Ji Wu
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| |
Collapse
|
10
|
Bergsma M, Brown K, Doornberg J, Sierevelt I, Jaarsma R, Jadav B. Distal Radius Volar Plate Design and Volar Prominence to the Watershed Line in Clinical Practice: Comparison of Soong Grading of 2 Common Plates in 400 Patients. J Hand Surg Am 2019; 44:853-859. [PMID: 31255374 DOI: 10.1016/j.jhsa.2019.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/19/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare plate positioning in clinical practice of 2 commonly used volar locking plate designs with respect to the watershed line as classified by the Soong grading system. METHODS For this retrospective study, we included a total of 400 patients who underwent open reduction and internal fixation between May 2013 and February 2018. Cohort 1 was defined as patients treated with distal volar radius (DVR) plates during this period. Cohort 2 comprised 200 patients who had volar plate fixation with variable angle locking compression plates (LCP) during the same period. Standardized lateral wrist radiographs were categorized into Soong grade 0, 1, or 2. RESULTS In cohort 1, 87 plates (43.5%) were not prominent volar to the watershed line, grade 0; 95 plates (47.5%) demonstrated grade 1 prominence; and 18 plates (9.0%) demonstrated grade 2 prominence. In cohort 2, 63 plates (31.5%) were grade 0; 103 plates (51.5%) were grade 1; and 34 plates (17%) had grade 2 prominence on, and volar to, the watershed line. These radiographic results show a greater incidence of volar plate prominence with respect to the watershed line, as defined as Soong grading, in cohort 2. CONCLUSION This study shows that the use of the variable angle LCP plate is associated with more prominent volar positioning with respect to the watershed line compared with the DVR plate. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
Collapse
Affiliation(s)
- Minke Bergsma
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, Australia; Department of Orthopaedic Surgery, Amsterdam University Medical Centra, University of Amsterdam, Amsterdam, The Netherlands.
| | - Kimberly Brown
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, Australia
| | - Job Doornberg
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, Australia; Department of Orthopaedic Surgery, Amsterdam University Medical Centra, University of Amsterdam, Amsterdam, The Netherlands
| | - Inger Sierevelt
- Specialized Centre of Orthopedic Research and Education, Amsterdam, The Netherlands
| | - Ruurd Jaarsma
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, Australia
| | - Bhavin Jadav
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, Australia
| |
Collapse
|
11
|
The Role of Additional K-Wires on AO Type C Distal Radius Fracture Treatment with External Fixator in Young Population. Adv Orthop 2019; 2019:8273018. [PMID: 30713776 PMCID: PMC6332986 DOI: 10.1155/2019/8273018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives Several methods have been proposed to treat AO type C distal radius fracture. External fixator has gained popularity for its simple procedure and rapid recovery. Some surgeons suggested that additional K-wires may play a critical role in the outcome. The purpose of study is to evaluate the role of additional K wires in treating distal radial fracture with external fixator regarding its outcome. Material and Methods From January 2006 to January 2010, 40 patients with AO type C distal radius fracture were treated with external fixator, with (EF) or without additional K wires (EFK). Radiologic outcome parameters include radial inclination, volar tilt, radial length, and the presence of radiocarpal arthritis according to Knirk and Jupiter. Clinical outcomes include New York Orthopedic Hospital (NYOH) wrist scoring scale. Results Radiographic outcome showed significant difference in regard of articular congruency at the final follow-up with the EFK group showing the advantage in maintaining the articular incongruity. NYOH wrist scoring scale showed no significant difference between both groups at final follow-up. The amount of articular step-off was less in EFK group with significant statistical finding on the final follow up. Conclusion Both EF and EFK technique were able to provide satisfactory result in treating AO type C distal radius fractures. We observed that EFK is superior in reducing the number of radiocarpal arthritic changes compared to EF group due to its superiority in reducing articular step-off.
Collapse
|
12
|
Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:15-18. [PMID: 30377011 PMCID: PMC6424667 DOI: 10.1016/j.aott.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 08/02/2018] [Accepted: 10/08/2018] [Indexed: 01/12/2023]
Abstract
Objective The aim of this study was to evaluate the efficacy of conservative treatment (cast immobilization) for complex intra-articular distal radius fractures (AO type C) in elderly patients and to determine whether or not the application of a volar locking plate (VLP) is necessary. Methods A retrospective study on patients treated at two different clinics was conducted between 2014 and 2016. A total of 49 elderly patients ≥60 years old were treated either operatively with volar locking plate fixation (n = 25; 7 males and 18 females; mean age: 66.6 ± 7.4 years) or conservatively with cast immobilisation (n = 24; 7 males and 17 females; mean age: 68.9 ± 8.7 years) for complex intra-articular distal fractures. Clinical, functional and radiological evaluations were conducted at the final follow-up examinations of the patients. Results There was no statistically significant difference between the two groups of patients with respect to the follow-up periods, gender, age and fracture type (p > 0.05). At the end of mean follow-up time of 16 months the grip strength (p = 0.03), radial tilt (p = 0.06), radial inclination (p = 0.01), radial height (p = 0.01) and articular step-off (p = 0.02) were significantly better in the volar locking plate group, while there was no significant difference between the functional results (based on the Quick Disabilities of the Arm, Shoulder and Hand score) (p = 0.8) and range of motion. The grip strength was significantly higher in the VLP group when compared to the cast group (p = 0.03). Conclusion The results of this study suggest that the locking plate fixation for the complex intra-articular distal radius fractures provides better results for the grip strength and radiographic parameters than cast immobilization in patients ≥60 years old, while no difference was found between the clinical and functional results. Level of Evidence Level III, Therapeutic Study.
Collapse
|
13
|
Otremski H, Dolkart O, Atlan F, Hutt D, Segev E, Pritsch T, Rosenblatt Y. Hairline fractures following volar plating of the distal radius: a recently recognized hardware-related complication. Skeletal Radiol 2018; 47:833-837. [PMID: 29356843 DOI: 10.1007/s00256-018-2877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Intraoperative hairline longitudinal fractures were recently reported in association with distal radius volar plating. Our aim was to further analyze this newly described complication. METHODS A retrospective radiographic and chart review was performed on 225 patients who underwent distal radius plating between June 2013 and June 2015. The Acu-Loc/Acu-Loc2© plating system (Acumed, Hillsboro, OR, USA) was used in 208 cases, and the VariAx© plating system (Stryker, Kalamazoo, MI, USA) was used in 17 cases. Three independent reviewers performed a blind evaluation of all relevant radiographs for the occurrence of longitudinal fractures around the plate, and validity was considered only when there was agreement among all three of them. RESULTS Hairline longitudinal fractures were identified in 57 cases (25%), 55 with the Acu-Loc/Acu-Loc2© system and 2 with the VariAx© system. All fractures occurred with volar plating. Fracture occurrence was associated with age over 59 years, female gender, extra-articular fractures, and the use of Hexalobe screws (Acu-Loc/Acu-Loc2© system). CONCLUSIONS We believe that the source of fracture occurrence lies within the screw design and that better screw design and possibly tapping in patients at risk may reduce the occurrence of intraoperative hairline longitudinal fractures. Further clinical and biomechanical research is needed to better understand this newly reported complication.
Collapse
Affiliation(s)
- Hila Otremski
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Hutt
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Segev
- Faculty of Science, Holon Institute of Technology, Holon, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Yuan ZZ, Yang Z, Liu Q, Liu YM. Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis. Orthop Traumatol Surg Res 2018; 104:95-103. [PMID: 29031702 DOI: 10.1016/j.otsr.2017.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/11/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The common fixation techniques for unstable distal radius fractures include open reduction and internal fixation (ORIF) with plates and closed reduction and external fixation (EF). There is controversy over the choice of surgical approach in treating unstable distal radius fractures. HYPOTHESIS This meta-analysis was performed to compare complication rates in patients treated with ORIF or EF for unstable distal radius fractures and to develop GRADE (grading of recommendations, assessment, development, and evaluation)-based recommendations for using the procedures to treat unstable distal radius fractures. MATERIALS AND METHODS A systematic search of all the studies published was conducted using the Pubmed, ScienceDirect, Embase, BIOSIS, Springer, Cochrane Library databases. The randomized controlled trials (RCTs) that compared ORIF with EF in treating adult patients with unstable distal radius fractures and provided data regarding the complication were identified. The demographic characteristics and adverse events were manually extracted from all of the included studies. RevMan 5.1 was used for data analysis. PRISMA guidelines were followed. RESULTS Sixteen studies that included a total of 1280 patients met the inclusion criteria. Compared with ORIF, EF results in higher incidence of total complications, infection and malunion. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DISCUSSION This meta-analysis indicates that ORIF and EF are both effective procedures for treating unstable distal radius fractures. ORIF may be superior to EF in the treatment of unstable distal radius fractures. Because of the low quality evidence currently available, high-quality RCTs are required. LEVEL OF EVIDENCE Level II: low-powered prospective randomized trial meta-analysis.
Collapse
Affiliation(s)
- Z Z Yuan
- Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China
| | - Z Yang
- Graduate School, Tianjin Medical University, Tianjin, China; Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
| | - Q Liu
- Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China
| | - Y M Liu
- Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China
| |
Collapse
|
15
|
ORTIZ-ROMERO JOEL, BERMUDEZ-SOTO IGNACIO, TORRES-GONZÁLEZ RUBÉN, ESPINOZA-CHOQUE FERNANDO, ZAZUETA-HERNANDEZ JESÚSABRAHAM, PEREZ-ATANASIO JOSÉMANUEL. FACTORS ASSOCIATED WITH COMPLEX REGIONAL PAIN SYNDROME IN SURGICALLY TREATED DISTAL RADIUS FRACTURE. ACTA ORTOPEDICA BRASILEIRA 2017; 25:194-196. [PMID: 29081703 PMCID: PMC5608737 DOI: 10.1590/1413-785220172505165544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: The aim of this study was to identify factors associated with developing complex regional pain syndrome (CRPS) after surgical treatment for distal radius fracture (DRF). Methods: This case-control study analyzed patients seen from January 2014 to January 2016. Results: In our sample of 249 patients, 4% developed CRPS. Associated factors were economic compensation via work disability (odds ratio [OR] 14.3), age (OR 9.38), associated fracture (OR 12.94), and level of impact (OR 6.46), as well as psychiatric history (OR 7.21). Conclusions: Economically-productive aged patients with a history of high-impact trauma and patients with a history of psychiatric disorders have greater risk of developing CRPS after DRF. Level of Evidence III, Case-Control Study.
Collapse
|
16
|
Zhang X, Hu C, Yu K, Bai J, Tian D, Xu Y, Zhang B. Volar locking plate (VLP) versus non-locking plate (NLP) in the treatment of die-punch fractures of the distal radius, an observational study. Int J Surg 2016; 34:142-147. [DOI: 10.1016/j.ijsu.2016.08.527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
|