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Ballet S, Guerzider-Regas I, Aouzal Z, Pozet A, Quemener-Tanguy A, Koehly A, Obert L, Loisel F. Distal radius fractures after 75 years of age: are six-month functional and radiological outcomes better with plate fixation than with conservative treatment? Orthop Traumatol Surg Res 2024:103959. [PMID: 39059547 DOI: 10.1016/j.otsr.2024.103959] [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: 08/23/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Surgery and non-operative treatment produce similar 1-year functional outcomes in patients older than 65 years. Data are lacking for patients older than 75 years. The main objective of this study was to compare surgical vs. non-operative treatment regarding short-term outcomes in patients older than 75 years. In addition to an overall analysis, sub-group analyses were done in patients with displacement and severe displacement (>20 ° posterior tilt). HYPOTHESIS Surgery provides better clinical and radiological outcomes than does non-operative treatment. PATIENTS AND METHODS Patients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson's Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications. RESULTS 74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons). DISCUSSION In patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Safire Ballet
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France.
| | - Inès Guerzider-Regas
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Edmond Garcin, Hôpital Public Aubagne, 179 avenue des sœurs Gastine, 13677 Aubagne, France
| | - Zouhair Aouzal
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - Astrid Pozet
- Délégation de la Recherche Clinique et de l'Innovation (DRCI), CHU de Besançon, 3 Boulevard Alexandre Fleming, 25030 Besançon, France
| | - Alexandre Quemener-Tanguy
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - Axel Koehly
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - Laurent Obert
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
| | - François Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France
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Tanner JL, Wang M, Le Nen D, Di Francia R, Andro C, Letissier H. Study of the position of six volar locking plates for distal radius fracture relative to the watershed line. HAND SURGERY & REHABILITATION 2024; 43:101624. [PMID: 38103596 DOI: 10.1016/j.hansur.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Volar plate malpositioning in the treatment of distal radial fracture can lead to tendinitis or even tendon tear, especially when the plate position is very distal. We studied the impact of design on plate position in the distal radius. The primary aim was to compare the position of six volar wrist plates relative to the watershed line using the Soong classification. The secondary objectives were to assess the epidemiology of volar locking plate fixation within the administrative Département of Finistère (northwestern France) and to study whether the type of fracture played a role in plate position. HYPOTHESIS The plate design itself influences positioning relative to the watershed line on the Soong classification. MATERIALS AND METHODS A total of 2723 volar locking plate fixation cases were analyzed and categorized according to the Soong classification. Plates used were divided into six groups based on design: Zimmer Biomet®, Newclip Technics®, Stryker®, Synthes®, Medartis® and Medartis® Footprint. The number of Soong 0 + 1 plates (i.e., plates graded 0 and 1 taken together) was determined for each design, then compared using the Marascuilo procedure with a significance level of α = 0.05. RESULTS On the Marascuilo procedure, we found significant differences in the number of Soong grade 0 + 1 plates. The Zimmer Biomet and Newclip Technics® plates were significantly more often proximal to the watershed line than the Synthes and Medartis Footprint plates. Plate position with the Medartis® design was significantly more proximal to the watershed line than for its companion design, the Medartis® Footprint plate. The rate of volar locking plate fixation of distal radial fractures over the past 10 years increased in Finistère. Also, the type of fracture affected the choice of plate when different designs were available within a hospital center (Medartis® Footprint plate used in 2R3A fractures). CONCLUSION Our study highlights a significant difference in volar locking plate position relative to the watershed line between the various models available. Plate design is a deciding factor when treating distal radial fracture, to avoid impingement when implant removal is not routinely planned. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Jean-Loup Tanner
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Michaël Wang
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Dominique Le Nen
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France; Université de Bretagne Occidentale, UBO, 29200 Brest, France
| | - Rémi Di Francia
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Christophe Andro
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Clermont-Tonnerre (Hôpital d'Instruction des Armées), Rue Colonel Fonferrier, 29240 Brest, France
| | - Hoel Letissier
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France; Université de Bretagne Occidentale, UBO, 29200 Brest, France; LaTIM, INSERM, UMR 1101, SFR IBSAM, Avenue Foch, 29200 Brest, France.
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Donndorff AG, Cafruni VM, Bronenberg Victorica P, Gallucci GL, Boretto JG, De Carli P. Description of unusual osteochondral laminar fragment patterns in Distal Radius fractures. Orthop Traumatol Surg Res 2022; 108:103321. [PMID: 35589086 DOI: 10.1016/j.otsr.2022.103321] [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: 03/05/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Distal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. PATIENTS AND METHODS We reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. RESULTS Two main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: Significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI 1.4 to 2.9). DISCUSSION Global prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. LEVEL OF EVIDENCE IV (Observational/Descriptive); Cross sectional study.
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Affiliation(s)
- Agustín Guillermo Donndorff
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Virginia Maria Cafruni
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina
| | - Pedro Bronenberg Victorica
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina.
| | - Gerardo Luis Gallucci
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Guillermo Boretto
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo De Carli
- "Carlos E. Ottolenghi" Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Potosi 4247 C1199ABB, Buenos Aires, Argentina; Hand Surgery and Upper Extremity Center, Carlos E. Ottolenghi Institute, Service of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Biz C, Cerchiaro M, Belluzzi E, Bortolato E, Rossin A, Berizzi A, Ruggieri P. Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern? J Pers Med 2022; 12:jpm12091532. [PMID: 36143316 PMCID: PMC9503670 DOI: 10.3390/jpm12091532] [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: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-3348
| | - Elena Bortolato
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Alessandro Rossin
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Antonio Berizzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
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Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference? INTERNATIONAL ORTHOPAEDICS 2022; 46:2165-2176. [PMID: 35690670 PMCID: PMC9372011 DOI: 10.1007/s00264-022-05469-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Purpose Two different locking plate designs are now being used for volar plating of the distal radius fractures based on the freedom of screw direction; the fixed-angle, and the variable-angle (polyaxial) plates. We investigated the clinical and radiographic outcomes of both designs. Methods We reviewed 96 patients with 113 unstable distal radius fractures that were operated on with volar locking plates. The patients’ mean age was 41 years. Fixed-angle volar locking plates were utilized in 65 fractures and variable-angle volar locking plates in 48 fractures through modified Henry approach or extended carpal tunnel approach. Full clinical and radiographic evaluation was done for all patients with a mean follow-up of 14 months. Results All patients had acceptable clinical and radiographic parameters. The overall functional results (Mayo score, Quick Disability of Arm, Shoulder, and Hand (Q-DASH) score, Range of motion (ROM), and grip strength) were in favor of the variable-angle plate. The radiographic parameters were better with the variable-angle group. The variable-angle group recorded less operative time but more mean image intensifier exposure time. There were two cases of flexor tendon rupture with the fixed-angle group. Fixation with the fixed-angle system needed K-wire augmentation more than the variable-angle group. There was a positive correlation between hand dominance and the final score. Conclusion Distal radius volar locking plates yield satisfactory results comparable among different designs. In our series, the variable-angle system showed slightly better function and radiographic outcomes. Supplementary K-wires were needed more frequently with the fixed-angle system.
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Kaji Y, Yamaguchi K, Nomura Y, Oka K, Nakamura O, Ishibashi Y, Yamamoto T. Postoperative early and proactive grip strength training program for distal radius fractures promotes earlier recovery of grip strength: A retrospective study. Medicine (Baltimore) 2022; 101:e29262. [PMID: 35583536 PMCID: PMC9276271 DOI: 10.1097/md.0000000000029262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/21/2022] [Indexed: 01/04/2023] Open
Abstract
The use of volar locking plates (VLPs) for distal radius fractures has remarkably improved clinical outcomes; however, there are some reports of delayed recovery of grip strength. Since January 2019, we have been conducting an early and proactive grip strength training program (EGTP). In this program, 20 minutes of grip strength training-using a gripper with a load of 0.7 kg-was initiated from 2 weeks after surgery; the load was then gradually increased. From 6 weeks postsurgery, daily home grip strength training was performed using a gripper with a load of 5 kg, provided to the patient.We investigated whether the introduction of the EGTP could lead to earlier recovery of grip strength. We also examined whether the EGTP caused postoperative correction loss at the fractured site, or contributed to the early improvement of wrist function.Thirty-nine patients who underwent surgery using VLPs for distal radius fractures were included in this study; 20 followed the EGTP (EGTP group) and 19 patients did not (NGTP group). For these patients, grip strength and range of motion of the wrist joint were evaluated both 3 and 6 months postoperatively. The Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were also evaluated 6 months postoperatively. Additionally, corrective losses of radial inclination (RI), palmar tilt (PT), and ulnar variance (UV)-occurring from immediately postsurgery to 6 months after surgery-were evaluated.At both 3 and 6 months postoperatively, the grip strength of the EGTP group was significantly higher than that of the NGTP group. Regarding range of motion, only palmar flexion was significantly improved in the EGTP group at 3 months postoperatively. Conversely, no differences in corrective losses of RI, PT, and UV, or in qDASH scores, were observed between the two groups.The results of this study suggest that the EGTP can provide early recovery of grip strength and palmar flexion of the wrist without causing corrective loss at the fracture site.
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Affiliation(s)
- Yoshio Kaji
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Konosuke Yamaguchi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yumi Nomura
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Kunihiko Oka
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Osamu Nakamura
- Department of Orthopedic Surgery, Kagawa Prefectural Shirotori Hospital, Mastubara, Higashikagawa City, Kagawa, Japan
| | - Yoichi Ishibashi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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Sakamoto S, Doi K, Hattori Y, Al-Bazzaz A, Hayashi K, Sonezaki S. Comminuted Dorsal Ulnar Fragment in Distal Radius Fractures Treated Using the Integrated Compression Screw With a Mini-Plate. J Hand Surg Am 2022; 47:394.e1-394.e6. [PMID: 34674899 DOI: 10.1016/j.jhsa.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
Stabilization for displaced dorsoulnar fragments in distal radius fractures is challenging to treat with conventional volar locking plates alone. The integrated compression screw combined with a volar locking plate has been introduced as an additional tool to stabilize the dorsoulnar fragment and has been reported to work effectively. However, the compression screw is unable to stabilize a comminuted dorsal ulnar fragment; therefore, it is necessary to consider using an additional dorsal plate. We have developed a modified surgical technique to stabilize a comminuted dorsal intra-articular fragment by combining the integrated compression screw with a mini-plate as a washer or a buttress.
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Affiliation(s)
- Sotetsu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan.
| | - Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Abdullah Al-Bazzaz
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Kota Hayashi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Shichoh Sonezaki
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
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McIver ND, Salas C, Menon N, Heifner J, Mercer D. Appropriately Matched Fixed-Angle Locking Plates Improve Stability in Volar Distal Radius Fixation. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:135-140. [PMID: 35601514 PMCID: PMC9120789 DOI: 10.1016/j.jhsg.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Size options for volar locking plates may provide value for distal radius fixation. We compared excessively narrow plates with plates that were appropriately matched in width for fixation of an multifragmented distal radius fracture model. Methods Eighteen matched pairs (right and left wrists) of large, cadaveric male distal radii specimens, prepared with a simulated Arbeitsgemeinschaft für Osteosynthesefragen type C-3 distal radius fractures, were tested. One specimen from each matched pair was randomized to receive a plate that was appropriately matched in width to the distal radius. The contralateral limb received a narrow plate, which in all cases was undersized in width. Fixation stability was tested and compared to the contralateral matched specimen. Specimens were preloaded at 50 N for 30 seconds before cyclic loading from 50–250 N at 1 Hz for 5000 cycles then loaded to failure. Results Loss of fixation under cyclic loading was significantly greater in the specimens fixed with excessively narrow plates compared with plates of appropriate width. When loaded to failure, the plates of appropriate width were stiffer, with higher force at failure and compressive strength than narrow plates. The primary mode of failure was displacement of the distal lunate facet fragment. Conclusions These findings suggest that optimally matching the volar locking plate width to the radius may provide advantages for stability of the fixation construct and fragment capture. This may be due to reduced stress concentration from the distribution of forces across a larger surface area. Clinical relevance Optimizing the plate width to the radial width may improve fracture stability and may carry additional importance in comminuted fractures, where narrow plates may not completely capture small bone fragments.
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Affiliation(s)
- Natalia D. McIver
- Department of Orthopaedics & Rehabilitation, the University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Christina Salas
- Department of Orthopaedics & Rehabilitation, the University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Nathan Menon
- Department of Orthopaedics & Rehabilitation, the University of New Mexico Health Sciences Center, Albuquerque, NM
| | - John Heifner
- St George’s University School of Medicine, Great River, NY
| | - Deana Mercer
- Department of Orthopaedics & Rehabilitation, the University of New Mexico Health Sciences Center, Albuquerque, NM
- Corresponding Author: Deana Mercer, MD, Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC10 5600, Albuquerque, NM 87131.
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Sanders L, Johnson N, Dias JJ. Kirschner Wire Fixation in Dorsally Displaced Distal Radius Fractures: A Biomechanical Evaluation. J Wrist Surg 2022; 11:21-27. [PMID: 35127260 PMCID: PMC8807103 DOI: 10.1055/s-0041-1729761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Background There is currently no consensus for the optimum configuration and number of Kirschner wires (K-wires) to use for the stabilization of dorsally displaced distal radius fractures. In this biomechanical study, we compared the load to failure and stiffness of four common K-wire configurations to identify the strongest construct for use in extra-articular dorsally displaced distal radius fractures. Case Description We created a standard distal radius fracture model in turkey tarsometatarsi which was stabilized using two or three K-wires (1.6 mm) in four different configurations. Following a power calculation, 10 fracture models of each configuration underwent testing in cantilever bending and axial compression. Literature Review Recent randomized trials have shown no evidence that volar locking plates are superior to K-wires for the treatment of dorsally displaced distal radius fractures. This has led to an increase in the popularity of much cheaper K-wires. Several different K-wire techniques have been described but there is no strong evidence to determine which is the optimal configuration and number of wires. Clinical Relevance The three-wire interfragmentary configuration was stiffer than the three-wire Kapandji in axial compression and cantilever bending. There was no difference in load to failure in cantilever bending or axial compression. The three-wire interfragmentary technique is the stiffest configuration of K-wires for dorsally displaced distal radius fractures. The two-wire Kapandji technique was significantly weaker than the other configurations, especially in cantilever bending. Conclusion The authors recommend to always use three wires for percutaneous pinning and never to use two intrafocal wires alone.
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Affiliation(s)
- Liam Sanders
- Department of Trauma and Orthopaedics, Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Nick Johnson
- Department of Trauma and Orthopaedics, Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
| | - Joseph J. Dias
- Department of Trauma and Orthopaedics, Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom
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Voss MR, Donnay RL, Homa JK. The effects of dry needling on the thumb: A case report. Hong Kong J Occup Ther 2022; 34:132-136. [PMID: 34987351 PMCID: PMC8721585 DOI: 10.1177/15691861211043687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Dry needling has been identified as a potential intervention for a variety of diagnoses. Limited evidence exists to support the use of dry needling following surgical intervention of a distal radius fracture. This case report demonstrates the impact of dry needling in the thumb following a distal radius fracture. Methods The patient was a 31-year-old healthy female who sustained a distal radius fracture and required surgical intervention. The patient required a volar plate removal and extensor tenolysis. The patient attended traditional occupational therapy with one session of dry needling to assist in improving range of motion and decreasing pain. Results The patient benefited from the use of dry needling. The patient had no pain with functional grasping and pinching following dry needling and improved on the Kapandji score from eight to nine out of ten. The patient also reported a decrease in overall pain, from seven to two on the Numeric Pain Rating Scale. Discussion The patient benefited from dry needling in the thumb to improve both range of motion and pain symptoms. While the evidence is limited, dry needling may be an appropriate intervention to assist in recovery and reduce thumb pain following distal radius fractures.
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Affiliation(s)
- Mitchell R Voss
- Outpatient Occupational Therapy, Aurora BayCare Medical Center, Green Bay, WI, USA
| | - Rebecca L Donnay
- Sports Physical Therapy, Aurora BayCare Medical Center, Green Bay, WI, USA
| | - Jennifer K Homa
- Advocate Aurora Health Research Institute, Advocate Aurora Health, Milwaukee, WI, USA
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11
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Kaji Y, Yamaguchi K, Nomura Y, Oka K, Shimamura M, Kawakami S, Yamamoto T. Lasso loop technique using bioabsorbable thread to treat intra-articular distal radius fracture. Medicine (Baltimore) 2021; 100:e27924. [PMID: 34964765 PMCID: PMC8615343 DOI: 10.1097/md.0000000000027924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023] Open
Abstract
This article introduces our lasso loop technique (LLT) using a bioabsorbable thread for the treatment of intra-articular distal radius fractures with displaced dorsal bone fragment containing articular surface (DBF). We also examined whether the articular gap is sufficiently reduced and maintained by the LLT, along with the results of other radiological and clinical evaluations. We retrospectively reviewed 19 patients who underwent LLT for intra-articular distal radius fracture with a displaced DBF. Patient radiographic images and medical records were used to investigate radiological characteristics, symptoms, physical findings, and the Quick Disabilities of the Arm, Shoulder, and Hand scores. Sagittal-view computed tomography showed that the mean preoperative articular gap was 2.6 mm, but the gap was reduced by LLT, and the gap immediately postoperatively was <1.0 mm in all patients. No re-displacement of the DBF was evident from immediately postoperatively to 6 months postoperatively. Postoperatively, no losses of correction in palmar tilt, radial inclination, or ulnar variance were seen in the evaluation of plain radiographs, and satisfactory joint range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand score were obtained. No significant complications due to LLT were observed. LLT appears to offer a simple and effective procedure to reduce displaced DBF with little risk of complications. LLT may become a useful option in the treatment of intra-articular distal radius fractures with displaced DBF.
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Affiliation(s)
- Yoshio Kaji
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Konosuke Yamaguchi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yumi Nomura
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Kunihiko Oka
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Masashi Shimamura
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Hiragishi, Sapporo City, Hokkaido, Japan
| | - Shohei Kawakami
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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12
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Abstract
There are several options for plate fixation of distal radius fractures. Volar plating has broad applicability and consistent outcomes, and thus is the most commonly used plate type. Dorsal plates are advantageous for specific fracture patterns, and can provide direct fracture reduction and buttressing, but may be prominent and can cause tendon irritation. Bridge plates offer an alternative to external fixation while avoiding the complications with prominent hardware, because they span highly comminuted fractures and can be used for immediate weight bearing; however, they require plate removal. Choice of plate fixation should depend on fracture type, patient factors, and surgeon experience.
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13
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Oh GH, Kim HS, Lee JI. Biomechanical evaluation of the stability of extra-articular distal radius fractures fixed with volar locking plates according to the length of the distal locking screw. Comput Methods Biomech Biomed Engin 2020; 24:922-932. [PMID: 33347357 DOI: 10.1080/10255842.2020.1861254] [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: 10/22/2022]
Abstract
Surgeons usually used short screws to avoid extensor tendon problems during volar locking plate fixation in distal radius fracture. However, the stability according to the length of distal locking screws have not been fully understood. We investigated this issue through finite element analysis and compression test using synthetic radius. Our results demonstrated that the bi-cortical full-length fixation does not contribute to the stiffness increase in the axial compression direction, and a reduction in length of up to more than 50% length can still provide similar stability to full-length screws. Our data can support that surgeon should undersize the distal screw.
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Affiliation(s)
- Gyung-Hwan Oh
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea
| | - Hak-Sung Kim
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea.,Institute of Nano Science and Technology, Hanyang University, Seoul, Korea
| | - Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri hospital, Guri, Korea
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14
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Asmar G, Bellity J, Falcone MO. Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:481-490. [PMID: 32955698 DOI: 10.1007/s00590-020-02791-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. MATERIALS AND METHODS This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. RESULTS In the first phase: mean incision size was 32 mm, and mean operative time was 28.5 min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2 months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. CONCLUSION The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.
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Affiliation(s)
- Ghada Asmar
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Jonathan Bellity
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Marc-Olivier Falcone
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France. .,Clinique Internationale du Parc Monceau, 21 rue de Chazelles, 75017, Paris, France.
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15
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Kikuchi Y, Sato K, Mimata Y, Murakami K, Takahashi G, Doita M. Ulnar facet locking screw locations of volar locking plates placed without flexor pollicis longus tendon contact: A cadaver study. Orthop Traumatol Surg Res 2020; 106:365-370. [PMID: 31899118 DOI: 10.1016/j.otsr.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 11/08/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The volar locking plate (VLP) system provides stable fixation and is widely used for distal radius fractures. Studies have shown that irritation of the implant prominence is a risk factor for flexor tendon rupture, especially of the flexor pollicis longus (FPL). Contact between VLPs and flexor tendons should be avoided. We aimed to investigate the ulnar facet locking screw locations of various VLPs placed without FPL tendon contact in cadaver wrists. HYPOTHESIS We hypothesized that ulnar facet locking screws would be in the vicinity of the subchondral bone when the plate is placed in the most distal position without FPL tendon contact. MATERIALS AND METHODS The study assessed two variable-angles and four fixed locking plates. We placed each plate in six different cadavers, resulting in 36 different plate-cadaver combinations. Plates were placed in the most distal position without FPL tendon contact. We drilled the most ulnar hole (hole A) and the second ulnar hole (hole B) of the distal row. All drilling procedures were performed using a specific jig for each fixed locking plate. For variable-angle locking plates, we drilled with a fixed jig for each plate. We obtained lateral radiographs when the drill penetrated the dorsal cortex and measured the distance between the drill and the articular surface. RESULTS With regard to hole A, the mean distances between the drill and the center of the articular surface were 2.6-5.2mm for the four fixed locking plates and 4.9-5.6mm for the two variable-angle locking plates. With regard to hole B, the mean distances between the drill and the center of the articular surface were 3.8-5.9mm for the four fixed locking plates and 5.5-5.9mm for the two variable-angle locking plates. DISCUSSION When clinicians place a VLP without FPL tendon contact, the distance between the ulnar facet screws and the center of the articular surface is over 3mm in most cases. Surgeons should select variable-angle drilling for strong articular support when using variable-angle locking plates. LEVEL OF EVIDENCE III, diagnostic Level.
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Affiliation(s)
- Yuki Kikuchi
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1, Idaidori, Yahaba-cho, Shiwa-gun, 028-3694 Iwate, Japan
| | - Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1, Idaidori, Yahaba-cho, Shiwa-gun, 028-3694 Iwate, Japan.
| | - Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1, Idaidori, Yahaba-cho, Shiwa-gun, 028-3694 Iwate, Japan
| | - Kenya Murakami
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1, Idaidori, Yahaba-cho, Shiwa-gun, 028-3694 Iwate, Japan
| | - Gaku Takahashi
- Department of Critical Care Medicine, Iwate Medical University, 1-1-1, Idaidori, Yahaba-cho, Shiwa-gun, 028-3694 Iwate, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1, Idaidori, Yahaba-cho, Shiwa-gun, 028-3694 Iwate, Japan
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16
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Guerrero EM, Lauder A, Federer AE, Glisson R, Richard MJ, Ruch DS. Metacarpal Position and Lunate Facet Screw Fixation in Dorsal Wrist-Spanning Bridge Plates for Intra-Articular Distal Radial Fracture: A Biomechanical Analysis. J Bone Joint Surg Am 2020; 102:397-403. [PMID: 31904607 DOI: 10.2106/jbjs.19.00769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A dorsal wrist-spanning plate (DWSP) can be affixed to the second or third metacarpal, depending on the morphology of the distal radial fracture (DRF) and on surgeon preference, but comparative biomechanical analyses between these methods are limited. This biomechanical study compared fixation to the second metacarpal versus the third metacarpal as measured by lunate facet fragment displacement in a cadaveric model of an axially loaded intra-articular DRF. The construct rigidity with the addition of an intrafragmentary lunate facet locking screw was also evaluated. METHODS A sample size of 14 cadaveric matched pairs was calculated to achieve 81.7% power. The 28 limbs were randomized to DWSP fixation to the second metacarpal (Group 1) or third metacarpal (Group 2); each wrist underwent an osteotomy simulating an unstable intra-articular DRF. Limbs were tested at axial loads of 50, 100, 150, 200, 250, and 300 N. Lunate facet displacement from the metaphyseal fragment at each load was measured with use of differential variable reluctance transducers. After initial testing, a locking screw was placed through the plate into the lunate facet fragment in the third metacarpal group (Group 3). Displacement measurements were repeated for all loads. Paired 2-tailed t tests with Bonferroni correction (significance, p < 0.008) were performed to assess differences in fragment stability between groups. RESULTS The average fracture displacement at 300 N was 0.8 mm in Group 1, 0.4 mm in Group 2, and 0.2 mm in Group 3. Plating to the third metacarpal more effectively resisted displacement compared with the second metacarpal at all axial loads (p < 0.008). The addition of a lunate facet screw further stiffened the construct at loads of ≥200 N (p < 0.008). CONCLUSIONS Plate fixation to the third metacarpal with an intrafragmentary screw was the most biomechanically favorable construct, although other factors may favor an alternative distal fixation site. Mean displacement of the lunate facet fragment at 300 N was <1 mm in all groups. CLINICAL RELEVANCE The present study demonstrated that a DWSP affixed to the third metacarpal with an intrafragmentary screw provides the most effective stabilization of the lunate facet fragment in intra-articular DRFs. This study validates the use of intrafragmentary screws to increase stability in DWSP fixation.
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Affiliation(s)
- Evan M Guerrero
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander Lauder
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, Colorado
| | - Andrew E Federer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Richard Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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17
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Austine J, Kotian P, Mirza K, Annappa R, Sujir P. Functional and radiological outcomes in 2.7-mm volar locking compression plating in distal radius fractures. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joasp.joasp_2_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Misir A, Ozturk K, Kizkapan TB, Yildiz KI, Gur V, Sevencan A. Fracture lines and comminution zones in OTA/AO type 23C3 distal radius fractures: The distal radius map. J Orthop Surg (Hong Kong) 2019; 26:2309499017754107. [PMID: 29366391 DOI: 10.1177/2309499017754107] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study was designed to define fracture lines and comminution zones in OTA/AO 23C3 distal radius fractures from axial computed tomography (CT) images that would influence surgical planning, development of new classifications, and possible implant designs. METHODS Thirty-four consecutive OTA/AO 23C3 fractures treated by a single surgeon between January 2014 and December 2014 were analyzed. For each fracture, maps of the fracture lines and zones of comminution were drawn. Each map was digitized and graphically superimposed to create a compilation of fracture lines and zones of comminution. Based on this compilation, major and minor fracture lines were identified and fracture patterns were defined. RESULTS All major fracture lines were distributed in the central region of the radius distal articular surface. There is a recurrent fracture pattern with a comminution zone including the scaphoid and lunate fossa; Lister's tubercle; and ulnar, volar, and radial zones. CONCLUSION It is important for the practicing surgeon to understand these four main fragments. Knowledge of this constant pattern should influence the development of new classifications and possible implant designs.
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Affiliation(s)
- Abdulhamit Misir
- 1 Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Kahraman Ozturk
- 2 Department of Hand and Upper Extremity Surgery, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Turan Bilge Kizkapan
- 3 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kadir Ilker Yildiz
- 3 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Volkan Gur
- 1 Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ahmet Sevencan
- 1 Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
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19
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Lans J, Alvarez J, Kachooei AR, Ozkan S, Jupiter JB. Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps. J Wrist Surg 2019; 8:118-123. [PMID: 30941251 PMCID: PMC6443535 DOI: 10.1055/s-0038-1673407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Background The dorsal lunate facet fragment represents part of a complex articular injury of the distal radius and is challenging to reduce through a standard volar approach. We propose reduction through a standard volar approach and intraoperative dorsal lunate facet reduction using a bone forceps. To evaluate the postoperative reduction, we used computed tomography (CT) scan. Methods We retrospectively included 60 patients with a median follow-up of 44 weeks. Fracture reduction was evaluated using pre- and direct postoperative CT scans of the wrist, measuring the articular gap and step of the sigmoid notch. The range of motion was evaluated clinically by the treating physician. Bivariate analysis was performed to compare pre- and postoperative radiographic measurements and to compare wrist range of motion. Results When comparing the injured with the uninjured wrist, there was a significant difference in flexion, extension, pronation, and supination. In 87% of the patients, there was complete radiographic reduction of the fracture. Conclusion This study shows that dorsal ulnar lunate facet fracture fragments in distal radius fractures can be reduced through a standard volar approach with the help of an intraoperative bone reduction forceps. Using wrist CT, we showed that 87% of the patients with a dorsal ulnar lunate facet fragment had a postoperative articular step or gap of <1 mm. Level of Evidence : This is a level IV, therapeutic study.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josefina Alvarez
- Department of Traumatology, British Hospital, Montevideo, Uruguay
| | - Amir R. Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sezai Ozkan
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Lauder A, Hanel DP. Spanning Bridge Plate Fixation of Distal Radial Fractures. JBJS Rev 2019; 5:01874474-201702000-00002. [PMID: 28248738 DOI: 10.2106/jbjs.rvw.16.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander Lauder
- Department of Orthopaedics, University of Washington, Seattle, Washington
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21
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Older Patient Preferences for Internal Fixation after a Distal Radius Fracture: A Qualitative Study from the Wrist and Radius Injury Surgical Trial. Plast Reconstr Surg 2018; 142:34e-41e. [PMID: 29952895 DOI: 10.1097/prs.0000000000004454] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Distal radius fracture treatments provide similar functional outcomes. It has been hypothesized that the use of internal fixation is increasing because of physician preferences. The multisite randomized Wrist and Radius Injury Surgical Trial provides a unique opportunity to examine patient preferences in the absence of surgeon influence. The authors' objective was to investigate patient preference for internal fixation even after being informed of the equipoise among treatments. METHODS The authors performed 30 semistructured interviews with older individuals, all older than 60 years, approached at their institution for the Wrist and Radius Injury Surgical Trial. The authors' sample included three groups: those with a preference for internal fixation (n = 11), those with preference for nonsurgical treatment (n = 6), and those without a preference who consented to surgical randomization (n = 13). We used grounded theory for data collection and analysis. RESULTS All participants indicated their chief concern was regaining full function. Patients based their preferences for internal fixation on multiple values, including obstacles to recovery, autonomy, aesthetics, and pain relief. Some patients who did not select internal fixation reflected on their experiences, questioning whether they would have had a potentially different outcome with internal fixation treatment. CONCLUSIONS Without evidence for a superior treatment, patients focus on factors that pertain to recovery rather than outcomes, with most preferring the volar locking plating system. To best align with patient values, physicians should focus their discussion with patients on aspects of the recovery period rather than functional outcomes. Evidence from the Wrist and Radius Injury Surgical Trial will provide high-level information about patient-reported, functional, and radiographic outcomes.
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22
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Guillou J, Darees M, Pougès C, Christiaens N, Guerre E, Chantelot C. What happens to the posterior comminution in extra-articular fractures of the distal radius treated with volar locking plates? HAND SURGERY & REHABILITATION 2018; 38:91-96. [PMID: 30425021 DOI: 10.1016/j.hansur.2018.10.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/11/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Abstract
Extra-articular fractures of the distal radius with posterior displacement are typically treated with volar locking plates. However, this fixation method does not address the posterior comminution, which seems to have no impact on the final result. The purpose of this study was to determine the fate of the posterior comminution. This was a retrospective study of 22 patients over 50 years old with a distal radius fracture. A preoperative computed tomography (CT) scan was performed to evaluate the comminution. All fractures were fixed with a volar locking plate. All patients underwent a bone density scan. Patients were reviewed at 6 months post-operative to determine their clinical, radiological and functional outcomes. The CT scan was performed again to determine the fate of the comminution. At 6 months post-operative, 82% of patients had an oval metaphyseal defect. The mean volume of this defect was 1.86 mL. The contents of this defect most closely resembled fat. There was no statistical link between the defect's volume and the various parameters studied. On the other hand, the defect's density was positively related to the functional outcome and negatively related to the patients' body mass index. Because of the compression experienced by the cancellous bone, a distal metaphyseal defect often persists after consolidation in dorsally displaced distal radius fractures. The posterior comminution is ultimately of little consequence.
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Affiliation(s)
- J Guillou
- Service de chirurgie orthopédique B, centre hospitalier de Valenciennes, avenue Desandrouin, 59322 Valenciennes cedex, France.
| | - M Darees
- Service de traumatologie, pôle de l'appareil locomoteur, Hôpital Roger-Salengro, CHRU de Lille, rue du Professeur Emile-Laine, 59037 Lille cedex, France.
| | - C Pougès
- Service d'orthopédie-traumatologie, hôpital Saint-Vincent de Paul, boulevard de Belfort, 59000 Lille, France.
| | - N Christiaens
- Service d'orthopédie-traumatologie, hôpital Saint-Vincent de Paul, boulevard de Belfort, 59000 Lille, France.
| | - E Guerre
- Service d'orthopédie-traumatologie, hôpital Saint-Vincent de Paul, boulevard de Belfort, 59000 Lille, France.
| | - C Chantelot
- Service de traumatologie, pôle de l'appareil locomoteur, Hôpital Roger-Salengro, CHRU de Lille, rue du Professeur Emile-Laine, 59037 Lille cedex, France.
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Alter TH, Ilyas AM. Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.18.00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mugnai R, Tarallo L, Capra F, Catani F. Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures. Orthop Traumatol Surg Res 2018; 104:877-882. [PMID: 29807189 DOI: 10.1016/j.otsr.2018.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. HYPOTHESIS Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. MATERIALS AND METHODS Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. RESULTS The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (-16%) for the titanium plate. Statistical analysis between groups reported significant values (p<001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (p=.197). DISCUSSION The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the post-operative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Raffaele Mugnai
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy.
| | - Luigi Tarallo
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
| | | | - Fabio Catani
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
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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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Loisel F, Kielwasser H, Faivre G, Rondot T, Rochet S, Adam A, Sergent P, Leclerc G, Obert L, Lepage D. Treatment of distal radius fractures with locking plates: an update. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1537-1542. [DOI: 10.1007/s00590-018-2274-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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Camus EJ, Van Overstraeten L. Treatment of the distal radius fractures with percutaneous pinning: evolution to the HK2 system. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1477-1485. [PMID: 29869724 DOI: 10.1007/s00590-018-2221-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/06/2018] [Indexed: 12/01/2022]
Abstract
Displaced fractures of the distal radius often require reduction and fixation to improve outcome in active patients. The volar locking plate gained ground over pinning, which was the first surgical solution described. But pinning methods have since evolved with fewer complications. The authors present a clinical study of distal radius fracture fixation using the HK2 technique, where subchondral pins are connected to intra-focal pins. The results are satisfactory with a lower complication rate compared to other pinning methods. This technical improvement relaunches the pinning technique, with its two advantages, being faster and significantly cheaper than locking plates, with similar long-term functional results.
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Affiliation(s)
- Emmanuel J Camus
- Clinique du Val de Sambre, 162 Route de Mons, Maubeuge, France. .,Clinique de Lille Sud, 96 rue Gustave Delory, Lesquin, France. .,ULB Brussels Free University, Route de Lennik 808, Brussels, Belgium.
| | - Luc Van Overstraeten
- Hand and Foot Surgery Unit, Rue Pierre Caille 9, Tournai, Belgium.,ULB Brussels Free University, Route de Lennik 808, Brussels, Belgium
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Kotian P, Mudiganty S, Annappa R, Austine J. Radiological Outcomes of Distal Radius Fractures Managed with 2.7mm Volar Locking Plate Fixation-A Retrospective Analysis. J Clin Diagn Res 2017; 11:RC09-RC12. [PMID: 28274010 DOI: 10.7860/jcdr/2017/24773.9282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/09/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Distal radius fractures accounts for around 15% of all fractures diagnosed and treated in the emergency rooms. These fractures usually result secondary to high velocity injury such as a motor vehicle accident or fall on an out stretched hand. In the elderly, it is a common fragility fracture. Volar Locking Compression Plates (LCP) is effective devices for fixation of the distal radius fractures. There is a lacuna with regard to literature on the 2.7 mm volar LCP and the current study retrospectively assesses the postoperative radiological outcomes. AIM To measure the radiological outcomes in patients with displaced distal radius fractures managed with 2.7 mm volar LCP fixation using Sarmiento's Modification of Lindstorm Criteria. MATERIALS AND METHODS A retrospective study was conducted in the Department of Orthopaedic Surgery at Kasturba Medical College Allied Hospitals, Mangalore from May 2014 to July 2016. All displaced distal radius fractures of skeletally mature patients who underwent volar locking plate fixation between May 2014 to July 2016 and follow up with X-rays at six weeks and three months were included as part of the study. The study comprised of 20 patients and fractures were classified using the AO and Melone's classification systems. The radiological outcome was scored based on Sarmiento's Modification of Lindstorm Criteria. RESULTS Post operative check X-rays were analysed at immediate post operative, six weeks and three months. The mean immediate post operative radial shortening, decrease in radial deviation and loss of palmar tilt were 4.08±2.23, 5.91±4.01and 4.11±3.29 respectively. The corresponding values at last follow up were 4.71±2.31, 7.9±5.13 and 4.91±3.32 respectively. No statistically significant difference (p=0.930;874;716) in radial shortening, decrease in palmar angulation and loss of radial deviation was seen till the final follow up. Sarmiento's Modification of Lindstorm Criteria showed a good radiological outcome in 60% followed by fair in 25% and excellent in 15%. CONCLUSION Use of 2.7 mm volar LCP showed good to excellent post operative radiological outcomes in majority of the cases. The fracture reduction achieved in the immediate post operative period is maintained throughout the follow up duration.
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Affiliation(s)
- Prem Kotian
- Professor, Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Srikanth Mudiganty
- Senior Resident, Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Rajendra Annappa
- Assistant Professor, Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Jose Austine
- Postgraduate Resident, Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
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Thiart M, Ikram A, Lamberts RP. How well can step-off and gap distances be reduced when treating intra-articular distal radius fractures with fragment specific fixation when using fluoroscopy. Orthop Traumatol Surg Res 2016; 102:1001-1004. [PMID: 27751844 DOI: 10.1016/j.otsr.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although fragment specific fixation has proved to be an effective treatment regime, it has not been established how successfully this treatment could be performed using fluoroscopy and what the added value of arthroscopy could be. Establish gap and step-off distances after in intra-articular distal radius fractures that have been treated with fragment specific fixation while using fluoroscopy. MATERIAL Forty-four patients with an intra-articular distal radius fracture were treated with fragment specific fixation while using fluoroscopy. METHODS After the treatment of the intra-articular distal radius fracture with fragment specific fixation and the use of fluoroscopy, but before the completion of the surgical intervention, all gap, and step-off distances were determined by using arthroscopy. In addition, the joint was checked for any other wrist pathologies. RESULTS Arthroscopy after the surgical intervention showed that in 37 patients no gap distances could be detected, while in six patients a gap distance of≤2mm was found and in one patient, a gap distance of 3mm. Similarly, arthroscopy revealed no step-off distances in 33 patients, while in 11 patients a step-off distance of≤2mm was found. Although additional wrist pathologies were found in 48% of our population, only one patient needed surgical intervention. Three months after the surgical intervention wrist flexion was 41±10°, wrist extension 51±17°, ulnar deviation 19±10°, radial deviation 32±12° while patients could pronate and supinate their wrist to 85±5° and 74±20°, respectively. CONCLUSION Intra-articular distal radius fractures can be treated successfully with fragment specific fixation and the use of fluoroscopy. As almost all gap and step-off distances could be reduced to an acceptable level, the scope for arthroscopy to further improve this treatment regime is limited. The functional outcome scores that were found 3 months after the surgical intervention were similar to what has been reported in other studies using different treatment option. These findings suggest that fragment specific fixation is a good alternative for treating intra-articular distal radius fractures. As in most cases, only fluoroscopy is needed for fragment specific fixation, this treatment technique is a good treatment option for resource-limited hospitals, setting who do not have access to arthroscopy. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- M Thiart
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - A Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - R P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa.
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Gauci MO, Lenoir H, Waitzenegger T, Andrin J, Lazerges C, Coulet B, Chammas M. [Extra-articular distal radius fractures in young adults]. HAND SURGERY & REHABILITATION 2016; 35S:S44-S50. [PMID: 27890211 DOI: 10.1016/j.hansur.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/23/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
Extra-articular distal radius fractures in young active patients are typically the result of sport injuries or traffic accidents. Displaced fractures are less well tolerated in young patients than in older people, especially in terms of dorsal tilt and radial shortening. Non-surgical treatment is only indicated when the fracture is minimally or not displaced. No fracture fixation method is superior to another, however, the treatment goal is a rapid return to previous activities.
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Affiliation(s)
- M-O Gauci
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - H Lenoir
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - T Waitzenegger
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Andrin
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Lazerges
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - B Coulet
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - M Chammas
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Williams D, Singh J, Heidari N, Ahmad M, Noorani A, Di Mascio L. Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study. Ann R Coll Surg Engl 2016; 98:138-42. [PMID: 26829667 DOI: 10.1308/rcsann.2016.0045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Volar locking plates are used to treat unstable and displaced fractures of the distal radius. Potential advantages of stable anatomical reduction (eg early mobilisation) can be limited by penetration of dorsal screws, leading to synovitis and potential rupture of extensor tendons. Despite intraoperative imaging, penetration of dorsal screws continues to be a problem in volar plating of the distal radius. Ultrasound is a well recognised, readily available, diagnostic tool used to assess soft-tissue impingement by orthopaedic hardware. In this cadaveric study, we wished to ascertain the sensitivity and specificity of ultrasound for identification of protrusion of dorsal screws after volar plating of the distal radius. METHODS Four adult, unpaired phenol-embalmed cadaveric distal radii were used. A VariAx™ Distal Radius Volar Locking Plate system (Stryker, Kalamazoo, MI, USA) was employed for instrumented fixation. A portable SIUI CTS 900 ultrasound machine (Providian Medical, Eastlake, OH, USA) was used to image the dorsal cortex to ascertain screw penetration. RESULTS Specificity and sensitivity of ultrasound for detection of screw protrusion through the dorsal cortex was 100%. CONCLUSIONS Ultrasound was found to be a safe and accurate method for assessment of dorsal-screw penetration through the dorsal cortex of the radius after volar plating of the distal radius. It also aids diagnosis of associated tendon disorders (eg tenosynovitis) that might cause pain and limit wrist function.
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Affiliation(s)
- D Williams
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - J Singh
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - N Heidari
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - M Ahmad
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - A Noorani
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - L Di Mascio
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
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Distal radius fracture malunion: Importance of managing injuries of the distal radio-ulnar joint. Orthop Traumatol Surg Res 2016; 102:327-32. [PMID: 26947732 DOI: 10.1016/j.otsr.2015.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. We report the outcomes in a case-series with special attention to the potential influence of the initial management. MATERIAL AND METHODS This single-centre retrospective study included 12 patients with a mean age of 35years (range, 14-60years) who were managed by different surgeons. There were 8 extra-articular fractures, including 3 with volar angulation, 2 anterior marginal fractures, and 2 intra-articular T-shaped fractures; the dominant side was involved in 7/12 patients. Initial fracture management was with an anterior plate in 2 patients, Kapandji intra-focal pinning in 5 patients, plate and pin fixation in 2 patients, and non-operative reduction in 3 patients. The malunion was anterior in 10 patients, including 2 with intra-articular malunion, and posterior in 2 patients. Corrective osteotomy of the radius was performed in all 12 patients between 2005 and 2012. In 11/12 patients, mean time from fracture to osteotomy was 168days (range, 45-180days). The defect was filled using an iliac bone graft in 7 patients and a bone substitute in 4 patients. No procedures on the distal radio-ulnar joint were performed. RESULTS All 12 patients were evaluated 24months after the corrective osteotomy. They showed gains in ranges not only of flexion/extension, but also of pronation/supination. All patients reported improved wrist function. The flexion/extension arc increased by 40° (+21° of flexion and +19° of extension) and the pronation/supination arc by 46° (+13° of pronation and +15° of supination). Mean visual analogue scale score for pain was 1.7 (range, 0-3). Complications recorded within 2years after corrective osteotomy were complex regional pain syndrome type I (n=1), radio-carpal osteoarthritis (n=3), and restricted supination due to incongruity of the distal radio-ulnar joint surfaces (n=3). This last abnormality should therefore receive careful attention during the management of distal radius malunion. DISCUSSION In our case-series study, 3 (25%) patients required revision surgery for persistent loss of supination. The main error in these patients was failure to perform a complementary procedure on the distal radio-ulnar joint despite postoperative joint incongruity. This finding and data from a literature review warrant a high level of awareness that distal radio-ulnar joint congruity governs the outcome of corrective osteotomy for distal radius malunion.
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Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures. Orthop Traumatol Surg Res 2016; 102:339-43. [PMID: 27026500 DOI: 10.1016/j.otsr.2016.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/26/2015] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal radius fractures are common injuries treated in a multitude of ways. One treatment paradigm not extensively studied is initial treatment by external fixation (EF) followed by conversion to open reduction internal fixation (ORIF). Such a paradigm may be beneficial in damage control situations, when there is extensive soft tissue injury, or when appropriate personnel/hospital resources are not available for immediate internal fixation. HYPOTHESIS There is no increased risk of infection when converting EF to ORIF in the treatment of complex distal radius fractures when conversion occurs early or if EF pin sites are overlapped by the definitive fixation. MATERIALS AND METHODS Using an IRB approved protocol, medical records over nine years were queried to identify patients with distal radius fractures that had undergone initial EF and were later converted to ORIF. Charts were reviewed for demographic data, injury characteristics, operative details, time to conversion from EF to ORIF, assessment of whether the EF pin sites overlapped the definitive fixation, presence of infection after ORIF, complications, and occupational therapy measurements of range of motion and strength. RESULTS In total, 16 patients were identified, only one of which developed an infection following conversion to ORIF. Fisher's exact testing showed that infection did not depend on open fracture, time to conversion of one week or less, presence of EF pin sites overlapping definitive fixation, fracture classification, high energy mechanism of injury, or concomitant injury to the DRUJ. DISCUSSION Planned staged conversion from EF to ORIF for complex distal radius fractures does not appear to result in an increased rate of infection if conversion occurs early or if the EF pin sites are overlapped by definitive fixation. This treatment paradigm may be reasonable for treating complex distal radius fractures in damage control situations, when there is extensive soft tissue injury, or when appropriate personnel/hospital resources are not available for immediate internal fixation. LEVEL OF EVIDENCE IV, retrospective case series.
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Obert L, Loisel F, Jardin E, Gasse N, Lepage D. High-energy injuries of the wrist. Orthop Traumatol Surg Res 2016; 102:S81-93. [PMID: 26782706 DOI: 10.1016/j.otsr.2015.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 02/02/2023]
Abstract
High-energy injuries to the wrist gather complex fractures of the distal radius, radiocarpal dislocations, perilunate dislocations, and other intracarpal dislocations. Depending on the energy of the injury and the position of the wrist at the time of impact, the patient, often a young male with a high functional demand, presents one of these injuries associating fracture(s) and ligament injury. The trauma is often bilateral, with proximal lesions (elbow) very often associated with contusion or compression of the median nerve. Diagnosis is confirmed by wrist X-rays, which are sufficient to determine treatment for radiocarpal and perilunate dislocations. In cases of distal radius fractures or other intracarpal dislocations, a preoperative CT is necessary. Reduction of the dislocation and relief of neurovascular compression are performed immediately. The final treatment of each lesion (bone fixation, ligament repair) can be undertaken simultaneously or delayed, depending on the patient and the lesions. Cartilage lesions, resulting from the high-energy injury, can be estimated using arthroscopy but cannot be repaired and determine the prognosis. The surgeon's objective is to restore joint congruence, which does not prevent stiffness, the main complication of these rare injuries, which the surgeon must know how to recognize and treat.
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Affiliation(s)
- L Obert
- EA 4268, « I4S », service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, université de Franche-Comté, CHRU Besançon, CIC IT, 808, boulevard Fleming, 25033 Besançon, France.
| | - F Loisel
- EA 4268, « I4S », service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, université de Franche-Comté, CHRU Besançon, CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - E Jardin
- EA 4268, « I4S », service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, université de Franche-Comté, CHRU Besançon, CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - N Gasse
- EA 4268, « I4S », service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, université de Franche-Comté, CHRU Besançon, CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - D Lepage
- EA 4268, « I4S », service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, université de Franche-Comté, CHRU Besançon, CIC IT, 808, boulevard Fleming, 25033 Besançon, France
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Cai L, Zhu S, Du S, Lin W, Wang T, Lu D, Chen H. The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients. Orthop Traumatol Surg Res 2015; 101:827-31. [PMID: 26188877 DOI: 10.1016/j.otsr.2015.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/21/2015] [Accepted: 04/27/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE OF THE STUDY Treatment of distal radius fractures in elderly patients is controversial. This study explored the relationship between radiographic parameters and clinical outcomes of patients with distal radius fractures following conservative treatment. The study was done using radiographic measurements of distal radius fractures in elderly patients. PATIENTS AND METHODS Ninety-two active, healthy patients with conservatively managed distal radius fractures were included in the study. Functional and radiographic assessments were made 1 year after injury. Fifty patients who underwent corrective osteotomy comprised the control group. Radiographic parameters and clinical outcomes were compared between the two groups. The correlation coefficients of the radiographic parameters were analysed using multiple regression. RESULT Radius height (RH), volar tilt (VT) and Mayo wrist and Disabilities of the Arm, Shoulder and Hand (DASH) scores in the experimental group were significantly superior to those of the control group. There was no significant group difference in radial inclination. Multiple regression analysis revealed that the most important factor affecting functional outcome was RH, followed by VT. DISCUSSION RH and VT were significantly correlated with the clinical outcomes of conservative treatment of distal radius fractures. RH should be given foremost consideration in elderly patients. Preoperatively, surgeons should evaluate this parameter carefully and be prepared to treat injuries accordingly. LEVEL OF EVIDENCE Level IV retrospective study.
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Affiliation(s)
- L Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - S Zhu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - S Du
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - W Lin
- Department of Radiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - T Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - D Lu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - H Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China.
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Lee JI, Cho JH, Lee SJ. The effects of the Frag-Loc(®) compression screw on distal radius fracture with a displaced dorsoulnar fragment. Arch Orthop Trauma Surg 2015. [PMID: 26204980 DOI: 10.1007/s00402-015-2290-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the radiographic and clinical outcomes of the Frag-Loc(®) compression screw with palmar plate fixation on distal radius fractures that include a displaced dorsoulnar fragment. PATIENTS AND METHODS This retrospective comparative study enrolled 48 patients who had an unstable distal radius fracture and a dorsoulnar fragment that was more than 2 mm displaced and that had involvement of more than one-quarter of the articular surface. Twenty-six of the 48 patients were treated with a palmar locking plate without a Frag-Loc(®) compression screw (group 1) and the other 22 patients were treated with palmar locking plate with a Frag-Loc(®) compression screw to fix the dorsoulnar fragment (group 2). First, we reviewed all pre-surgical computerized tomographic (CT) scans. Second, we used the gap distance between the dorsoulnar and palmar fragment as seen on post-surgical axial and sagittal CT scans to determine outcome. The gap distance was measured at the point of maximum distance perpendicular to the plane of the main fracture line. Clinical outcomes were evaluated based on the patient-rated wrist evaluation (PRWE) score; the disabilities of the arm, shoulder and hand score; wrist active range of motion; and grip strength. RESULTS There were no statistically significant differences in clinical outcome between the two groups. However, there were statistically significant differences in post-surgical gap distance. The mean post-surgical gap distances for group 1 were 1.3 mm (range 0.2-3.8 mm) on axial CT scans and 1.4 mm (range 0.5-2.4 mm) on sagittal CT scans, while the mean post-surgical gap distances for group 2 were 0.7 mm (range 0.7-1.6 mm) and 0.7 mm (range 0.3-1.1 mm). CONCLUSION This study shows that the Frag-Loc(®) compression screw can reduce the gap distance between the dorsoulnar fragment and the distal radius, according to evaluation of post-surgical axial and sagittal CT scans. This result suggests that the Frag-Loc(®) compression screw is an effective and simple treatment option to immobilize a dorsoulnar fragment associated with distal radius fracture.
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Affiliation(s)
- Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
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Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg Am 2015; 40:1554-62. [PMID: 26143028 DOI: 10.1016/j.jhsa.2015.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the functional outcomes of patients treated with dorsal spanning distraction bridge plate fixation for distal radius fractures. METHODS All adult patients at our institution who underwent treatment of a unilateral distal radius fracture using a dorsal bridge plate from 2008 to 2012 were identified retrospectively. Patients were enrolled in clinical follow-up to assess function. Wrist range of motion, grip strength, and extension torque were measured systematically and compared with the contralateral, uninjured wrist. Patients also completed Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation outcomes questionnaires. RESULTS Eighteen of 100 eligible patients, with a minimum of 1 year from the time of implant removal, were available for follow-up (mean, 2.7 y). All fracture patterns were comminuted and intra-articular (AO 23.C3). There were significant decreases in wrist flexion (43° vs 58°), extension (46° vs 56°), and ulnar deviation (23° vs 29°) compared with the contralateral uninjured wrist. Grip strength was 86% and extension torque was 78% of the contralateral wrist. Comparison of dominant and nondominant wrist injuries identified nearly complete recovery of grip (95%) and extension (96%) strength of dominant-sided wrist injuries, compared with grip (79%) and extension (65%) strength in those with an injured nondominant wrist. Mean Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 16 and 14, respectively. There were 2 cases of postoperative surgical site pain and no cases of infection, tendonitis, or tendon rupture. CONCLUSIONS Distraction bridge plate fixation for distal radius fractures is safe with minimal complications. Functional outcomes are similar to those published for other treatment methods. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Alexander Lauder
- Department of Orthopaedics, University of Washington, Seattle, WA.
| | - Sonya Agnew
- Division of Plastic Surgery, Northwestern University, Jesse Brown VAMC, Chicago, IL
| | - Karim Bakri
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
| | | | - Douglas P Hanel
- Department of Orthopaedics, University of Washington, Seattle, WA
| | - Jerry I Huang
- Department of Orthopaedics, University of Washington, Seattle, WA
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Obert L, Loisel F, Gasse N, Lepage D. Distal radius anatomy applied to the treatment of wrist fractures by plate: a review of recent literature. SICOT J 2015; 1:14. [PMID: 27163070 PMCID: PMC4849245 DOI: 10.1051/sicotj/2015012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Few studies on the anatomy of the radial epiphysis have been published in the past 10 years. However, with the availability of new intra- and extra-medullary implants and the recent rash of avoidable iatrogenic injuries, now is the time for a more detailed description of the metaphyseal-epiphyseal regions in the distal radius. Published studies on distal radius anatomy in recent years have focused on three aspects: distal limit and watershed line, dorsal tubercle, and wrist columns. Furthermore, a fresh look at distal radius biomechanics shows that the loads experienced by the distal radius vary greatly. This information should be taken into account during volar plating of distal radius fractures.
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Affiliation(s)
- Laurent Obert
- Orthopaedic, Traumatology, Plastic & Hand Surgery Unit, University Hospital of Besançon 25000 Besançon France ; Intervention, Innovation, Imagery, Engineering in Health (EA 4268), Medical and Pharmacology Section, IFR 133, University of Franche-Comté 25000 Besançon France
| | - François Loisel
- Orthopaedic, Traumatology, Plastic & Hand Surgery Unit, University Hospital of Besançon 25000 Besançon France
| | - Nicolas Gasse
- Clinique Saint Vincent 40 chemin des Tilleroyes 25044 Besançon Cedex France
| | - Daniel Lepage
- Orthopaedic, Traumatology, Plastic & Hand Surgery Unit, University Hospital of Besançon 25000 Besançon France ; Intervention, Innovation, Imagery, Engineering in Health (EA 4268), Medical and Pharmacology Section, IFR 133, University of Franche-Comté 25000 Besançon France
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Loisel F, Bouilloux X, Uhring J, Rochet S, Obert L. Early postoperative improvements in the QuickDASH score after distal radius fracture are related to the type of surgical treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:865-9. [PMID: 25893608 DOI: 10.1007/s00590-015-1626-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
The goal of this prospective study was to evaluate the real-life experience of 52 patients and their recovery kinetics in the first 6 weeks after surgical treatment of distal radius fractures. The fractures were treated with either a fourth-generation volar locking plate (34 patients, mean age 67 years, range 54-82) or by percutaneous pinning (18 patients, mean age 56 years, range 43-69). These patients were evaluated every week for 6 weeks with the QuickDASH (QD) questionnaire. A lower QD score indicated that the patient's physical function and symptoms had improved. At postoperative week 1, all the patients who had undergone percutaneous pinning had a QD of 80 (out of 100). One-third of patients who had undergone plate fixation had a QD of 80, while the remainder had a QD of 65. Out of all the patients who had a QD of 80 at postoperative week 1, the patients who had undergone plate fixation improved more quickly. After 6 weeks, the patients who had undergone plate fixation had a greater reduction in the QD (50 points) than the ones who had undergone pinning (30 points). Although the direct costs of locking plate fixation are 10 times higher than those of K-wire pinning, evidence suggests that these plates reduce the indirect costs. This study has shown that a patient's recovery rate, day-to-day life and physical function are better over the first 6 weeks postsurgery when the distal radius fracture is fixed with a locking plate.
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Affiliation(s)
- François Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, EA 4268 Innovation, Imagerie, Ingénierie et Intervention en santé « I4S » IFR 133 INSERM, C.H.U. Besançon, 25033, Besançon, France,
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Can the use of variable-angle volar locking plates compensate for suboptimal plate positioning in unstable distal radius fractures? A biomechanical study. J Orthop Trauma 2015; 29:e1-6. [PMID: 24786734 DOI: 10.1097/bot.0000000000000146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the biomechanical stability under load-to-failure conditions of optimally placed fixed-angle volar locking plates versus suboptimally placed variable-angle volar locking plates in unstable, intraarticular distal radius fractures. METHODS A Melone type 1 (AO 23-C3) fracture was created in 25 sawbone radii and plated with either a fixed-angle or variable-angle Synthes plate with identical profile. Four plate positions were tested: distal ulnar (DU, positioned distally to obtain subchondral support and ulnar to hold the lunate facet fragments), distal radial (DR, 3 mm radial to DU), proximal ulnar (PU, 3 mm proximal to DU), and proximal radial (PR, 3 mm proximal and 3 mm radial to DU). The specimens were loaded until failure as defined by a 2-mm displacement of any fracture fragment. The fixed-angle plates were tested in the DU position, whereas the variable-angle plates were tested in all 4 positions. RESULTS The dorsal lunate fragment was the first to fail in every group followed by the radial styloid and volar lunate fragments, respectively. Load-to-failure, from greatest to least, occurred at the DR (278 ± 56 N), PR (277 ± 68 N), DU fixed-angle (277 ± 68 N), DU variable-angle (236 ± 31 N), and PU (202 ± 75 N) positions, respectively. Rigidity was calculated using the slope of the dorsal lunate force-displacement curve before failure (at loads 100-150 N). Rigidity was greatest at the PU position (126 ± 60 N/mm) followed by PR (125 ± 30 N/mm), DU fixed-angle (125 ± 25 N/mm), DR (122 ± 66 N/mm), and DU variable-angle (101 ± 35) positions, respectively. Univariate analysis of rigidity and load-to-failure was not significantly different between groups. CONCLUSIONS In this experimental model, variable-angle screws provided a leeway of 3 mm in both the sagittal and coronal directions without sacrificing construct strength, which may considerably facilitate fixation of these difficult fractures.
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Technical note: How to spare the pronator quadratus during MIPO of distal radius fractures by using a mini-volar plate. ACTA ACUST UNITED AC 2014; 33:95-9. [DOI: 10.1016/j.main.2013.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/11/2013] [Accepted: 12/18/2013] [Indexed: 11/23/2022]
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Deniz G, Kose O, Yanik S, Colakoglu T, Tugay A. Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1155-9. [DOI: 10.1007/s00590-013-1389-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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