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Liverneaux P, Amiri LE, Facca S, Sapa MC. Technique, Indications and Limitations of a Minimally Invasive Approach to Treat Distal Radius Fractures and Malunions. HANDCHIR MIKROCHIR P 2023. [PMID: 36716774 DOI: 10.1055/a-1951-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. It offers the advantage of preserving ligamentotaxis, which facilitates the reduction and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intra-articular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.
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Affiliation(s)
- Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France.,ICube CNRS UMR7357, Strasbourg University, rue Boussingault, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France.,ICube CNRS UMR7357, Strasbourg University, rue Boussingault, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France
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Ducournau F, El Amiri L, Vernet P, Sapa MC, Liverneaux P. Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: "expertise" versus "performance". INTERNATIONAL ORTHOPAEDICS 2023; 47:193-199. [PMID: 36264303 DOI: 10.1007/s00264-022-05609-5] [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: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. MATERIAL AND METHODS The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). RESULTS Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. DISCUSSION The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. CONCLUSION Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale.
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Affiliation(s)
- François Ducournau
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Paul Vernet
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.
- ICube CNRS, UMR7357, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France.
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Moreels R, Lambrechts J, Cromheecke M, De Keyzer PB, Goubau J. Early dislocation of a dual mobility ball-and-socket prosthesis: importance of early sequential postoperative radiography. HAND SURGERY & REHABILITATION 2022; 41:413-414. [DOI: 10.1016/j.hansur.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
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Vernet P, Gouzou S, Hidalgo Diaz JJ, Facca S, Liverneaux P. Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series. Orthop Traumatol Surg Res 2020; 106:1619-1625. [PMID: 33153957 DOI: 10.1016/j.otsr.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Since the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. OBJECTIVE The present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. MATERIAL AND METHODS The series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. RESULTS At a mean 7 months' follow-up, mean scar length was 17mm (range, 10-40mm), pain 1.13/10 (0-8), Quick-DASH 13.28 (0-86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0-91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DISCUSSION The minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. LEVEL OF EVIDENCE III; single-centre retrospective study.
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Affiliation(s)
- Paul Vernet
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Stéphanie Gouzou
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Juan José Hidalgo Diaz
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Sybille Facca
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Philippe Liverneaux
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France.
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Tarallo L, Giorgini A, Novi M, Zambianchi F, Porcellini G, Catani F. Volar PEEK plate for distal radius fracture: analysis of adverse events. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1293-1298. [PMID: 32435847 DOI: 10.1007/s00590-020-02701-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present retrospective study was to evaluate complications following carbon-fiber-reinforced polyetheretherketon (CFR-PEEK) volar plating in distal radius fracture in a large cohort of patients. As an alternative to conventional metallic devices, CFR-PEEK plates have been introduced over the last few years. METHODS We performed a retrospective study including all patients who were treated for distal radius fracture using a volar fixed-angle plate DiPHOS-RM (Lima Corporate, Udine, Italy). All CFR-PEEK plates implanted were reviewed between May 2012 and December 2017. Plate removal, second surgery and adverse events were collected by reviewing medical records. A total of 110 patients were included with a mean follow-up of 4 years. RESULTS Adverse side effects were observed in 9 cases (8%), developed during or after treatment. The most frequent complication was represented by intraoperative plate rupture (4%). Infection was reported in one case. DISCUSSION The rate of complications of PEEK volar plates seems to be similar to those occurring with plates of different materials. Advantages of PEEK plates are the absence of the cold-welding phenomenon and the absence of exuberant bone callus on the plate, ensuring an easy hardware removal. Intraoperative rupture remains the main complication correlated with PEEK material. These complications can be reduced with an accurate surgical technique, especially at the beginning of the learning curve. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Luigi Tarallo
- Orthopaedic and Traumatology Department, Policlinic of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Andrea Giorgini
- Orthopaedic and Traumatology Department, Policlinic of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Michele Novi
- Orthopaedic and Traumatology Department, Policlinic of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Francesco Zambianchi
- Orthopaedic and Traumatology Department, Policlinic of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Giuseppe Porcellini
- Orthopaedic and Traumatology Department, Policlinic of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio Catani
- Orthopaedic and Traumatology Department, Policlinic of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Abstract
This article reviews the author's currently used minimal invasive approach for volar plating of distal radius fractures. A single longitudinal incision of 1.5 cm is drawn on the lateral aspect of the flexor carpi radialis tendon in order to insert a plate under the pronator quadratus. With the wrist flexed, the plate is applied on the anterior cortex of the radius to reduce the fracture. This approach offers the advantage of preserving ligamentotaxis, which facilitates the reduction, and the small scar improves the cosmetics. It is mainly indicated for extra-articular and simple intra-articular fractures of the distal radius. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable with those obtained with an extended flexor carpi radialis approach. My colleagues and I have used it for more than 2000 cases since 2012. This technique requires practise. Attempted conversion to a larger incision is possible in case of difficulty, but this is seldom necessary.
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Igeta Y, Vernet P, Facca S, Naroura I, Hidalgo Diaz JJ, Diaz JJH, Liverneaux PA. The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1515-1522. [PMID: 29368237 DOI: 10.1007/s00590-018-2124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022]
Abstract
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used. It offers the advantage of preserving ligamentotaxis which facilitates the reduction, and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intraarticular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.
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Affiliation(s)
- Yuka Igeta
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France.,Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Paul Vernet
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Sybille Facca
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Ismaël Naroura
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | | | - Juan José Hidalgo Diaz
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Philippe A Liverneaux
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France.
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