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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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Staehlke S, Barth T, Muench M, Schroeter J, Wendlandt R, Oldorf P, Peters R, Nebe B, Schulz AP. The Impact of Ultrashort Pulse Laser Structuring of Metals on In-Vitro Cell Adhesion of Keratinocytes. J Funct Biomater 2024; 15:34. [PMID: 38391887 PMCID: PMC10889705 DOI: 10.3390/jfb15020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Besides the need for biomaterial surface modification to improve cellular attachment, laser-structuring is favorable for designing a new surface topography for external bone fixator pins or implants. The principle of this study was to observe how bioinspired (deer antler) laser-induced nano-microstructures influenced the adhesion and growth of skin cells. The goal was to create pins that allow the skin to attach to the biomaterial surface in a bacteria-proof manner. Therefore, typical fixator metals, steel, and titanium alloy were structured using ultrashort laser pulses, which resulted in periodical nano- and microstructures. Surface characteristics were investigated using a laser scanning microscope and static water contact angle measurements. In vitro studies with human HaCaT keratinocytes focused on cell adhesion, morphology, actin formation, and growth within 7 days. The study showed that surface functionalization influenced cell attachment, spreading, and proliferation. Micro-dimple clusters on polished bulk metals (DC20) will not hinder viability. Still, they will not promote the initial adhesion and spreading of HaCaTs. In contrast, additional nanostructuring with laser-induced periodic surface structures (LIPSS) promotes cell behavior. DC20 + LIPSS induced enhanced cell attachment with well-spread cell morphology. Thus, the bioinspired structures exhibited a benefit in initial cell adhesion. Laser surface functionalization opens up new possibilities for structuring, and is relevant to developing bioactive implants in regenerative medicine.
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Affiliation(s)
- Susanne Staehlke
- Institute for Cell Biology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Tobias Barth
- Laboratory for Biomechanics, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Matthias Muench
- Laboratory for Biomechanics, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Joerg Schroeter
- Clinic for Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Robert Wendlandt
- Clinic for Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Paul Oldorf
- SLV Mecklenburg-Vorpommern GmbH, 18069 Rostock, Germany
| | - Rigo Peters
- SLV Mecklenburg-Vorpommern GmbH, 18069 Rostock, Germany
| | - Barbara Nebe
- Institute for Cell Biology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Arndt-Peter Schulz
- Laboratory for Biomechanics, BG Hospital Hamburg, 21033 Hamburg, Germany
- Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, 23562 Lübeck, Germany
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Modest JM, Raducha JE, Schilkowsky RM, Molino J, Got CJ, Katarincic JA, Gil JA. Supplementary Fixation Improves Stability of Intra-Articular Distal Radius Fractures Managed With a Spanning Plate. J Hand Surg Am 2023:S0363-5023(23)00021-7. [PMID: 36792395 DOI: 10.1016/j.jhsa.2023.01.002] [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: 08/11/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Previous studies evaluating weight bearing of distal radius fractures treated through dorsal spanning bridge plates used extra-articular fracture models, and have not evaluated the role of supplementary fixation. We hypothesized that supplementary fixation with a spanning dorsal bridge plate for an intra-articular wrist fracture would decrease the displacement of individual articular pieces with cyclic axial loading and allow for walker or crutch weight bearing. METHODS Thirty cadaveric forearms were matched into 3 cohorts, controlling for age, sex, and bone mineral density. An intra-articular fracture model was fixed with the following 3 techniques: (1) cohort A with a dorsal bridge plate, (2) cohort B with a dorsal bridge plate and two 1.6-mm k-wires, and (3) cohort C with a dorsal bridge plate and a radial pin plate. Specimens were axially loaded cyclically with escalating weights consistent with walker and crutch weight-bearing with failure defined as 2-mm displacement. RESULTS No specimens failed at 2- or 5-kg weights, but cohort A had significantly more displacement at these weights compared with cohort B. Cohort A had significantly more failure than cohort C. Both cohort A and cohort B had significantly more displacement at crutch weight bearing compared with cohort C. The supplementary fixation group had significantly lower displacement at crutch weight-bearing compared with cohort A in all gaps. Survival curves demonstrated the fixation cohort to survive higher loads than the nonfixation group. CONCLUSION There was significantly less displacement and less failure of intra-articular distal radius fractures treated with a spanning dorsal bridge plate and supplementary fixation. Our model showed that either type of fixation was superior to the nonfixation group. CLINICAL SIGNIFICANCE When considering early weight-bearing for intra-articular distal radius fractures treated with a spanning dorsal bridge plate, supplementary fixation may be considered as an augmentation to prevent fracture displacement.
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Affiliation(s)
- Jacob M Modest
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI.
| | - Jeremy E Raducha
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Rachel M Schilkowsky
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Janine Molino
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Christopher J Got
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Julia A Katarincic
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Joseph A Gil
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
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Henry TW, Matzon JL, McEntee RM, Lutsky KF. Outcomes of Type I Open Distal Radius Fractures: A Comparison of Delayed and Urgent Open Reduction Internal Fixation. Hand (N Y) 2022; 17:952-956. [PMID: 33215540 PMCID: PMC9465772 DOI: 10.1177/1558944720964965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Type I open distal radius fractures treated with open reduction internal fixation (ORIF) have demonstrated minimal risk of infection. For this reason, they may not require urgent surgical treatment. The purpose of this study was to evaluate the outcomes of patients with type I open distal radius fractures treated with delayed ORIF compared with urgent ORIF. METHODS We identified all Gustilo-Anderson type I open distal radius fractures that had undergone ORIF using volar plating over a 5-year period. Patients were stratified into those treated urgently within 24 hours and those scheduled for delayed surgery. Outcomes including functional scores, complications, reoperations, and radiographic measures were compared. RESULTS Twenty-four patients (17 treated urgently and 7 treated delayed) had open type I distal radius fractures. All patients were started on empiric antibiotics at initial presentation-patients in the delayed treatment group were prescribed oral antibiotics, whereas those admitted for urgent treatment received intravenous antibiotics. There were no infections in either group and a single reoperation in each group. The mean postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 29 (range = 0-77) and did not differ significantly between delayed (mean = 19) and urgent (mean = 38) treatment. Rate of complications and radiographic measures did not differ significantly between the groups. CONCLUSIONS Type I open distal radius fractures appear amenable to delayed outpatient ORIF provided that the wound is clean at the time of initial presentation and that antibiotics are initiated appropriately. Further prospective studies comparing delayed and urgent treatment strategies are warranted.
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Doğan N, Büyükdoğan H, Çalışkan G, Genç Y, Şahin A, Ertürk C. Are external fixators as effective as volar plates in multi-fragmented radius distal intra-articular fractures (AO type C)? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03351-7. [PMID: 35945390 DOI: 10.1007/s00590-022-03351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study aimed to compare the radiological and clinical results of VP and EF applications in multi-fragmented radius distal intra-articular fractures (AO type C) in our clinic. METHODS We retrospectively analysed 80 patients who underwent surgery for radius distal fracture (AO type C) between 2014 and 2020. Group 1 comprised patients who were treated with VP, and Group 2 comprised patients who were treated with EF. Radiological evaluation was performed by measuring radial inclination, radial length, volar tilt, intra-articular step-off and ulnar variance by two-way radiography. The clinical findings were evaluated using the Gartland and Werley scoring system, and complications were noted. RESULTS There were no statistically significant differences between the two groups in terms of age, gender, side, fracture subtypes and follow-up time (p > 0.05). There were no statistically significant differences between the two groups in radiological parameters (based on cut-off values) (p > 0.05). The clinical evaluation did not reveal a statistically significant difference between the two groups (p = 0.613). CONCLUSION EF is as successful as VP in providing radiological cut-off values. EF treatment can be used as an effective and safe alternative method for multi-fragmented radius distal intra-articular fractures.
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Affiliation(s)
- Necati Doğan
- Department of Orthopaedics and Traumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey.
| | - Halil Büyükdoğan
- Department of Orthopaedics and Traumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
| | - Gürkan Çalışkan
- Department of Orthopaedics and Traumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
| | - Yasin Genç
- Department of Orthopaedics and Traumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
| | - Adem Şahin
- Department of Orthopaedics and Traumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
| | - Cemil Ertürk
- Department of Orthopaedics and Traumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
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Raducha JE, Hresko A, Molino J, Got CJ, Katarincic J, Gil JA. Weight-Bearing Restrictions With Distal Radius Wrist-Spanning Dorsal Bridge Plates. J Hand Surg Am 2022; 47:188.e1-188.e8. [PMID: 34023193 DOI: 10.1016/j.jhsa.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 01/29/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The fixation of comminuted distal radius fractures using wrist-spanning dorsal bridge plates has been shown to have good postoperative results. We hypothesized that using a stiffer bridge plate construct results in less fracture deformation with loads required for immediate crutch weight bearing. METHODS We created a comminuted, extra-articular fracture in 7 cadaveric radii, which were fixed using dorsal bridge plates. The specimens were positioned to simulate crutch/walker weight bearing and axially loaded to failure. The axial load and mode of failure were measured using 2- and 5-mm osteotomy deformations as cutoffs. Bearing 50% and 22% of the body weight was representative of the force transmitted through crutch and walker weight bearing, respectively. RESULTS The load to failure at 2-mm deformation was greater than 22% body weight for 2 of 7 specimens and greater than 50% for 1 of 7 specimens. The load to failure at 5-mm deformation was greater than 22% body weight for 6 of 7 specimens and greater than 50% for 4 of 7 specimens. The mean load to failure at 2-mm gap deformation was significantly lower than 50% body weight (110.4 N vs 339.2 N). The mean load to failure at 5-mm deformation was significantly greater than 22% body weight (351.8 N vs 149.2 N). All constructs ultimately failed through plate bending. CONCLUSIONS All constructs failed by plate bending at forces not significantly greater than the 50% body weight force required for full crutch weight bearing. The bridge plates supported forces significantly greater than the 22% body weight required for walker weight bearing 6 of 7 times when 5 mm of deformation was used as the failure cutoff. CLINICAL RELEVANCE Elderly, walker-dependent patients may be able to use their walker as tolerated immediately after dorsal bridge plate fixation for extra-articular fractures. However, patients should not be allowed to bear full weight using crutches immediately after bridge plating.
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Affiliation(s)
- Jeremy E Raducha
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
| | | | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Christopher J Got
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI; University Orthopedics Incorporated, Providence, RI
| | - Julia Katarincic
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI; University Orthopedics Incorporated, Providence, RI
| | - Joseph A Gil
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI; University Orthopedics Incorporated, Providence, RI
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Gunaratne R, Nazifi O, D'Souza H, Tay A. Optimal screw length in volar locking plate osteosynthesis for distal radius fractures: a systematic review. ANZ J Surg 2021; 92:674-684. [PMID: 34825448 DOI: 10.1111/ans.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fractures of the distal radius represent the most common fracture of the upper limb, and can be managed surgically with volar locking plate osteosynthesis (VLPO). Uncertainty remains regarding the optimal length of the distal locking screws. The aim of this study was to determine the optimal VLPO screw length which provided adequate stability while minimizing complications. METHODS A systematic review of relevant literature published within Cochrane, PubMed, MEDLINE and Embase, including studies up to April 2020, was performed using the Preferred Reporting Items for Systemic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included if they investigated distal radius fracture fixation with VLPO, screw lengths, complications, and associated imaging. RESULTS Search results identified 664 relevant studies, of which 14 studies examining 926 radii were included for review. Synthesis revealed that unicortical locking fixation with screws ~75% the depth of the radius, or 2 mm short of the dorsal cortex, provided equivalent stability to bicortical fixation. The lunate may be used as a proxy to determine radial depth at each quartile column. Inadvertent screw protrusion can be assessed by taking four images intra-operatively; anteroposterior (AP), lateral, 45° supinated and dorsal tangential views (DTVs). Radial shaft screws can have up to 2 mm prominence with no clinical significance. CONCLUSION Unicortical locking fixation at least 75% the depth of the distal radius provides equivalent stability to bicortical fixation in extra-articular fractures with lower complication rates. Imaging should be used to confirm that penetration of the dorsal cortex has not occurred.
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Affiliation(s)
- Rajitha Gunaratne
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Omid Nazifi
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Harry D'Souza
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Aaron Tay
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Xun Y, Zhou Q, Yang N, Du L, Zhai S, Li H, Zhao Y, Yang K, Chen Y. Clinical Epidemiology in China series. Paper 2: Promoting GRADE at the national level: The experience from China. J Clin Epidemiol 2021; 140:172-177. [PMID: 34411696 DOI: 10.1016/j.jclinepi.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To share the experience of promoting GRADE in China. STUDY DESIGN AND SETTING We designed the study and collected data on the following three aspects of the GRADE in China: the key activities related to GRADE, the main achievements of the GRADE, and potential challenges and future opportunities. RESULTS Three GRADE centres have been established in China since 2011. Seventeen articles of the GRADE working group have been translated and published in Chinese, and 31 articles have been written by Chinese scientists in Chinese to introduce and interpret the GRADE approach so far. More than 50 GRADE workshops and meetings have been held by GRADE centres in China, covering two-thirds of all provinces and autonomous regions of China. The percentages of societies from the Chinese Medical Association (CMA) and the Chinese Medical Doctor Association (CMDA) that used the GRADE system to develop guidelines were 30% and 18%, respectively. CONCLUSION Over the past decade, China has made progress in promoting the GRADE system and Chinese GRADE centres have made a significant contribution.
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Affiliation(s)
- Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China
| | - Liang Du
- Chinese Evidence-Bassed Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Hui Li
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yingren Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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van Leeuwen RJH, van de Wall BJM, van Veleen NM, Hodel S, Link BC, Knobe M, Babst R, Beeres FJP. Temporary external fixation versus direct ORIF in complete displaced intra-articular radius fractures: a prospective comparative study. Eur J Trauma Emerg Surg 2021; 48:4349-4356. [PMID: 33630119 DOI: 10.1007/s00068-021-01611-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In complex distal radius fractures (DRF), both direct osteosynthesis (one-stage approach) and temporary external fixation as a bridge to definitive osteosynthesis (two-stage approach) are used. Studies directly comparing these two management options are lacking. This study aims to compare the two procedures with regard to complications, and radiological and functional outcomes. MATERIAL This prospective observational study included all patients presenting with AO OTA C2 or C3 DRF (1) between January 2011 and January 2018. All patients were categorised into two groups according to received treatment: patients who underwent direct definitive osteosynthesis (Group One Stage) and patients who received an external fixator followed by definitive fixation (Group Two Stage). Primary outcome was the Patient-Rated Wrist Evaluation score (PRWE) measured at 1 year follow-up. Secondary outcomes included complications, range of motion (ROM), and radiologic parameters (ulnar variance, radial inclination and volar tilt). RESULTS A total of 187 patients were included in Group One Stage with a mean age of 55.6 years (SD 17.2), of which 67 had a C2 and 120 a C3 fracture. Group Two Stage consisted of 66 patients with a mean age of 53.7 years (SD 20.4 years), of which 6 patients having a C2 and 60 a C3 fracture. There was no significant difference in complications and median PRWE between Group One Stage (12.0, IQR 2.0-20.0) and Group Two Stage (12.2, IQR 5.5-23.4) (p = 0.189), even after correction for differences in baseline characteristics. The ROM and radiologic parameters did not show any significant differences as well. CONCLUSION No differences were found in clinical, functional, and radiological outcome between one- and two-staged surgical techniques. It may be concluded that a two-stage approach is a viable and safe alternative.
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Affiliation(s)
| | | | - Nicole M van Veleen
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Sandro Hodel
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Matthias Knobe
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Reto Babst
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
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Woolnough T, Axelrod D, Bozzo A, Koziarz A, Koziarz F, Oitment C, Gyemi L, Gormley J, Gouveia K, Johal H. What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res 2021; 479:348-362. [PMID: 33165042 PMCID: PMC7899542 DOI: 10.1097/corr.0000000000001524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many acceptable treatment options exist for distal radius fractures (DRFs); however, a simultaneous comparison of all methods is difficult using conventional study designs. QUESTIONS/PURPOSES We performed a network meta-analysis of randomized controlled trials (RCTs) on DRF treatment to answer the following questions: Compared with nonoperative treatment, (1) which intervention is associated with the best 1-year functional outcome? (2) Which intervention is associated with the lowest risk of overall complications? (3) Which intervention is associated with the lowest risk of complications requiring operation? METHODS Ten databases were searched from inception to July 25, 2019. Search and analysis reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Included studies were English-language RCTs that assessed at least one surgical treatment arm for adult patients with displaced DRFs, with less than 20% loss to follow-up. We excluded RCTs reporting on patients with open fractures, extensive bone loss, or ipsilateral upper extremity polytrauma. Seventy RCTs (n = 4789 patients) were included. Treatments compared were the volar locking plate, bridging external fixation, nonbridging external fixation, dynamic external fixation, percutaneous pinning, intramedullary fixation, dorsal plating, fragment-specific plating, and nonoperative treatment. Subgroup analyses were conducted for intraarticular fractures, extraarticular fractures, and patients with an average age greater than 60 years. Mean (range) patient age was 59 years (56 to 63) and was similar across all treatment groups except for dynamic external fixation (44 years) and fragment-specific plating (47 years). Distribution of intraarticular and extraarticular fractures was approximately equal among the treatment groups other than that for intramedullary fixation (73% extraarticular), fragment-specific plating (66% intraarticular) [13, 70], and dorsal plating (100% intraarticular). Outcomes were the DASH score at 1 year, total complications, and reoperation. The minimum clinically important different (MCID) for the DASH score was set at 10 points. The analysis was performed using Bayesian methodology with random-effects models. Rank orders were generated using surface under the cumulative ranking curve values. Evidence quality was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology. Most studies had a low risk of bias due to randomization and low rates of incomplete follow-up, unclear risk of bias due to selective reporting, and high risk of bias due to lack of patient and assessor blinding. Studies assessing bridging external fixation and/or nonoperative treatment arms had a higher overall risk of bias while studies with volar plating and/or percutaneous pinning treatment arms had a lower risk of bias. RESULTS Across all patients, there were no clinically important differences in terms of the DASH score at 1 year; although differences were found, all were less than the MCID of 10 points. Volar plating was ranked the highest for DASH score at 1 year (mean difference -7.34 [95% credible interval -11 to -3.7) while intramedullary fixation, with low-quality evidence, also showed improvement in DASH score (mean difference -7.75 [95% CI -14.6 to -0.56]). The subgroup analysis revealed that only locked volar plating was favored over nonoperative treatment for patients older than 60 years of age (mean difference -6.4 [95% CI -11 to -2.1]) and for those with intraarticular fractures (mean difference -8.4 [95% CI -15 to -2.0]). However, its clinical importance was uncertain as the MCID was not met. Among all patients, intramedullary fixation (odds ratio 0.09 [95% CI 0.02 to 0.84]) and locked volar plating (OR 0.14 [95% CI 0.05 to 0.39]) were associated with a lower complication risk compared with nonoperative treatment. For intraarticular fractures, volar plating was the only treatment associated with a lower risk of complications than nonoperative treatment (OR 0.021 [95% CI < 0.01 to 0.50]). For extraarticular fractures, only nonbridging external fixation was associated with a lower risk of complications than nonoperative treatment (OR 0.011 [95% CI < 0.01 to 0.65]), although the quality of evidence was low. Among all patients, the risk of complications requiring operation was lower with intramedullary fixation (OR 0.06 [95% CI < 0.01 to 0.85) than with nonoperative treatment, but no treatment was favored over nonoperative treatment when analyzed by subgroups. CONCLUSION We found no clinically important differences favoring any surgical treatment option with respect to 1-year functional outcome. However, relative to the other options, volar plating was associated with a lower complication risk, particularly in patients with intraarticular fractures, while nonbridging external fixation was associated with a lower complication risk in patients with extraarticular fractures. For patients older than 60 years of age, nonoperative treatment may still be the preferred option because there is no reliable evidence showing a consistent decrease in complications or complications requiring operation among the other treatment options. Particularly in this age group, the decision to expose patients to even a single surgery should be made with caution. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Taylor Woolnough
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Daniel Axelrod
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Anthony Bozzo
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Frank Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Colby Oitment
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Lauren Gyemi
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Jessica Gormley
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Kyle Gouveia
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
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Xie M, Cao Y, Cai X, Shao Z, Nie K, Xiong L. The Effect of a PEEK Material-Based External Fixator in the Treatment of Distal Radius Fractures with Non-Transarticular External Fixation. Orthop Surg 2020; 13:90-97. [PMID: 33274607 PMCID: PMC7862170 DOI: 10.1111/os.12837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To explore the effect of a PEEK material‐based external fixator in the treatment of distal radius fractures with non‐transarticular external fixation. Methods There were 48 patients in this prospective comparative study. They were divided into two groups according to the materials used: the PEEK group and the titanium group. Wrist dorsiflexion, palmar flexion, pronation, supination, radial deviation, ulnar deviation, grip strength of the palm on the affected side, kneading force, Visual Analogue Scale/Score (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, operation time, frequency of fluoroscopy procedures, and X‐ray results were compared between the two groups. Functional recovery was evaluated at the last follow‐up according to the wrist joint evaluation criteria. Results The baseline data were comparable between the two groups, and no significant differences were found in age, sex, fracture types (P > 0.05). There was no significant difference between the two groups in the results of DASH, grip strength, and recovery of pinch force and wrist function (dorsiflexion, clavicle, ulnar deviation, deviation, pronation, and supination) (P > 0.05). Normal limb function was achieved in the two groups of patients at an average of 6 weeks after surgery, and there was no significant difference in X‐ray examination radial height (10.60 ± 1.59 vs 11.00 ± 1.53, P = 0.687), radial inclination (1.11 ± 0.24 vs 1.12 ± 0.24, P = 0.798), volar tilt (10.33 ± 2.13 vs 10.00 ± 2.08, P = 0.660), ulnar variance (20.87 ± 3.00 vs 20.38 ± 3.04, P = 0.748), and step‐off persistence (1.73 ± 0.69 vs 1.68 ± 0.72, P = 0.425) between the two groups (P > 0.05). However, the operation time (54.80 ± 12.20 vs 85.23 ± 15.14, P = 0.033) and number of fluoroscopy procedures (36.93 ± 6.89 vs 64.77 ± 9.74, P = 0.000) in the PEEK group were significantly reduced compared with those in the titanium group. Conclusion Compared with the traditional titanium external fixator, the PEEK composite external fixator has advantages, such as a shorter operation time and fewer fluoroscopy procedures when used to treat different types of distal radius fracture.
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Affiliation(s)
- Mao Xie
- Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinghao Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianyi Cai
- Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Nie
- Department of Orthopaedic Surgery, Zhijiang People's Hospital, Zhijiang, China
| | - Liming Xiong
- Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Ding H, Lu Y. [Research progress in the treatment of distal radius fractures assisted by wrist arthroscopy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1341-1345. [PMID: 33063502 DOI: 10.7507/1002-1892.201912041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of wrist arthroscopy assisted treatment of distal radius fractures. Methods To summarize and describe the anatomical characteristics and fracture classification of the distal radius, indications and contraindications of wrist arthroscopy-assisted treatment, surgical methods, and associated soft tissue injuries, and summarize the advantages and disadvantages of the operation through a large number of literature at home and abroad on the treatment of distal radius fractures assisted by wrist arthroscopy. Results Wrist arthroscopy as a minimally invasive technique for the treatment of distal radius fractures, compared with traditional surgery, can accurately observe intra-articular damage and perform operations under the microscope to avoid secondary damage to blood vessels, nerve, and tendon, etc., and can achieve one-stage repair and reconstruction by repairing the ligament, trigonal fibrocartilage complex, and carpal dislocation. It has the advantages of less trauma, fast postoperative recovery, extensive indications, fewer complications, and satisfactory effectiveness. Conclusion Wrist arthroscopy has advantages that traditional X-ray film, CT, MRI, and arthrography examinations do not have. Moreover, wrist arthroscopy has achieved satisfactory effectiveness in the adjuvant treatment of intra-articular distal radius fractures.
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Affiliation(s)
- Haibo Ding
- Tianjin Medical University, Tianjin, 300070, P.R.China
| | - Yun Lu
- Department of Hand and Foot Surgery and Reparative and Reconstructive Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China
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13
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Visser D, Mathijssen NMC, van Outeren MV, Colaris JW, de Vries MR, Kraan GA. Long-term follow-up of distal radius fractures, an evaluation of the current guideline: the relation between malunion, osteoarthritis and functional outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1357-1362. [PMID: 32458129 DOI: 10.1007/s00590-020-02700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Last decades there is an increased tendency of performing surgery on displaced distal radius fractures. However, it is unclear whether this affects the development of osteoarthritis. This study aims to determine the relation between anatomical position, radiological osteoarthritis and functional outcome of the elderly wrist, 10-15 years after a distal radius fracture. PATIENTS AND METHODS 173 patients between the age of 50 and 70 at time of trauma were included in this retrospective cohort study with a 10-15-year follow-up. Based on the reassessed initial X-rays, the patients were placed into 4 groups (1: anatomical, 2a: acceptable, 2b: current operative indication but treated conservative, 2c: operative indication and operated). Functional outcome was measured, questionnaires were answered, and new bilateral X-rays of the wrist were obtained. Factors influencing osteoarthritis, the difference in osteoarthritis between the groups and the difference between the fractured and non-fractured wrists were studied. RESULTS Group 2b showed a significantly higher degree of osteoarthritis in comparison with the contralateral wrist. In the other groups, this difference was not observed. We found no significant difference in OA and functional outcomes between the groups. The degree of osteoarthritis of the non-fractured wrist appeared to be highly associated with osteoarthritis of the fractured wrist. CONCLUSION The results of this study showed that the degree of radiocarpal osteoarthritis is higher in conservatively treated patients that should have been operated on according to current guidelines in comparison with patients without an indication for surgery. This might suggest that our current guidelines can be effective in prevention of posttraumatic osteoarthritis. However, the effect on the functional outcome is very limited. Since the degree of radiocarpal osteoarthritis of the non-fractured wrist appeared to be highly associated with the degree of osteoarthritis of the fractured wrist, future studies should always assess osteoarthritis of both wrists in order to study the real posttraumatic effect of a fracture.
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Affiliation(s)
- D Visser
- Reinier de Graaf Hospital, Delft, The Netherlands.
| | | | | | - J W Colaris
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - M R de Vries
- Reinier de Graaf Hospital, Delft, The Netherlands
| | - G A Kraan
- Reinier de Graaf Hospital, Delft, The Netherlands
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Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients. Orthop Traumatol Surg Res 2020; 106:319-323. [PMID: 32044260 DOI: 10.1016/j.otsr.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/18/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of the distal radius fracture in elderly remains controversial. The objective was to assess the outcomes of volar locking plate for displaced complete intra-articular distal radius fractures in elderly as compared to younger patients. HYPOTHESIS The outcomes in elderly patients would be comparable with those in younger patients with a low rate of complications. MATERIAL AND METHODS Non-randomised prospective comparative study between 70 patients older than 65 years and 46 younger patients with AO type-C fractures. The main outcome was Disabilities Arm, Shoulder and Hand (DASH) score. Secondary variables were Patient-Rated Wrist Evaluation (PRWE) score, range of motion, Visual Analogue Scale (VAS) for pain, and grip strength. Radiological measurements were also performed. RESULTS The mean follow-up was 30.9 (range, 24-53) months. There were no significant differences in mean DASH, PRWE, VAS-pain, wrist motion or radiological parameters at final follow-up. Multivariate analysis showed that the functional outcomes were significantly influenced by baseline ulnar positivity greater than 3mm at baseline but not by age. DISCUSSION The study hypothesis was confirmed. Surgical treatment with volar locking plate for displaced complete intra-articular fractures of the distal radius in elderly patients represents a safe and effective treatment alternative with similar early complication rate than in younger. LEVEL OF EVIDENCE III, cohort study.
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Zhuang YQ, Zhang JY, Yu XB, Chen H, Wu YS, Sun LJ. Detection of dorsal screw penetration during volar plating of the distal radius fractures: A comparison of different fluoroscopic views and screw sizes. Orthop Traumatol Surg Res 2020; 106:377-380. [PMID: 31980390 DOI: 10.1016/j.otsr.2019.11.011] [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: 02/04/2019] [Revised: 10/12/2019] [Accepted: 11/13/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to compare different screw lengths combined with different fluoroscopic views to detect intraoperative dorsal screw penetration in distal radius fractures treated with volar locked plating. MATERIAL AND METHODS From April 2014 to October 2018, one hundred and eighty patients were included. We divided the patients into four groups. Intraoperative AP and lateral views were taken and sizes of the screws were chosen based on actual measurement (Group A, 45 patients). AP, lateral and tangential views were taken and sizes of the screws were also chosen based on actual measurement (Group B, 45 patients). Intraoperative AP and lateral views were taken and the selected screws were 2mm shorter than actual measurement (Group C, 45 patients). AP, lateral and tangential views were taken and the selected screws were 2mm shorter than actual measurement (Group D, 45 patients). Prominent screws were changed intraoperatively according to each view. A computed tomography (CT) was taken postoperatively to identify residual prominent screws. RESULTS The number of dorsally prominent screws exceeding 1mm was 6 of 301 in Group A (2.0%), 15 of 290 (5.2%) in Group B, 2 of 289 in Group C (0.7%), and 2 of 282 (0.7%) in Group D. All these prominent screws (25 screws) were exchanged for shorter screws during surgery. Group A and Group B had significant difference in detecting intraoperative dorsal screw penetration (p<0.05). Group C and Group D had no significant difference in detecting intraoperative dorsal screw penetration (p>0.05). Postoperative CT identified 12 additional prominent screws with≥1mm dorsal penetration in Group A, 2 screws in Group B, 1 screw in Group C and 0 screw in Group B respectively. Significant difference was found between Group A and Group B of CT results (p<0.05) while no statistical difference was found between Group C and Group D of CT results (p>0.05). DISCUSSIONS Tangential view helped identify screw penetration. If tangential view was not available intraoperatively, screw penetration could also be avoided by downsizing the distal locking screw by 2mm shorter than actual measurement.
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Affiliation(s)
- Yun-Qiang Zhuang
- Department of Orthopaedic Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Jia-Yu Zhang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian-Bin Yu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hua Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao-Sen Wu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liao-Jun Sun
- Department of Orthopaedic Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Huang YY, Lin TY, Chen CH, Chou YC, Su CY. Surgical outcomes of elderly patients aged more than 80 years with distal radius fracture: comparison of external fixation and locking plate. BMC Musculoskelet Disord 2020; 21:91. [PMID: 32041567 PMCID: PMC7011248 DOI: 10.1186/s12891-020-3101-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To compare the outcomes after surgical intervention, including external fixation (EF) with the optional addition of K-pins or open reduction and internal fixation (ORIF) with a volar locking plate (VLP), in patients with distal radius fracture aged > 80 years. METHODS We reviewed 69 patients with a distal radius fracture aged > 80 years who treated under surgical intervention from 2011 to 2017 retrospectively. Their demographic data and complications were recorded. Preoperative, postoperative, and last follow-up plain films were analyzed. The functional outcomes of wrist range of motion were also evaluated. RESULTS 41 patients were treated with EF with the optional addition of K-pins, while 28 patients were treated with ORIF with a VLP. The radiological parameters, including ulnar variance and radial inclination, at the last follow-up were significantly more acceptable in the VLP group (p = 0.01, p = 0.03, respectively). The forearm supination was significantly better in patients treated with VLP (p = 0.002). The overall incidence of complications was lower in the VLP group (p = 0.003). CONCLUSION VLP provides better radiological outcomes, wrist supination and lower complication rates than EF. Therefore, although EF is still widely used because of its acceptable results and easy application, we recommend VLP as a suitable treatment option for distal radius fracture in the geriatric population aged > 80 years.
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Tung-Yi Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Chien-Hao Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Division of Trauma, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Su
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
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Ali Fazal M, Denis Mitchell C, Ashwood N. Volar locking plate: Age related outcomes and complications. J Clin Orthop Trauma 2020; 11:642-645. [PMID: 32684703 PMCID: PMC7355060 DOI: 10.1016/j.jcot.2020.05.025] [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: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is no unanimity for the treatment of distal radius fractures in older people. The purpose of our study is to assess the efficacy of volar locking plate for the treatment of unstable distal radius fractures in older independent individuals. METHODS A retrospective comparative study of 105 patients. 58 patients were below the age of 55 years and 47 above the age of 55 years. Mean follow-up was 18.4 months in patients below the age of 55 years and 18.1 months above the age of 55 years. Wrist movements, complications, reoperations, grip strength, Visual Analogue Score (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo wrist score were analysed. RESULTS There was no statistical difference in the wrist movements, grip strength, complications, reoperations, VAS, QuickDASH and Mayo scores. Mean grip strength under 55 was 84.1 and above 55 was 84.5 (p = 0.87). The complication rate was 19.1% above 55 years of age and 17.2% below the age of 55years (p = 0.79). The reoperation rate above 55 years was 8.5% and below 55 years was 8.6% (p = 0.50). Mean VAS under 55 years of age was 1.6 and above 55 years was 1.7 (p = 0.58). Mean Mayo score in under 55 was 80.7 and 80.1 in above 55 (p = 0.78). Mean Quick DASH score under 55 was 20.9 and above 55 was 21.0 (p = 0.97). CONCLUSION Our results indicate that outcomes in older independent patients are satisfactory with a comparable complication and reoperation rate with younger individuals. We conclude that a volar locking plate is a favourable modality for the treatment of unstable distal radius fractures in older patients.
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Affiliation(s)
- Muhammad Ali Fazal
- Department of Trauma & Orthopaedics, Royal Free Hospitals London NHS Foundation Trust, The Ridgeway, Enfield, London, UK,Corresponding author. Royal Free NHS Foundation Trust, The Ridgeway, Enfield, EN2 8JL, United Kingdom.
| | - Christopher Denis Mitchell
- Department of Trauma & Orthopaedics, Royal Free Hospitals London NHS Foundation Trust, The Ridgeway, Enfield, London, UK
| | - Neil Ashwood
- Consultant Orthopaedic Surgeon, Department of Trauma & Orthopaedics, Burton Hospital NHS Foundation Trust, Burton Upon Trent, UK
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Johnson NA, Dias J. The current evidence-based management of distal radial fractures: UK perspectives. J Hand Surg Eur Vol 2019; 44:450-455. [PMID: 30991865 DOI: 10.1177/1753193419843201] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal radial fractures are extremely common injuries, yet many basic questions remain unanswered about their optimum management. Recently in the United Kingdom several guideline development groups have produced national standards and best-practice guidelines based on review of the best available evidence and expert knowledge. All guideline groups agree that when surgery is needed for dorsally displaced distal radial fractures, that can be reduced closed, K-wire fixation and cast immobilization, should be offered. Further research questions have been identified. The important findings and recommendations are summarized in this article.
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Affiliation(s)
- Nick A Johnson
- 1 Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, UK.,2 Pulvertaft Hand Unit, Royal Derby Hospital, Derby, UK
| | - Joseph Dias
- 1 Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, UK
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19
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Barbier O, Obert L. Distal radius fracture: The right treatment for each patient. Orthop Traumatol Surg Res 2019; 105:403-405. [PMID: 30853455 DOI: 10.1016/j.otsr.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/20/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Olivier Barbier
- Service de chirurgie orthopédique et de traumatologie de l'appareil locomoteur, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
| | - Laurent Obert
- Service de chirurgie orthopédique, département universitaire, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
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