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Seeher U, Bode S, Arora R. [Basic principles of surgical treatment of distal radius fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:419-429. [PMID: 38653814 PMCID: PMC11133141 DOI: 10.1007/s00113-024-01429-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with a low risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.
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Affiliation(s)
- Ulrike Seeher
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | - Simone Bode
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Rohit Arora
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
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Goorens CK, Eetvelde GV, Debaenst N, Royen KV. A Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating. J Wrist Surg 2023; 12:384-389. [PMID: 37841359 PMCID: PMC10569858 DOI: 10.1055/s-0043-1760736] [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: 10/11/2022] [Accepted: 11/28/2022] [Indexed: 02/11/2023]
Abstract
Background Although outcome of volar plating is generally good, care should be taken to avoid specific iatrogenic and preventable complications, with an incidence reporting averaging 15%. Flexor tendon rupture due to a prominent plate, extensor tendon rupture due to a dorsal protruding screw tips, cartilage lesions due to intra-articular screw placement, loss of reduction due to insufficient stability, and persisting ulnar pain with distal radioulnar joint instability due to unstable triangular fibrocartilaginous complex lesions or unstable ulnar styloid base fractures all have been described. Purpose We believe that a majority of these complications can be prevented by meticulous assessment of several intraoperative parameters during volar plating. Therefore, we introduce the WRIST protocol, a stepwise easy-to-remember manual that combines multiple fluoroscopic measurements to guide intraoperative decision making. Conclusion Large prospective studies of the "WRIST" protocol are needed for validation. But we believe that it may help surgeons to optimize surgical technique, functional and radiographic outcome, and prevent complications when treating distal radial fractures.
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Affiliation(s)
- Chul Ki Goorens
- Department of Orthopaedics and Traumatology, Regionaal Ziekenhuis Tienen, Kliniekstraat, Tienen, Belgium
| | - Gilles Van Eetvelde
- Department of Orthopaedics and Traumatology, Regionaal Ziekenhuis Tienen, Kliniekstraat, Tienen, Belgium
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - Niels Debaenst
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - Kjell Van Royen
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
- Department of Orthopaedics and Traumatology, OLV Aalst, Moorselbaan, Aalst, Belgium
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Kim JK, Shin YH, Kim M. Ultrasonographic evaluation of contact configuration between flexor pollicis longus tendon and the volar prominence of volar plate in patients with distal radius fracture. Arch Orthop Trauma Surg 2023; 143:1103-1108. [PMID: 35674821 DOI: 10.1007/s00402-022-04499-x] [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: 01/19/2022] [Accepted: 05/22/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION We classified the contact configuration between the volar prominence of volar locking plate (VLP) and flexor pollicis longus (FPL) tendon using ultrasound (US) into indentation contact and smooth contact, and investigated whether the contact configuration is associated with the flexor tendon attrition. MATERIALS AND METHODS Ninety-four patients who underwent VLP removal were included in this study. We assessed pain using visual analogue scale, grip strength, and Disabilities of the Arm, Shoulder and Hand score for clinical evaluations, radial inclination, palmar tilt, ulnar variance, and Soong classification for radiological evaluations, and contact configuration using US at 1 year after VLP fixation. After these evaluations, we removed the VLP with observation for the presence of fibrillation or wear of FPL tendon substance. Subsequently, we classified the patients into either of FPL attrition and FPL intact group. RESULTS Twenty-eight patients had indentation contact configuration and 66 patients had smooth contact configuration. The kappa value for inter-observer reliability for the contact configuration was 0.78. Twelve patients were included in the FPL attrition group and 82 in the FPL intact group. There was no significant difference in clinical outcomes and Soong classification between the groups. However, palmar tilt of the flexor tendon attrition group was significantly lower than that of the flexor tendon intact group and the FPL attrition group showed significantly higher indentation contact configuration rate than the FPL intact group. FPL tendon attrition was diagnosed using the contact configuration on US with a sensitivity of 100% and specificity of 80%. CONCLUSION This study demonstrated that FPL tendon attrition was significantly associated with indentation contact on US with high sensitivity. Therefore, we recommend selective implant removal in patients with indentation contact configuration.
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Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Minsoo Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Goorens CK, Debaenst N, Van Royen K, Provyn S, Goubau JF. Minimally Invasive Pronator Quadratus Sparing Approach versus Extended Flexor Carpi Radialis Approach with Pronator Quadratus Repair for Volar Plating in Distal Radial Fractures. J Wrist Surg 2022; 11:41-47. [PMID: 35127263 PMCID: PMC8807095 DOI: 10.1055/s-0041-1731329] [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: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
Background Several volar plating techniques exist to treat distal radial fractures. Question We investigated minimally invasive plate osteosynthesis (MIPO) with pronator quadratus (PQ) sparing versus conventional flexor carpi radialis approach for volar plating with PQ repair after distal radial fractures during the first postoperative year. Patients and Methods Prospective data of two consecutive cohorts were compared: 62 patients in MIPO group with an average age of 61.2 years and 66 patients in PQ repair group with an average age of 61.4 years completed the entire follow-up period. Results Range of motion was not significantly different, except flexion-extension that was significantly higher in the MIPO group. Quick Disabilities of the Arm, Shoulder and Hand was significantly lower in the MIPO group. Pain visual analogue scale was only significantly lower at 6 weeks. Grip strength measurements and patient satisfaction were not significantly different. Conclusions MIPO volar plating with PQ sparing is a surgical technique that can be chosen according to surgeon's preference and expertise, resulting in a better flexion-extension mobility and function score according to our study. Level of evidence This is a Level 3 study.
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Affiliation(s)
- Chul ki Goorens
- Department of Orthopaedics and Traumatology, Regional Hospital Tienen, Tienen, Belgium
| | - Niels Debaenst
- Department of Orthopaedics and Traumatology, Regional Hospital Tienen, Tienen, Belgium
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kjell Van Royen
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Provyn
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean F. Goubau
- Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
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Goorens CK, De Keyzer PB, Van Royen K, Provyn S, Goubau JF. Pronator quadratus repair after volar plate fixation in distal radial fractures: evaluation of the clinical and functional outcome and of the protective role on the flexor tendons-a randomized controlled study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:541-548. [PMID: 33047176 DOI: 10.1007/s00590-020-02804-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
The objective was to evaluate pronator quadratus (PQ) repair following volar plating of distal radial fractures on clinical and functional outcome, as well as flexor tendon friction, during the first 12 months in ideally positioned plates (Soong 0). Confounding factors like variation in plate positioning, anatomical consolidation of the fracture and associated lesions were excluded. Eighty patients were included with distal radius fractures treated by volar locking plate in Soong grade 0 position, who were randomized to group PQ repair and group no repair. Sixty-five patients completed the 1-year follow-up: group PQ repair (n = 35) and group no repair (n = 30). Primary outcomes included range of motion, grip strength, pain level and QuickDASH. Secondary outcomes included distance between flexor pollicis longus (FPL) and volar rim and the largest distance between FPL and plate (soft tissue thickness occupied by PQ), assessed by ultrasonography. Mobility, grip strength and QuickDASH revealed no significant differences, except extension was significantly higher only in first 3 months and radial deviation was significantly higher only at 6 weeks after PQ repair. Pain level was significantly lower after PQ repair only in the first 3 months. Distance between FPL and volar rim and the largest distance between FPL and plate were significantly higher after PQ repair. No friction contact between FPL and volar rim was measured in both groups at all measurement moments. Consequently, protective flexor tendon effect of PQ repair could consequently not be concluded. In conclusion, clinical and functional short term benefits, except improved wrist extension and reduced pain in the first 3 months, were not proven in this study. In Soong grade 0, PQ repair is probably not necessary to prevent flexor tendon pathology. In Soong grade 1 or 2, this is still to be investigated. LEVEL OF EVIDENCE: 2.
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Affiliation(s)
- C K Goorens
- Regionaal Ziekenhuis Tienen, Kliniekstraat 45, 3300, Tienen, Belgium.
| | - P B De Keyzer
- Regionaal Ziekenhuis Tienen, Kliniekstraat 45, 3300, Tienen, Belgium.,University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - K Van Royen
- University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - S Provyn
- Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - J F Goubau
- University Hospital Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures. Arch Orthop Trauma Surg 2020; 140:611-621. [PMID: 32193677 DOI: 10.1007/s00402-020-03365-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 02/09/2023]
Abstract
Distal Radius fractures (DRF) are one of the most common injuries in the upper extremity and incidence is expected to rise due to a growing elderly population. The complex decision to treat patients operatively or conservatively depends on a large variety of parameters which have to be considered. No unanimous consensus has been reached yet, which operative approach and fixation technique would produce the best postoperative functional results with lowest complication rates. This article addresses the available evidence for indications, approaches, reduction, and fixation techniques in treating DRF.
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Abstract
In the recent years, treatment of distal radius fractures (DRF) has advanced considerably. Surgical fixation with palmar angular stable plate has gained popularity, due to a reported lower complication rate when compared to dorsal fixation. The type of trauma or injury, surgical procedure and impaired bone quality are all contributors to complications in DRF. The main aim of this review is to summarize the most common complications and possible therapeutic solutions. In addition, strategies for minimizing these complications will be discussed.
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