1
|
Fang PC, Lo TYY, Cheng CY, Wu CT, Chen ACY. Radiographic Analysis in Extra-Articular and Intra-Articular Distal Radius Fractures Treated with Variable-Angle Volar Locking Plate Fixation. J Clin Med 2023; 12:jcm12103494. [PMID: 37240600 DOI: 10.3390/jcm12103494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Different distal radial fracture types have different prognosis after fixation. Our study aim is to evaluate the differences in radiographic parameters by using variable-angle volar locking plate (VAVLP) fixation according to extra-articular and intra-articular distal radial fracture. (2) Methods: There are two groups: extra-articular group (21) and intra-articular group (25). Forearm radiographs immediately after surgery and at 3 months after operation were reviewed for analyzing radial height (RH), ulnar variance (UV), radial inclination (RI), volar tilt (VT), tear drop angle (TDA), distal dorsal cortical distance (DDD), and Soong classification (SC). (3) Results: There were no significant differences in the above parameters between two groups at either immediately post-operative or at 3-month follow-up, except for TDA (p = 0.048). Most patients in both groups were at low risk of flexor tendon rupture, except for two cases. We observed a positive correlation between post-operative DDD and 3-month change in the intra-articular group, but not the extra-articular group. (4) Conclusions: Our study demonstrates that VAVLP fixation is effective in maintaining the stability of most radiographic parameters and reduces the risk of tendon rupture in both extra-articular and intra-articular distal radial fractures. Post-operative DDD can be used to predict the degree of subsequent displacement in patients with intra-articular fractures fixed with VAVLP.
Collapse
Affiliation(s)
- Pin-Chieh Fang
- Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Tak-Yu-Yubie Lo
- Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chun-Ying Cheng
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Taoyuan, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chun-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Taoyuan, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| |
Collapse
|
2
|
Kaji Y, Yamaguchi K, Nomura Y, Oka K, Shimamura M, Kawakami S, Yamamoto T. Lasso loop technique using bioabsorbable thread to treat intra-articular distal radius fracture. Medicine (Baltimore) 2021; 100:e27924. [PMID: 34964765 PMCID: PMC8615343 DOI: 10.1097/md.0000000000027924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023] Open
Abstract
This article introduces our lasso loop technique (LLT) using a bioabsorbable thread for the treatment of intra-articular distal radius fractures with displaced dorsal bone fragment containing articular surface (DBF). We also examined whether the articular gap is sufficiently reduced and maintained by the LLT, along with the results of other radiological and clinical evaluations. We retrospectively reviewed 19 patients who underwent LLT for intra-articular distal radius fracture with a displaced DBF. Patient radiographic images and medical records were used to investigate radiological characteristics, symptoms, physical findings, and the Quick Disabilities of the Arm, Shoulder, and Hand scores. Sagittal-view computed tomography showed that the mean preoperative articular gap was 2.6 mm, but the gap was reduced by LLT, and the gap immediately postoperatively was <1.0 mm in all patients. No re-displacement of the DBF was evident from immediately postoperatively to 6 months postoperatively. Postoperatively, no losses of correction in palmar tilt, radial inclination, or ulnar variance were seen in the evaluation of plain radiographs, and satisfactory joint range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand score were obtained. No significant complications due to LLT were observed. LLT appears to offer a simple and effective procedure to reduce displaced DBF with little risk of complications. LLT may become a useful option in the treatment of intra-articular distal radius fractures with displaced DBF.
Collapse
Affiliation(s)
- Yoshio Kaji
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Konosuke Yamaguchi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yumi Nomura
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Kunihiko Oka
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Masashi Shimamura
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Hiragishi, Sapporo City, Hokkaido, Japan
| | - Shohei Kawakami
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| |
Collapse
|
3
|
Nishiwaki M, Terasaka Y, Kiyota Y, Inaba N, Koyanagi T, Horiuchi Y. A Prospective Randomized Comparison of Variable-Angle and Fixed-Angle Volar Locking Plating for Intra-Articular Distal Radius Fractures. J Hand Surg Am 2021; 46:584-593. [PMID: 33965295 DOI: 10.1016/j.jhsa.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiographic outcomes of using a variable-angle volar locking plate (VAVLP) with those of using a fixed-angle volar locking plate (FAVLP) for treating unstable intra-articular fractures of the distal radius. METHODS One hundred twenty patients with unstable intra-articular fractures of the distal radius were randomized to open reduction and internal fixation with a VAVLP (n = 60) or an FAVLP (n = 60). Supplementary methods (eg., Kirschner wire fixation) were required in 4 patients with a VAVLP and 9 with an FAVLP. Clinical outcomes were evaluated at 6 weeks, 3 months, 6 months, and 1 year after surgery. Posteroanterior and lateral radiographs were used to measure standard radiographic parameters before surgery, in the immediate postoperative period, and at 1 year. Plate prominence and articular congruity were quantified using computed tomography at 6 months. RESULTS There were no significant differences in any clinical outcome between the groups at any follow-up time. Volar tilt was significantly greater in patients treated with a FAVLP in the immediate postoperative period (8° vs 6°) and at 1 year (8° vs 5°). Although significant differences were not found in articular gap or stepoff between the 2 plates, the distal and volar prominence of the VAVLP was significantly greater than that of the FAVLP at 6 months. Significantly more patients treated with a VAVLP had a complication (38% vs 19%). However, most secondary surgeries were performed for hardware removal, and no patients from either group had complex regional pain syndrome or tendon rupture. CONCLUSIONS Patients with intra-articular distal radius fractures can expect good functional and radiographic outcomes with VAVLP or FAVLP fixation. The VAVLP may be more prone to technical errors, leading to complications, whereas the FAVLP is more likely to require supplementary fixation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
Collapse
Affiliation(s)
- Masao Nishiwaki
- Hand and Elbow Surgery Center, Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan.
| | - Yukinori Terasaka
- Hand and Elbow Surgery Center, Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Yasuhiro Kiyota
- Hand and Elbow Surgery Center, Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Naoto Inaba
- Hand and Elbow Surgery Center, Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Takahiro Koyanagi
- Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Yukio Horiuchi
- Hand and Elbow Surgery Center, Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| |
Collapse
|
4
|
Oh GH, Kim HS, Lee JI. Biomechanical evaluation of the stability of extra-articular distal radius fractures fixed with volar locking plates according to the length of the distal locking screw. Comput Methods Biomech Biomed Engin 2020; 24:922-932. [PMID: 33347357 DOI: 10.1080/10255842.2020.1861254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Surgeons usually used short screws to avoid extensor tendon problems during volar locking plate fixation in distal radius fracture. However, the stability according to the length of distal locking screws have not been fully understood. We investigated this issue through finite element analysis and compression test using synthetic radius. Our results demonstrated that the bi-cortical full-length fixation does not contribute to the stiffness increase in the axial compression direction, and a reduction in length of up to more than 50% length can still provide similar stability to full-length screws. Our data can support that surgeon should undersize the distal screw.
Collapse
Affiliation(s)
- Gyung-Hwan Oh
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea
| | - Hak-Sung Kim
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea.,Institute of Nano Science and Technology, Hanyang University, Seoul, Korea
| | - Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri hospital, Guri, Korea
| |
Collapse
|
5
|
Park YH, Song JH, Choi GW, Kim HJ. Comparative analysis of clinical outcomes of fixed-angle versus variable-angle locking compression plate for the treatment of Lisfranc injuries. Foot Ankle Surg 2020; 26:338-342. [PMID: 31054803 DOI: 10.1016/j.fas.2019.04.007] [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: 01/23/2019] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fixed-angle locking compression plate (LCP) and variable-angle LCP are utilized for internal fixation of Lisfranc injuries. However, studies regarding the difference of clinical outcomes of these two plates are limited. The purpose of present study was to compare postoperative outcomes between these two plate types in Lisfranc injuries. METHODS A total of 45 consecutive patients (22 patients with fixed-angle LCP and 23 patients with variable-angle LCP) who underwent surgical treatment for Lisfranc injury were reviewed for this retrospective study. The Foot Function Index (FFI), numerical rating scale (NRS) for pain, development of complications, operative time, and patient satisfaction for current activity were compared. RESULTS There were no significant differences in FFI and NRS for pain at three months and 12 months following surgery. Postoperative complication rate was similar between two groups. Patients with variable-angle LCP had an 18 min shorter mean length of operation (p = 0.040). Patient satisfaction for current activity was not differ between two groups. CONCLUSIONS The use of variable-angle LCP for treatment of Lisfranc injuries did not show superiority in functional outcomes, pain, complication rates, or patient satisfaction to fixed-angle LCP, but operative time was shorter with variable-angle LCP. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Jong Hyub Song
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| |
Collapse
|
6
|
Ruch DS, Tocci FL, Grier AJ, Miles JJ, Patel PS, Mithani SK, Richard MJ. Integrated Compression Screw Stabilization of the Dorsal Lunate Facet in Intra-Articular Distal Radius Fractures. J Hand Surg Am 2020; 45:361.e1-361.e7. [PMID: 31668407 DOI: 10.1016/j.jhsa.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 06/14/2019] [Accepted: 09/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate outcomes of intra-articular distal radius fractures with displaced dorsal lunate facet fragments treated with a combination of volar plating and the use of a dorsal screw that integrates into the plate. METHODS We reviewed a retrospective cohort of 22 patients who underwent open reduction and internal fixation of an intra-articular distal radius fracture with a volar plate in conjunction with the Frag-Loc Compression screw. Patient charts and radiographs were reviewed for clinical and radiographic outcomes. RESULTS A total of 12 patients with a minimum 6-month follow-up who met all eligibility criteria were included in this study. There were 8 women and 4 men. The mean age was 55.2 years. Mean follow-up was 11.5 months (range, 6-21 months). The most common mechanism of injury was a fall from standing (75.0%). At final follow-up, all patients were able to return to their previous level of function. Bony union was achieved in all patients at the time of final follow-up. Average radiographic parameters at final follow-up were radial inclination 24.2° ± 5.3°, volar tilt 1.3° ± 5.2°, and ulnar variance 0.9 ± 1.7 mm. During the follow-up period, transient median nerve paresthesias were observed in 4 patients, with spontaneous resolution in 3 of 4 patients. Loss of articular reduction was not observed in any case. CONCLUSIONS This study demonstrates satisfactory clinical and radiographic results and minimal complications with utilization of a new fixation device for distal radius fractures with displaced dorsal lunate facet fragments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Durham, NC.
| | - Francesca L Tocci
- Division of Hand Surgery, Department of Orthopaedic Surgery, Durham, NC
| | - A Jordan Grier
- Division of Hand Surgery, Department of Orthopaedic Surgery, Durham, NC
| | - Jeremy J Miles
- Division of Hand Surgery, Department of Orthopaedic Surgery, Durham, NC
| | | | - Suhail K Mithani
- Division of Hand Surgery, Department of Orthopaedic and Plastic Surgery, Duke University Medical Center, Durham, NC
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopaedic Surgery, Durham, NC
| |
Collapse
|
7
|
Ramavath A, Howard N, Lipscombe S. Biomechanical considerations for strategies to improve outcomes following volar plating of distal radius fractures. J Orthop 2019; 16:445-450. [PMID: 31528050 DOI: 10.1016/j.jor.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/15/2019] [Indexed: 01/30/2023] Open
Abstract
This article is a systematic review of the recent published literature on the biomechanics of volar locking plate fixation of distal radius fractures. PUBMED/MEDLINE and EMBASE databases were searched on 13th Sep 2018. Biomechanical papers on volar locking plate fixation of distal radius fractures since 2010 were included. Papers were analysed and included studies were appraised by the author using the validated quality assessment GRADE tool. The search revealed 456 papers between January 2010 and the present day whose abstracts were reviewed for relevance and 21 papers were included for full paper review. The aim of this systematic review was to evaluate the evidence to determine the surgical techniques and strategies that are associated with the best biomechanical outcomes of volar plating for distal radius fractures. Review of the literature revealed that it was not necessary to fill all available distal locking screws, there was little evidence to support the use of 2 rows of screws distally over 1 row. Screws of 75% length of the distal cortex are sufficient to withstand standard postoperative regimes in extrarticular fractures. The was a paucity of evidence to conclude multidirectional locking plates were superior to fixed angle plates or that one brand of plate was superior to another.
Collapse
Affiliation(s)
- A Ramavath
- Department of Trauma and Orthopaedics, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - N Howard
- Department of Trauma and Orthopaedics, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - S Lipscombe
- Department of Trauma and Orthopaedics, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| |
Collapse
|
8
|
Nourbakhsh A, Hirschfeld AG, Dhulipala S, Hutton W, Ganey T, Lozada L, Schlatterer D, Lourie GM. Biomechanical Comparison of Fixed- versus Variable-Angle Locking Screws for Distal Humerus Comminuted Fractures. Clin Orthop Surg 2019; 11:302-308. [PMID: 31475051 PMCID: PMC6695320 DOI: 10.4055/cios.2019.11.3.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To compare the stability of fixed- versus variable-angle locking constructs for the comminuted distal humerus fracture (AO/OTA 13-A3). METHODS Eight pairs of complete humeri harvested from eight fresh frozen cadavers were used for the study. We fixed the intact humeri using 2.7-mm/3.5-mm locking VA-LCP stainless steel distal humerus posterolateral (nine-hole) and medial (seven-hole) plates. An oscillating saw was used to cut a 1-cm gap above the olecranon fossa. The specimens were loaded in axial mode with the rate of 1 mm per 10 seconds to failure, and stress-strain curves were compared in each pair. The mode of failure was recorded as well as the load needed for 2- and 4-mm displacement at the lateral end of the gap. RESULTS The stiffness of the constructs, based on the slope of the stress-strain curve, did not show any difference between the fixed- versus variable-angle constructs. Likewise, there was no difference between the force needed for 2- or 4-mm displacement at the lateral gap between the fixed- and variable-angle constructs. The mode of failure was bending of both plates in all specimens and screw pull-out in four specimen pairs in addition to the plate bending. CONCLUSIONS Our results did not show any difference in the biomechanical stability of the fixed- versus variable-angle constructs. There was not any screw breakage or failure of the plate-screw interface.
Collapse
Affiliation(s)
- Ali Nourbakhsh
- Department of Orthopedics, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - Adam G. Hirschfeld
- Department of Orthopedics, MetroHealth Medical Center, Cleveland, OH, USA
| | - Sravan Dhulipala
- Department of Orthopedics, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - William Hutton
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy Ganey
- Department of Orthopedics, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - Luis Lozada
- Department of Orthopedics, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - Daniel Schlatterer
- Department of Orthopedics, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - Gary Mark Lourie
- Department of Orthopedics, The Hand and Upper Extremity Center of Georgia, Atlanta, GA, USA
| |
Collapse
|
9
|
Drobetz H, Black A, Davies J, Buttner P, Heal C. Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates. World J Orthop 2018; 9:203-209. [PMID: 30364833 PMCID: PMC6198296 DOI: 10.5312/wjo.v9.i10.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.
METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.
RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.
CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.
Collapse
Affiliation(s)
- Herwig Drobetz
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Alyce Black
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
| | - Jonathan Davies
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Petra Buttner
- Tropical Health Solutions PTY Ltd, Townsville 4810, Queensland, Australia
- Centre for Chronic Disease Prevention, James Cook University, Cairns 4878, Queensland, Australia
| | - Clare Heal
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, Townsville 4810, Queensland, Australia
| |
Collapse
|
10
|
Mugnai R, Tarallo L, Capra F, Catani F. Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures. Orthop Traumatol Surg Res 2018; 104:877-882. [PMID: 29807189 DOI: 10.1016/j.otsr.2018.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. HYPOTHESIS Carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. MATERIALS AND METHODS Three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. RESULTS The mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (-16%) for the titanium plate. Statistical analysis between groups reported significant values (p<001) for all comparisons except for Hand Innovations vs. Zimmer bending stiffness post fatigue (p=.197). DISCUSSION The significant higher load to failure of the titanium plate, makes it indicated for patients with higher functional requirements or at higher risk of trauma in the post-operative period. The CFR-PEEK plate showed material-specific disadvantages, represented by little tolerance to plastic deformation, and lower load to failure. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Raffaele Mugnai
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy.
| | - Luigi Tarallo
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
| | | | - Fabio Catani
- Orthopaedics and Traumatology Department, Modena University Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126 Modena MO, Italy
| |
Collapse
|
11
|
Lee SK, Chun YS, Shin HM, Kim SM, Choy WS. Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly. Orthop Traumatol Surg Res 2018; 104:883-891. [PMID: 29807188 DOI: 10.1016/j.otsr.2018.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/26/2018] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients. METHODS One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared. RESULTS Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group. CONCLUSION The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients. LEVEL OF EVIDENCE III Therapeutic study.
Collapse
Affiliation(s)
- Sang Ki Lee
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea.
| | - Young Sub Chun
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| | - Hyun Min Shin
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| | - Soo Min Kim
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| | - Won Sik Choy
- Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea
| |
Collapse
|
12
|
Are Variable-Angle Locking Screws Stable Enough to Prevent Calcaneal Articular Surface Collapse? A Biomechanical Study. J Orthop Trauma 2018; 32:e204-e209. [PMID: 29432319 DOI: 10.1097/bot.0000000000001147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare fixed- or variable-angle locking screws in calcaneal fracture plates using a sawbones biomechanical model. METHODS Intra-articular calcaneal fractures were created in synthetic bones. Reduction and stabilization was performed with 3 different plates. In group A, a fixed-angle locking plate was used with screws fastened perpendicularly to the plate (3.5 LCP, DePuySynthes). In groups B and C (2.7 VA-LCP, DePuySynthes and 3.5 Aptus, Medartis, respectively), fracture fixation was performed using variable-angle locking plates. Biomechanical testing was conducted. Displacement of the subtalar articular surface, stiffness, maximum displacement, change in the angle of Gissane, and mode of failure under cyclic loading at 200 N, 600 N, and 1000 N (500 cycles each) were determined. RESULTS No statistically significant difference of articular surface dislocation under cyclic loading was detected. The stiffness and maximum displacement did not reveal any disparity as well. The change in the angle of Gissane showed only minor displacement of the articular surface. CONCLUSION In our study, the resistance of variable-angle locking plates against articular surface displacement was similar to fixed-angle locking screws.
Collapse
|
13
|
[Prevention of postoperative infections : Risk factors and the current WHO guidelines in musculoskeletal surgery]. Unfallchirurg 2018; 120:472-485. [PMID: 28573554 DOI: 10.1007/s00113-017-0362-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the many scientific and technological advances postoperative infection continues to be a large problem for trauma and orthopedic surgeons. Based on a review of the current literature, this study provides a comprehensive overview of the risk factors (RF) and possible preventive measures to control surgical site infections. METHODS Medline search and analysis from 1968-2017 (as of 01 March 2017). Selection of trauma and orthopedic relevant RFs and comparison with WHO recommendations (global guidelines for the prevention of surgical site infection, Nov. 2016). RESULTS Identification of 858 relevant articles from the last 50 years (1968-2017). Pooled postoperative rate of infection is 0.3% (hand surgery) and 19% (3rd degree open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RF from three areas (patient-dependent RF, organizational and procedural RF, trauma- and surgery-dependent RF). The five most important RFs are body mass index over 35 kg/m2, increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period also in the case of nondiabetic patients, and errors in the perioperative antibiotic prophylaxis. DISCUSSION Inconsistent definition of "infection", interaction of the RF and the different follow-up duration limit the meaningfulness of the study. CONCLUSION In the future, considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high-risk patients.
Collapse
|
14
|
Im JH, Lee JY. Pearls and Pitfalls of the Volar Locking Plating for Distal Radius Fractures. J Hand Surg Asian Pac Vol 2016; 21:125-32. [PMID: 27454625 DOI: 10.1142/s242483551640004x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Volar locking plate fixation has been widely accepted method for the treatment of unstable distal radius fractures. Although the results of volar locking plate fixation are encouraging, it may cause implant-related complications such as flexor or extensor tendon injuries. In depth understanding of anatomy of the distal radius is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid these complications. This article will review the anatomic characteristics of the distal radius because selecting proper implant and positioning of the plate is closely related to the volar surface anatomy of the distal radius. The number and the length of distal locking screws are also important to provide adequate fixation strength to maintain fracture fixation. We will discuss the pros and cons of the variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation. Finally, we will discuss about correcting radial length and volar tilt by using eccentric drill holes and distal locking first technique.
Collapse
Affiliation(s)
- Jin-Hyung Im
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| | - Joo-Yup Lee
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
15
|
Vosbikian MM, Ketonis C, Huang R, Ilyas AM. Optimal Positioning for Volar Plate Fixation of a Distal Radius Fracture: Determining the Distal Dorsal Cortical Distance. Orthop Clin North Am 2016; 47:235-44. [PMID: 26614937 DOI: 10.1016/j.ocl.2015.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are currently among the most common fractures of the musculoskeletal system. With a population that is living longer, being more active, and the increasing incidence of osteoporosis, these injuries will continue to become increasingly prevalent. When operative fixation is indicated, the volar locking plate has recently become the treatment of choice. However, despite its success, suboptimal position of the volar locking plate can still result in radiographic loss of reduction. The distal dorsal cortical distance is being introduced as an intraoperative radiographic tool to help optimize plate position and minimize late loss of fracture reduction.
Collapse
Affiliation(s)
- Michael M Vosbikian
- Hand and Microvascular Surgery, Harvard-Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman Building-10th Floor, Boston, MA 02215, USA.
| | - Constantinos Ketonis
- Orthopaedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, College Building-Room 516, Philadelphia, PA 19107, USA
| | - Ronald Huang
- Orthopaedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, College Building-Room 516, Philadelphia, PA 19107, USA
| | - Asif M Ilyas
- The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| |
Collapse
|
16
|
Messina AP, van den Bergh D, Goff DA. Antimicrobial Stewardship with Pharmacist Intervention Improves Timeliness of Antimicrobials Across Thirty-three Hospitals in South Africa. Infect Dis Ther 2015; 4:5-14. [PMID: 26362291 PMCID: PMC4569642 DOI: 10.1007/s40121-015-0082-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Ensuring timely administration of antimicrobials is critical in the management of patients with infections. Mortality increases by 7.6% for every hour of delay in the administration of antimicrobial therapy in patients with sepsis. The time elapsed from the written antibiotic order to actual intravenous administration or ‘hang-time’ can often be several hours due to logistics within the hospital. Our purpose is to evaluate the change in compliance with administering antimicrobials within an hour of prescription after implementation of a national antibiotic stewardship pharmacist-driven hang-time process improvement protocol. Methods This was a prospective multicenter study in 33 South African hospitals from 1 July 2013–30 August 2014. Two pilot sites established the mechanism for noninfectious disease pharmacists to make interventions and document hang-time data. Following this, a hang-time compliance assessment was initiated using the tools of healthcare improvement spread methodology. This consisted of five stages and an implementation toolkit was developed. The pharmacist study coordinator was responsible for implementation, the development of an implementation toolkit and real-time coordination of data with monthly feedback to all sites. Results A total of 32,985 patients who received intravenous antibiotics were assessed for hang-time compliance with first doses of new antibiotic orders. Over the 60-week period, 21,069 patients received antibiotics within an hour following prescription and were assessed as hang-time compliant. The change in improvement of hang-time compliance following implementation of a pharmacist-driven hang-time process improvement protocol was 41.2% pre-intervention week 1 (164/398) to 78.4% post-intervention week 60 (480/612; P < 0.0001). Pharmacists reviewed and evaluated twice as many patients during the final 4 weeks (1680) compared to the first 4 weeks (834; P < 0.0001). Conclusion Noninfectious disease pharmacists can significantly improve the timely administration of antimicrobials and contribute to low-hanging-fruit antimicrobial stewardship initiatives within a hospital system in a resource-limited country.
Collapse
Affiliation(s)
- Angeliki P Messina
- Department of Quality Leadership, Netcare Hospitals Ltd., Johannesburg, South Africa
| | - Dena van den Bergh
- Department of Quality Leadership, Netcare Hospitals Ltd., Johannesburg, South Africa
| | - Debra A Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
17
|
Baumbach SF, Synek A, Traxler H, Mutschler W, Pahr D, Chevalier Y. The influence of distal screw length on the primary stability of volar plate osteosynthesis--a biomechanical study. J Orthop Surg Res 2015; 10:139. [PMID: 26351239 PMCID: PMC4563846 DOI: 10.1186/s13018-015-0283-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Extensor tendon irritation is one of the most common complications following volar locking plate osteosynthesis (VLPO) for distal radius fractures. It is most likely caused by distal screws protruding the dorsal cortex. Shorter distal screws could avoid this, yet the influence of distal screw length on the primary stability in VLPO is unknown. The aim of this study was to compare 75 to 100 % distal screw lengths in VLPO. Methods A biomechanical study was conducted on 11 paired fresh-frozen radii. HRpQCT scans were performed to assess bone mineral density (BMD) and bone mineral content (BMC). The specimens were randomized pair-wise into two groups: 100 % (group A) and 75 % (group B) unicortical distal screw lengths. A validated fracture model for extra-articular distal radius fractures (AO-23 A3) was used. Polyaxial volar locking plates were mounted, and distal screws was inserted using a drill guide block. For group A, the distal screw tips were intended to be flush or just short of the dorsal cortex. In group B, a target screw length of 75 % was calculated. The specimens were tested to failure using a displacement-controlled axial compression test. Primary biomechanical stability was assessed by stiffness, elastic limit, and maximum force as well as with residual tilt, which quantified plastic deformation. Results Nine specimens were tested successfully. BMD and BMC did not differ between the two groups. The mean distal screw length of group A was 21.7 ± 2.6 mm (range: 16 to 26 mm), for group B 16.9 ± 1.9 mm (range: 12 to 20 mm). Distal screws in group B were on average 5.6 ± 0.9 mm (range: 3 to 7 mm) shorter than measured. No significant differences were found for stiffness (706 ± 103 N/mm vs. 660 ± 124 N/mm), elastic limit (177 ± 25 N vs. 167 ± 36 N), maximum force (493 ± 139 N vs. 471 ± 149 N), or residual tilt (7.3° ± 0.7° vs. 7.1° ± 1.3°). Conclusion The 75 % distal screw length in VLPO provides similar primary stability to 100 % unicortical screw length. This study, for the first time, provides the biomechanical basis to choose distal screws significantly shorter then measured. Electronic supplementary material The online version of this article (doi:10.1186/s13018-015-0283-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sebastian F Baumbach
- Department of Trauma Surgery, University Hospital of Munich (LMU), Campus Innenstadt, Nußbaumstrasse 20, 80336, Munich, Germany.
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria
| | - Hannes Traxler
- Center of Anatomy and Cell Biology, Department of Systematic Anatomy, Medical University Vienna, Währinger Straße 13, 1090, Vienna, Austria
| | - Wolf Mutschler
- Department of Trauma Surgery, University Hospital of Munich (LMU), Campus Innenstadt, Nußbaumstrasse 20, 80336, Munich, Germany
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
18
|
Abstract
The management of blast-related soft tissue wounds requires a comprehensive surgical approach that acknowledges extensive zones of injury and the likelihood of massive contamination. The experiences of military surgeons during the last decade of war have significantly enhanced current understandings of the optimal means of mitigating infectious complications, the timing of soft tissue coverage attempts, and the reconstructive options available for definitive wound management. Early administration of antibiotics in the setting of soft tissue wounds and associated open fractures is the single most important aspect of open fracture care. Both civilian and military reports have elucidated the incidence of invasive fungal infection in the setting of high-energy injuries with significant wound burdens, and novel treatment protocols have emerged. The type of reconstruction is predicated upon the zone of injury and location of the soft tissue defect. Multiple reports of military cohorts have suggested the equivalency of various techniques and types of soft tissue coverage. Longer-term follow-up will inform future perspectives on the durability of these surgical approaches.
Collapse
Affiliation(s)
- Andrew J Sheean
- Department of Orthopedic Surgery and Rehabilitation, San Antonio Military Medical Center, San Antonio, TX, USA
| | | | | |
Collapse
|
19
|
Open distal tibial shaft fractures: a retrospective comparison of medial plate versus nail fixation. Eur J Trauma Emerg Surg 2015; 42:101-6. [PMID: 26038037 DOI: 10.1007/s00068-015-0519-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Studies comparing open reduction internal fixation (ORIF) vs. intramedullary nailing (IMN) for distal tibia shaft fractures focus upon closed injuries containing small patient series with open fractures. As such, complication rates for open fractures are unknown. To characterize complications associated with ORIF vs. IMN, we compared complications based on surgical approach in a large patient series of open distal tibia shaft fractures. METHODS Through retrospective analysis at an urban level I trauma center, 180 IMN and 36 ORIF patients with open distal tibia fractures from 2002 to 2012 were evaluated. Patient charts were reviewed to identify patient demographics, fracture grade (G), patient comorbidities, and postoperative complications including nonunion, malunion, infection, hardware-related pain, and wound dehiscence. Fisher's exact tests compared complications between ORIF and IMN groups. Multivariate regression identified risk factors with statistical significance for the development of a postoperative complication. RESULTS One hundred and eighty IMN (G1 22, G2 79, and G3 79) and 36 ORIF (G1 10, G2 16, and G3 10) patients were included for analysis. ORIF patients had a higher rate of nonunion (25.0 %, n = 9) compared with IMN patients (10.6 %, n = 20, p = 0.03). No additional complication had a significant statistical difference between groups. Multivariable analysis shows only surgical method influenced the development of complications: ORIF patients had 2.52 greater odds of developing complications compared with IMN patients (95 % CI 1.05-6.02; p = 0.04). CONCLUSIONS ORIF leads to higher rates of nonunion and significantly increases the odds of developing a complication compared with IMN for open distal tibia fractures. This is the first study investigating complication rates based on surgical approach in a large cohort of patients with exclusively open distal tibia fractures.
Collapse
|