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Muramatsu K, Gandionco JA, Suguitan AA, Tani Y, Iwanaga R, Hashimoto T, Sakai T. Unidirectional Porous β-Tricalcium Phosphate: A New Bone Filling Substitute for Treatment of Distal Radius Fracture in the Elderly Population. J Hand Surg Asian Pac Vol 2020; 25:59-66. [PMID: 32000605 DOI: 10.1142/s2424835520500083] [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] [Indexed: 11/18/2022]
Abstract
Background: A new beta-tricalcium phosphate with unidirectional pore structure (UDPTCP), Affinos® (Kurray, Okayama, Japan), has been in clinical use since 2015. To date, there have been only a few clinical studies using this material. We report here the first clinical study for distal radial fracture in the elderly population treated with UDPTCP. Methods: Consecutive patients aged 65 years or older with dorsally displaced unstable fracture of the distal radius (n = 36) were treated operatively in our department. Following reduction of the fracture site, a 7 mm size cube of UDPTCP was placed in the gap of the bony defect and the fracture stabilized with mono-axial or poly-axial type locking plates and screws. Remodeling of the UDPTCP was evaluated by plain radiograph and clinical outcomes were also assessed. Results: UDPTCP was significantly resorbed at 2 months after surgery, both at the center and periphery of the material. Complications were only observed in the post-operative period. Significant correction loss of radial alignment was seen in patients stabilized with poly-axial locking plate. The clinical outcome in all cases was excellent. Conclusions: Block UDPTCP is a safe and convenient material for the treatment of distal radius fracture and is replaced within a suitable time period after grafting into the fracture site. UDPTCP and stable internal fixation is therefore a reliable strategy for restoring and preserving anatomical position, especially in the elderly population.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan.,Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Jessica A Gandionco
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Anthony A Suguitan
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, Japan
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Takahiro Hashimoto
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Vakhshori V, Alluri RK, Stevanovic M, Ghiassi A. Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation. Hand (N Y) 2020; 15:116-124. [PMID: 30003802 PMCID: PMC6966280 DOI: 10.1177/1558944718787877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Internal radiocarpal distraction plating is a versatile tool in the treatment of distal radius fractures that are not amenable to nonoperative treatment or operative fixation with standard volar or dorsal implants. Internal distraction plates may also be indicated in the setting of polytrauma or osteopenic bone. The plate functions as an internal fixator, using ligamentotaxis to restore length and alignment while providing relative stability for bony healing. The plate can be fixed to either the second or the third metacarpal, and anatomic and biomechanical studies have assessed the strengths and weaknesses of each strategy. This operative fixation technique leads to acceptable radiographic results and functional outcomes. Following fracture union, the plate is removed, and wrist range of motion is resumed.
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Affiliation(s)
- Venus Vakhshori
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
| | - Ram Kiran Alluri
- Keck Medical Center at the University of
Southern California, Los Angeles, USA,Ram Kiran Alluri, Department of Orthopaedic
Surgery, Keck Medical Center at the University of Southern California, 1520 San
Pablo Street, #2000, Los Angeles, CA 90033, USA.
| | - Milan Stevanovic
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
| | - Alidad Ghiassi
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
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Volar plate versus k-wire fixation of distal radius fractures. Injury 2016; 47:372-6. [PMID: 26592093 DOI: 10.1016/j.injury.2015.08.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/26/2015] [Accepted: 08/30/2015] [Indexed: 02/02/2023]
Abstract
The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the volar plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a volar plate (p<0.007). Higher values for radial inclination, radial length and volar tilt correlated with better functional outcome as measured by disabilities of the arm shoulder and hand (DASH) and patient rated wrist evaluation (PRWE) scores. Lower values for ulnar variance correlated with better functional outcome. Although volar plate treatment resulted in a superior radiological outcome, there was no evidence that this translated into a superior functional outcome (DASH 13.12 vs. 11.25, p=0.28) (PRWE 17.56 vs. 16.31, p=0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.
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Caruso G, Vitali A, del Prete F. Multiple ruptures of the extensor tendons after volar fixation for distal radius fracture: a case report. Injury 2015; 46 Suppl 7:S23-7. [PMID: 26738455 DOI: 10.1016/s0020-1383(15)30040-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 62-year-old woman was admitted to our hospital after a bicycle accident with a displaced left (non-dominant) distal radius fracture. After closed reduction a long cast was applied. Due to loss of reduction, twenty-four days later open reduction internal fixation with locking compression plate (LCP) was performed. The patient returned to her normal activities but nineteen months after surgery showed functional impairment of the left thumb for Extensor Pollicis Longus (EPL) injury for which she necessitated transposition surgery. Twenty-six months after ORIF, functional deficit of the extension of the third and fourth left finger was noted secondary to injury of extensor tendons. Ultrasound and CT scan showed protrusion of the angular stability screws in LCP plate that caused a progressive wear resulting in rupture of the extensor tendons. Another tendon transposition surgery was performed with dorsal approach while the plate was removed utilising the original volar incision. Reconstruction of distal radius fractures with volar plating, requires accurate plate application with precise measurement of the length of the screws in order to prevent dorsal protrusion and thus avoiding tendon injuries.
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Affiliation(s)
| | - Andrea Vitali
- Health Firm Hand, Palagi Hospital (I.O.T.), Florence, Italy
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Brogan DM, Richard MJ, Ruch D, Kakar S. Management of Severely Comminuted Distal Radius Fractures. J Hand Surg Am 2015; 40:1905-14. [PMID: 26243322 DOI: 10.1016/j.jhsa.2015.03.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are among the most common fractures of the upper extremity. Indications for operative and nonsurgical management have evolved over time, as have fixation techniques. Volar locking plates are commonly used in the treatment of selected distal radius fractures such as low-energy or relatively uncomplicated fractures. They have limitations, however, in the management of highly comminuted fracture patterns and in polytrauma patients. In these patients, other methods ranging from spanning fixation to fragment-specific fixation have emerged as useful alternatives in the surgeon's armamentarium for treatment of these challenging fractures.
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Affiliation(s)
- David M Brogan
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - David Ruch
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - Sanjeev Kakar
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Liu X, Wu WD, Fang YF, Zhang MC, Huang WH. Biomechanical comparison of osteoporotic distal radius fractures fixed by distal locking screws with different length. PLoS One 2014; 9:e103371. [PMID: 25080094 PMCID: PMC4117495 DOI: 10.1371/journal.pone.0103371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/30/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length. Methods A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure. Results Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009), whereas stiffness in group B and C was statistically similar (P = 0.93). Load to clinical failure was significantly less for group A (456.54±78.59 N) compared with groups B (580.24±73.85 N) and C (591.07±38.40 N). Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C. Conclusions The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion.
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Affiliation(s)
- Xiong Liu
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
- Department of Orthopaedics, Shilongboai Hospital (The Eight People’s Hospital of Dongguan), Dongguan, Guangdong, P.R. China
| | - Wei-dong Wu
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
- Department of Orthopaedics, Wuzhou Red Cross Hospital, Wuzhou, Guangxi, P.R. China
| | - Ya-feng Fang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
| | - Mei-chao Zhang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
- * E-mail:
| | - Wen-hua Huang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong, P.R. China
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Anakwe R, Khan L, Cook R, McEachan J. Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction. J Orthop Surg Res 2010; 5:51. [PMID: 20687926 PMCID: PMC2924300 DOI: 10.1186/1749-799x-5-51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 08/05/2010] [Indexed: 11/27/2022] Open
Abstract
Background Distal radius fractures are common. The increasing prevalence of osteoporosis contributes to frequently complex articular injuries sustained even after low energy falls. The best method of treating complex type C distal radius fractures is debated. Locked volar plating and external fixation are both widely used with good reported results. Measures of success are traditionally based on technical measurements or the perception of the surgeon. Patient reported measures of outcome are increasingly recognised as important markers of surgical success. We report our experience using locked volar plating for complex type C distal radius fractures as well as patient reported measures of success and satisfaction. Methods Over a 12 month period we treated 21 patients with type C distal radius fractures using locked volar plating. These patients were followed up for at least 12 months and the outcome was assessed using clinical examination, grip strength measurements, radiographs and Patient Rated Wrist Evaluation (PRWE) scoring. Results The 21 patients studied had an average age of 48 years. There were 8 men and 13 women. All of the fractures had united by 3 months. There were no cases of wound infection or tendon injury/irritation. Patients reported low pain scores, good patient rated wrist evaluation scores and high levels of satisfaction. Conclusions Locked volar plating for complex distal radius fractures produces good results when assessed using patient reported measures of outcome. Further work should address whether locked volar plating offers superior outcomes and patient satisfaction compared to external fixation.
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Affiliation(s)
- Re Anakwe
- The Hand Service, Department of Trauma & Orthopaedic Surgery Queen Margaret Hospital, Whitefield Road, Dunfermline, KY12 0SU, UK.
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Abstract
Surgical treatment options for distal radius fractures are many and commonly involve volar locked plating. More recently, newer volar locking plates have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. This article reviews this new technology and presents the authors' experience with the Aptus (Medartis, Kennett Square, Pennsylvania) variable-angle volar locking plates.
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Affiliation(s)
- Jung H Park
- Department of Orthopaedic Surgery, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
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Abstract
Locked fixed-angle plating in the hand and wrist helps to optimize outcomes following surgical fixation of select acute fractures and complex reconstructions. Select indications include unstable distal ulna head/neck fractures, periarticular metacarpal and phalangeal fractures, comminuted/multifragmentary diaphyseal fractures with bone loss (ie, combined injuries of the hand), osteopenic/pathologic fractures, nonunions and corrective osteotomy fixation, and small joint arthrodesis. Locked plating techniques in the hand should not be seen as a panacea for wrist and digital acute trauma and delayed reconstructions. An understanding of the biomechanics of fixed-angle plating and proper technical application of locking constructs will optimize outcomes and minimize complications. As clinical experience with locking technology in hand trauma broadens, new indications and applications will emerge. Currently, several systems are available. The specific implants share common features in their protocols for insertion, but unique differences in their design (ie, individual locking mechanisms, uniaxial vs polyaxial locking capability, metallurgy, and plate profiles) must be appreciated and considered preoperatively.
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External fixation versus closed treatment of displaced distal radial fractures in elderly patients: a randomized controlled trial. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181cd6513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Functional results and complications of locked distal radius volar plates. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/s1988-8856(09)70198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sánchez-Crespo M, del Canto-Álvarez F, Peñas-Díaz F, de Diego-Gutiérrez V, Gutiérrez-Santiago M, Sánchez-Juan P. Resultados funcionales y complicaciones de las placas volares bloqueadas de radio distal. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2009.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Grote S, Boecker W, Mutschler W, Schieker M. Current Aspects of Fragility Fracture Repair. Eur J Trauma Emerg Surg 2008; 34:535-41. [DOI: 10.1007/s00068-008-8207-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
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