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Hosokawa T, Tajika T, Suto M, Nagashima T, Arisawa S, Chikuda H. Ultrasonography of the median nerve before removal of anterior locking plates from the distal radius. J Hand Surg Eur Vol 2024:17531934241280184. [PMID: 39340258 DOI: 10.1177/17531934241280184] [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] [Indexed: 09/30/2024]
Abstract
Both forearms of 36 patients who had been treated with an anterior locking plate using the trans-flexor carpi radialis approach for unilateral distal radial fractures were investigated by ultrasonography from the distal end of the radius to 5 cm proximally before plate removal. After fixation of the anterior locking plate, the median nerve was significantly more radially located to the flexor carpi radialis tendon than on the healthy side and showed hypertrophy and flattening at the distal end of the radius. In six cases, the median nerve on the plate side lay radial to the flexor carpi radialis tendon. The median nerve after plate fixation may lie more radially than its original position. Confirming the radial deviation of the median nerve by ultrasonography before removal of the anterior locking plate is useful to prevent the complication of median nerve injury.Level of evidence: IV.
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Affiliation(s)
- Takafumi Hosokawa
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Tsuyoshi Tajika
- Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Morimichi Suto
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Taito Nagashima
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Shinsuke Arisawa
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Lee JK, Lee Y, Kim C, Kim M, Han SH. Volar locking plate removal after distal radius fracture: a 10-year retrospective study. Arch Orthop Trauma Surg 2021; 141:1711-1719. [PMID: 33119801 DOI: 10.1007/s00402-020-03637-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Distal radius fracture (DRF) is the most common upper extremity fracture. After the introduction of volar locking plate (VLP) fixation, treatment has shifted from conservative management to more operative management. The implant removal rate after VLP fixation in patients with DRF varies and the reasons for removal and associated patient characteristics have not been clearly defined. This study aimed to compare the characteristics of patients who underwent VLP with and without subsequent implant removal. Second, the rate of implant removal according to the implant position and type was investigated. Finally, we summarized clinical outcome with implant removal, the reasons for, and complications associated with implant removal. METHODS In this retrospective study, patient data were collected between January 1, 2008, and December 31, 2017. The study population was divided into two groups based on subsequent implant removal. Data on patient characteristics, such as age, sex, comorbidities, side of the fractured arm, the AO Foundation and Orthopaedic Trauma Association classification of the DRF, plate position grade based on the Soong classification type, type of inserted plate, insurance coverage, and treatment costs were collected. Furthermore, we investigated the reason for implant removal, clinical outcomes, and post-removal complications. RESULTS After applying the exclusion criteria, 806 patients with a total of 814 DRFs were included in the study. Among the 806 patients who underwent VLP fixation for DRF, 252 (31.3%) patients underwent implant removal. Among the patients undergoing implant removal, the mean age was 50.8 ± 14.0 years, 94 (37.3%) were male. The average time to implant removal from the fracture fixation was 12.1 ± 9.2 months (range 1-170 months). When comparing groups, patients who underwent implant removal were significantly younger and had fewer cases of diabetes, hypertension, and cancer history. According to the Soong plate position grade, the most common position was G1 in both groups. Although there was no significant difference (p = 0.075), more G2 cases were found in the removal group (15.0%) than in the retention group (10.2%). About 66.5% of the patients with implant removal had other health insurance as well as the national service, compared with 47% of the patients with implant retention. In total, 186 patients (73.8%) underwent implant removal despite being asymptomatic after the bony union. The patient satisfaction scores improved from 4.1 to 4.4 after implant removal, and 93% of the patients answered that they would choose implant removal again. Only 10% of the patients who underwent removal reported minor complications. No major complications were reported. CONCLUSION Although the implant removal was conducted without clinical symptoms in the majority of patients, overall patients presented improved functional outcomes with implant removal. The evidence is inconclusive regarding its necessity, however, implant removal after VLP fixation for DRF is not a challenging procedure and is not associated with major complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jun-Ku Lee
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Younghun Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Choongki Kim
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Minwook Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Lee JH, Lee JK, Park JS, Kim DH, Baek JH, Kim YJ, Yoon KT, Song SH, Gwak HG, Ha C, Han SH. Complications associated with volar locking plate fixation for distal radius fractures in 1955 cases: A multicentre retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2057-2067. [DOI: 10.1007/s00264-020-04673-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
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Boydstun S, Nash L, Rayan GM. Distal Radius Fracture Fixation Devices and Their Radiographs. J Hand Surg Asian Pac Vol 2019; 24:412-420. [PMID: 31690197 DOI: 10.1142/s2424835519500528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Distal radius fractures are among the most common fractures encountered in orthopedic practices. If treated operatively, most implants are retained after the fracture heals unless there is hardware failure, limitation of wrist motion, pain, infection, tendon rupture, or tenosynovitis. Complications have been reported during hardware removal, including not knowing the exact implant prior to its removal. If a patient presents for plate removal to a surgeon who did not perform the initial fracture fixation, having a preoperative visual aid can help the treating surgeon choose the right instruments for their removal. Methods: To identify many of the available distal radius fixation devices, we searched the Internet and contacted local industry representatives. We also approached industry personnel at the commercial exhibit of a national hand society meeting to provide us with implants they manufacture. The implants were placed on the volar and dorsal aspects of sawbone models of the distal radius and in one case the radial styloid, using the screws, screwdrivers and accessories in the standard implant set and then posteroanterior and lateral x-rays of the implants were obtained. We created an atlas and a list of the screwdriver(s) used for each. Results: We obtained radiographs and photographs for 28 implants that were manufactured by 14 different companies. Two companies sent us radiographs and photographs placed on either a sawbone or cadaveric model. We found that 7 of the implants were outliers and could be identified easily on the x-rays, whereas 21 implants had similar design of shaft and distal components. Conclusions: To aid the orthopedic surgeon in their removal, we compiled a comprehensive list of most distal radius fixation devices on the market including plates and their corresponding screws and screwdrivers. The goal was to help the surgeon when removing the plate to identify the implant on radiographs.
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Affiliation(s)
- Seth Boydstun
- Department of Orthopedic Surgery & Rehabilitation, University of Oklahoma College of Medicine, Oklahoma, OK, USA
| | - Lisa Nash
- Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma, OK, USA
| | - Ghazi M Rayan
- Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma, OK, USA
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Özbek EA, Ayanoğlu T, Armangil M. How effective is skyline view for avoiding dorsal cortex penetration in volar plate fixation of intra-articular and dorsal cortex comminuted distal radius fractures. Injury 2019; 50:1684-1688. [PMID: 31371169 DOI: 10.1016/j.injury.2019.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The incidence of osteosynthesis is increased by volar anatomic plate used for treatment of distal radius fractures and this increases the incidence of wrist extensor tendon irritation, a postoperative complication of the aforementioned surgical technique. The purpose of this study; was to evaluate the intraoperative skyline view which is commonly used to prevent dorsal cortex penetration of distal screws during the surgical treatment of intra-articular distal radius fractures with comminuted dorsal cortex with CT (computed tomography) scanning to determine its effectiveness. In the literature review, no other study focused on similar fracture types was found. METHODS 52 patients with a minimum follow-up of 13 months were included in the study. These patients were operated by two different national board certified surgeons. One of the surgeons unlike the other, adopted intraoperative skyline view method. X-ray and CT scans which were performed preoperative and postoperative first day, were evaluated by a senior author with a blind evaluation method. Fractures were classified according to AO/OTA (Orthopaedic Trauma Association) classification and postoperative dorsal cortex penetrations were registered. RESULTS Intra-articular distal radius fractures with comminuted dorsal cortex (AO/OTA 2R3C2, C3) were detected in 25 of the patients and no significant difference between two groups for the distribution of these patients was found. The CT scan of 14 patients showed dorsal cortex screw penetration and this rate was significantly higher in the group, in which intraoperative skyline view was not used (p > 0,05). In the postoperative CT examination, the most common dorsal cortex penetration was related to the 4th distal screw (42.9%) which were inserted the nearest ulnar hole of plate. CONCLUSION The insertion of a distal screw 2 mm (millimeter) shorter than the length measured with the help of skyline view is considered to be a more effective method than other intraoperative methods for preventing dorsal cortex penetration. In addition, more comprehensive studies are required in order to recommend the mono-cortex fixation, in which distal screws measuring 4 mm shorter are used.
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Affiliation(s)
- Emre Anıl Özbek
- Yozgat City Hospital, Orthopedics and Traumatology Department, Viyana Avenue, 66100, Yozgat, Turkey.
| | - Tacettin Ayanoğlu
- Yozgat City Hospital, Orthopedics and Traumatology Department, Viyana Avenue, 66100, Yozgat, Turkey.
| | - Mehmet Armangil
- İbn'i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, İbn'i Sina Hospital, Ankara University Medicine Faculty, 06100, Samanpazarı, Ankara, Turkey.
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Alter TH, Ilyas AM. Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.18.00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Liu CH, Yeh WL, Tsai PJ, Fan KF, Cheng HW, Chen JM. A novel implant removal technique by endoscopy. J Orthop Surg Res 2018; 13:74. [PMID: 29625614 PMCID: PMC5889551 DOI: 10.1186/s13018-018-0783-4] [Citation(s) in RCA: 2] [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: 02/18/2018] [Accepted: 03/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Routine implant removal after fracture healing remains controversial. However, it has been suggested that implant removal should be performed in cases of joint impingement, painful scar adhesion, and implant malposition. Entrance selection is relatively critical in patients with poor soft tissue conditions or sloughing coverage. We propose an innovative technique using endoscopy. METHODS Consecutive surgeries of endoscopic implant removal performed between 2005 and 2016 by a single experienced arthroscopic surgeon were included. Overall, 73 patients were enrolled; 44 were not eligible for inclusion and were excluded from the study. RESULTS Twenty-nine patients, including 32 surgical sites, were included. Twenty-four plates and 166 screws were removed using this technique. There were five complications during the follow-up period (range, 0.5 to 104 months; mean, 8.8), including one broken screw, one persistent knee joint contracture, and three wound dehiscence. There were no infections or neurovascular injuries. CONCLUSION Implant removal using endoscopy is a minimally invasive surgery that ensures that the screw axis does not strip, and treats the intra-articular pathology concomitantly. This innovative technique may be considered as an alternative to the traditional open method in cases with good surgical indications.
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Affiliation(s)
- Chang Heng Liu
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Wen Lin Yeh
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Athletic Training and Health, National Taiwan Sports University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping Jui Tsai
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Kuo Feng Fan
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Hung Wei Cheng
- Department of Athletic Training and Health, National Taiwan Sports University, Taoyuan, Taiwan
| | - Jian Ming Chen
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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