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Tariq MA, Ali U, Uddin QS, Altaf Z, Mohiuddin A. Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials. J Wrist Surg 2024; 13:469-480. [PMID: 39296653 PMCID: PMC11407842 DOI: 10.1055/s-0043-1768235] [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: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 09/21/2024]
Abstract
Objective This study aims to compare the outcomes of volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of unstable distal radius fractures. Methods We systematically searched multiple databases, including MEDLINE, EMBASE, Cochrane Central till January 2022 for randomized controlled trials (RCTs) that met eligibility criteria. Following outcomes were evaluated at 6-week, 3-, 6-, and 12-month follow-up period: Disabilities of the Arm, Shoulder, and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) score, grip strength, range of motion, and complication incidence. Meta-analysis was performed using random effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval. Results Fourteen RCTs with 1,450 participants met the inclusion criteria. DASH scores were significantly better for VLP fixation at 6th week (MD = 19.02; p < 0.001), 3rd (MD = 10.79; p < 0.001), 6th (MD= 7.78; p < 0.001), and 12th month (MD = 2.94; p < 0.001) postoperation. At 3-month follow-up period, VLP treatment exhibited better grip strength (MD = - 10.32; p < 0.001) and PRWE scores (MD = 8.78; p < 0.001). There was a statistically significant early advantage in flexion, extension, pronation, supination, radial deviation, and ulnar deviation in the VLP group at 6-week follow-up, but at 1-year follow-up only significantly better extension was observed. At 1 year, radiographic outcomes were similar except for volar tilt favoring VLP fixation ( p < 0.001). Superficial infections were more common in patients treated with K-wire (RR = 2.89; p = 0.001), but there was no difference in total complications or reoperation rates ( p > 0.05). Conclusion This meta-analysis suggests that VLP fixation and K-wire fixation are both effective procedures, but existing literature does not provide sufficient evidence to demonstrate the superiority of either method. Although VLP fixation improves DASH score, extension and volar tilt at 12-month follow-up, the difference is small and unlikely to be noticeable to the patients.
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Affiliation(s)
- Muhammad A Tariq
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Uzair Ali
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Qazi S Uddin
- Department of Surgery, Dow Medical College, Dow University of Health Sciences Karachi, Pakistan
| | - Zahabia Altaf
- Department of Surgery, Dow Medical College, Dow University of Health Sciences Karachi, Pakistan
| | - Ashar Mohiuddin
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
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Suojärvi N, Waris E. Radiographic measurements in distal radius fracture evaluation: a review of current techniques and a recommendation for standardization. Acta Radiol 2024; 65:1065-1079. [PMID: 39043232 DOI: 10.1177/02841851241266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Radiographic measurements play a crucial role in evaluating the alignment of distal radius fractures (DRFs). Various manual methods have been used to perform the measurements, but they are susceptible to inaccuracies. Recently, computer-aided methods have become available. This review explores the methods commonly used to assess DRFs. The review introduces the different measurement techniques, discusses the sources of measurement errors and measurement reliability, and provides a recommendation for their use. Radiographic measurements used in the evaluation of DRFs are not reliable. Standardizing the measurement techniques is crucial to address this and automated image analysis could help improve accuracy and reliability.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Eda Y, Asai R, Kohyama S, Ikumi A, Totoki Y, Yoshii Y. Three-Dimensional Morphometric Analysis of the Volar Cortical Shape of the Lunate Facet of the Distal Radius. Diagnostics (Basel) 2024; 14:1802. [PMID: 39202290 PMCID: PMC11353463 DOI: 10.3390/diagnostics14161802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.
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Affiliation(s)
- Yusuke Eda
- Department of Orthopaedic Surgery, Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba 305-8576, Japan
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan;
| | - Reo Asai
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan;
| | - Sho Kohyama
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan (Y.T.)
| | - Yasukazu Totoki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan (Y.T.)
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan;
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Cangussu BL, Baldanza HC, Carmo RL, Nobre DM, Estanislau AR, Barros TSV. RADIOGRAPHIC EVALUATION OF CONSERVATIVE TREATMENT OF DISTAL RADIUS FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e275070. [PMID: 38933348 PMCID: PMC11197943 DOI: 10.1590/1413-785220243202e275070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/01/2023] [Indexed: 06/28/2024]
Abstract
Objective This article aims to evaluate the evolution of radio-graphic parameters (radial tilt, volar tilt, and radial height) of distal radius fractures in patients indicated for conservative treatment at three different times: date of diagnosis, first outpatient visit within 2 weeks after closed reduction, and last outpatient visit. Methods We included 84 patients seen at the emergency department of Hospital Municipal Odilon Behrens, with a diagnosis of distal radius fracture and an indication for conservative treatment. We considered only those patients who had serial radiographs taken at least three different times (n=69) in this analysis. Results There was an improvement in radiographic parameters of volar tilt after closed reduction and immobilization, which was maintained until the last outpatient visit. Radial inclination and radial height showed increased values from the first to the second radiographic evaluation and both values had regression when comparing the second to the third (last) evaluation. Conclusion Universal classification stable fractures tend to evolve well with conservative therapy. Level of Evidence II; Development of Diagnostic Criteria in Consecutive Patients (with Gold Standard of Reference Applied).
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Affiliation(s)
- Brenno Lopes Cangussu
- Hospital Municipal Odilon Behrens, Department of Orthopedics, Belo Horizonte, MG, Brazil
- Hospital Municipal Odilon Behrens, Teaching and Research Committee, Belo Horizonte, MG, Brazil
| | - Henrique Cruz Baldanza
- Hospital Municipal Odilon Behrens, Department of Orthopedics, Belo Horizonte, MG, Brazil
- Hospital Municipal Odilon Behrens, Teaching and Research Committee, Belo Horizonte, MG, Brazil
| | - Ricardo Leão Carmo
- Hospital Municipal Odilon Behrens, Department of Orthopedics, Belo Horizonte, MG, Brazil
- Hospital Municipal Odilon Behrens, Teaching and Research Committee, Belo Horizonte, MG, Brazil
| | - Daniel Magalhães Nobre
- Hospital Municipal Odilon Behrens, Department of Orthopedics, Belo Horizonte, MG, Brazil
| | | | - Tomás Santos Vasconcelos Barros
- Hospital Municipal Odilon Behrens, Department of Orthopedics, Belo Horizonte, MG, Brazil
- Hospital Municipal Odilon Behrens, Teaching and Research Committee, Belo Horizonte, MG, Brazil
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Emet A, Veizi E, Karaman Y, Akgun E, Tolunay T, Firat A. Volar fixed plating of distal radius fractures: optimizing plate position for enhanced clinical outcomes. BMC Musculoskelet Disord 2024; 25:320. [PMID: 38654260 PMCID: PMC11036783 DOI: 10.1186/s12891-024-07415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The precise influence of plate position on clinical outcomes in the context of volar fixed-angle plating for distal radius fractures is not fully understood. This article aims to investigate the influence of plate position on clinical results, and functional outcomes in patients treated with volar fixed plating for distal radius fractures. METHODS A total of 58 patients with 64 distal radius fractures were included in the study. Patient demographics, fracture characteristics, surgical details, and radiographic data were collected. Post-operative AP and Lat views of all patients taken on the first day after surgery were evaluated. Volar Tilt, Radial Inclination and Radial Height measurements were used as reduction criteria. In the follow-up, the patients were called for their last control, flexion and extension angles of the wrist and Mayo Wrist Scores, the distance of the plate to the joint line and the angle between the plate and the radial shaft were measured and recorded. RESULTS A total of 64 distal radius fractures, with a mean age of 46.9 years, and the mean follow-up period 24.9 months were included in this study. There was a significant relationship between the Radial Inclination and Plate-Shaft Angle variables and the Mayo Wrist Score at a 99% confidence interval. Additionally, a relationship was observed between the Radial Height variable and the Mayo Score at a 90% confidence interval. A significant positive association was observed between radial inclination and achieving a Good-to-Excellent Mayo score (OR = 1.28, 95% CI [1.08-1.51], p = 0.004). Plate distance to joint line demonstrated a marginally significant positive association with a Good-to-Excellent Mayo score (OR = 1.31, 95% CI [0.97-1.77], p = 0.077). Univariate analysis revealed a significant negative association between plate-shaft angle and achieving a Good-to-Excellent Mayo score (OR = 0.71, 95% CI [0.52-0.99], p = 0.045). This negative association remained statistically significant in the multivariate analysis (p = 0.016). CONCLUSION Radial inclination, plate distance to joint line, and angle between plate and radius shaft were identified as significant factors associated with improved Mayo Wrist Scores.
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Affiliation(s)
- Abdulsamet Emet
- Department of Orthopedics and Traumatology, Etlik City Hospital, Turan Gunes Blv. Koz Apt. 41/22 Cankaya, Ankara, Turkey.
| | - Enejd Veizi
- Ankara City Hospital, Department of Orthopedics and Traumatology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Yavuz Karaman
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Erkan Akgun
- Department of Orthopedics and Traumatology, Etlik City Hospital, Turan Gunes Blv. Koz Apt. 41/22 Cankaya, Ankara, Turkey
| | - Tolga Tolunay
- Department of Orthopedics and Traumatology, Gazi University, Ankara, Turkey
| | - Ahmet Firat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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Jensen J, Graumann O, Gerke O, Torfing T, Precht H, Rasmussen BS, Tromborg HB. Accuracy of radiographic measurements of fracture-induced deformity in the distal radius. Acta Radiol Open 2023; 12:20584601231205986. [PMID: 37767057 PMCID: PMC10521277 DOI: 10.1177/20584601231205986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Background Management of the distal radius fracture (DRF) is to some extent based on radiographic characterization of fracture displacement. It remains unclear, however, if the measurements used to quantify displacement are accurate. Purpose To quantify accuracy of two radiographic measurements: dorsal/volar tilt and fracture compression, measured indirectly as ulnar variance (UV), using radiostereometric analyses (RSA) as reference standard. Material and Methods Twenty-one fresh frozen non-fractured human cadaveric forearms (right = 11, left = 10) were thawed and eligible for inclusion. The forearms were mounted on a custom made platform that allowed for controlled forearm rotation, and they underwent two rounds of imaging (both rounds consisted of RSA and radiographs). In round one, the non-fractured forearms were radiographed. In round two, artificial DRF´s with compression and dorsal angulation were created and imaging procedures repeated. Change in tilt and UV between the non-fractured and later fractured forearms was defined as fracture-induced deformity. Deformity was measured radiographically and additionally calculated using RSA. Bland Altman analyses were used to estimate agreement between radiographically measured, and RSA calculated, fracture-induced deformity. Results Our results indicated that radiographs underestimate the amount of fracture-induced deformity. Mean measured differences (bias) in dorsal tilt deformity between radiographs and RSA were -2.5° for both observers. The corresponding values for UV were -1.4 mm and -1.5 mm. Conclusion Quantifying fracture-induced deformity on radiographs underestimated the actual deformity when compared to RSA calculated deformity. These findings suggest that clinicians, at least in part, base fracture management and potentially corrective surgery on inaccurate measurements.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Torfing
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Helle Precht
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Radiology, Kolding, Lillebaelt Hospital, University Hospitals of Southern, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin S Rasmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence), University of Southern, Odense, Denmark
| | - Hans B Tromborg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
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Johnston GHF, Mastel M, Sims LA, Cheng Y. Coronal translation of the forearm, proximal capitate, and ulnar styloid predict radial inclination in distal radius fractures in older female patients. Bone Joint J 2023; 105-B:688-695. [PMID: 37257858 DOI: 10.1302/0301-620x.105b6.bjj-2022-1111.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims The aims of this study were to identify means to quantify coronal plane displacement associated with distal radius fractures (DRFs), and to understand their relationship to radial inclination (RI). Methods From posteroanterior digital radiographs of healed DRFs in 398 female patients aged 70 years or older, and 32 unfractured control wrists, the relationships of RI, quantifiably, to four linear measurements made perpendicular to reference distal radial shaft (DRS) and ulnar shaft (DUS) axes were analyzed: 1) DRS to radial aspect of ulnar head (DRS-U); 2) DUS to volar-ulnar corner of distal radius (DUS-R); 3) DRS to proximal capitate (DRS-PC); and 4) DRS to DUS (interaxis distance, IAD); and, qualitatively, to the distal ulnar fracture, and its intersection with the DUS axis. Results In the study (fracture) and control groups, respectively, the mean values were: RI, 17.2° (SD 7.2°; -7° to 35°) and 25.6° (SD 2.6°; 21° to 30°); DRS-U, 13.5 mm (SD 1.7; 4.9 to 20.8) and 15.3 mm (SD 0.72; 13.8 to 16.3); DUS-R, 13.4 mm (SD 2.1; 4.8 to 18.5) and 12.0 mm (SD 0.99; 9.7 to 13.9); DRS-PC (positive value radial to DRS, negative value ulnar), 0.14 mm (SD 5.4; -10.9 to 22.7) and -6.1 mm (SD 1.6; -10.6 to -2.3); and IAD, 25.3 mm (SD 2.5; 17.6 to 31.1) and 27.1 mm (SD 1.5; 24.5 to 31.0). All means were significantly different between the study and control groups. RI correlated strongly with DRS-PC. Ulnar styloid fracture intersection with the DUS axis, reflective of ulnar translation of both radial and ulnar shafts, was associated with significantly lower RI. Conclusion After DRF, the relationship of the proximal capitate to the DRS axis in the coronal plane correlates with the final radial inclination. Additionally, ulnar styloid intersection with the DUS axis is associated with even lower radial inclination. DRF reduction should seek to restore the normal coronal relationship of both radial and ulnar shafts to their distal counterparts.
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Affiliation(s)
- Geoffrey H F Johnston
- Department of Orthopaedics, Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
- RebalanceMD, Victoria, Canada
- Department of Surgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Canada
| | - Matthew Mastel
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Laura A Sims
- Saskatoon Orthopedic and Sports Medicine Centre, University of Saskatchewan, Saskatoon, Canada
| | - Yanzhao Cheng
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
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Fu J, Cai X, Ouyang H, Gong C, Huang Y. Efficacy of electroacupuncture in assisting postoperative healing of distal radius fractures: study protocol for a randomized controlled trial. J Orthop Surg Res 2022; 17:517. [PMID: 36456969 PMCID: PMC9713955 DOI: 10.1186/s13018-022-03415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Manual reduction and surgical treatment are common methods for distal radius fractures (DRFs). The existing literature suggests that postoperative combined rehabilitation treatment and medication are effective for the healing of DRFs. However, the side effects of these treatments remain to be solved. Previous studies have shown that electroacupuncture (EA) can effectively relieve wrist swelling and improve the joint function in patients with DRFs, but more evidence is needed to prove the effectiveness of EA. This trial aims to explore the efficiency and feasibility of combined EA treatment in postoperative treatment of DRFs compared with routine treatment. METHODS This is a parallel randomized controlled trial. A total of 222 patients diagnosed with moderate DRFs will be recruited and randomly assigned to an EA group or a routine treatment group at a ratio of 1:1. Routine treatment group will receive medication and rehabilitation. Yangxi (LI 5), Yangchi (TE 4), Yanggu (SI 5), Hegu (LI 4), and Taiyuan (LU 9) will be selected in the EA group for intervention three times a week on the basis of routine treatment. Both groups will receive 8 weeks of treatment and 4 weeks of follow-up. The primary outcome will be ulnar positive variance. The secondary outcomes will include radiographic healing rate, bone strength, hemorheological indices, serum biochemical indicators and inflammatory factors, grip strength, wrist swelling score, patient-rated wrist evaluation, disabilities of arm, shoulder and hand, and visual analogue scale. Outcomes will be evaluated at baseline, postoperative 3rd day, 2nd, 4th, 6th, 8th, and 12th weeks. DISCUSSION The results of this study will help establish a more optimized scheme to treat patients with DRFs. Trial registration Chinese Clinical Trial Registry ChiCTR2200062857. Registered on 21 August 2022, www.chictr.org.cn/com/25/showproj.aspx?proj=175567 .
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Affiliation(s)
- Jiani Fu
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Xiaowen Cai
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Huailiang Ouyang
- grid.417404.20000 0004 1771 3058Department of Traditional Chinese Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chunzhu Gong
- grid.470230.2Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, China
| | - Yong Huang
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
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Suojärvi N, Lindfors N, Höglund T, Sippo R, Waris E. Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians' radiograph interpretation. J Hand Surg Eur Vol 2021; 46:176-183. [PMID: 33148107 DOI: 10.1177/1753193420968399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examined the reliability of a computer-aided cone-beam CT analysis of radiographic parameters of 50 normal distal radii and compared it with interobserver agreement of measurements made by three groups of physicians on two-dimensional plain radiographs. The intra-rater reliability of the computer-aided analysis was evaluated on 33 wrists imaged twice by cone-beam CT. The longitudinal axis, anterior tilt, radial inclination and ulnar variance were measured. The reliability of computer-aided analysis was excellent (intraclass correlation coefficient (ICC) 0.94-0.96) while the interobserver agreement of two-dimensional radiograph interpretation was good (ulnar variance, ICC 0.80-0.84) to poor (anterior tilt and radial inclination, ICC 0.20-0.42). We conclude that computer-aided cone-beam CT analysis was a reliable tool for radiographic parameter determination, whereas physicians demonstrated substantial variability especially in interpreting the angular parameters.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Nina Lindfors
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Robert Sippo
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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10
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Mishra P, Iqbal M, Faraj A. Functional Outcome of Distal Radial Fractures in Patients With a Mean Age of 75 Years at a Mean Follow-Up of 5.4 Years. Cureus 2020; 12:e11959. [PMID: 33312828 PMCID: PMC7725202 DOI: 10.7759/cureus.11959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Distal radial fractures in the elderly are common and present in a wide spectrum of severity. Their management is varied. The aim of this retrospective case review is to evaluate the late functional outcome of surgically treated distal radial fractures in the elderly population. Methods Forty-two patients (36 female and six male) were surgically treated for an unstable distal radial fracture. The mean age of the patients was 75 years. Frykman classification was used to assess the severity of the injury. Surgical options used were reduction and K wires (19 patients) or open reduction and internal fixation (ORIF) using volar distal radial plate fixation (23 patients). At a mean follow-up of 5.4 years, a validated questionnaire (Patient Rated Wrist Evaluation-PRWE) of the functional ability was completed for each patient. Results The outcome in both groups was satisfactory (PRWE 40-50) with no significant statistical difference, however, a better functional outcome (<40 PRWE) was achieved in the K wire group compared to the ORIF group. Factors such as post injury fear from fall, weakness of grip, wrist pain, and other comorbidities altered the predicted functional outcome score. Conclusion In conclusion, surgically treated fractures in the elderly generally lead to good outcomes. However, confounding factors can contribute to unpredictable results despite good surgical reduction and fixation.
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Affiliation(s)
- Pranav Mishra
- Trauma and Orthopaedic Surgery, Scarborough Hospital, Scarborough, GBR.,Trauma and Orthopaedics, University Hospitals Leicester, Leicester, GBR
| | - Mohammad Iqbal
- Orthopaedics and Trauma, Scarborough Hospital, Scarborough, GBR
| | - Adnan Faraj
- Orthopaedics and Trauma, Scarborough Hospital, Scarborough, GBR
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11
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柳 晓, 叶 晖, 施 进. [Effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:814-819. [PMID: 32666721 PMCID: PMC8180435 DOI: 10.7507/1002-1892.201911089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/31/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults. METHODS The clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation. RESULTS There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group ( P<0.05). Patients in both groups were followed up 6-30 months, with an average of 13 months. The VAS score and ROM of wrist of the observe group at 3 days after operation were superior to the control group ( P<0.05), but there was no significant difference between the two groups at 3 months after operation ( P>0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups ( χ 2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) ( χ 2=9.325, P=0.002). CONCLUSION It is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.
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Affiliation(s)
- 晓林 柳
- 福建医科大学附属第二医院骨科(福建泉州 362000)Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - 晖 叶
- 福建医科大学附属第二医院骨科(福建泉州 362000)Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - 进兴 施
- 福建医科大学附属第二医院骨科(福建泉州 362000)Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
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