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Pacchiarini L, Massimo Oldrini L, Feltri P, Lucchina S, Filardo G, Candrian C. Complications after volar plate synthesis for distal radius fractures. EFORT Open Rev 2024; 9:567-580. [PMID: 38828969 PMCID: PMC11195338 DOI: 10.1530/eor-23-0188] [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: 06/05/2024] Open
Abstract
Purpose Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor. Methods A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the 'Down and Black's Checklist for measuring quality'. Results About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient's will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%). Conclusion The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient's willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.
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Affiliation(s)
- Luca Pacchiarini
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Stefano Lucchina
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
- Locarno Hand Center, Locarno, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Laane CLE, Dijkmans AL, Messinger CJ, Wijffels MME, Bhashyam AR, Chen NC. Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate. Hand (N Y) 2024:15589447241233763. [PMID: 38420781 DOI: 10.1177/15589447241233763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND This research sought to analyze a cohort of patients with extensor pollicis longus (EPL) ruptures after volar locked plating of a distal radius fracture (DRF) to characterize the incidence of ruptures that are unlikely to be related to dorsal screw prominence. METHODS This is a retrospective, observational, descriptive cohort study of adults with operative fixation of a closed DRF and an EPL rupture between 2002 and 2022. Eighteen patients with operative fixation using a volar plate of a closed DRF had an EPL rupture. The cohort consisted of 66% women with an average age of 57.5 years. Median follow-up was 14.5 months. RESULTS The incidence of EPL rupture was 0.4% (18/4768). The average time from DRF and DRF fixation to EPL rupture was 3.7 and 3.4 months, respectively. Based on the operative record, in 2 of the 18 patients (11%), the rupture was directly attributable to prominent hardware; however, in 4 of the 18 patients (22%), the rupture was not related to prominent hardware, and the cause was indeterminate in 12 patients (67%). Radiologic analysis of those in the indeterminate group demonstrated that 5 of the 12 patients had screws that had a high probability of being prominent. CONCLUSIONS The incidence of EPL rupture after volar plating of DRF is between 0% and 1% and usually occurs about 3 months after fixation. Approximately 50% of EPL ruptures are attributable to prominent dorsal screws. Although screw prominence is an important cause of EPL rupture, it is not the sole cause of rupture.
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Affiliation(s)
- Charlotte L E Laane
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Anjuli L Dijkmans
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Chelsea J Messinger
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mathieu M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Abhiram R Bhashyam
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Neal C Chen
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Factor S, Druckmann I, Kazum E, Atlan F, Tordjman D, Rosenblatt Y, Eisenberg G, Pritsch T. A novel pulsed electromagnetic field device as an adjunct therapy to surgical treatment of distal radius fractures: a prospective, double-blind, sham-controlled, randomized pilot study. Arch Orthop Trauma Surg 2024; 144:543-550. [PMID: 37971511 DOI: 10.1007/s00402-023-05117-0] [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: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate whether using a Fracture Healing Patch (FHP) device that generates pulsed electromagnetic fields (PEMF), applied at the fracture site immediately after open reduction and internal fixation surgery, can accelerate healing of acute distal radius fractures. METHODS In a prospective, double-blind, randomized, and sham-controlled study, thirty-two patients with DRFs treated with ORIF were included. Patients were allocated to a PEMF (active) group (n = 15) or a control (sham) group (n = 17). All patients were assessed with regard to functional Patient-Rated Wrist Evaluation (PRWE), SF12, and radiological union outcomes (X-rays and computed tomography (CT) scans) at 2, 4, 6, and 12 weeks postoperatively. RESULTS Patients treated with the FHP demonstrated significantly bone bridging at 4 weeks as assessed by CT (70% vs 54%, p = 0.05). Mean grip strength in the active group was significantly higher as compared to control (16 ± 9 kg vs 7 ± 3.5 kg, respectively, p = 0. 02). The function subscale of the PRWE was significantly better in PEMF-treated group at 6 weeks after surgery (27.2 VS 35.5, p = 0.04). No statistically significant differences were found in SF12. CONCLUSION PEMF application after ORIF of DRFs is safe, may accelerate bone healing which could lead to an earlier return to daily life activities and work. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Shai Factor
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel.
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ido Druckmann
- Division of Radiology, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Efi Kazum
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Eisenberg
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lundqvist E, Olivecrona H, Wretenberg P, Sagerfors M. CT-Based Micromotion Analysis After Locking Plate Fixation of AO Type C Distal Radius Fractures. Indian J Orthop 2023; 57:2031-2039. [PMID: 38026840 PMCID: PMC10673767 DOI: 10.1007/s43465-023-01020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Background Volar locking plate fixation (VLPF) is the most common method for operative fixation of distal radius fractures (DRF). The dorsal ulnar corner (DUC) can be difficult to stabilize as the fragment is small and not exposed when using the volar approach. The purpose of this study was to study fracture fragment migration after VLPF of AO type C DRF, using a volume registration technique of paired CT scans with special focus on the DUC fragment. Materials and Methods This pilot study included ten patients with AO type C DRF, all operated with VLPF. The primary outcome was radiographic outcome. Postoperative and 1-year scans were compared and analyzed. Fragment migration was assessed with CT-based micromotion analysis (CTMA), a software technique used for volume registration of paired CT scans. Results All plates were stable over time. Two patients showed signs of screw movement (0.2-0.35 mm and 0.35- > 1 mm respectively). Postoperative reduction was maintained, and there was no fragment migration at the 1-year follow-up except for one case with increased dorsal tilt. The DUC fragment was found in 8/10 cases, fixated in 7/8 cases, and not dislocated in any case at the 1-year follow-up. Conclusion The CTMA results indicate that variable-angle VLPF after AO type C DRF can yield and maintain a highly stable reduction of the fracture fragments. The DUC fragment remained stable regardless of the number of screws through the fragment. CT volume registration can be a valuable tool in the detailed assessment of fracture fragment migration following volar plate fixation of DRFs.
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Affiliation(s)
- Eva Lundqvist
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Per Wretenberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
| | - Marcus Sagerfors
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
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Hong DY, Kunes JA, Tedesco LJ, Danford NC, Strauch RJ. Anatomic Risks with Overpenetration of the Volar Locking Plates' Proximal Holes. J Wrist Surg 2023; 12:534-539. [PMID: 38213563 PMCID: PMC10781574 DOI: 10.1055/s-0043-1768926] [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: 09/12/2022] [Accepted: 04/03/2023] [Indexed: 01/13/2024]
Abstract
Background Volar locking plate fixation (VLP) is commonly used to treat distal radius fractures (DRF). Risk of dorsal compartment injury with distal screw hole fixation has been studied; however, the risk with proximal screw hole fixation is not well studied. Purpose The goal of this study was to investigate the risk of dorsal structure injury from the screw holes proximal to the two distal rows. Methods Nine cadaveric forearms were used. After volar distal radius exposure, a long VLP was applied. Kirschner wires were placed through the most proximal holes into the dorsal compartments. The extensor structures penetrated were noted and tagged with hemoclips. The distance from the dorsal cortex to the structures was measured. Results The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscle bodies were only penetrated; no tendons were penetrated. Proportion of muscle penetration increased with the more proximal screw holes. EPB was more likely to be penetrated distally and APL proximally; both were injured at holes 2 and 3. The extensors were 2 mm from the dorsal cortex of the radius on average; this did not decrease with compression of the forearm. Conclusions This is the first study to examine the anatomic risk of extensor structure injury with VLP proximal screw hole penetration. No extensor tendons were penetrated by these proximal screw holes; first dorsal compartment muscle bellies may be irritated with overpenetration. Our findings suggest that proximal VLP screws do not need to be downsized if they are not over 2 mm prominent.
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Affiliation(s)
- Daniel Y. Hong
- Columbia University Medical Center, New York City, New York
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