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Bowers M, Gruenberger E, Jardaly AH, Wood M, Ko A, D'Almeida S, Rubin TA. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-Specific Fixation. J Wrist Surg 2023; 12:500-508. [PMID: 38213565 PMCID: PMC10781579 DOI: 10.1055/s-0043-1761286] [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: 07/06/2022] [Accepted: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t -Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion ( p = 0.08), extension ( p = 0.33), supination ( p = 0.35), or pronation ( p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.
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Affiliation(s)
- Mitchell Bowers
- Department of Orthopaedics, Vanderbilt University, Nashville, Tennessee
| | - Eric Gruenberger
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Achraf H. Jardaly
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Madison Wood
- Medical College of Georgia, Medical College of Georgia, Augusta, Georgia
| | - Andrew Ko
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Stacey D'Almeida
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Todd A. Rubin
- Hand and Upper Extremity Surgery Department, Hughston Clinic Orthopaedics, TriStar Centennial Medical Center, Nashville, Tennessee
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Fallah Y, Zohrabi K, Shariyate MJ. Persian Fixation - A Novel Surgical Method for Intra-articular Distal Radius Fractures. J Hand Surg Asian Pac Vol 2023; 28:172-177. [PMID: 37120293 DOI: 10.1142/s2424835523500170] [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: 05/01/2023]
Abstract
Background: Intra-articular distal radius fracture treatment options include Kirschner wires (K-wire) fixation, external fixation and plate fixation, however, fixation of small bone fragments in distal radius fractures in a secure and anatomical manner was a challenging issue with several limitations. In this study, we present a novel surgical method that we have called the Persian Fixation for intra-articular distal radius fracture and describe a short-term clinical result. Methods: We described the surgical procedure and clinical result of 15 patients between 2019 and 2020 in whom the Persian Fixation technique was utilised. Through clinical examination and questionnaires, objective and subjective clinical results were determined. Results: At the final follow-up, the mean Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score for our patients was 17.6 ± 12.1, the mean WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) score was 20.7 ± 4.4 and the mean Visual Analogue Scale (VAS) score was 27.8 ± 16.5, indicating a good to excellent clinical result. Conclusions: We recommended the Persian Fixation technique for intra-articular distal radius fractures, which is a low-cost and readily accessible procedure that provides stable fixation of a tiny bone piece. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Yousef Fallah
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kian Zohrabi
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Javad Shariyate
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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de Villeneuve Bargemon JB, Soudé G, Levadoux M, Viaud-Ambrosino S, Peras M, Camuzard O. Radiocarpal fracture-dislocation: Review of the literature, new classification and decision algorithm. Orthop Traumatol Surg Res 2023; 109:103547. [PMID: 36638866 DOI: 10.1016/j.otsr.2023.103547] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Radiocarpal fractures and dislocations are rarely described in the literature. However, the consequences at the functional level are severe, with the loss of almost half of the articular amplitude. The most widespread classification is that of Dumontier, which divides the injury into two categories according to the presence or absence of a fracture. Currently, no classification considers fracture-dislocations in a global and multi-tissue manner; therefore, no therapeutic strategy has been reported. METHODS We conducted an exhaustive bibliographic search for cohort or case report articles concerning radiocarpal fracture-dislocations published between 1990 and the present. Only descriptions of the injury were identified (noting the type of fracture, direction of displacement and carpal injuries). RESULTS In all, data were collected from 14 retrospective series and 16 case reports involving 218 patients. Thirty-five and 183 cases involved anterior and posterior displacement, respectively. A fracture of the distal radius was found in 183 cases and 35 cases had a dislocation only, with no significant fracture. Among the posterior displacements, 44 isolated styloid fractures, 62 styloid and posterior marginal fractures, 29 bimarginal fractures (large anterior fragment and small posterior fragment) and 31 fractures of all the fragments described by Medoff with impaction of the central pavement were found. Anterior displacement fractures were found in 17 cases (styloid and/or anterior marginal fracture). We were able to group the different traumatic clinical forms according to a six-category classification. DISCUSSION A review of the literature highlighted three major components in the management of radiocarpal fracture-dislocations: the bone component, the ligament component and the associated intracarpal lesions. These three components were included in our classification and allowed us to accurately describe all types of radiocarpal fracture-dislocations published in the literature. Authors currently agree on management of the bone component but disagree on that of the ligament component. Particular attention should be paid to intracarpal lesions, which lead to poor outcomes if ignored. Based on our biographical research, we propose a management plan for these complex injuries. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand, Wrist and Elbow Surgery, Saint-Roch Private Hospital, 99, avenue Saint-Roch, 83100 Toulon, France; University Institute of Locomotor and Sport (IULS), Pasteur Hospital, 30, voie romaine, 06100 Nice, France.
| | - Guillaume Soudé
- Orthopedic and Traumatology Surgery, Hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint-Roch Private Hospital, 99, avenue Saint-Roch, 83100 Toulon, France
| | - Sébastien Viaud-Ambrosino
- Hand surgery and limb reconstructive surgery, Timone Adult Hospital, Aix-Marseille University, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Matthieu Peras
- Department of orthopedic surgery and traumatology, Teaching Naval Hospital Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon France
| | - Olivier Camuzard
- University Institute of Locomotor and Sport (IULS), Pasteur Hospital, 30, voie romaine, 06100 Nice, France
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4
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Biondi M, Poggetti A, Fagetti A, Di Maro A, Bigazzi P, Pfanner S, Lauri G. Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study. Eur J Trauma Emerg Surg 2021; 48:4577-4584. [PMID: 34041552 DOI: 10.1007/s00068-021-01710-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Volar rim fractures of the distal radius are a spectrum of pathology that must be well identified and treated to achieve good outcomes and avoid surgical failures. New devices of fragment specific fixation have been developed during the last decades to fix this fragment. The purpose of this retrospective study was to evaluate the ability of APTUS® wrist distal radius system to securely fix different types of volar rim fractures. METHODS Patients with at least 1 year of follow-up and a preoperative CT-scan evaluation of the fracture pattern were included in the study. Clinical, radiological and functional outcomes were assessed. RESULTS Sixty-eight patients with an average follow-up of 34, 1 months (12-61) were included in the study. There were no clinical and radiological complications, including loss of reduction, device failure and tendon ruptures. No patients required hardware removal. Wrist range of motion in flexion-extension averaged 96°, while in pronation-supination 144°. At final follow-up mean visual analogue scale pain was 1,8. Questionnaires, as dissabilities of the arm, shouldder and hand (DASH) score and patient-related wrist evolution (PRWE) score were 6,6 and 3 respectively. Grip strenght measured 86% compared to the normal side. CONCLUSION APTUS® wrist presents a versatile set of fragment specific fixation plates able to easily and securely fix all types of volar rim fracture. The system can be used with other devices without any kind of interference between them. When correctly placed and used with the right indications, no late complications can be recorded.
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Affiliation(s)
- Marco Biondi
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Andrea Poggetti
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Agostino Di Maro
- Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Prospero Bigazzi
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sandra Pfanner
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Lauri
- Surgery and Reconstructive Microsurgery Unit of the Hand, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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5
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Garg B, Bansal T, Mehta N. The "AIIMS hairpin loop" technique for 'extreme' volar rim fractures of distal radius. J Clin Orthop Trauma 2020; 15:46-50. [PMID: 33680824 PMCID: PMC7919956 DOI: 10.1016/j.jcot.2020.10.049] [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: 08/10/2020] [Revised: 09/06/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Treatment of distal radius fractures has seen a paradigm shift since the use of volar locking plates became popular. However, there is a subset of fractures, which includes extreme distal volar rim fractures, that is often not amenable to fixation by volar locking plates as there is insufficient bone mass to put screws. These fractures as such are quite rare but carry a huge morbidity due to frequent lack of anatomical reduction and fixation. A number of different techniques like hook plates, specially designed distal volar locking plates and loop wire techniques have been described for these fractures, but they have been found to be less helpful when the fracture fragments are very small. METHODS Herein, we describe our experience on 6 patients, using a novel surgical technique for fixation of distal radius volar rim fractures which works equally well even when the fragments are quite small (2-3 mm). The technique uses low cost and readily available implants (K wire and conventional volar locking plate) without the need of any special implants. RESULTS The total of 6 cases of distal radius volar rim fractures (AO/OTA Type B3 = 4, Type C1 = 2) were operated. The mean age was 50.83 years (range: 31-72). The mean follow-up duration was 43.3 months (range: 26-66). The mean size of the volar fragment was 3.66 mm (range: 2-5). The mean pronation and supination were 72.5° (60-80) and 74.2° (60-85). The main flexion and extension were 52.5° (40-75) and 58.3° (50-80) respectively. The mean grip strength was 19.8 kg (4-38) and it was mean 79.3% (40-130%) compared to uninjured side. The mean PRWE score was 12.3 (2-31). One patient developed symptoms of Complex Regional Pain syndrome 1 (CRPS 1) which resolved with conservative management and no other complications were noted. CONCLUSION Our technique offers an indigenous, cost-effective way for fixation of extreme volar rim fracture fragments which can be easily adopted and used by surgeons in developing countries.
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6
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Meaike JJ, Kakar S. Management of Comminuted Distal Radius Fractures: A Critical Analysis Review. JBJS Rev 2020; 8:e2000010. [PMID: 32960024 DOI: 10.2106/jbjs.rvw.20.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Distal radius fractures occur in a bimodal age and sex distribution. Their incidence continues to rise with an increasingly active aging population. The current American Academy of Orthopaedic Surgeons guidelines for operative intervention are radial shortening of >3 mm, dorsal tilt of >10[degrees], or intra-articular displacement or step-off of >2 mm. The method of reduction and fixation should be selected on a case-by-case basis with a focus on patient factors, fracture behavior, surgical proficiency, and functional outcomes.
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Affiliation(s)
- Joshua J Meaike
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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7
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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.
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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
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8
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Abstract
Distal radial fractures account for up to 18% of all fractures in patients over 65 years of age, and osteoporosis is a predominant factor in these fractures. Fracture treatment may include closed reduction and casting/splinting, external fixation, and open reduction and internal fixation.
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Affiliation(s)
- John C Wu
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - Carson D Strickland
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James S Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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9
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Tordjman D, Hinds RM, Yang SS, Capo JT. Radial Shaft Convergence in Distal Radius Fractures: Diagnosis and Treatment. Tech Hand Up Extrem Surg 2018; 22:19-25. [PMID: 29462074 DOI: 10.1097/bth.0000000000000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Radial shaft convergence in distal radius fractures is often misdiagnosed. This common deformation is often associated with a radial translation of the distal fragment. This parameter has to be corrected because of the increased risk of distal radioulnar joint instability due to detensioning of the distal interosseous membrane if there is an associated triangular fibrocartilage complex lesion. A new radiologic sign for diagnosis of proximal radius convergence during distal radius fracture is presented as well as technical tips for correction of this deformity.
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Affiliation(s)
- Daniel Tordjman
- Department of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Richard M Hinds
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases
| | - S Steven Yang
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases
| | - John T Capo
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases
- RWJ Barnabas Health-Jersey City Medical Center, Jersey City, NJ
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10
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Rhee PC, Shin AY. Management of Complex Distal Radius Fractures: Review of Treatment Principles and Select Surgical Techniques. J Hand Surg Asian Pac Vol 2016; 21:140-54. [PMID: 27454627 DOI: 10.1142/s2424835516400063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most distal radius fractures are the result of low-energy mechanisms that can be successfully treated either non-operatively or with a variety of operative techniques if indicated. Complex distal radius fractures occur most commonly in high-energy injuries with extensive comminution or bone loss and associated soft tissue or vascular injuries. These high-energy fractures can present many challenges in reconstructing the distal radius. Effective restoration of the bony architecture requires a thorough knowledge of distal radius anatomy, understanding of the goals of treatment, versatility in surgical approaches, and familiarity with multiple fixation options.
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Affiliation(s)
- Peter Charles Rhee
- Division of Hand and Microvascular Surgery, Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX, United States
| | - Alexander Y. Shin
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
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11
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Ross M, Allen L, Couzens GB. Correction of Residual Radial Translation of the Distal Fragment in Distal Radius Fracture Open Reduction. J Hand Surg Am 2015; 40:2465-70. [PMID: 26489900 DOI: 10.1016/j.jhsa.2015.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/15/2015] [Accepted: 09/18/2015] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are common injuries of the upper extremity requiring treatment. In recent years, volar locking plate (VLP) fixation has become favored for operative treatment with the main goals being anatomic reduction and rigid fixation allowing for an early range of motion rehabilitation protocol. VLP fixation is excellent at correcting sagittal plane alignment with restoration of volar tilt. However, plate designs do not have any intrinsic features to their designs to assist with correction of coronal plane translation. One possible sequela of distal radius fractures is residual instability of the distal radioulnar joint. This instability can lead to pain and disability after treatment of distal radius fractures requiring further interventions. It has been demonstrated that coronal plane malreduction with residual radial translation of the distal fragment may contribute to ongoing distal radioulnar joint instability after distal radius fractures. We describe a technique for intraoperative correction of residual radial translation. It may be used when radial translation is recognized during internal fixation with a VLP or when correction of radial translation is required as part of a corrective osteotomy for radial malunion.
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Affiliation(s)
- Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Queensland, Australia; Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; School of Medicine, The University of Queensland, St. Lucia, Queensland, Australia.
| | - Lex Allen
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Queensland, Australia; Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Southern Utah Orthopedics and Sports Medicine Clinic, Valley View Medical Centre, Cedar City, Utah
| | - Gregory B Couzens
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Queensland, Australia; Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
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12
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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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13
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Kitay A, Mudgal C. Volar carpal subluxation following lunate facet fracture. J Hand Surg Am 2014; 39:2335-41. [PMID: 24908555 DOI: 10.1016/j.jhsa.2014.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 03/26/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Alison Kitay
- Department of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Boston, MA.
| | - Chaitanya Mudgal
- Department of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Boston, MA
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14
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Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in addition to volar-locked plating. Hand (N Y) 2014; 9:230-6. [PMID: 24839427 PMCID: PMC4022945 DOI: 10.1007/s11552-013-9585-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The volar lunate facet fragment of a distal radius fracture may not be stabilized with volar-locked plating alone due to the small size and distal location of the fragment. Identification and stabilization of this small fragment is critical as unstable fixation may result in radiocarpal and radioulnar joint subluxation. The addition of spring wire fixation with volar plating can provide stable internal fixation of this critical fracture fragment. METHODS A retrospective review (2006-2011) identified nine patients with distal radius fractures with an associated volar lunate facet fragment that were treated with volar-locked plating and spring wire fixation of the volar lunate facet fragment. Radiographic indices, range of motion, grip strength, and postoperative Patient-related wrist evaluation (PRWE) scores were obtained to assess pain and function. RESULTS All distal radius fractures healed, and the volar lunate facet fragment reduction was maintained. The mean follow-up was 54 weeks. Mean active range of motion was 46° wrist flexion, 51° wrist extension, 80° pronation, and 68° supination. The mean grip strength was 21 Kg, achieving 66 % of the uninjured limb. The average PRWE score was 17. No patient required removal of hardware or had evidence of tendon irritation. CONCLUSIONS The addition of spring wire fixation to volar-locked plating provided stable fixation of the volar lunate facet fragment of distal radius fractures without complication. This technique addresses a limitation of volar-locked plating to control the small volar lunate facet fragment in distal radius fractures otherwise amenable to volar plating. LEVEL OF EVIDENCE A retrospective case series, Level IV.
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