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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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Newton A, Julian H, Theodoraki M, Redfern J, Cheung G, Brown D. Modes of failure following locking plate fixation of the distal radius: a thematic analysis of 517 fractures. J Hand Surg Eur Vol 2024; 49:366-371. [PMID: 37310030 DOI: 10.1177/17531934231179382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Anterior locking plate fixation of the distal radius is a common procedure with reliable results. Failure of fixation is sometimes seen. The aim of the present study was to identify the reasons for failure. In total, 517 cases met the study inclusion criteria. Of them, 23 cases had failure of fixation (4.4%). Failure analysis generated qualitative data. Subsequent thematic analysis identified the primary mode of failure and contributing factors. Primary modes were identified as failure to support all key fracture fragments (n = 20), wrong choice of implant (n = 1), failure of union (n = 1) and poor bone quality (n = 1). Contributing factors were errors in plate positioning, fracture reduction, implant selection and screw configuration, as well as fracture pattern complexity and poor bone quality. Most failed fixations had a primary mode and two or three contributing factors. Overall anterior plating is reliable with a low rate of surgical failure. Knowledge of failure modes will aid operative planning and prevent failure.Level of evidence: V.
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Affiliation(s)
- Ashley Newton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Harriet Julian
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mona Theodoraki
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - James Redfern
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Graham Cheung
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel Brown
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Pawan Kumar KM, Hawaldar S, Patil M. Functional outcome of volar variable angle locking compression plate in distal end radius fractures: A retrospective case record analysis. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2023. [DOI: 10.4103/jodp.jodp_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Holm-Glad T, Røkkum M, Röhrl SM, Roness S, Godang K, Reigstad O. A randomized controlled trial comparing two modern total wrist arthroplasties : improved function with stable implants, but high complication rates in non-rheumatoid wrists at two years. Bone Joint J 2022; 104-B:1132-1141. [PMID: 36177637 DOI: 10.1302/0301-620x.104b10.bjj-2022-0201.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. METHODS A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared. RESULTS Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis. CONCLUSION Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J 2022;104-B(10):1132-1141.
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Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Roness
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Jain M, Solanki M, Sharma D, Prasad R. Evaluation of functional and radiological outcome of five-pin technique in management of distal end radius fractures. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2022. [DOI: 10.4103/jotr.jotr_113_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bahar-Moni AS, Wong SK, Mohd-Shariff N, Sapuan J, Abdullah S. A Review of Surgically Treated Distal Radius Fractures in a University Hospital. Malays Orthop J 2021; 15:52-57. [PMID: 34966495 PMCID: PMC8667247 DOI: 10.5704/moj.2111.008] [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] [Received: 11/07/2020] [Accepted: 07/19/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Distal radius fracture (DRF) is the most common orthopaedic injury with a reported incidence of 17.5%. It is commonly seen in young males and elderly females. Over the last two decades, there is an increasing tendency to treat DRF surgically by open reduction and internal fixation (ORIF) with plate and screws owing to improved device design, better fixation and operative technique. The purpose of this study was to evaluate the demographic characteristics, type and method of fixation, and outcome in all surgically treated DRF cases from 2014 to 2018 in a university hospital. Materials and methods: A retrospective review of all surgically treated DRF cases with one year follow-up in a tertiary hospital in Malaysia was done. Patients who left the follow-up clinic before one-year post-surgery or before fracture union were excluded. A total of 82 patients with 88 DRF were finally included into the study and outcome in terms of union time and need of multiple surgeries were analysed along with the predictors. Results: In this study, mean age of the patient was 46.2 years. Motor vehicle accident was the commonest cause of the fracture and AO Type C fracture was the commonest fracture type. Seventeen (19.3%) out of 88 fractures were compound fracture. Open reduction and internal fixation with volar plate was the most common surgical technique done in this series (93.2%). Three (3.5%) out of 88 fractures required multiple surgeries and eighty-three (94.3%) DRF cases were united before nine months of the surgery in this study. There was statistically significant association between clinical type of the fracture and the union time (p-value <0.05). Conclusion: There was a 1.7:1 male-female ratio with AO-C fracture being the most common type of fracture. The most common method of fixation was ORIF with volar locked plate. Patients with closed fractures have a higher rate of union compared to open fractures at nine months.
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Affiliation(s)
- A S Bahar-Moni
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kepala Batas, Malaysia
| | - S K Wong
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - N Mohd-Shariff
- Life Style Cluster, Universiti Sains Malaysia, Kepala Batas, Malaysia
| | - J Sapuan
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - S Abdullah
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Jose A, Suranigi SM, Deniese PN, Babu AT, Rengasamy K, Najimudeen S. Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates. J Clin Diagn Res 2017; 11:RC04-RC08. [PMID: 28274009 DOI: 10.7860/jcdr/2017/24114.9261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. AIM The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. MATERIALS AND METHODS We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento's modification of Lindstorm criteria respectively. RESULTS There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento's modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. CONCLUSION The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius.
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Affiliation(s)
- Anto Jose
- Resident, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Shishir Murugharaj Suranigi
- Associate Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Pascal Noel Deniese
- Assistant Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Abey Thomas Babu
- Assistant Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Kanagasabai Rengasamy
- Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Syed Najimudeen
- Professor and Head, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
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Optimal management of distal radial fractures in the elderly. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weil YA, Mosheiff R, Firman S, Liebergall M, Khoury A. Outcome of delayed primary internal fixation of distal radius fractures: a comparative study. Injury 2014; 45:960-4. [PMID: 24731691 DOI: 10.1016/j.injury.2014.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND AIM Operative fixation of distal radius fractures using fixed-angle devices has become increasingly common. Although good to excellent results have been reported in acute fractures, little is currently known regarding the fixation of healing displaced distal radius fractures that were presented late. The aim of this study was to evaluate the results of internal fixation of distal radius fractures presented late (>21 days) as compared with an acute-care control group. METHODS Forty patients operated on for displaced distal radius fractures, presenting more than 21 days after injury (delayed treatment (DT) group), were compared with 75 age-matched controls with acute fracture repair (≤21 days). The same surgical approach was used in both groups, together with dorsal soft-tissue and brachioradialis release. No osteotomy was required. Direct and indirect reduction aids were used. A fixed-angle device (DVR; Biomet Inc., Warsaw, IN, USA) was used in both groups. Mean follow-up was 3.4 years. Quick DASH (Disabilities of the Arm, Shoulder and Hand) and Short Form 12 scores were used to evaluate outcome, as well as radiographic analysis for Arbeitsgemeinschaft für Osteosynthesefragen(AO)/Orthopaedic Trauma Association(OTA) classification, volar tilt, radial inclination and radial length. RESULTS Average age was 53 years in both groups and male to female (M/F) ratio was similar in the study groups. Mean time to surgery was 30 days in the DT group and 8 days in the control group. There were significantly more type C (91.5% vs. 67.5%) fractures in the control group. The average quick DASH score was 27.1 in the DT group as compared with 6.3 in the control group (p<0.03); however, when controlling for two outlier cases with complications (hardware irritation and a sensory neuropathy) there was no significant difference. Volar tilt, radial inclination and length were similar in both groups and were within normal anatomical values. CONCLUSIONS Delayed primary operative fixation of displaced unstable distal radial fractures is a viable option for cases that were presented late, with predictable, favourable results. Neither extensile approaches nor formal osteotomies are required.
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Affiliation(s)
- Yoram A Weil
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
| | - Rami Mosheiff
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Shimon Firman
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Meir Liebergall
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Amal Khoury
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
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Machado DG, da Cruz Cerqueira SA, Rodarte RRP, de Souza Araújo Netto CA, de Mathias MB. STATISTICAL ANALYSIS ON FUNCTIONAL AND RADIOGRAPHIC RESULTS AFTER USE OF LOCKED VOLAR PLATE FOR FRACTURES OF THE DISTAL RADIUS. Rev Bras Ortop 2012; 47:297-303. [PMID: 27042637 PMCID: PMC4799408 DOI: 10.1016/s2255-4971(15)30102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/26/2011] [Indexed: 12/02/2022] Open
Abstract
Objectives: To evaluate the functional results from using a fixed-angle locked volar plate for treating fractures of the distal extremity of the radius, using the DASH (disorders of the arm, shoulder and hand) questionnaire and its radiographic correlation with the Lidström classification. Methods: Thirty patients with unstable fractures of the distal extremity of the radius were evaluated after they had undergone a surgical procedure consisting of open reduction and internal fixation using a fixed-angle locked volar plate, at the Military Police Central Hospital of Rio de Janeiro between 2008 and 2009. The results were assessed based on range of motion, DASH protocol scores and radiographies with the Lidström classification. Results: The mean age of the patients in the study was 51 years. The mean DASH score was 11.9 points. It was observed that the radiographic findings did not influence the DASH score. It was found that flexion, pronation, supination and radial deviation correlated with the DASH score. Conclusions: The study showed that subjective functional outcomes using the DASH protocol, obtained from using a locked volar plate to treat fractures of the distal extremity of the radius, are influenced by the range of motion, and especially by the flexion, supination, pronation and radial deviation of the wrist after surgery. There is no correlation between the radiological parameters of either the normal or the operated radius, and the subjective functional outcomes assessed using the DASH protocol.
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Affiliation(s)
- Daniel Gonçalves Machado
- Former Resident at the Central Hospital of the Military Police; Member of the Brazilian Society of Orthopedics and Traumatology (SBOT), Rio de Janeiro, RJ, Brazil
| | - Sergio Auto da Cruz Cerqueira
- Former Resident at the Central Hospital of the Military Police; Member of the Brazilian Society of Orthopedics and Traumatology (SBOT), Rio de Janeiro, RJ, Brazil
| | - Rodrigo Ribeiro Pinho Rodarte
- MSc in Public Health; Preceptor of Medical Residence, Central Hospital of the Military Police, Rio de Janeiro, RJ, Brazil
| | | | - Marcelo Bezerra de Mathias
- MSc in Orthopedics; Head of the Orthopedics and Traumatology Service, Central Hospital of the Military Police, Rio de Janeiro, RJ, Brazil
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