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Lau V, Tosti R, Rivlin M. Technique for Minimally Invasive, Arthroscopic-assisted Distal Radius Fracture Fixation. Tech Hand Up Extrem Surg 2024; 28:101-105. [PMID: 37968967 DOI: 10.1097/bth.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Distal radius fractures are common injuries that often require surgical intervention. Commonly, these fractures are fixed using open reduction internal fixation with plating and screws. This often requires a more extensive soft tissue dissection and exposure. In contrast for certain cases, percutaneous headless compression screws may be appropriate. We present a technique for minimally invasive arthroscopic-assisted reduction and percutaneous screw fixation with an extremity traction device. A case is provided to demonstrate the technique as a viable option for the treatment of intra-articular distal radius fractures.
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Affiliation(s)
- Vincent Lau
- Jefferson Health, New Jersey Department of Orthopedic Surgery, Stratford, NJ
| | - Rick Tosti
- Rothman Orthopedic Institute Department of Hand Surgery, Philadelphia, PA
| | - Michael Rivlin
- Rothman Orthopedic Institute Department of Hand Surgery, Philadelphia, PA
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2
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Kamal RN, Bronenberg P, Shapiro LM. Volar Intra-articular Extended Window Approach for Intra-articular Distal Radius Fractures. Tech Hand Up Extrem Surg 2024; 28:115-121. [PMID: 37994780 PMCID: PMC11105992 DOI: 10.1097/bth.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Distal radius fractures are one of the most common injuries seen globally with increasing use of use of volar plating for surgical treatment. Although it is common to directly visualize the articular surface for most other periarticular fractures, during volar plating of the distal radius the joint is typically not visualized. This is due to concern for carpal instability from disruption of the volar carpal ligaments. When direct visualization of the articular surface is deemed necessary, either to reduce articular fragments or to confirm the quality of reduction, current options include a separate dorsal arthrotomy or arthroscopic assistance. However, biomechanical evidence supports safely performing a volar capsulotomy to visualize the articular surface. We describe the Volar Intra-Articular Extended Window approach, which allows direct visualization of the articular surface through the volar approach to treat distal radius fractures.
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Affiliation(s)
- Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Pedro Bronenberg
- Hand and Upper Extremity Surgery Department, Prof. Dr. “Carlos Ottolenghi Institute”, Hospital Italiano de Buenos Aires
| | - Lauren M. Shapiro
- UC San Francisco Department of Orthopaedic Surgery, San Francisco, CA
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Douleh DG, Baldini T, Rogers M, Leversedge FJ, Lauder A. Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Anatomical Description and Quantification of Articular Surface Area Visualized in a Cadaveric Model. J Hand Surg Am 2024; 49:491.e1-491.e6. [PMID: 36253197 DOI: 10.1016/j.jhsa.2022.08.015] [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: 01/20/2022] [Revised: 07/06/2022] [Accepted: 08/10/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius (DR) fracture repair using the volar locked plating technique typically involves indirect fracture reduction, assessed using fluoroscopy, without direct visualization of the articular surface. This method of fracture repair may be guided by the rationale that volar radiocarpal ligament disruption may cause radiocarpal instability, although direct articular visualization may facilitate improved fracture reduction. This study investigated anatomical feasibility and articular surface visualization using volar ligament-sparing radiocarpal arthrotomy pertinent to DR fracture repair. METHODS Ten fresh-frozen cadaveric specimens of the upper extremity underwent volar arthrotomy via the standard flexor carpi radialis approach with partial longitudinal sectioning of the long radiolunate and partial transverse sectioning of the short radiolunate ligaments to visualize the articular surface of the DR. Following arthrotomy, the visible surface of the DR was analyzed using digital photography. The wrist was disarticulated, and the fully exposed articular surface was photographed. The visible area of the articular surface was quantified using digital imaging software by calculating the ratio of the surface area visualized using the arthrotomy to the total articular surface area. RESULTS The percentage of the articular surface area of the DR visualized using the volar arthrotomy was 76% ± 7.6% (range, 69%-90%), including both the scaphoid facet, lunate facet, and scapholunate ridge. CONCLUSIONS Volar radiocarpal arthrotomy allows clinically relevant visualization of the articular surface of the DR, including the scaphoid and lunate facets. CLINICAL RELEVANCE Radiocarpal arthrotomy may facilitate improved articular reduction during DR fracture repair via the volar approach.
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Affiliation(s)
- Diana G Douleh
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Todd Baldini
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Michael Rogers
- Department of Physics, University of Colorado, Denver, CO
| | - Fraser J Leversedge
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Alexander Lauder
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO; Department of Orthopedics, Denver Health Medical Center, Denver, CO.
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Pérez-Úbeda MJ, Arribas P, Gimeno García-Andrade MD, Garvín L, Rodríguez A, Ponz V, Ballester S, Fernández S, Fuentes-Ferrer M, Ascaso A, Portolés-Pérez A, Marco F. Adjuvant Arthroscopy Does Not Improve the Functional Outcome of Volar Locking Plate for Distal Radius Fractures: A Randomized Clinical Trial. Arthroscopy 2024; 40:305-317. [PMID: 37394147 DOI: 10.1016/j.arthro.2023.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To evaluate the outcomes of adding arthroscopy to osteosynthesis of distal radius fractures (DRF) with volar locking plate (VLP), by Patient-Rated Wrist Evaluation (PRWE) 1 year after surgery. METHODS In total, 186 functionally independent adult patients who met the inclusion criteria (DRF and a clinical decision for surgery with a VLP) were randomized to arthroscopic assistance or not. Primary outcome was PRWE questionnaire results 1 year after surgery. For the main variable, PRWE, we obtained the minimal clinically important difference based on a distribution-based method. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand and 12-Item Short Form Health Survey questionnaires, range of motion, strength, radiographic measures, and presence of joint step-offs by computed tomography. Data were collected preoperatively and at +1 and +4 weeks, +3 and +6 months, and +1 year after surgery. Complications were recorded throughout the study. RESULTS In total, 180 patients (mean age: 59.0 ± 14.9 years; 76% women) were analyzed by modified intention to treat. A total of 82% of the fractures were intra-articular (AO type C). No significant difference between arthroscopic (AG) and control (CG) groups in median PRWE was found at +1 year (median AG: 5.0, median CG: 7.5, difference in medians 2.5; 95% confidence interval [CI] -2.0, 7.0, P = .328). The proportion of patients who exceeded the minimal clinically important difference of 12.81 points in the AG and CG was 86.4% vs 85.1%, P = .819, respectively. Percentage of associated injuries and step-offs reduction maneuvers was greater with arthroscopy (mean differences: 17.1 95% CI -0.1, 26.1, P < .001) and 17.4 (95% CI 5.0, 29.7, P = .007). The difference in percentage of residual joint step-offs at the postsurgical computed tomography in radioulnar, radioscaphoid, and radiolunate joints was not significant (P = .990, P = .538, and P = .063). Complications were similar between groups (16.9% vs 20.9%, P = .842). CONCLUSIONS Adjuvant arthroscopy did not significantly improve PRWE score +1 year after surgery for DRF with VLP, although the statistical power of the study is below the initially estimated to detect the expected difference. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- María José Pérez-Úbeda
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
| | - Pedro Arribas
- Rehabilitation Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Lucía Garvín
- Rehabilitation Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto Rodríguez
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Virginia Ponz
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Sandra Ballester
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Jiménez Díaz Foundation, Madrid, Spain
| | - Sergio Fernández
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Manuel Fuentes-Ferrer
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ana Ascaso
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain; Pharmacology and Toxicology Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Antonio Portolés-Pérez
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain; Pharmacology and Toxicology Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Fernando Marco
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Surgery Department, Complutense University of Madrid, Madrid, Spain
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Román-Veas J, Gutiérrez-Espinoza H, Campos-Jara C, Martínez-García D. Arthroscopic Assistance in Surgical Management of Distal Radius Fractures: A Systematic Review and Meta-analysis. J Wrist Surg 2024; 13:86-95. [PMID: 38264129 PMCID: PMC10803148 DOI: 10.1055/s-0042-1757768] [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: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 10/17/2022]
Abstract
Background Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance. Methods Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed. Two authors independently performed the search and data extraction and assessed risk of bias (RoB) using the Cochrane RoB tool. Results A total of 1,780 relevant abstracts and citations were extracted in the preliminary search, which yielded 6 trials that met the eligibility criteria, and 3 studies were included in the quantitative synthesis. The overall pooled mean difference (MD) estimate showed no significant difference in the Disabilities of the Arm, Shoulder, and Hand scores between surgical groups with and without arthroscopic assistance (MD = 0.77 points, 95% confidence interval = -6.58 to 5.03, p = 0.79), with substantial heterogeneity (I 2 = 85%). Conclusion There was low-quality evidence that wrist arthroscopy conveyed not clinically or statistically significant difference to functional outcomes of patients with DRFs. However, our findings are limited by the numbers of studies included and lack of long-term follow-up, although they do provide a good starting point for future quality research.
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Affiliation(s)
| | | | - Christian Campos-Jara
- Exercises and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Darío Martínez-García
- Department of Physical Education and Sports, Faculty of Sports Sciences, University of Granada, Granada, Spain
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Yao J, Fogel N. Arthroscopic-Assisted Fracture Treatment in the Wrist. Hand Clin 2023; 39:533-543. [PMID: 37827606 DOI: 10.1016/j.hcl.2023.05.004] [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] [Indexed: 10/14/2023]
Abstract
Wrist arthroscopy in the setting of wrist fracture affords direct visualization of reduction and identification of associated cartilage and soft tissue injuries. Further, mitigating soft tissue insult in the setting of perilunate injuries may decrease postoperative pain and stiffness while attaining outcomes equivalent to open techniques in appropriately selected patients. Technical proficiency of the surgeon continues to be a limitation of the technique. Randomized controlled studies are needed to better understand outcomes.
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Affiliation(s)
- Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
| | - Nathaniel Fogel
- Department of Orthopaedic Surgery, Duke University, 10 Duke Medicine Circle, Durham, NC 27710, USA
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Crowe CS, Kakar S. Periarticular distal radius fractures and complex ligamentous injury: The role of arthroscopic evaluation. J Orthop 2023; 42:6-12. [PMID: 37389206 PMCID: PMC10302116 DOI: 10.1016/j.jor.2023.06.006] [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: 03/27/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose Distal radius fractures are associated with a high incidence of concomitant soft tissue injuries, including lesions of the triangular fibrocartilage complex and intercarpal ligaments. While advanced imaging has allowed for greater identification of such tears, discerning which lesions pose a functional consequence remains a challenge for the hand surgeon. A review and guideline for arthroscopic evaluation of suspected combined injuries is presented. Results Arthroscopic evaluation of distal radius fractures provides several unique advantages in such instances. Articular reduction can be performed via direct visualization with improvement in step-off and gapping. Furthermore, ligamentous injuries and carpal alignment can be directly assessed and treated. Conclusions Subtle features of combined ligamentous trauma may be overlooked in the presence of more obvious fracture patterns. Wrist arthroscopy allows not only for a gold-standard method of evaluating of these soft tissue injuries, but also a means of treatment.
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Affiliation(s)
| | - Sanjeev Kakar
- Corresponding author. Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 1st St. Southwest, Rochester, MN, 55905, United States.
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Karjalainen VL, Harris IA, Räisänen M, Karjalainen T. Minimal invasions: is wrist arthroscopy supported by evidence? A systematic review and meta-analysis. Acta Orthop 2023; 94:200-206. [PMID: 37114362 PMCID: PMC10141317 DOI: 10.2340/17453674.2023.11957] [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] [Received: 11/19/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures. METHODS We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention. RESULTS Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise. CONCLUSION The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.
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Affiliation(s)
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South West-ern Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Mikko Räisänen
- Department of Orthopae-dics and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Teemu Karjalainen
- Department of Surgery, Hospital Nova of Central Finland, Jyvaskyla, Finland and Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Malvern, Australia.
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9
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Williams DC, Piñal FD. Arthroscopic Management of Distal Radius Fractures and Malunions. HANDCHIR MIKROCHIR P 2023. [PMID: 36972589 DOI: 10.1055/a-1994-7446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Articular congruity is the most important prognostic factor when dealing with a distal intra-articular radius fracture or the correction of intra-articular malunion. This article details our approach with tips and tricks for effectively managing these complex injuries with the aid of dry arthroscopy.
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Affiliation(s)
- Daniel C Williams
- Hand, Wrist and Microsurgery, Dr Piñal and Associates, Madrid, Spain
- Griffith University School of Medicine and Dentistry, Gold Coast, Australia
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10
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Arthroscopic debridement of the dorsal capsule in intraarticular distal radius fractures: does it provide superior outcomes? Arch Orthop Trauma Surg 2022; 142:691-699. [PMID: 35059823 DOI: 10.1007/s00402-021-04246-8] [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: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Distal radius fractures (DRFs) are very common. One of the most significant complications after intraarticular DRF is arthrofibrosis with loss of wrist motion and pain. Wrist arthroscopy has become increasingly popular in the treatment of DRF with the advantage of good visualization of the joint surface and soft tissue injuries. In intraarticular DRFs injuries of the dorsal capsule are a characteristic finding which potentially cause loss of wrist motion. In this study, we investigated if arthroscopic debridement of dorsal capsule injuries at time of surgical fixation provides superior outcomes compared to the same treatment without debridement. MATERIALS AND METHODS Between 2013 and 2017, we included 42 patients who underwent arthroscopy-assisted palmar plating for intraarticular DRFs in a prospective randomized controlled study. In group A (intervention group), the dorsal capsule tears were debrided during primary surgery, while in group B these were left in place. Active range of motion (AROM), grip strength, subjective outcomes and radiographic results were assessed 3, 6 and 12 months after primary surgery. A subgroup analysis was performed for patient age, fracture severity and duration of immobilization. RESULTS Arthroscopic debridement of the dorsal capsule improved AROM in patients over 60 years of age, more severe fractures (AO 23 C2/C3) and prolonged postoperative immobilization for more than two weeks, while it was not relevant for younger patients with simple fractures and short immobilization. CONCLUSIONS Debridement of the injured dorsal capsule in arthroscopic-assisted surgical treatment of intraarticular DRFs can improve surgical performance and optimize patient outcomes in a specific subgroup of patients.
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American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand Clinical Practice Guideline Summary Management of Distal Radius Fractures. J Am Acad Orthop Surg 2022; 30:e480-e486. [PMID: 35143462 PMCID: PMC9196973 DOI: 10.5435/jaaos-d-21-00719] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 02/01/2023] Open
Abstract
The Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of distal radius fractures in adults older than 18 years. The scope of this guideline is limited to the treatment of acute distal radius fractures and does not address distal radius malunion. This guideline contains seven recommendations to assist orthopaedic surgeons and all qualified physicians managing patients with acute distal radius fractures based on the best current available evidence. It serves as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.
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Özdemir A, Pulatkan A, Eravsar E, Acar MA. The role of arthroscopy in the diagnosis of concomitant soft tissue injuries in scaphoid fractures and the effect of concomitant soft tissue injuries and fracture comminution on outcomes: A case-control study. Jt Dis Relat Surg 2021; 32:729-735. [PMID: 34842106 PMCID: PMC8650654 DOI: 10.52312/jdrs.2021.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives
This study aims to evaluate the role of arthroscopy in the diagnosis of concomitant injuries, to investigate the relationship between comminution and concomitant injuries, and to analyze the effect of concomitant injuries on functional outcomes in acute and subacute scaphoid fracture. Patients and methods
Between January 2011 and September 2018. A total of 32 acute scaphoid fracture patients (29 males, 3 females; mean age: 30±12 years; range, 18 to 65 years) were retrospectively analyzed. None of them had an obvious ligament injury in the radiological assessment. Functional outcomes were compared between concomitant and non-concomitant injuries and between comminuted and non-comminuted injuries. The percentage of range of motion (ROM), grip, and pinch strength were recorded according to the contralateral extremity to detect the restriction rate. The Mayo Wrist Score (MWS), the Turkish version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires were used to evaluate the functional results. Subjective pain was assessed using the Visual Analog Scale (VAS). The relationship between concomitant injuries and comminution was investigated. Results
There were 13 patients with comminuted fractures. Concomitant injuries were diagnosed in 17 patients. The presence of concomitant injuries was higher in comminuted fractures than in non-comminuted fractures. There was no significant difference between the groups in ROMs. The final follow-up Q-DASH, PRWE, MWS, and VAS scores and the pinch strength of non-comminuted fractures were found to be statistically better than those of comminuted fractures. There were statistically worse Q-DASH, PRWE, MWS, and VAS scores in patients with concomitant injuries. Conclusion
Arthroscopic scaphoid fracture surgery allows the diagnosis and treatment of concomitant lesions. The functional outcomes of concomitant lesions and comminuted fractures seem to be worse than those of others, while the ROM is comparable.
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Affiliation(s)
- Ali Özdemir
- Gazi Yaşargil Eğitim ve Araştırma Hastanesi El Cerrahisi Bölümü, 21010 Kayapınar, Diyarbakır, Türkiye.
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13
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Abstract
Wrist arthroscopy in the setting of distal radius fractures allows for direct visualization of the articular surface and treatment of associated soft tissue injuries. Arthroscopic techniques may be used to fine tune reductions with residual articular step-off or gap after an initial reduction attempt and are critical for addressing free articular fragments and die-punch lesions. Surgeon training, experience, and comfort with wrist arthroscopy remains a barrier to widespread adoption of this technique. Level I studies are needed to investigate whether improved articular reduction leads to meaningful clinical differences.
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14
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Klifto KM, Hein RE, Klifto CS, Pidgeon TS, Richard MJ, Ruch DS. Outcomes Associated With Scapholunate Ligament Injury Following Intra-Articular Distal Radius Fractures. J Hand Surg Am 2021; 46:309-318. [PMID: 33526293 DOI: 10.1016/j.jhsa.2020.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 09/26/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate a series of intra-articular distal radius fractures (DRFs) to determine whether patients without radiographic evidence of scapholunate (SL) ligament injury have a difference in outcomes in comparison with patients with radiographic evidence of SL ligament injury and no ligament repair or reconstruction. Our hypothesis is that there are no significant differences in outcomes between patients after treatment of their intra-articular DRF. METHODS A retrospective analysis of patients from a single institution who sustained an intra-articular DRF from January 2006 through January 2019 with minimum 12-month (n = 192) and 24-month (n = 100) follow-up was performed. Patient demographic, clinical, and outcome variables were compared between SL angles less than 70° (cohort 1) and SL angles 70° or greater (cohort 2). Radiographic parameters were measured and recorded at 3 time points: baseline in the contralateral wrist, following closed reduction but prior to surgical intervention, and at final follow-up. Outcomes collected included Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Global Assessment of Function (mGAF), and a visual analog scale (VAS) for pain. RESULTS One hundred ninety-two patients were included. Of these 192 patients, cohort 1 (n = 110) was observed to have median (range) SL angles of 58° (42°-68°) and cohort 2 (n = 82) median (range) SL angles of 74.5° (70°-87°) after closed reduction. Cohort 2 had statistically significant increases in median SL angles from closed reduction to final follow-up (74.5° [range, 70°-87°) to 78.5° (range, 71°-107°). There were no statistically significant differences in QuickDASH disability scores, mGAF scores, and VAS pain scores between the cohorts at initial and final follow-ups. CONCLUSIONS Patient-reported outcomes at 12 and 24 months do not differ between patients without radiographically apparent SL ligament injury (SL angles < 70°) and patients with radiographically apparent SL ligament injury(SL angles ≥ 70°) who do not undergo ligament repair or reconstruction following treatment of their intra-articular DRF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Kevin M Klifto
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Rachel E Hein
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Tyler S Pidgeon
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Marc J Richard
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - David S Ruch
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC.
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15
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Koo SCJJ, Leung KYA, Chau WW, Ho PC. Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment. J Wrist Surg 2021; 10:102-110. [PMID: 33815944 PMCID: PMC8012086 DOI: 10.1055/s-0040-1719039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.
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Affiliation(s)
| | - Kam Yiu Adrian Leung
- Occupational Therapy Department, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Wai Wang Chau
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong
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Slichter ME, Kraan GA, Bramer WM, Colaris JW, Mathijssen NMC. The role of concomitant ligament injury in the development of post-traumatic osteoarthritis after distal radius fractures: a protocol for a systematic review. BMJ Open 2020; 10:e039591. [PMID: 33093034 PMCID: PMC7583071 DOI: 10.1136/bmjopen-2020-039591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Treatment of distal radius fractures (DRFs) aims to restore anatomic position of the fracture fragments and congruity of the articular surface to optimise functional outcomes and prevent osteoarthritis in the long term. While ligament injury of the wrist is often associated with DRFs and sole ligament injuries of the wrist lead to osteoarthritis, it is plausible that concomitant ligament injury in DRFs may aggravate degenerative changes of the wrist. The relationship between concomitant ligament injury and post-traumatic osteoarthritis in patients with DRFs is unclear. This study aims to identify the types of associated ligament injury in patients with a DRF and to elucidate the association of ligament injury on the development of post-traumatic osteoarthritis. METHODS AND ANALYSIS This protocol is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines. An electronic search in MEDLINE, Embase, Web of Science, Cochrane Central Register of Trials and Google Scholar has been created and performed by a Health Sciences librarian with expertise in systematic review searching. Original research articles in English literature, which report on concomitant ligament injury of the wrist in relation to post-traumatic osteoarthritis, patient-reported outcome measures or clinician-reported outcome measures in patients (aged ≥18 years) with DRFs will be included. Two reviewers will independently screen and appraise articles and perform data extraction. In case of any disagreements, a third reviewer will be consulted. A systematic qualitative synthesis will be performed using text and tables. ETHICS AND DISSEMINATION No ethical approval is required, since this is a protocol for a systematic review. The systematic review will be submitted for publication in a peer-reviewed scientific journal and for presentation at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42020165007.
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Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost W Colaris
- Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
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Abstract
We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment.We retrospectively analyzed the records of 15 patients with chronic wrist pain following DRF, who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment from 2010 to 2017. The average patient age was 44 years (range, 20-68 years), average time from injury to treatment 21 ± 23.46 months (range, 3-96 months) and average follow up period 20.13 ± 8.71 months (range, 12-39 months). The functional outcome was evaluated by comparing the preoperative and final follow up values of the range of motion, grip strength, pinch strength, visual analogue scale for pain and quick disabilities of the arm, shoulder and hand score.Based on the arthroscopic findings, synovitis was found in all cases and the pathologic intra-articular lesions were classified into 4 patterns. Triangular fibrocartilage complex rupture was seen in 14 cases, intercarpal and radiocarpal ligament ruptures in 9 cases, ulnar impaction syndrome in 5 cases, and cartilage lesion in 9 cases. In terms of surgical treatment, 15 patients underwent arthroscopic synovectomy, 7 foveal or capsular repair of TFCC, 7 intercarpal Kirschner wires fixation or intercarpal thermal shrinkage, 1 intercarpal ligament reconstruction, 2 Sauve-Kapandji procedure, and 2 unlar shortening osteotomy. Postoperatively, the average range of motion, grip strength, and pinch strength increased significantly. From preoperative to final follow up values, the average visual analogue scale and quick disabilities of the arm score decreased from 5.93 ± 1.58 (range, 3-8) to 1.33 ± 1.29 (range, 0-3) (P = .001) and from 49.38 ± 19.09 to 12.63 ± 7.63 (P = .001), respectively.Diagnostic arthroscopy and arthroscopically-assisted tailored treatment of chronic wrist pain following DRF can provide an accurate diagnosis, significant pain relief, and functional improvement.
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Selles CA, Mulders MAM, Colaris JW, van Heijl M, Cleffken BI, Schep NWL. Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures: a randomized controlled trial. J Hand Surg Eur Vol 2020; 45:327-332. [PMID: 31686586 DOI: 10.1177/1753193419866128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to determine the difference in functional outcomes after open reduction and internal fixation (ORIF) with and without arthroscopic debridement in adults with displaced intra-articular distal radius fractures. In this multicentre trial, 50 patients were randomized between ORIF with or without arthroscopic debridement. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcome measures were Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, pain scores, range of wrist motion, grip strength, and complications. Median PRWE was worse for the intervention group at 3 months and was equal for both groups at 12 months. The secondary outcome measures did not show consistent patterns of differences at different time-points of follow-up. We conclude that patients treated with additional arthroscopy to remove intra-articular hematoma and debris did not have better outcomes than those treated with ORIF alone. We therefore do not recommend arthroscopy for removal of hematoma and debris when surgically fixing distal radius fractures. Level of evidence: I.
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Affiliation(s)
- Caroline A Selles
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost W Colaris
- Department of Orthopedic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Berry I Cleffken
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Krustins U, Krustins J, Bringina D, Laurane K, Jumtins A. Comparison of volar locking plates with external fixation and K-wires in arthroscopically assisted intra-articular distal radial fracture fixation. J Hand Surg Eur Vol 2020; 45:333-338. [PMID: 31594424 DOI: 10.1177/1753193419879567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article presents the results of a prospective cohort study that included 63 patients with intra-articular (AO Type C) distal radial fractures who were treated using an arthroscopically assisted approach with either volar locking plates or external fixator and K-wires. Postoperative analysis was carried out using X-ray assessment, clinical data, Patient-Rated Wrist Evaluation score, Gartland and Werley score, Modern Activity Subjective Survey of 2007 score, range of motion, grip, pinch and tripod pinch assessment at 1, 3, 6 and 12 months postoperatively. Despite the statistically significant differences found in a number of parameters during the period of observation, there were no clinically relevant differences determined between the two methods. There was a greater number of complications in the external fixator and K-wire treated patients. Level of evidence: II.
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Affiliation(s)
- Uldis Krustins
- Centre of Microsurgery of Latvia, Riga East University Hospital, Riga, Latvia
| | - Janis Krustins
- Centre of Microsurgery of Latvia, Riga East University Hospital, Riga, Latvia
| | - Diana Bringina
- Centre of Microsurgery of Latvia, Riga East University Hospital, Riga, Latvia
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Karelson MC, Jokihaara J, Launonen AP, Huttunen T, Mattila VM. Lower nationwide rates of arthroscopic procedures in 2016 compared with 1997 (634925 total arthroscopic procedures): has the tide turned? Br J Sports Med 2020; 55:1018-1023. [PMID: 32241819 PMCID: PMC8408579 DOI: 10.1136/bjsports-2019-101844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2020] [Indexed: 11/08/2022]
Abstract
Objectives To assess the rates and secular trends of different joint arthroscopies—shoulder, elbow, wrist, hip, knee and ankle—in Finland between 1997 and 2016. Design Retrospective nationwide registry study. Participants All adults in Finland with any arthroscopic intervention procedure code for knee, shoulder, ankle, wrist, elbow or hip arthroscopy between 1 January 1997 and 31 December 2016 were included. Main outcome measures Incidence rate of arthroscopic surgery per 100 000 person-years. Results The rate of knee and shoulder arthroscopies declined after reaching a peak in 2006 and 2007, respectively. The rates of wrist, elbow and hip joint arthroscopies declined after their 2014 peak. At the same time, the median age of patients who had knee, ankle and hip arthroscopy decreased, whereas the age of patients who had shoulder arthroscopy increased. Conclusions Numerous randomised controlled trials point to lack of efficacy of the most common knee and shoulder arthroscopic procedures. It should not be assumed that this has contributed to decreased rates of arthroscopic surgery. The concurrent decrease in most of the other joint arthroscopic procedures was unexpected.
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Affiliation(s)
- Margit C Karelson
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Department of Hand and Microsurgery, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tuomas Huttunen
- Department of Emergency, Anesthesia and Pain Medicine; Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere University, Tampere, Pirkanmaa, Finland.,Coxa Hospital Ltd, Tampere, Pirkanmaa, Finland
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Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types. HAND SURGERY & REHABILITATION 2019; 39:102-106. [PMID: 31874275 DOI: 10.1016/j.hansur.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/13/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the prevalence of arthroscopic scapholunate (SL) and/or lunotriquetral (LQ) laxity and triangular fibrocartilaginous complex (TFCC) injuries in patients who have an intraarticular fracture of the distal radius and to correlate these lesions with fracture type. Fifty-seven intraarticular radius fractures, whether or not they were associated with an ulnar styloid fracture, were evaluated and treated by arthroscopy. Scapholunate and lunotriquetral ligament injuries were classified according to the EWAS classification. TFCC lesions were assessed according to Palmer's classification. Each injury was documented through preoperative X-rays and a CT scan. Fracture type and soft tissue injury were not significantly associated one to another. Arthroscopic examination revealed at least one soft tissue injury in 39 intraarticular fractures of the distal radius (68.4%). Twenty-five percent of arthroscopic SL laxities (including severe EWAS 3 injuries) were not detected on standard radiographs. Arthroscopic SL laxity was present in 8 of 11 cases (72.7%) of radial styloid fracture and in 15 of 25 cases (60%) of fractures with at least one radial styloid component. There was no association between LQ integrity and fracture type. Ulnar styloid fractures (base or tip) and TFCC lesions were significantly correlated (P<0.0001). The prevalence of soft tissue lesions secondary to intraarticular fractures of the distal radius was 68.4%. However, there was no statistically significant relationship between the different types of radius fractures and soft tissue injuries. On the other hand, ulnar styloid fracture was predictive of TFCC injury.
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Saab M, Guerre E, Chantelot C, Clavert P, Ehlinger M, Bauer T. Contribution of arthroscopy to the management of intra-articular distal radius fractures: Knowledge update based on a systematic 10-year literature review. Orthop Traumatol Surg Res 2019; 105:1617-1625. [PMID: 31526708 DOI: 10.1016/j.otsr.2019.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/01/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
The objective of this study was to review current data on the contribution of wrist arthroscopy to the management of intra-articular distal radius fractures (IADRFs). The literature published over the last 10 years was reviewed by searching databases with the key indexing terms 'distal radius fracture', 'articular', and 'wrist arthroscopy'. The information in the 21 articles thus retrieved was used to answer the following questions: (i) Can arthroscopy improve the reduction of IADRFs? (ii) How does arthroscopy contribute to the diagnosis and treatment of concomitant ligament injuries? and (iii) Does arthroscopy help to improve the functional scores? The contribution of arthroscopy to IADRF reduction remains controversial. Follow-ups were limited (15 months on average) and some of the studies provided only level IV evidence. The data do not consistently suggest that arthroscopically assisted surgery may improve the quality of reduction. In contrast, they highlight the usefulness of arthroscopy in allowing the same-stage management of carpal ligament injuries. In the 12 studies providing data on this point, scapholunate inter-osseous ligament injuries were present in 41% of cases; one-fourth of these injuries were full-thickness tears that were successfully repaired by arthroscopy. The triangular fibrocartilage complex was injured in 48% of cases, and 30% of these injuries were peripheral ulnar detachments that were successfully repaired by arthroscopy. At present, arthroscopy does not allow the repair of all diagnosed ligament injuries. Comparative studies with longer follow-ups will shed light on the ability of arthroscopy to improve functional scores. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Marc Saab
- Service orthopédie B, hôpital Roger-Salengro, CHRU de Lille, rue du Professeur-Emile-Laine, 59037 Lille cedex, France.
| | - Elvire Guerre
- Service orthopédie B, hôpital Roger-Salengro, CHRU de Lille, rue du Professeur-Emile-Laine, 59037 Lille cedex, France
| | - Christophe Chantelot
- Service orthopédie B, hôpital Roger-Salengro, CHRU de Lille, rue du Professeur-Emile-Laine, 59037 Lille cedex, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, CCOM, Hôpitaux Universitaires de Strasbourg, avenue Baumann, Illkirch cedex, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologie, Hôpital Ambroise Paré AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Xu J, Zhang G, He Z, Zhong S, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00795-w. [PMID: 31641940 PMCID: PMC7026237 DOI: 10.1007/s13246-019-00795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/10/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022]
Abstract
To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1-4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.
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Affiliation(s)
- Jing Xu
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Zaopeng He
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Shizhen Zhong
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Yongshao Chen
- Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Chunrong Wei
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Yudong Zheng
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Wei Li
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
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Abstract
Injuries to the scapholunate (SL) and lunotriquetral (LT) interosseous ligaments occur in approximately one third of distal radius fractures. The diagnosis of these injuries is challenging because plain radiographs are not reliably diagnostic. Wrist arthroscopy may be the most accurate way to examine and diagnose soft-tissue injuries of the carpus adjacent to a distal radius fracture. Treatment options for SL and LT ligament injuries include open repair and/or percutaneous pinning. Because the natural history of these injuries is unclear, the necessity of diagnosing and treating these SL and LT interosseous ligament defects remains speculative.
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Fang K, Wang W. [Preliminary effectiveness of carpal arthroscopic adjuvant treatment of intra-articular fractures of distal radius]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:138-143. [PMID: 30739404 DOI: 10.7507/1002-1892.201807038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the early-term effectiveness of carpal arthroscopy in the treatment of intra-articular fractures of distal radius. Methods The clinical data of 50 cases of intra-articular fractures of distal radius between January 2015 and December 2017 were retrospectively analyzed. According to the different methods of intraoperative assisted treatment, the patients were divided into the trial group (11 cases with carpal arthroscopy assisted treatment) and the control group (39 cases with traditional open reduction). There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, time from injury to operation, and preoperative displacement ( P>0.05), which were comparable. Six patients in the trial group had triangular fibrocartilage complex (TFCC) injury and received one-stage repair. Postoperative X-ray films were taken to estimate the fracture reduction. Patient-Rated Wrist Evaluation (PRWE) wrist function score and modified Mayo score were used at 3 months after operation to evaluate the function of the wrist. The range of wrist flexion, extension, pronation, and supination motion of the two groups were recorded and compared at 3 months after operation. Patients in the trial group were further divided into the reduction group after arthroscopic exploration (group A, 6 cases) and the simple cleaning group after arthroscopic exploration (group B, 5 cases), and their wrist motions were compared. Results The operation time of the trial group was greater than that of the control group ( t=11.08, P=0.00). There was no significant difference in intraoperative blood loss and fracture reduction between the two group ( P>0.05). X-ray film at 1 day after operation showed that the degree of fracture displacement was significantly decreased when compared with preoperative one in each group ( P<0.05), but no significant difference was found between the two groups at 1 day after operation ( t=0.19, P=0.85). Patients in both groups were followed up 8-20 months, with an average of 12 months. There was no significant difference in fracture healing time between the two groups ( t=0.52, P=0.60). At 3 months after operation, the PRWE score, modified Mayo score, and wrist motions in the trial group were all better than those in the control group ( P<0.05). There was no significant difference in wrist motions between group A and group B ( P>0.05). Conclusion Carpal arthroscope assisted treatment of intra-articular fractures of distal radius can achieve good reduction and postoperative function. Meanwhile, TFCC, ligament, articular cartilage, and other injuries can be repaired in one stage.
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Affiliation(s)
- Kaibin Fang
- Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China
| | - Wenhuai Wang
- Department of Orthopedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000,
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Abstract
PURPOSE OF REVIEW The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact on the return to play. RECENT FINDINGS Fractures of the shoulder and elbow can have profound implications in an athlete career. Recent technique of fractures management trended toward to preserve soft tissue which is critical for an early recovery in athletic population. Arthroscopy presents a strong interest for the treatment of intra-articular fracture, and minimally invasive approach as developed in humeral shaft fracture can be considered to avoid soft tissue damage. Non-articular, stable, and minimally displaced fractures are mainly treated conservatively. However, we encourage a more aggressive approach in shoulder and elbow injuries in the athletes including minimally invasive and stable fixation to preserve vascularity and muscle environment.
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Affiliation(s)
- M Burnier
- Department of Orthopedic Surgery, Mayo Clinic and Mayo College of Medicine, Gonda 14, 200 First Street SW, Rochester, MN, 55905, USA
| | - J D Barlow
- Department of Orthopedic Surgery, Mayo Clinic and Mayo College of Medicine, Gonda 14, 200 First Street SW, Rochester, MN, 55905, USA
| | - J Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic and Mayo College of Medicine, Gonda 14, 200 First Street SW, Rochester, MN, 55905, USA.
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Does arthroscopic assistance improve reduction in distal articular radius fracture? A retrospective comparative study using a blind CT assessment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:405-411. [DOI: 10.1007/s00590-018-2348-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
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Why do we use arthroscopy for distal radius fractures? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1505-1514. [DOI: 10.1007/s00590-018-2263-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/30/2018] [Indexed: 01/12/2023]
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Burnier M, Le Chatelier Riquier M, Herzberg G. Treatment of intra-articular fracture of distal radius fractures with fluoroscopic only or combined with arthroscopic control: A prospective tomodensitometric comparative study of 40 patients. Orthop Traumatol Surg Res 2018; 104:89-93. [PMID: 29241818 DOI: 10.1016/j.otsr.2017.08.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/30/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Considering articular distal radius fractures treated with volar plate, we hypothesized that articular radio-carpal displacement was better reduced with arthroscopic control than with only fluoroscopic control. METHODS Forty patients with similar articular radius fracture (type C according to AO classification) and high functional needs were treated with volar plate fixation. They were divided in two comparative groups: 20 patients in Fluoroscopic group and 20 patients in Arthroscopic group. Pre and postoperative radiographs and tomodensitometric images were analysed by an independent observer. We evaluate extra and intra-articular displacements according to "Patient Accident Fracture" classification. RESULTS We observed a better reduction of the radio-carpal step-off and gap in the arthroscopic group, with a statistically significant difference (p<0.05). The index of postoperative intra-articular reduction was better in the fluoroscopic group (5.5) than in the arthroscopic group (2.2) with a significant difference (p<0.05). CONCLUSIONS According to these results, arthroscopy is useful to perform a better articular radio-carpal reduction in distal radius fracture. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- M Burnier
- Wrist surgery unit, department of orthopaedics, Claude-Bernard-Lyon university, Herriot hospital, Lyon, France
| | - M Le Chatelier Riquier
- Wrist surgery unit, department of orthopaedics, Claude-Bernard-Lyon university, Herriot hospital, Lyon, France
| | - G Herzberg
- Wrist surgery unit, department of orthopaedics, Claude-Bernard-Lyon university, Herriot hospital, Lyon, France.
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Lans J, Lasa A, Chen NC, Jupiter JB. Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation. Open Orthop J 2018; 12:33-40. [PMID: 29456778 PMCID: PMC5806195 DOI: 10.2174/1874325001812010033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable. OBJECTIVE The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures. METHODS We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score. RESULTS There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL. CONCLUSION In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Alejandro Lasa
- Department of Traumatology, British Hospital, Avenida Italia 2420, 11600 Montevideo, Uruguay
| | - Neal C. Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
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Lameijer CM, ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 2018; 138:1699-1712. [PMID: 30317380 PMCID: PMC6224009 DOI: 10.1007/s00402-018-3046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.
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Affiliation(s)
- C. M. Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - H. J. ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - D. Vroling
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. T. Hartlief
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - C. K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Affiliation(s)
- Maria Moloney
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Lars Adolfsson
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
- Department of Orthopaedics, Linköping University, Sweden
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Christiaens N, Nedellec G, Guerre E, Guillou J, Demondion X, Fontaine C, Chantelot C. Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases. HAND SURGERY & REHABILITATION 2017; 36:268-274. [DOI: 10.1016/j.hansur.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/17/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2017; 1:325-331. [PMID: 28461964 PMCID: PMC5367527 DOI: 10.1302/2058-5241.1.160016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness. Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term. In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle. The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications. ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues. Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time. The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
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Affiliation(s)
- Luca Dei Giudici
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Faini
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Garro
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Agostino Tucciarone
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Childs S, Mann T, Dahl J, Ketz J, Hammert WC, Murray PM, Elfar J. Differences in the Treatment of Distal Radius Fractures by Hand Fellowship Trained Surgeons: A Study of ABOS Candidate Data. J Hand Surg Am 2017; 42:e91-e97. [PMID: 28027845 PMCID: PMC5292287 DOI: 10.1016/j.jhsa.2016.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The management of distal radius fractures differs based on the nature of the fracture and the experience of the surgeon. We hypothesized that patients requiring surgical intervention would undergo different procedures when in the care of a surgeon with subspecialty training in hand surgery as compared with surgeons with no subspecialty training in hand surgery. METHODS We queried the ABOS database for case log information submitted for part II of the ABOS examination. Queries for all codes involved with distal radius fracture management were combined with associated codes for the management of median nerve neuropathy, triangular fibrocartilage complex tears, ulnar shaft, and styloid fractures. Hand fellowship trained orthopedic surgeons were compared with those completing other fellowships and non-fellowship trained orthopedic surgeons during their board collection period. RESULTS During the study period, 2,317 orthopedic surgeons reported treatment of 15,433 distal radius fractures. Of these surgeons, 411 had hand fellowship training. On a per surgeon basis, fellowship trained hand surgeons operatively treated more multifragment intra-articular distal radius fractures than their non-hand fellowship trained counterparts (5.3 vs 1.2). Additional procedures associated with the management of distal radius fractures were also associated with the fellowship training of the treating surgeon. CONCLUSIONS Among orthopedic surgeons taking part II of the ABOS certifying examination, differences exist in the type, management, and reporting of distal radius fractures among surgeons with different areas of fellowship training. CLINICAL RELEVANCE This study describes the association of hand surgery fellowship training on the choice of intervention for distal radius fractures and associated conditions.
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Affiliation(s)
- Sean Childs
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Tobias Mann
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Jason Dahl
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - John Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Warren C Hammert
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Peter M Murray
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL
| | - John Elfar
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY.
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Fontès D. [Pathology of the triangular fibrocartilaginous complex in distal radius fractures]. HAND SURGERY & REHABILITATION 2016; 35S:S60-S68. [PMID: 27890214 DOI: 10.1016/j.hansur.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/23/2016] [Indexed: 10/20/2022]
Abstract
Distal radius fracture is actually quite rarely isolated and triangular fibrocartilaginous complex (TFCC) is often involved with the same mechanism of injury. A contemporary management of the treatment of the initial fracture is ideal and so benefits from a routine arthroscopic management. Nevertheless, in the absence of diagnosis and therefore early treatment, the symptoms may be located at the ulnar crossroads and justify specific treatment of TFCC. It is generally conducted after an accurate arthroscopic lesion classification guiding a procedure, depending on the lesion vascularization as well as its possible destabilization potential (debridement, capsular suture or foveal reattachment). Unfortunately, too often the radius fracture is insufficiently stabilized by an inadequate fixation process or inappropriate orthopedic management with a positive ulnar variance consequence and an ulnar plus syndrome. A "wafer procedure" may then sometimes be proposed if a shortening of less than 3mm is needed and that the distal radio-ulnar joint is not too disorganized.
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Affiliation(s)
- D Fontès
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France.
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Smeraglia F, Del Buono A, Maffulli N. Wrist arthroscopy in the management of articular distal radius fractures. Br Med Bull 2016; 119:157-65. [PMID: 27554281 DOI: 10.1093/bmb/ldw032] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Fractures of the distal radius account for 15% of all fractures. The use of arthroscopy is increasingly popular in the last years, with the goal to achieve a better anatomical reduction of the articular fragments. SOURCES OF DATA We searched the literature on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'wrist', 'distal radial fracture', 'distal radius fracture' and 'arthroscopy'. Twenty-eight studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT Arthroscopy allows to detect intra-articular, ligamentous and triangular fibrocartilage complex injuries in an acute setting with a better prognosis. Arthroscopy increases the quality of the intra-articular reduction compared to fluoroscopy. AREAS OF CONTROVERSY The main limitation of the selected studies is the short follow-up: the average follow-up in 20 studies was 12 months, a period long enough to assess functional outcomes, but not to assess the occurrence of post-traumatic degenerative changes and their impact on function. Better stratification of the fracture population is needed. GROWING POINTS The shorter recovery time and the low incidence of adverse effects are the main advantages of this new technology. AREAS TIMELY FOR DEVELOPING RESEARCH There is need to perform randomized controlled trials reporting on the use of volar locking plates as, at the present time, they are the standard management for these fractures. In addition, the different pattern of fracture should be better classified to manage the patients who will benefit after the management.
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Affiliation(s)
- Francesco Smeraglia
- Department of Orthopaedic Surgery, University of Naples Federico II, via Sergio Pansini 5, 80131 Naples, Italy
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Ospedale Vaio Via Don Enrico Tincati, 5, 43036 Fidenza (PR), Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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Kasapinova K, Kamiloski V. The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2016; 41:516-20. [PMID: 26763270 DOI: 10.1177/1753193415624669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- K Kasapinova
- Department of Traumatology, University Surgery Clinic, 'St. Naum Ohridski', Skopje, Republic of Macedonia
| | - V Kamiloski
- Department of Traumatology, University Surgery Clinic, 'St. Naum Ohridski', Skopje, Republic of Macedonia
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Ezzat A, Baliga S, Carnegie C, Johnstone A. Volar locking plate fixation for distal radius fractures: Does age affect outcome? J Orthop 2016; 13:76-80. [PMID: 27053837 PMCID: PMC4805772 DOI: 10.1016/j.jor.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The AAOS guidelines are unable to recommend for or against operative treatment of distal radius fractures in older patients. AIMS This study compares the outcomes of older patients (≥60 years) against a cohort of younger patients treated with volar locking plate (VLP) fixation. METHODS We assessed 78 patients, comparing range of movement (ROM), grip and pinch strength, subjective Visual Analogue Score (VAS) for pain and function and composite outcome scores. RESULTS There was no difference in clinical outcomes between the two groups at six months. CONCLUSION Open reduction and VLP for distal radius fractures gives comparable outcomes in the older population.
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Affiliation(s)
- Ahmed Ezzat
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Santosh Baliga
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
- Department of Trauma Orthopaedics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Carol Carnegie
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
- Department of Trauma Orthopaedics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Alan Johnstone
- University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
- Department of Trauma Orthopaedics, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
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De Smet A, Lamouille J, Vostrel P, Loret M, Hoffmeyer P, Beaulieu JY. Dorsal approach and internal fixation of impacted intra-articular distal radius fractures with 2.4 mm locking plates. HAND SURGERY & REHABILITATION 2016; 35:203-209. [DOI: 10.1016/j.hansur.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/26/2016] [Accepted: 01/30/2016] [Indexed: 10/21/2022]
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Inagaki K, Kawasaki K. Distal radius fractures-Design of locking mechanism in plate system and recent surgical procedures. J Orthop Sci 2016; 21:258-62. [PMID: 27006135 DOI: 10.1016/j.jos.2015.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 12/25/2015] [Accepted: 01/06/2016] [Indexed: 02/03/2023]
Abstract
Recently, many studies have emphasized the importance of the comprehension of detailed functional anatomy of the distal forearm and wrist joint, and their biomechanics. A significant contribution which yields good functional outcomes of surgical treatment was the development of the locking plate technology; this technology has facilitated the improvement of the surgical technique for the fixation of fractures. This article reviews the locking mechanism and design of the fixation screws and plate, and the details of the surgical technique including the double-tired subchondral support procedure as it is applied to common fractures. Arthroscopic-assisted surgical procedures can be used to reduce the intra-articular fracture fragments after realignment of the distal radius with the locking plate. This technique is also useful at the time of fixation to assess soft tissue injury. The combination of arthroscopic-assisted reduction and locking plate fixation is now indicated for AO type C2 and C3 intra-articular comminuted fractures.
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Affiliation(s)
- Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan.
| | - Keikichi Kawasaki
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Japan
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Dacombe PJ, Amirfeyz R, Davis T. Patient-Reported Outcome Measures for Hand and Wrist Trauma: Is There Sufficient Evidence of Reliability, Validity, and Responsiveness? Hand (N Y) 2016; 11:11-21. [PMID: 27418884 PMCID: PMC4920509 DOI: 10.1177/1558944715614855] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are important tools for assessing outcomes following injuries to the hand and wrist. Many commonly used PROMs have no evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. This systematic review examines the PROMs used in the assessment of hand and wrist trauma patients, and the evidence for reliability, validity, and responsiveness of each measure in this population. METHODS A systematic review of Pubmed, Medline, and CINAHL searching for randomized controlled trials of patients with traumatic injuries to the hand and wrist was carried out to identify the PROMs. For each identified PROM, evidence of reliability, validity, and responsiveness was identified using a further systematic review of the Pubmed, Medline, CINAHL, and reverse citation trail audit procedure. RESULTS The PROM used most often was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Patient-Rated Wrist Evaluation (PRWE), Gartland and Werley score, Michigan Hand Outcomes score, Mayo Wrist Score, and Short Form 36 were also commonly used. Only the DASH and PRWE have evidence of reliability, validity, and responsiveness in patients with traumatic injuries to the hand and wrist; other measures either have incomplete evidence or evidence gathered in a nontraumatic population. CONCLUSIONS The DASH and PRWE both have evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. Other PROMs used to assess hand and wrist trauma patients do not. This should be considered when selecting a PROM for patients with traumatic hand and wrist pathology.
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Affiliation(s)
- Peter Jonathan Dacombe
- University Hospitals Bristol, Bristol Royal Infirmary, Bristol, England,Peter Jonathan Dacombe, University Hospitals Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, England.
| | - Rouin Amirfeyz
- University Hospitals Bristol, Bristol Royal Infirmary, Bristol, England
| | - Tim Davis
- Queen’s Medical Centre, Nottingham, England
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Horst TA, Jupiter JB. Stabilisation of distal radius fractures: Lessons learned and future directions. Injury 2016; 47:313-9. [PMID: 26553426 DOI: 10.1016/j.injury.2015.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/29/2015] [Indexed: 02/02/2023]
Abstract
Our understanding of the diagnosis and management of distal radius fractures has been a long developed over centuries. There has been a shift in treatment of these very common injuries from closed reduction and casting to internal fixation. The answer to the best method of treatment has yet to be found. Today, we have a multitude of treatment options available with varying degrees of evidence to support their use. This review helps to illustrate the lessons we have learned and future directions for treatment.
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Affiliation(s)
- Taylor A Horst
- Division of Hand Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Jesse B Jupiter
- Division of Hand Surgery, Massachusetts General Hospital, Boston, MA, United States.
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El-Mowafi H, El-Hawary A, Kandil Y. The management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy. Foot (Edinb) 2015; 25:238-43. [PMID: 26442442 DOI: 10.1016/j.foot.2015.08.004] [Citation(s) in RCA: 9] [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] [Received: 01/01/2015] [Revised: 07/11/2015] [Accepted: 08/06/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pilon fractures usually result from high energy trauma, and are commonly associated with extensive soft tissue damage which prevents the use of open reduction and internal fixation. PURPOSE This study was designed to evaluate the use of the Ilizarov external fixator in the treatment of pilon fractures of the ankle, and to determine whether arthroscopy of the ankle could improve the outcome. METHODS From February 2011 to May 2013 a total of 23 patients with unilateral closed pilon fractures were divided into two groups treated with and without arthroscopy during fixation with the Ilizarov external fixator. The fractures were classified according to the AO Rüdi and Allgőwer classification. Follow up ranged from 10 to 37 months with a mean of 18 months. RESULTS All cases were evaluated at follow up by the AOFAS and the Bone et al. grading system. According to Bone et al. there were 3 cases excellent, 4 cases good, 2 cases fair, and 2 cases poor in Group A (without arthroscopy), whereas there were 4 cases excellent, 6 cases good, 2 cases fair in Group B (with arthroscopy). The AOFAS score for Group A was 77.8±5.8, and for Group B was 78.4±6.9. CONCLUSION We concluded that the Ilizarov external fixator is an excellent method in treating pilon fractures as it minimizes the need for extensive surgery. We also conclude that the use of arthroscopy during pilon fracture fixation did not add statistically significant improvement to our results and it needs longer term investigation to assess its advantage - if any - to the final outcome. LEVEL OF EVIDENCE level 2.
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Affiliation(s)
- Hani El-Mowafi
- Mansoura University Hospital, Mansoura Faculty of Medicine, Elgomhoria Street, Mansoura 35516, Aldakhlia, Egypt.
| | - Ahmed El-Hawary
- Mansoura University Hospital, Mansoura Faculty of Medicine, Elgomhoria Street, Mansoura 35516, Aldakhlia, Egypt
| | - Yasser Kandil
- Mansoura University Hospital, Mansoura Faculty of Medicine, Elgomhoria Street, Mansoura 35516, Aldakhlia, Egypt
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Abstract
The prevalence of ligamentous injury associated with fractures of the distal radius is reported to be as high as 69% with injury to the scapholunate interosseous ligament and lunotriquetral interosseous ligament occurring in 16% to 40% and 8.5% to 15%, respectively. There is a lack of consensus on which patients should undergo advanced imaging, arthroscopy, and treatment and whether this changes their natural history. Overall, patients with high-grade intercarpal ligament injuries are shown to have longer-term disability and sequelae compared with those with lower-grade injuries. This article reviews the diagnosis and treatment options for these injuries.
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Yamazaki H, Uchiyama S, Komatsu M, Hashimoto S, Kobayashi Y, Sakurai T, Kato H. Arthroscopic assistance does not improve the functional or radiographic outcome of unstable intra-articular distal radial fractures treated with a volar locking plate. Bone Joint J 2015; 97-B:957-62. [DOI: 10.1302/0301-620x.97b7.35354] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is no consensus on the benefit of arthroscopically assisted reduction of the articular surface combined with fixation using a volar locking plate for the treatment of intra-articular distal radial fractures. In this study we compared the functional and radiographic outcomes of fluoroscopically and arthroscopically guided reduction of these fractures. Between February 2009 and May 2013, 74 patients with unilateral unstable intra-articular distal radial fractures were randomised equally into the two groups for treatment. The mean age of these 74 patients was 64 years (24 to 92). We compared functional outcomes including active range of movement of the wrist, grip strength and Disabilities of the Arm, Shoulder, and Hand scores at six and 48 weeks; and radiographic outcomes that included gap, step, radial inclination, volar angulation and ulnar variance. There were no significant differences between the techniques with regard to functional outcomes or radiographic parameters. The mean gap and step in the fluoroscopic and arthroscopic groups were comparable at 0.9 mm (standard deviation (sd) 0.7) and 0.7 mm (sd 0.7) and 0.6 mm (sd 0.6) and 0.4 mm (sd 0.5), respectively; p = 0.18 and p = 0.35). Arthroscopic reduction conferred no advantage over conventional fluoroscopic guidance in achieving anatomical reduction of intra-articular distal radial fractures when using a volar locking plate. Cite this article: Bone Joint J 2015; 97-B:957–62.
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Affiliation(s)
- H. Yamazaki
- Aizawa Hospital, 1-5-2
Honjo, Matsumoto, 390-8510, Japan
| | - S. Uchiyama
- Shinshu University School of Medicine, Matsumoto, Japan
| | - M. Komatsu
- Aizawa Hospital, 1-5-2
Honjo, Matsumoto, 390-8510, Japan
| | - S. Hashimoto
- Aizawa Hospital, 1-5-2
Honjo, Matsumoto, 390-8510, Japan
| | - Y. Kobayashi
- Aizawa Hospital, 1-5-2
Honjo, Matsumoto, 390-8510, Japan
| | - T. Sakurai
- Aizawa Hospital, 1-5-2
Honjo, Matsumoto, 390-8510, Japan
| | - H. Kato
- Shinshu University School of Medicine, Matsumoto, Japan
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Clinical results of using minimally invasive long plate osteosynthesis versus conventional approach for extensive comminuted metadiaphyseal fractures of the radius. Arch Orthop Trauma Surg 2015; 135:361-7. [PMID: 25663020 DOI: 10.1007/s00402-015-2162-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The minimally invasive plate osteosynthesis (MIPO) technique has been introduced recently. The extensive comminuted fractures of the distal radial metaphysis with diaphyseal involvement are probably good indications for MIPO technique because of less extensive dissection and soft-tissue stripping. The purpose of this retrospective study was to compare the clinical results of MIPO technique to those of conventional open reduction in extensive metadiaphyseal fractures of distal radius. MATERIALS AND METHODS Of 34 patients treated for comminuted metadiaphyseal fractures of the distal radius between June 2006 and May 2012, all the patients had extra-articular fractures. Twenty-one patients underwent MIPO technique and 13 underwent conventional open reduction with long periarticular locking plates system (Zimmer). Six patients in the MIPO group and three in the conventional group who had concomitant distal ulnar fractures or distal radioulnar joint (DRUJ) injury underwent plate osteosynthesis or Kirschner-wire fixation before radial fixation. Perioperative parameters and union time were recorded. Radiologic assessment, Mayo Wrist Score, and satisfaction scale were evaluated at the final follow-up. RESULTS All fractures united without secondary procedures. Radiologic assessment, Mayo wrist score, and time to union showed no significant difference between the two groups, but the MIPO group had significantly smaller incision wound, higher satisfaction scale, and shorter operative time than did the conventional group. CONCLUSIONS MIPO is capable of achieving functional results as good as those of conventional open reduction, with a higher satisfaction scale, smaller incision, and shorter operative time. When MIPO intervention is planned, concurrent distal ulnar fracture or DRUJ injury should be repaired first, thus facilitating subsequent indirect reduction. For treating intra-articular fractures, anatomical reduction of the articular surface is more important, and the MIPO technique described here is not recommended.
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Abstract
Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed.
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Affiliation(s)
- Sanjay Meena
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Kumar Sambharia
- Department of Orthopaedics, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ashok Dawar
- Department of Orthopaedics, ESI Hospital, Okhla, New Delhi, India
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Hacihaliloglu I, Guy P, Hodgson AJ, Abugharbieh R. Automatic extraction of bone surfaces from 3D ultrasound images in orthopaedic trauma cases. Int J Comput Assist Radiol Surg 2015; 10:1279-87. [PMID: 25549799 DOI: 10.1007/s11548-014-1141-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE 3D ultrasound (US) imaging has the potential to become a powerful alternative imaging modality in orthopaedic surgery as it is radiation-free and can produce 3D images (in contrast to fluoroscopy) in near-real time. Conventional B-mode US images, however, are characterized by high levels of noise and reverberation artifacts, image quality is user-dependent, and bone surfaces are blurred, which makes it difficult to both interpret images and to use them as a basis for navigated interventions. 3D US has great potential to assist orthopaedic care, possibly assisting during surgery if the anatomical structures of interest could be localized and visualized with sufficient accuracy and clarity and in a highly automated rapid manner. METHODS In this paper, we present clinical results for a novel 3D US segmentation technique we have recently developed based on multi-resolution analysis to localize bone surfaces in 3D US volumes. Our method is validated on scans obtained from 29 trauma patients with distal radius and pelvic ring fractures. RESULTS Qualitative and quantitative results demonstrate remarkably clear segmentations of bone surfaces with an average surface fitting error of 0.62 mm (standard deviation (SD) of 0.42 mm) for pelvic patients and 0.21 mm (SD 0.14 mm) for distal radius patients. CONCLUSIONS These results suggest that our technique is sufficiently accurate for potential use in orthopaedic trauma applications.
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Affiliation(s)
- Ilker Hacihaliloglu
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, 08854, NJ, USA,
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Abstract
Olecranon fractures in dogs are often both comminuted and intra-articular. Anatomic reduction and stable internal fixation are thus paramount to achieving primary bone healing and mitigating the development of posttraumatic osteoarthritis. Intraoperative fluoroscopy can be useful to confirm accurate fracture reduction and facilitate precise implant placement, potentially reducing the surgical exposure required and additional trauma. Despite widespread use in human surgery, reports of fluoroscopic-assisted fracture repair in dogs are limited. Presented here are three dogs in which intraoperative fluoroscopy was used to facilitate accurate olecranon fracture reduction and implant positioning. The olecranon fractures appeared to heal by primary bone union, although the anconeal process failed to obtain osseous union in one dog. Despite the development of mild-to-moderate osteoarthritis in all three dogs, and the nonunion of the anconeal process in one dog, the clinical outcome was considered successful with all dogs subjectively free of lameness at long-term follow-up evaluation. Intraoperative fluoroscopy was found to be a useful modality during fracture reduction and implant placement in dogs with olecranon fractures.
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