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Jafari D, Birjandinejad A, Daliri M, Emami K, Moradi A. Treatment outcomes of applying external fixator on distal radius fractures: a randomized clinical trial to compare between two directions of force exertion in parallel to radius shaft and perpendicular to the distal radius articular surface. BMC Musculoskelet Disord 2023; 24:283. [PMID: 37046238 PMCID: PMC10091534 DOI: 10.1186/s12891-023-06358-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND External fixation has been one of the conventional managements of unstable distal radius fracture. The main aim of this paper is to compare two methods of applying distractive force along the radius shaft versus perpendicular to the distal radius articular surface. DESIGN Sixty patients with unstable distal radius fracture were included in present clinical trial and randomized in two groups, using block randomization method. In group A (first arm), distraction force was exerted parallel to the radius shaft. In group B (second arm), the external fixator was adjusted based on radial and palmar tilt of the mean population healthy wrist so that distraction was exerted perpendicular to the wrist articular surface. METHODS Radiological and clinical parameters were evaluated in both groups of patients pre-operatively, immediately after surgery, and 6 weeks post-operatively. We also followed up patients clinically at 12 weeks after surgery. Patient-Rated Wrist Evaluation (PRWE), Mayo wrist score, and Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires were used in order to assess patients' clinical and functional states. RESULTS The method used in group B resulted in better improvement of palmar tilt both immediately (P = 0.007) and at 6 weeks follow up (P = 0.013) post-operatively in comparison with patients in group A. Radius height and radial inclination were also better restored when using the proposed modified method (P = 0.001 and < 0.001, respectively). There was no difference in any of clinical results (range of motion, grip strength, PRWE, Mayo, and DASH scores) between two groups of study, 12 weeks after surgery. CONCLUSION Applying distractive force perpendicular to the distal radius articular surface seems to improve some radiological outcomes, probably due to better reduction maintenance, when compared with the technique of applying distraction force along distal radius shaft axis. LEVEL OF EVIDENCE Level I (clinical trial study). TRIAL REGISTRATION This study is registered at Iranian Registry of Clinical Trials (IRCT) with approval code of IRCT20200313046759N1.
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Affiliation(s)
- Davood Jafari
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Birjandinejad
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kimia Emami
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Van Oijen GW, Van Lieshout EMM, Reijnders MRL, Appalsamy A, Hagenaars T, Verhofstad MHJ. Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:4333-4348. [PMID: 34009418 PMCID: PMC9712287 DOI: 10.1007/s00068-021-01679-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures. METHODS Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation. RESULTS Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups. CONCLUSION Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.
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Affiliation(s)
- Guido W. Van Oijen
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M. M. Van Lieshout
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maarten R. L. Reijnders
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anand Appalsamy
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Tjebbe Hagenaars
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michael H. J. Verhofstad
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures. Chin J Traumatol 2021; 24:301-305. [PMID: 33994084 PMCID: PMC8564728 DOI: 10.1016/j.cjtee.2021.04.005] [Citation(s) in RCA: 4] [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: 08/04/2020] [Revised: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation. METHODS A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score. RESULTS Patients in volar plate group had superior PRWE score and DASH score at each stage of follow-up. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group. CONCLUSION Fixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.
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van Leeuwen RJH, van de Wall BJM, van Veleen NM, Hodel S, Link BC, Knobe M, Babst R, Beeres FJP. Temporary external fixation versus direct ORIF in complete displaced intra-articular radius fractures: a prospective comparative study. Eur J Trauma Emerg Surg 2021; 48:4349-4356. [PMID: 33630119 DOI: 10.1007/s00068-021-01611-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In complex distal radius fractures (DRF), both direct osteosynthesis (one-stage approach) and temporary external fixation as a bridge to definitive osteosynthesis (two-stage approach) are used. Studies directly comparing these two management options are lacking. This study aims to compare the two procedures with regard to complications, and radiological and functional outcomes. MATERIAL This prospective observational study included all patients presenting with AO OTA C2 or C3 DRF (1) between January 2011 and January 2018. All patients were categorised into two groups according to received treatment: patients who underwent direct definitive osteosynthesis (Group One Stage) and patients who received an external fixator followed by definitive fixation (Group Two Stage). Primary outcome was the Patient-Rated Wrist Evaluation score (PRWE) measured at 1 year follow-up. Secondary outcomes included complications, range of motion (ROM), and radiologic parameters (ulnar variance, radial inclination and volar tilt). RESULTS A total of 187 patients were included in Group One Stage with a mean age of 55.6 years (SD 17.2), of which 67 had a C2 and 120 a C3 fracture. Group Two Stage consisted of 66 patients with a mean age of 53.7 years (SD 20.4 years), of which 6 patients having a C2 and 60 a C3 fracture. There was no significant difference in complications and median PRWE between Group One Stage (12.0, IQR 2.0-20.0) and Group Two Stage (12.2, IQR 5.5-23.4) (p = 0.189), even after correction for differences in baseline characteristics. The ROM and radiologic parameters did not show any significant differences as well. CONCLUSION No differences were found in clinical, functional, and radiological outcome between one- and two-staged surgical techniques. It may be concluded that a two-stage approach is a viable and safe alternative.
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Affiliation(s)
| | | | - Nicole M van Veleen
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Sandro Hodel
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Matthias Knobe
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Reto Babst
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
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Vakhshori V, Rounds AD, Heckmann N, Azad A, Intravia JM, Rosario S, Stevanovic M, Ghiassi A. The Declining Use of Wrist-Spanning External Fixators. Hand (N Y) 2020; 15:255-263. [PMID: 30084266 PMCID: PMC7076625 DOI: 10.1177/1558944718791185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: External fixation has been traditionally used to treat comminuted or open distal radius fractures that are not amenable to open reduction internal fixation. This procedure is associated with a relatively high complication rate and has been used with decreasing frequency in recent years. However, trends in external fixation utilization for the treatment of distal radius fractures have not been described. Methods: Using the Nationwide Inpatient Sample, patients with a distal radius fracture treated with external fixation from 2003 to 2014 were identified. The annual incidence was reported, and hospital and demographic variables associated with external fixation use were determined. Results: During the study period, 593 929 patients with a distal radius fracture were identified, of which 51 766 (8.7%) were treated with a wrist-spanning external fixator. Wrist external fixation for the treatment of distal radius fractures declined steadily from 2003 to 2014. In 2003, external fixation use was highest, accounting for 17.4% of distal radius fractures. By 2014, only 4.9% of distal radius fracture were treated with external fixation. During this period, the incidence of distal radius fractures declined by 6.9% while external fixator utilization decreased by 73.7%. Patients receiving an external fixator were more likely to be male, low-income, and treated in a rural, nonteaching, privately owned hospital. Conclusions: External fixator use for the treatment of distal radius fractures steadily declined during the study period. Males and those with lower incomes treated in rural, nonteaching, and privately owned hospitals are more likely to receive external fixation.
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Affiliation(s)
- Venus Vakhshori
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Alexis D. Rounds
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Ali Azad
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Jessica M. Intravia
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Santano Rosario
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
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Vakhshori V, Alluri RK, Stevanovic M, Ghiassi A. Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation. Hand (N Y) 2020; 15:116-124. [PMID: 30003802 PMCID: PMC6966280 DOI: 10.1177/1558944718787877] [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: 01/17/2023]
Abstract
Internal radiocarpal distraction plating is a versatile tool in the treatment of distal radius fractures that are not amenable to nonoperative treatment or operative fixation with standard volar or dorsal implants. Internal distraction plates may also be indicated in the setting of polytrauma or osteopenic bone. The plate functions as an internal fixator, using ligamentotaxis to restore length and alignment while providing relative stability for bony healing. The plate can be fixed to either the second or the third metacarpal, and anatomic and biomechanical studies have assessed the strengths and weaknesses of each strategy. This operative fixation technique leads to acceptable radiographic results and functional outcomes. Following fracture union, the plate is removed, and wrist range of motion is resumed.
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Affiliation(s)
- Venus Vakhshori
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
| | - Ram Kiran Alluri
- Keck Medical Center at the University of
Southern California, Los Angeles, USA,Ram Kiran Alluri, Department of Orthopaedic
Surgery, Keck Medical Center at the University of Southern California, 1520 San
Pablo Street, #2000, Los Angeles, CA 90033, USA.
| | - Milan Stevanovic
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
| | - Alidad Ghiassi
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
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ORTIZ-ROMERO JOEL, BERMUDEZ-SOTO IGNACIO, TORRES-GONZÁLEZ RUBÉN, ESPINOZA-CHOQUE FERNANDO, ZAZUETA-HERNANDEZ JESÚSABRAHAM, PEREZ-ATANASIO JOSÉMANUEL. FACTORS ASSOCIATED WITH COMPLEX REGIONAL PAIN SYNDROME IN SURGICALLY TREATED DISTAL RADIUS FRACTURE. ACTA ORTOPEDICA BRASILEIRA 2017; 25:194-196. [PMID: 29081703 PMCID: PMC5608737 DOI: 10.1590/1413-785220172505165544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: The aim of this study was to identify factors associated with developing complex regional pain syndrome (CRPS) after surgical treatment for distal radius fracture (DRF). Methods: This case-control study analyzed patients seen from January 2014 to January 2016. Results: In our sample of 249 patients, 4% developed CRPS. Associated factors were economic compensation via work disability (odds ratio [OR] 14.3), age (OR 9.38), associated fracture (OR 12.94), and level of impact (OR 6.46), as well as psychiatric history (OR 7.21). Conclusions: Economically-productive aged patients with a history of high-impact trauma and patients with a history of psychiatric disorders have greater risk of developing CRPS after DRF. Level of Evidence III, Case-Control Study.
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