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Pacchiarini L, Massimo Oldrini L, Feltri P, Lucchina S, Filardo G, Candrian C. Complications after volar plate synthesis for distal radius fractures. EFORT Open Rev 2024; 9:567-580. [PMID: 38828969 PMCID: PMC11195338 DOI: 10.1530/eor-23-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Purpose Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor. Methods A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the 'Down and Black's Checklist for measuring quality'. Results About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient's will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%). Conclusion The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient's willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.
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Affiliation(s)
- Luca Pacchiarini
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Stefano Lucchina
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
- Locarno Hand Center, Locarno, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Fu J, Cai X, Ouyang H, Gong C, Huang Y. Efficacy of electroacupuncture in assisting postoperative healing of distal radius fractures: study protocol for a randomized controlled trial. J Orthop Surg Res 2022; 17:517. [PMID: 36456969 PMCID: PMC9713955 DOI: 10.1186/s13018-022-03415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Manual reduction and surgical treatment are common methods for distal radius fractures (DRFs). The existing literature suggests that postoperative combined rehabilitation treatment and medication are effective for the healing of DRFs. However, the side effects of these treatments remain to be solved. Previous studies have shown that electroacupuncture (EA) can effectively relieve wrist swelling and improve the joint function in patients with DRFs, but more evidence is needed to prove the effectiveness of EA. This trial aims to explore the efficiency and feasibility of combined EA treatment in postoperative treatment of DRFs compared with routine treatment. METHODS This is a parallel randomized controlled trial. A total of 222 patients diagnosed with moderate DRFs will be recruited and randomly assigned to an EA group or a routine treatment group at a ratio of 1:1. Routine treatment group will receive medication and rehabilitation. Yangxi (LI 5), Yangchi (TE 4), Yanggu (SI 5), Hegu (LI 4), and Taiyuan (LU 9) will be selected in the EA group for intervention three times a week on the basis of routine treatment. Both groups will receive 8 weeks of treatment and 4 weeks of follow-up. The primary outcome will be ulnar positive variance. The secondary outcomes will include radiographic healing rate, bone strength, hemorheological indices, serum biochemical indicators and inflammatory factors, grip strength, wrist swelling score, patient-rated wrist evaluation, disabilities of arm, shoulder and hand, and visual analogue scale. Outcomes will be evaluated at baseline, postoperative 3rd day, 2nd, 4th, 6th, 8th, and 12th weeks. DISCUSSION The results of this study will help establish a more optimized scheme to treat patients with DRFs. Trial registration Chinese Clinical Trial Registry ChiCTR2200062857. Registered on 21 August 2022, www.chictr.org.cn/com/25/showproj.aspx?proj=175567 .
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Affiliation(s)
- Jiani Fu
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Xiaowen Cai
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Huailiang Ouyang
- grid.417404.20000 0004 1771 3058Department of Traditional Chinese Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chunzhu Gong
- grid.470230.2Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, China
| | - Yong Huang
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
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Poiset S, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Kwok M, Liss F, Rivlin M, Takei TR, Wang M, Ilyas AM. Predictive Factors for Return to Driving following Volar Plate Fixation of Distal Radius Fracture. J Wrist Surg 2020; 9:298-303. [PMID: 32760608 PMCID: PMC7395838 DOI: 10.1055/s-0040-1709189] [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: 09/24/2019] [Accepted: 02/27/2020] [Indexed: 01/05/2023]
Abstract
Background A common query by patients undergoing distal radius fracture (DRF) repair is when (s)he can resume driving postoperatively. A prospective cohort analysis was performed to assess fracture and patient factors on a patient's self-reported ability to return to driving to better inform patients and surgeons. Methods Consecutive patients undergoing DRF repair with locking volar plate were enrolled. Preoperative demographic and radiographic characteristics, and postoperative time to return to driving were collected. Data collected included age, sex, hand dominance, body mass index (BMI), level of education, concomitant ulnar fracture, fracture setting prior to surgery, and AO fracture classification. Results A total of 131 patients were enrolled (108 women, 23 men) with 36 AO type A, 22 AO type B, and 73 AO type C DRFs, with an average age of 59.5 years. Fracture severity by classification did not significantly affect time to return to driving. However, BMI, sex, and age were found to significantly affect time to return to driving. Patients aged 19 to 59 years, 60 to 75 years, and over 75 years returned to driving 13.1, 15.4, and 30.1 days following surgery, respectively ( p < 0.01). Classified by BMI, patients that were normal weight, overweight, and obese returned to driving 11.5, 13.1, and 21.0 days following surgery, respectively ( p < 0.05). Men returned to driving 8.8 days and women 17.3 days postoperatively ( p = 0.001). Conclusion Patients severity of fracture as determined by AO fracture type did not affect time to driving, while increased BMI, female sex, and increased age were found to be significant factors in patients' return to driving time after distal radius fracture repair. Level of Evidence This is a Level II, prospective cohort study.
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Affiliation(s)
- Spencer Poiset
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory Gallant
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher Jones
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William Kirkpatrick
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Moody Kwok
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Frederic Liss
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark Wang
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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姚 晓, 伍 玲, 李 建, 黄 文, 王 崇, 顾 祖, 王 跃. [Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:809-813. [PMID: 32666720 PMCID: PMC8180431 DOI: 10.7507/1002-1892.201911108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/29/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures. METHODS Between July 2014 and July 2018, 15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation. There were 6 males and 9 females, aged from 30 to 66 years with an average age of 56.6 years. The cause of injury was falling from height in 2 cases and falling in 13 cases. All of them were fresh closed injuries. The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association (AO/OTA) classification. There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability. The time from injury to operation was 6 to 9 days with an average of 7.3 days. The fracture healing and the radial height, palm inclination, and ulnar deviation were observed by X-ray reexamination. Cooney score was used to evaluate the effectiveness. RESULTS All incisions healed by first intention. All patients were followed up 12-24 months, with an average of 14.6 months. X-ray films showed that all fractures healed, and the healing time ranged from 5 to 10 months, with an average of 8.2 months. No internal fixation failure or secondary fracture displacement occurred. At last follow-up, the radial height, palm inclination, and ulnar deviation recovered well, and the differences between pre- and post-operation were significant ( P<0.05). The pain, function, activity, and grip strength scores and the total score of Cooney score were significantly higher than those before operation ( P<0.05). There were 11 cases of excellent, 3 cases of good, and 1 case of good, with an excellent and good rate of 93%. CONCLUSION For extreme distal radius fractures, the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radialheight, palm inclination, and ulnar deviation, fix firmly, and recover the wrist joint function exercise early, and obtain satisfactory effectiveness.
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Affiliation(s)
- 晓克 姚
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 玲娜 伍
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 建华 李
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 文刚 黄
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 崇文 王
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 祖超 顾
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
| | - 跃 王
- 成都市第一人民医院骨科(成都 610041)Department of Orthopedics, Chengdu First People’s Hospital, Chengdu Sichuan, 610041, P.R.China
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Creighton JJ, Jensen CD, Kaplan FTD. Intrarater and Interrater Reliability of the Soong Classification for Distal Radius Volar Locking Plate Placement. Hand (N Y) 2020; 15:414-417. [PMID: 30141699 PMCID: PMC7225881 DOI: 10.1177/1558944718797347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The purpose of this study was to analyze the intrarater and interrater reliability of the Soong classification for volar locking plate placement on a randomly selected, consecutive series of radiographs. Our hypothesis was that the classification would be reliable. Methods: Six physicians of differing levels of training (orthopedic surgery intern to fellowship-trained upper extremity staff) were asked to review 40 radiographs in a random order on 2 separate occasions, 4 weeks apart. All observers graded each image (0, 1, or 2) based on the corresponding Soong grade. A weighted κ was used to determine the intrarater agreement. The interrater agreement was determined using an intraclass coefficient: Results: The intrarater reliability using a weighted κ ranged from 0.229 (95% confidence interval [CI]: 0.048-0.411) to 0.946 (95% CI: 0.840-1.051). The interrater intraclass coefficient for Randomization 1 was 0.944 (95% 0.912-0.967) and Randomization 2 was 0.877 (95% CI: 0.797-0.930). Conclusion: The Soong classification is a reliable tool, both interrater and intrarater, for assessing distal radius volar locking plate placement. The classification system remained reliable despite a randomly selected, consecutive series of images and physician observers of varying levels of training.
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Affiliation(s)
- James J. Creighton
- Indiana University School of Medicine, Indianapolis, USA,James J. Creighton III, Department of Orthopedic Surgery, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Bank Building, 2nd Floor, Indianapolis, IN 46202, USA.
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Li D, Liu Y, Li D, Tang W, Yin Q. Identification of a novel three-column classification for double-column die-punch fractures of the distal radius. Exp Ther Med 2020; 19:1871-1877. [PMID: 32104243 PMCID: PMC7026990 DOI: 10.3892/etm.2020.8434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
The present study aimed to classify double-column die-punch fractures of the distal radius according to imaging data, and to evaluate their clinical features. A retrospective analysis of imaging data derived from 498 patients diagnosed with a double-column die-punch fracture of the distal radius was performed. The fractures were divided into those with middle-column avulsion with fracture of the radial-column articular surface (type I), those with middle-column collapse with fracture of the radial-column articular surface (type II), those with middle-column collapse with fracture of epiphysis of the radial column (type III) or mixed-type fractures (type IV). The intra- and inter-observer consistency between assessors was analyzed with kappa statistics. The patients with double-column die-punch fractures of the distal radius were followed up. There were 21 cases of type I fracture, 135 cases of type II fracture, 130 cases of type III fracture and 212 cases of type IV fracture. The intra-observer kappa coefficient ranged from 0.810–0.861, whereas the inter-observer kappa coefficient range was 0.830–0.876, with high consistency. Following 13 months of follow-up, the patients were assessed for functional recovery of the wrist and hand using the Gartland-Werley scoring system. The analysis indicated that in 95.78% of the patients, wrist function was rated as excellent or good (n=477), while in 4.22% of patients it was rated as fair (n=21), mainly due to the development of post-traumatic arthritis of the wrist following inappropriate therapy. All of the cases were type IV and type III fractures. These data demonstrated the application of a novel classification system named the Three-Column Classification, used to classify double-column die-punch fractures of the distal radius. This method reflected the mechanisms and severity of the fractures, conforming to the principle of AO fracture classification. Furthermore, it exhibited high consistency and may provide reference values for clinical diagnosis, treatment and prognostic evaluation.
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Affiliation(s)
- Dong Li
- Department of Radiology, Liyang People's Hospital, Liyang, Jiangsu 213000, P.R. China
| | - Yu Liu
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
| | - Dongcheng Li
- Department of Radiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
| | - Wen Tang
- Department of Radiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
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Ali Fazal M, Denis Mitchell C, Ashwood N. Volar locking plate: Age related outcomes and complications. J Clin Orthop Trauma 2020; 11:642-645. [PMID: 32684703 PMCID: PMC7355060 DOI: 10.1016/j.jcot.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is no unanimity for the treatment of distal radius fractures in older people. The purpose of our study is to assess the efficacy of volar locking plate for the treatment of unstable distal radius fractures in older independent individuals. METHODS A retrospective comparative study of 105 patients. 58 patients were below the age of 55 years and 47 above the age of 55 years. Mean follow-up was 18.4 months in patients below the age of 55 years and 18.1 months above the age of 55 years. Wrist movements, complications, reoperations, grip strength, Visual Analogue Score (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo wrist score were analysed. RESULTS There was no statistical difference in the wrist movements, grip strength, complications, reoperations, VAS, QuickDASH and Mayo scores. Mean grip strength under 55 was 84.1 and above 55 was 84.5 (p = 0.87). The complication rate was 19.1% above 55 years of age and 17.2% below the age of 55years (p = 0.79). The reoperation rate above 55 years was 8.5% and below 55 years was 8.6% (p = 0.50). Mean VAS under 55 years of age was 1.6 and above 55 years was 1.7 (p = 0.58). Mean Mayo score in under 55 was 80.7 and 80.1 in above 55 (p = 0.78). Mean Quick DASH score under 55 was 20.9 and above 55 was 21.0 (p = 0.97). CONCLUSION Our results indicate that outcomes in older independent patients are satisfactory with a comparable complication and reoperation rate with younger individuals. We conclude that a volar locking plate is a favourable modality for the treatment of unstable distal radius fractures in older patients.
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Affiliation(s)
- Muhammad Ali Fazal
- Department of Trauma & Orthopaedics, Royal Free Hospitals London NHS Foundation Trust, The Ridgeway, Enfield, London, UK,Corresponding author. Royal Free NHS Foundation Trust, The Ridgeway, Enfield, EN2 8JL, United Kingdom.
| | - Christopher Denis Mitchell
- Department of Trauma & Orthopaedics, Royal Free Hospitals London NHS Foundation Trust, The Ridgeway, Enfield, London, UK
| | - Neil Ashwood
- Consultant Orthopaedic Surgeon, Department of Trauma & Orthopaedics, Burton Hospital NHS Foundation Trust, Burton Upon Trent, UK
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Poiset S, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Kwok M, Liss F, Rivlin M, Takei TR, Wang M, Ilyas AM. Splinting after Distal Radius Fracture Fixation: A Prospective Cohort Analysis of Postoperative Plaster Splint versus Soft Dressing. J Wrist Surg 2019; 8:452-455. [PMID: 31815058 PMCID: PMC6892648 DOI: 10.1055/s-0039-1688946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Background The effect of postoperative dressing and splinting after distal radius fracture (DRF) open reduction internal fixation (ORIF) is not well understood. A prospective cohort analysis was performed to assess differences in functional and radiographic outcomes with the use of plaster splinting or soft dressing following DRF ORIF. Methods All patients undergoing DRF ORIF with locking volar plates were consecutively enrolled. Preoperative demographic and postoperative radiographic and functional outcome data were collected at 2 weeks and 3 months postoperatively. Functional data included range of motion (ROM), pain on visual analog scale (VAS), Patient-Rated Wrist Evaluation (PRWE), and quick Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiographic data included loss of fracture reduction. Results A total of 139 patients were enrolled (79 plaster splinting, 60 soft dressing). By the first postoperative visit (POV), there was one case of loss of reduction with plaster splinting and one case with soft dressing with no hardware failure or revision surgery in either group, and no difference in DASH, PRWE, or VAS pain scores. By the final POV, the soft dressing group showed greater ROM in extension by 9.6, flexion by 10.9, and supination by 4.8 degrees over plaster splinting. Additionally, the soft dressing group demonstrated statistically significant improvement in PRWE and DASH scores, as well as VAS pain scores as compared with plaster splinting. Conclusions Applying only soft dressing following DRF ORIF demonstrated improvements in ROM, VAS, and functional outcomes by final follow-up, with no significant differences in radiographic outcomes. No benefit of applying a plaster splint was identified.
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Affiliation(s)
- Spencer Poiset
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jack Abboudi
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory Gallant
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher Jones
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - William Kirkpatrick
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Moody Kwok
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Frederic Liss
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - T. Robert Takei
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mark Wang
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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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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Wu X, Xia Q, Rong K, Gan M, Wen G, Yin X, Yang H. Preliminary exploration of a quantitative assessment index for the matching performance of anatomical bone plates using computer. J Orthop Surg Res 2019; 14:202. [PMID: 31272451 PMCID: PMC6610890 DOI: 10.1186/s13018-019-1229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore a new quantitative index to assess the matching performance of anatomical bone plates using digital technology. METHODS CT data of normal tibias of 40 adults were collected. Two brands of medial distal tibia plates were digitized. Two trained orthopedists simulated the surgical operation in Rhino 5.1 software by placing the plate curve on the medial distal tibia surface. The volume of the interstice between the plate curve and the bone surface was measured. The inverse value of this average interstice distance was used as the matching performance index (MPI). A wall thickness analysis tool was used to mark various interstice distances with varied colors. RESULTS The Kangli medial distal tibia plate had a MPI of 0.55 ± 0.08 by operator A and 0.55 ± 0.06 by operator B. The general care medial distal tibia plate had a MPI of 0.32 ± 0.06 by operator A and 0.31 ± 0.05 by operator B. There were significant variations in the MPI between the two types of plates by both operators (p < 0.001). And significant variations were observed in the MPI of general care medial distal tibia plates among various operator groups (p = 0.028). CONCLUSION This quantitative index of matching performance is straightforward and intuitive. However, we still need a method to improve the experimental repeatability, especially when it comes to a plate with poor matching performance.
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Affiliation(s)
- Xuhua Wu
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China
| | - Qingquan Xia
- Department of orthopedics, Minhang Hospital, Fudan University, No.170, Xinsong Road, Shanghai, 201199, China
| | - Ke Rong
- Department of orthopedics, Minhang Hospital, Fudan University, No.170, Xinsong Road, Shanghai, 201199, China
| | - Minfeng Gan
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China
| | - Gen Wen
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China
| | - Xiaofan Yin
- Department of orthopedics, Minhang Hospital, Fudan University, No.170, Xinsong Road, Shanghai, 201199, China
| | - Huilin Yang
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China.
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Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5786089. [PMID: 30519581 PMCID: PMC6241235 DOI: 10.1155/2018/5786089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/22/2018] [Indexed: 12/03/2022]
Abstract
Introduction Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.
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