Radiological Outcomes of Distal Radius Fractures Managed with 2.7mm Volar Locking Plate Fixation-A Retrospective Analysis

Dorsally displaced distal radius fractures: introduction of Pacetti's line as radiological measurement to predict dorsal fracture displacement

BACKGROUND AND AIM OF THE WORK

In the best of our knowledge there is not yet in the literature a measurement able to assess post reduction stability of distal radius fractures.

AIM

to study the relationship between our newly introduced Pacetti's line, anatomical reduction of DRFs and post-reduction stability of fractures.

METHODS

Patients/Participants: 230 patients (122men, 108women) who sustained a dorsally displaced distal radius fracture. Close reduction procedures attempted; below elbow cast applied.

FOLLOW-UP

Pacetti's line used on true AP and lateral view xrays after reduction and casting (T0) and at 7-14 days (T1-T2).

MAIN OUTCOME MEASUREMENTS

Assessment and prediction of early displacement of DRFs.

RESULTS

The Pacetti's line intersected the lunate bone in 162 cases (70.4%) after anatomical reduction, of which 20.4% (N=33) lost anatomical reduction. Cramer's V test: significant relationship between transition of Pacetti's line through the semilunar bone and stability of anatomical reduction at T0 follow-up (p<0.001, Cramer's value=0.83). The Pacetti's line intersected the lunate bone in 119 cases (51.7%) at 7-14 days follow-up. None of patients lost anatomical reduction. Cramer's V test: significant relationship between transition of Pacetti's line through the semilunar bone and stability anatomical reduction at T1 and T2 follow-up (p<0.001, Cramer's value=0.73).

CONCLUSIONS

We strongly recommend the use of the Pacetti's line as it seems to provide reliable prediction of further fracture displacement and consequently of definitive management. The Pacetti's line seems to represent a very useful tool providing simple, feasible, efficient and reliable information on DRFs characteristics and natural course.

Evaluating the necessity of bone augmentation for distal radius fracture fixed with a volar locking plate: a retrospective study

Background

Multiple approaches for fixation of distal radius fractures exist; nonetheless, there is no consensus on the optimal treatment for these injuries. Although using volar locking plates has become increasingly common as a surgical intervention, the usefulness of bone augmentation remains debatable. Therefore, this study aimed to evaluate the necessity of bone augmentation for distal radius fractures fixed with a volar locking plate.

Methods

This retrospective study enrolled patients with a single distal radius fracture treated with a volar locking plate between January 2014 and December 2016. Overall, 105 fractures were included and divided into two groups (non-bone augmentation: group 1, n = 88; bone augmentation: group 2, n = 17). Images were reviewed, and dorsal cortex collapse, volar tilting, and radial height and inclination were measured immediately after surgery and at the 6-month follow-up.

Results

Both groups exhibited significant differences in dorsal collapse (p < 0.001 and p = 0.001, respectively) and radial height shortening (p < 0.001 and p = 0.039, respectively); volar tilting and radial inclination did not differ significantly. There was no difference in the degree of dorsal collapse (p = 0.715) and radial height shortening (p = 0.651) between the two groups. Of the 105 fractures, 54 were identified as comminuted type according to the AO classification (A3, C2, and C3), and similar radiographic outcomes were noted.

Conclusions

Volar locking plates for the treatment of distal radius fractures with or without bone augmentation do not affect the radiographic outcomes. In comminuted fractures, additional bone augmentation is unnecessary if intraoperative anatomical reduction and fixation are performed when possible.

Preliminary radiological result after establishment of hospital-based trauma registry in level-1 trauma hospital in developing country setting, prospective cohort study

Introduction

Injuries are the second most common cause of disability, the fifth most common cause of healthy years of life lost per 1000 people and unfortunately 90% of mortality takes place in low-to middle-income countries. Trauma registries guide policymakers and health care providers in decision making in terms of resource allocation as well as enhancing trauma care outcomes. Furthermore data from these registries inform policy makers to decrease the rate of death and disability occurring as a result of injuries. We present our experience in setting up an orthopedic trauma registry and the first short term follow-up of radiological outcomes.

Materials and methodology

Our study is a non-funded, non-commercial, prospective cohort study that was registered at Research Registry. The primary objectives of our study included assessing pattern of injuries in patients with upper and lower limb skeletal trauma presenting to our tertiary care academic university hospital and their respective outcomes. Data was collected by the musculoskeletal service line team members supervised by an experienced research associate and trauma consultants. The work has been reported in line with the STROCSS criteria.

Results

A total of 177 patients were included in this analysis, of whom 101 (57.1%) patients had lower limb fractures, 64(36.1%) patients ad upper limb fractures and 12 (6.8%) patients had both upper and lower limbs involved. A total of 189 upper and lower limb fracture cases were recorded. 176 patients (93.1%) underwent surgeries and 13(6.9%) were managed nonoperatively. Roentgenographic outcomes were assessed using radiological criteria for each bone fractured.

Conclusion

Establishing a trauma registry assists in identification of the pattern of injuries presenting to the hospital which helps in priority setting, care management and planning. This continuous audit of outcomes in turn, plays a significant role in quality improvement.