Minimally Invasive Surgical Fixation of Distal Radius Fractures

2009 ◽  
pp. 109-121
Author(s):  
Phani K. Dantuluri
Keyword(s):  
Minimally Invasive ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Minimally Invasive Surgical ◽  
Surgical Fixation

Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Hand ◽  
2019 ◽  
pp. 155894471986264
Author(s):  
Michael C. Daly ◽  
Taylor A. Horst ◽  
Chaitanya S. Mudgal
Keyword(s):  
Distal Radius ◽  
Null Hypothesis ◽  
Independent Predictor ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Fracture Geometry ◽  
Plain Radiographs ◽  
Fracture Patterns ◽  
Discrete Fracture ◽  
Surgical Fixation

Background: Volar Barton fractures involve the volar articular margin of the distal radius with proximal and volar subluxation of the carpus. Although traditionally conceptualized as partial articular, some volar Barton fractures are complete articular injuries due to a dorsal cortical break in the distal radial metaphysis. While dorsal cortical breaks can affect surgical strategy, they may be difficult to identify on plain radiographs and their epidemiology remains poorly characterized. Some authors have hypothesized an association with osteoporosis; however, this hypothesis remains untested. To better characterize volar Barton fractures, we analyzed fracture geometry on pre-operative computed tomography (CT) scans to: (1) determine the frequency of a dorsal cortical break; and (2) test the null hypothesis that a dorsal cortical break is not associated with age or gender. Methods: We retrospectively reviewed adults with a volar Barton distal radius fracture and an available pre-operative CT who underwent surgical fixation. Using multivariable logistic regression, we assessed whether age or gender was an independent predictor of a dorsal cortical break. Results: Forty patients (mean age 52 years, 57% female) were identified. Including the shaft as a fragment, 32 (80%) had 3 or more discrete fracture fragments. Thirty patients (75%) had a dorsal cortical break. Dorsal cortical breaks were not associated with either age or gender ( P > 0.05). Conclusions: Most (75%) patients with volar Barton distal radius fractures had a dorsal cortical break. Dorsal cortical breaks were not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously hypothesized.

Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Hand ◽  
2020 ◽  
pp. 155894472093030
Author(s):  
Stella J. Lee ◽  
Derek S. Stenquist ◽  
Jamie E. Collins ◽  
Ariana N. Mora ◽  
Brett A. Teplitz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Matched Cohort ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Surgical Fixation

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

Volar Marginal Rim Fractures of the Distal Radius Have a Higher Rate of Associated Carpal Injuries—A Comparative Cohort Study

2021 ◽  
Author(s):  
Nathan Eardley-Harris ◽  
Simon B.M. MacLean ◽  
Ruurd Jaarsma ◽  
Jock Clarnette ◽  
Gregory Ian Bain
Keyword(s):  
Distal Radius ◽  
Revision Surgery ◽  
Distal Radius Fractures ◽  
Carpal Instability ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Fixation Failure ◽  
Scapholunate Instability ◽  
Surgical Fixation ◽  
Comparative Cohort Study

Abstract Background Volar marginal rim distal radius fractures can be challenging due to volar instability of the carpus. The associated carpal injuries, however, have not previously been reported. Purpose The aim of this study was to compare volar marginal rim fractures to other distal radius fractures to determine if there is any association with other carpal injuries. If so, do these injuries lead to further instability and fixation failure? Materials and Methods A retrospective radiological review of 25 volar marginal rim fractures was conducted. This was compared with a comparison cohort of 25 consecutive intra-articular distal radius fractures not involving the volar marginal rim. All radiographs were reviewed for associated carpal injuries, including carpal and ulnar styloid fractures, scapholunate instability, and carpal translocation. Results Volar marginal rim fractures had a significantly higher incidence of associated carpal injuries per patient (2.52 vs. 1.64), scapholunate diastasis (36 vs. 12%), and carpal dislocation (80 vs. 48%). The fixation chosen was more likely to involve a volar rim-specific plate (44 vs. 0%). Following surgical fixation, the volar marginal rim fractures had a significantly higher incidence of carpal instability (56 vs. 24%), failure of fixation (24 vs. 0%), and revision surgery (12 vs. 0%). Conclusions Volar marginal rim fractures have significantly more carpal injuries, scapholunate instability, and volar carpal instability, compared with other distal radius fractures. Despite the use of volar rim-specific plating, volar marginal rim fractures have a significantly higher incidence of persistent carpal instability, including scapholunate instability, ulnar translocation, volar subluxation, failure of fixation, and revision surgery. Level of Evidence This is a level III, retrospective review.

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