scholarly journals Lessons learned with the Cobra prosthesis in elderly patients with complex distal radius fractures—a retrospective follow-up study

2021 ◽  
Author(s):  
Stefan Benedikt ◽  
Peter Kaiser ◽  
Gernot Schmidle ◽  
Tobias Kastenberger ◽  
Kerstin Stock ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
Lessons Learned ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Extensor Pollicis Longus ◽  
Follow Up Study ◽  
Alternative Treatment Option ◽  
The Mean

Abstract Introduction Recently, the Cobra prostheses were introduced in the treatment of distal radius fractures (DRF) of elderly patients. Fracture prostheses provide an alternative treatment option for complex fractures where conservative therapy seems not acceptable and osteosynthesis seems not possible. Data reporting the feasibility of the Cobra prosthesis are sparse. Therefore, this retrospective follow-up study investigated the clinical and radiological mid-term outcome of the Cobra implant in complex DRFs of elderly patients. Materials and methods Thirteen patients (mean age 73.5 years, range 65–87 years) were retrospectively evaluated with at least a 1-year follow-up after surgery. Objective and subjective clinical parameters as well as the radiological outcome and complications were analyzed. Results The mean follow-up period was 31.2 months. Seven cases required a cemented prosthesis. The mean relative range-of-motion compared to the healthy side was 72.3% and 51.8% for extension and flexion, respectively, and 87.9% and 85.7% for pronation and supination, respectively. The mean grip strength was 78.3% compared to the non-operated side. Eight patients were very satisfied, five patients were partly satisfied with the result. The DASH, PRWE, MHQ and Lyon-Scores averaged 39.1, 36.2, 64.9 and 63.3 points, respectively. The mean VAS-Score for pain was 1.1 at rest and 3.2 during activities. Perioperative complications included one dissection of the extensor pollicis longus tendon, one heterotopic ossification, one radiocarpal dislocation and two cases of an ulnar impaction syndrome due to implant subsidence. Conclusion The prosthetic treatment of complex DRFs in elderly patients with the Cobra implant led to clinically and radiologically satisfactory mid-term results. The Cobra prosthesis still does not represent a gold standard but can be regarded as a feasible salvage option for complex DRFs when osteosyntheses may not be possible and non-operative treatment will lead to further functional restrictions and wrist pain during performing activities of daily life in high functional demand patients.

scholarly journals Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Paul Ruckenstuhl ◽  
Gerwin A Bernhardt ◽  
Patrick Sadoghi ◽  
Mathias Glehr ◽  
Lukas A Holzer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Locked Plating ◽  
Follow Up Study

COMPARISON OF RADIOLOGICAL AND CLINICAL OUTCOMES OF INTERNAL FIXATION USING TWO DIFFERENT VOLAR PLATES FOR DISTAL RADIUS FRACTURES

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 357-362 ◽  
Author(s):  
Chul-Hyun Cho ◽  
Si-Wook Lee ◽  
Gu-Hee Jung
Keyword(s):  
Clinical Outcomes ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Implant Design ◽  
Radius Fractures ◽  
Radial Length ◽  
Type C ◽  
The Mean ◽  
The Difference

The purpose of this study was to compare the outcomes of volar plating using two different implants for distal radius fractures. Fifty-two patients with AO type C fractures were placed in either of two groups: the AO LDRS group (26 patients) or the Acu-Loc group (26 patients). Radiological parameters including radial length, radial inclination, volar tilt, and intra-articular step-off were significantly improved after surgery. The mean Mayo Wrist Performance Score was 84.6 in the AO LDRS group and 81.1 in the Acu-Loc group. The mean Subjective Wrist Value was 86.7% in the AO LDRS group and 86.3% in the Acu-Loc group. There were no significant differences between the two groups with respect to both radiological and clinical outcomes at the final follow-up evaluation. Volar fixed-angle plating for unstable distal radius fractures had satisfactory radiological and clinical outcomes. The difference of implant design did not influence overall final outcomes.

scholarly journals Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study

2019 ◽  
Vol 08 (05) ◽  
pp. 408-415
Author(s):  
Marcio Aurelio Aita ◽  
Fabio Lucas Rodrigues ◽  
Karyse Helena Crispim Ribeiro Alves ◽  
Ricardo Kaempf de Oliveira ◽  
Gustavo Mantovani Ruggiero ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Grip Strength ◽  
External Fixation ◽  
Distal Radius ◽  
Randomized Study ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Dynamic Fixation ◽  
The Mean

Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.

Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

2017 ◽  
Vol 22 (04) ◽  
pp. 423-428 ◽  
Author(s):  
Yoshihiro Abe ◽  
Masahiro Suzuki ◽  
Hiromasa Wakita
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Locking Plates ◽  
Radius Fractures ◽  
Radial Inclination ◽  
The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

scholarly journals A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients Following Distal Radius Fractures Treated With 4- and 6-Week Cast Immobilization

2021 ◽  
Vol 10 (24) ◽  
pp. 5774
Author(s):  
Jarosław Olech ◽  
Grzegorz Konieczny ◽  
Łukasz Tomczyk ◽  
Piotr Morasiewicz
Keyword(s):  
Muscle Strength ◽  
Elderly Patients ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Cast Immobilization ◽  
The Mean

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: 1) muscle strength, 2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

scholarly journals The spanning plate as an internal fixator in complex distal radius fractures – a prospective cohort study

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
R Liechti ◽  
R Babst ◽  
U Hug ◽  
B -C Link ◽  
B van de Wall ◽  
...  
Keyword(s):  
Distal Radius ◽  
The United States ◽  
Distal Radius Fractures ◽  
Outcome Analysis ◽  
Dash Score ◽  
Initial Operation ◽  
Radius Fractures ◽  
Articular Fractures ◽  
The Mean

Abstract Objective Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Methods Indication for SP fixation included DRFs with severe metaphyseal comminution, radiocarpal luxation fractures with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. Post-operative assessments included radiological, functional and patient-rated outcomes at a minimum of 12 months follow-up. Results In the mentioned timeframe, a total of 508 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). The mean follow-up time was 14.5 months (range 12-24 months). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced oligosymptomatic non-union. Complications included 2 patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8 (range 0-10) and mean visual analogue scale for resting pain was 0.9 (range 0-9). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Conclusion The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.

Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients

2013 ◽  
Vol 3 (1) ◽  
pp. 93-98
Author(s):  
Leonid I Katolik ◽  
Douglas P Hanel ◽  
Daniel A Wartinbee ◽  
David Ruch
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
The Elderly ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Trauma Centers ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Internal Distraction

ABSTRACT Purpose To evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures. Materials and methods A retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained. Results Thirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32. Conclusion In the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures. Level of evidence Therapeutic, Level IV (Retrospective case series). Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.

scholarly journals Functional Outcomes in Volar-Displaced Distal Radius Fractures Patients with Marginal Rim Fragment Treated by Volar Distal Locking Plates

2018 ◽  
Vol 11 (02) ◽  
pp. 100-105 ◽  
Author(s):  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Mayuko Kinoshita ◽  
Hiroyuki Obata ◽  
Kenji Goto ◽  
...  
Keyword(s):  
Distal Radius ◽  
Functional Outcomes ◽  
Visual Analog Scale Score ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Pronator Quadratus ◽  
Ao Classification ◽  
The Mean ◽  
Pronator Quadratus Muscle

Abstract Background Treatment of volar-displaced distal radius fractures (DRF) accompanied by marginal rim fragment has recently been actively discussed. It is difficult to obtain a sufficient buttress effect on this fragment. Therefore, we actively apply a distal volar locking plate (DVLP) to fractures with this fragment. Here, we report the treatment outcomes and caveats of surgery of fractures with this fragment. Materials and Methods The subjects were 32 patients (male: 11, female: 21, and mean age: 59.4 years) with volar dislocated DRF accompanied by the marginal rim fragment treated using DVLP. The fracture type of AO classification was B3 in 6 patients, C1 in 12, C2 in 6, and C3 in 8. Results The mean duration of follow-up was 13.8 (12–30) months. The plate could be covered with the pronator quadratus muscle in surgery in all patients. On the final follow-up, visual analog scale score was 1.4/10, quick disabilities of the arm, shoulder, and hand score was 9.2/100, and the Mayo wrist score was 93.7/100. No complication was observed in the soft tissue, such as the nerves and flexor tendons. Conclusion The factor determining retention of the reduction position of the marginal rim fragment is a sufficient buttress effect, and DVLP is a useful implant in terms of this point.

scholarly journals Complications of Volar Locked Plating of Distal Radius Fractures: A Prospective Investigation of Modern Techniques

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 698-706
Author(s):  
Tyler S. Pidgeon ◽  
Peter Casey ◽  
Rita E. Baumgartner ◽  
Harrison Ferlauto ◽  
David S. Ruch
Keyword(s):  
Distal Radius ◽  
Complication Rate ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Locked Plating ◽  
Type C ◽  
The Mean ◽  
Removal Of Hardware

Although volar locked plating (VLP) of distal radius fractures is common, complications remain a considerable concern for upper extremity specialists using modern techniques. Complications following VLP of DR fractures were recorded prospectively from January 2005 to January 2017. Fractures were characterized using the AO classification, and complications were described by severity. Severe complications required operative treatment and/or resulted in permanent impairment, moderate complications required nonoperative treatment, and mild complications resolved without intervention. The available Current Procedural Terminology data for uncomplicated VLP were used to calculate the complication rate. Statistical analysis compared severe and nonsevere complications. Thirty-seven patients (27 women; 39 radii) experienced complications following VLP of DR fractures, resulting in a complication rate of 13.2%. For those with complications, the mean age was 48.5 ± 13.5 years (range: 19-78 years) and the mean follow-up was 13.7 ± 9.0 months (range: 3-36 months). A majority (28/39: 71.8%) had type C fractures. The most common complications were hardware complication requiring removal (18) and malunion (6). There were only 3 tendon ruptures. There were 25 unplanned returns to the operating room in 24 radii (22 patients). The most common reason was removal of hardware (18). Patients with severe complications more commonly had AO type C fractures and required longer follow-up. Modern VLP of DR fractures has a complication rate of 13.2%. Hardware complication requiring removal was the most notable complication of VLP. Tendon rupture has become rare with modern techniques. AO type C fractures were associated with more severe complications.

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