Minimally Invasive Surgery: Is There a Role in Distal Radius Fracture Management?

BACKGROUND Distal radius fractures are one of the most common injuries that orthopaedic surgeons will face during their trauma practice. Despite this, many aspects in distal radius fracture management like the definition of what constitutes an acceptable reduction and when or even whether to operate a patient with a distal radius fracture remain a poignant subject of debate even to this day. We wanted to evaluate the functional outcome of fractures of distal end of radius managed with buttress plate. The importance of anatomical reduction in attaining a good functional outcome and post-operative complications of the procedure are also studied. METHODS A prospective study of cases of distal end of radius fractures meeting the inclusion criteria who were admitted in Thrissur Government Medical College, Kerala between 1 – 01 - 2016 to 1 – 06 - 2017 was carried out. Fractures were classified according to Frykman system and anatomical reduction of fragments attempted using buttress plate and screws. After a minimum follow up period of 3 months, the anatomical and functional outcomes were standardised using Lindstorms anatomical and functional scoring system. RESULTS A series of 32 cases with distal end of radius fracture were studied comprising of 24 males and 8 females. Majority were in the age group of 20 to 29 years (50 %). Road Traffic Accidents was the commonest cause of injury (62.5 %). Type III Frykman made the largest contribution with 11 (34 %) cases. A total of 7 cases were found to develop complications including blisters, joint stiffness, infection and paraesthesia. Postoperatively, excellent anatomical reduction was achieved in 75 % of cases and good results in 12.5 % cases. Functionally 68.75 % cases had an excellent outcome and 18.75 % had a good result. CONCLUSIONS Good to excellent results were seen in majority of patients after buttress plate fixation of the distal radius, with outcomes and complications comparable to other studies in literature. This study supports the finding that precise identification of unstable lower radial fractures, and satisfactory anatomical restoration results in improved functional outcome. KEYWORDS Distal End Radius Fracture, Buttress Plating, Functional Outcome, Frykman Classification, Lindstorm Scoring System

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The Role of Early Post-Operative Radiographs Following Distal Radius Fracture Fixation with a Volar Locking Plate: Time for Change?

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500553 ◽

2019 ◽

Vol 24 (04) ◽

pp. 435-439

Author(s):

Vivek Sharma ◽

Caroline Witney-Lagen ◽

Samuel Cullen ◽

Edward Kim ◽

Zakir Haider ◽

...

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Clinical Information ◽

Median Number ◽

Radius Fracture ◽

Volar Locking Plate ◽

Articular Fractures ◽

Fracture Management

Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient’s first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9–16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

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