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

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.

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The Fate of Pronator Quadratus Muscle after Volar Locking Plating of Unstable Distal Radius Fractures

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2014.27.3.191 ◽

2014 ◽

Vol 27 (3) ◽

pp. 191

Author(s):

Chae-Hyun Lim ◽

Heun-Guyn Jung ◽

Ju-Yeong Heo ◽

Young-Jae Jang ◽

Yong-Soo Choi

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Pronator Quadratus ◽

Pronator Quadratus Muscle

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

Hand Surgery ◽

10.1142/s0218810414500270 ◽

2014 ◽

Vol 19 (03) ◽

pp. 357-362 ◽

Cited By ~ 2

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.

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Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation

The Open Orthopaedics Journal ◽

10.2174/1874325001812010033 ◽

2018 ◽

Vol 12 (1) ◽

pp. 33-40 ◽

Cited By ~ 2

Author(s):

Jonathan Lans ◽

Alejandro Lasa ◽

Neal C. Chen ◽

Jesse B. Jupiter

Keyword(s):

Distal Radius ◽

Functional Outcomes ◽

Primary Treatment ◽

Contralateral Side ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Interosseous Ligament ◽

Additional Surgery ◽

Osteoarthritis Of The Wrist

Background:The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable.Objective:The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures.Methods:We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score.Results:There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL.Conclusion:In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.

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Preexisting Carpal and Carpometacarpal Osteoarthritis Has No Impact on Function after Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0037-1602800 ◽

2017 ◽

Vol 06 (04) ◽

pp. 301-306

Author(s):

Jonah Davies ◽

Hugo Centomo ◽

Stéphane Leduc ◽

Pierre Beaumont ◽

G.-Yves Laflamme ◽

...

Keyword(s):

Distal Radius ◽

Functional Outcomes ◽

Short Form ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Retrospective Case ◽

Level Of Evidence ◽

Treatment Type ◽

Significant Difference

Background Functional outcomes of distal radius fractures vary widely regardless of treatment methods. Purpose This study aims to verify whether preexisting carpal and carpometacarpal (CMC) osteoarthritis (OA) will negatively impact wrist functional outcome in patients with distal radius fractures. Patients and Methods A retrospective case–control study was done using a prospective trauma database. Patients were matched 1:1 in two groups based on the presence of wrist or carpal arthritis (OA). The groups were matched for sex, follow-up, and treatment type. Patients were followed up for a minimum of 1 year and functional outcomes were assessed using validated scores. Results A total of 61 patients were included. Mean age was 63 years (range: 20–85) and average follow-up was 26 months. There were 31 patients in the OA+ group and 30 in the OA− group. Forty-one patients were treated surgically and 20 nonoperatively. None of the patients in the OA− developed OA during follow-up. Both groups were comparable for sex, residual deformity, and follow-up. There was no significant difference for the visual analog scale, Short Form-12, Quick Disability Arm Shoulder Hand, and Patient-rated Wrist Evaluation, or for radiographic outcomes. Conclusion Preexisting OA in the wrist or CMC does not seem to impact outcomes of distal radius fractures, regardless of treatment, age, or sex. Although this is a negative study, the results are important to help counsel patients with distal radius fractures. Further work must be done to identify other potential causes for negative outcomes. Level of Evidence Level III, prognostic study.

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Correlation of Flexor Pollicis Longus Tendon Status by Ultrasonography with Plate Position on Radiographs Following Volar Plate Fixation of Distal Radius Fractures with Pronator Quadratus Repair

Indian Journal of Orthopaedics ◽

10.1007/s43465-021-00369-7 ◽

2021 ◽

Author(s):

Anil. K. Bhat ◽

Ashwath. M. Acharya ◽

Prajwal P. Mane ◽

Lakshmikanth. H. Karegowda

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Pronator Quadratus ◽

Longus Tendon ◽

Flexor Pollicis Longus Tendon ◽

Grade One

Abstract Background Purpose was to correlate flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs following volar locked compression plate fixation (LCP) in patients who have undergone pronator quadratus (PQ) repair for distal radius fractures. Methods Status of flexor pollicis longus tendon was analyzed by ultrasonography in patients who underwent volar locked compression plating with pronator quadratus repair at a minimum of one year follow up. Soong’s criteria was used to assess the plate position and then correlated the ultrasonography findings of flexor pollicis longus. Results There were 33 patients included in our study, of which 15 belonged to Soong’s grade zero, 10 were grade one and eight were grade two. Flexor pollicis longus attrition was noted in all cases with grade two plating. Conclusion Pronator quadratus repair may not prevent attritional changes in higher grades of Soong’s, hence follow up may be required in these patients to identify attritional changes and early implant removal to prevent complications.

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

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

10.1142/s0218810417500447 ◽

2017 ◽

Vol 22 (04) ◽

pp. 423-428 ◽

Cited By ~ 1

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.

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

British Journal of Surgery ◽

10.1093/bjs/znab202.059 ◽

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.

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Examination of the Pronator Quadratus Muscle during Hardware Removal Procedures after Volar Plating for Distal Radius Fractures

Clinics in Orthopedic Surgery ◽

10.4055/cios.2014.6.3.267 ◽

2014 ◽

Vol 6 (3) ◽

pp. 267 ◽

Cited By ~ 10

Author(s):

Jae-Hwi Nho ◽

Hyun Sik Gong ◽

Cheol Ho Song ◽

Seung Myung Wi ◽

Young Ho Lee ◽

...

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Hardware Removal ◽

Volar Plating ◽

Radius Fractures ◽

Pronator Quadratus ◽

Pronator Quadratus Muscle

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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04101-w ◽

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.

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