Wound Complications with Multiple Wrist Incisions in Distal Radius Reconstruction

2021 ◽  
Author(s):  
Joshua J. Meaike ◽  
Christian Athens ◽  
Nicole Sgromolo ◽  
Alexander Y. Shin ◽  
Peter C. Rhee
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Surgical Management ◽  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Wound Complications ◽  
Radius Fractures ◽  
Increased Risk ◽  
Delayed Healing

Abstract Background Placement and spacing of skin incisions are important for maintaining soft tissue perfusion and viability, particularly in the setting of local trauma. Question/Purpose The aim of this article is to determine if multiple skin incisions in the surgical management of distal radius fractures result in an increased risk of postoperative wound complications, particularly in the setting of high-energy mechanisms of injury with substantial initial displacement and associated soft-tissue insult that require multiple incisions for distal radius reconstruction. Patients and Methods A multicenter, retrospective chart review was performed for all adult patients who underwent open reduction, internal fixation of a closed distal radius fracture with multiple (≥2) hand, and wrist incisions with minimum follow-up of 6 weeks. Primary outcome measures included wound healing complications such as partial or complete skin necrosis, dehiscence, delayed healing, and superficial or deep infections. Results For 118 wrists, a total of 305 incisions were utilized, averaging 2.6 incisions per patient (range: 2–6) with the flexor carpi radialis and dorsal distal radius approaches occurring in 86 and 78% of cases, respectively. One patient was identified as having a pyogenic granuloma along an incision. However, two patients were identified as having wound concerns, including fracture blisters (n = 1) and wound margin epidermolysis (n = 1) along the incision. There were no cases of skin bridge necrosis, delayed healing, wound dehiscence, or infection. Conclusions There is no increased risk of wound healing complications with the use of multiple skin incisions (≥2) in the surgical management of distal radius fractures, afforded by the abundant and robust angiosomes around the wrist. Surgeons should have the confidence to utilize the necessary number of skin incisions to effectively reconstruct distal radius fractures.

Management of Complex Distal Radius Fractures: Review of Treatment Principles and Select Surgical Techniques

2016 ◽  
Vol 21 (02) ◽  
pp. 140-154 ◽  
Author(s):  
Peter Charles Rhee ◽  
Alexander Y. Shin
Keyword(s):  
Soft Tissue ◽  
Distal Radius ◽  
Surgical Techniques ◽  
High Energy ◽  
Low Energy ◽  
Distal Radius Fractures ◽  
Surgical Approaches ◽  
Vascular Injuries ◽  
Operative Techniques ◽  
Radius Fractures

Most distal radius fractures are the result of low-energy mechanisms that can be successfully treated either non-operatively or with a variety of operative techniques if indicated. Complex distal radius fractures occur most commonly in high-energy injuries with extensive comminution or bone loss and associated soft tissue or vascular injuries. These high-energy fractures can present many challenges in reconstructing the distal radius. Effective restoration of the bony architecture requires a thorough knowledge of distal radius anatomy, understanding of the goals of treatment, versatility in surgical approaches, and familiarity with multiple fixation options.

Strategies for Specific Reduction in High-Energy Distal Radius Fractures

Hand Clinics ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 267-278
Author(s):  
Nicholas Pulos ◽  
Alexander Y. Shin
Keyword(s):  
Distal Radius ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fractures

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mulrain ◽  
K Joshi ◽  
F Doyle ◽  
A Abdulkarim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Volar Plating ◽  
Radius Fractures ◽  
Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

scholarly journals Perfil epidemiológico das fraturas radiais distais em hospital de referência em Ribeirão Preto, Brasil

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Felipe Azevedo Mendes de Oliveira ◽  
Thiago Agostini Pereira Albeny ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Filipe Jun Shimaoka ◽  
Amanda Favaro Cagnolati ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
High Energy ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Distal Radial Fracture ◽  
Fracture Treatment ◽  
Radius Fractures ◽  
Distal Radial Fractures

Objetivo: Avaliar o perfil epidemiológico das fraturas do rádio distal em hospitais de referência em Ribeirão Preto(SP), Brasil. Não existem dados suficientes na literatura nacional que corroborem com o perfil epidemiológico das fraturas do rádio distal. Métodos: 245 pacientes apresentaram 254 fraturas do rádio distal, ocorridas entre 2014 a 2017 foram avaliadas retrospectivamente para obtenção do perfil epidemiológico. Os fatores analisados foram idade e sexo, mecanismo do trauma, sazonalidade, tipo de fratura baseada na Classificação AO, presença de exposição óssea, lesões associadas, tipo de tratamento realizado (conservador ou cirúrgico) e o tipo de implante utilizado nos tratamentos cirúrgicos. Resultados: 60,2% dos pacientes participantes eram do sexo masculino e 39,8% do sexo feminino, distribuídos de forma bimodal. A média de idade foi 45,4 anos. Fraturas expostas corresponderam a 92,1% das fraturas e 7,9% representaram as expostas. Pacientes politraumatizados representaram 62,6%. O tempo médio de internação foi 8,09 dias. Conclusão: Apesar do padrão de fraturas mostrar semelhanças com outros estudos, o padrão apresentado pode não traduzir, de forma homogênea, o padrão obtido em outras metrópoles e grandes centros.Descritores: Fraturas do Rádio; Traumatismos do Punho; Epidemiologia; Hospitais Especializados.ReferênciasBruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-45.Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97.Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-312.Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124-28.Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One. 2012;7(8):e43367.Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-96.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56(5):391-93.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Tsai CH, Muo CH, Fong YC, et al. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int. 2011;22(11):2809-815.Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-13. Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65(4):432-33.Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.Pagano M, Gauvreau K. Princípios de Bioestatística. 2. ed. São Paulo: Pioneira Thompson Learning; 2004.                                  Court-Brown CM. Epidemiologia das fraturas e luxações. In: Court-Brown CM et al. (ed.); Fraturas em adultos de Rockwood Green. 8. ed. Barueri, SP: Manole; 2016.Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313-19.Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):96-106.

Distal radius fracture with ipsilateral elbow dislocation: a rare but challenging injury

2021 ◽  
Author(s):  
Henrik Constantin Bäcker ◽  
Kathi Thiele ◽  
Chia H. Wu ◽  
Philipp Moroder ◽  
Ulrich Stoeckle ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Elbow Dislocation ◽  
High Energy ◽  
Low Energy ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Associated Injuries ◽  
Radius Fractures ◽  
High Energy Trauma

Abstract IntroductionDistal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. The aim of this study was to analyse the mechanism and level of injury, demographics, and associated injuries in distal radius fractures with ipsilateral elbow dislocations.Methods:Between 2012 and 2019, we searched our trauma database for distal radius fractures with ipsilateral elbow dislocations. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatments were collected. ResultsA total of 7 patients were identified. The mean age was 68.7 ± 13.3 years old and the left side was involved in 71.4% of cases. Females were affected in 85.7% (n=6/7) of cases. All suffered from low-energy mechanism without other orthopaedic injuries at a mean age of 71.5 ± 12.3 years old. The one male patient that was included suffered from high-energy trauma at 52 years of age. Most commonly, posterior elbow dislocations were observed (66.7%; n=4/6). Distal radius fracture patterns include two C2, two C3, and one case each of C1-type and B1-type fracture pattern in the low energy group. In the group of patients who sustained high energy trauma, associated injuries include a concomitant open elbow dislocation, an ulnar artery rupture and damage to the flexor digitorum superficialis muscle.ConclusionAlthough distal radius fracture with ipsilateral elbow dislocation is thought to be resulting from high energy injuries, this study shows that most patients were elderly females suffering from low energy mechanisms. If not suspected, this could be missed especially in the setting of altered mental status. Careful physical examination of one joint proximal and one joint distal to the presumed site of injury is recommended.

Surgical management of delayed union and nonunion of distal radius fractures

2001 ◽  
Vol 26 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Diego L. Fernandez ◽  
David Ring ◽  
Jesse B. Jupiter
Keyword(s):  
Surgical Management ◽  
Distal Radius ◽  
Delayed Union ◽  
Distal Radius Fractures ◽  
Radius Fractures
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