TREATMENT WITH OR WITHOUT INTERNAL FIXATION FOR ULNAR STYLOID BASE FRACTURES ACCOMPANIED BY DISTAL RADIUS FRACTURES FIXED WITH VOLAR LOCKING PLATE

Hand Surgery ◽  
2012 ◽  
Vol 17 (02) ◽  
pp. 181-190 ◽  
Author(s):  
Yukichi Zenke ◽  
Akinori Sakai ◽  
Toshihisa Oshige ◽  
Shiro Moritani ◽  
Toshitaka Nakamura
Keyword(s):  
Internal Fixation ◽  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Fixation Group ◽  
Significant Difference

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

scholarly journals 173 Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-Centre Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Elerian ◽  
T Singh ◽  
N A Jagodzinski ◽  
R Norris ◽  
S Tan ◽  
...  
Keyword(s):  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Radius Fractures ◽  
Centre Study ◽  
Articular Fractures ◽  
Variable Angle ◽  
Flexion Extension

Abstract Introduction This study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and to identify notable findings related to treatment variations. Method This is a retrospective bi-centre study collecting patient details from a District General Hospital and a Regional Hand Unit. We assessed 61 consecutive patients with distal radius fractures (AO grade A = 19, B = 9, C = 33) fixed using Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union. Results All but two fractures united within six weeks. Mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8kg which was comparable to the contralateral side at 31.5kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic. Conclusions Variable-angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.

Mid-Term Functional Outcome after Volar Locking Plate Fixation of Distal Radius Fractures in Elderly Patients

2018 ◽  
Vol 23 (02) ◽  
pp. 238-242 ◽  
Author(s):  
Haruhiko Shimura ◽  
Akimoto Nimura ◽  
Koji Fujita ◽  
Takashi Miyamoto
Keyword(s):  
Elderly Patients ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Significant Difference

Background: The volar locking plate is frequently used in the fixation of unstable distal radius fractures, but despite this there is a paucity of mid to long term outcome studies. The purpose of this study was to investigate the mid-term functional outcomes of elderly patients treated with a volar locking plate for unstable distal radius fractures. Methods: Thirty-two patients with a mean age of 74.1 (range, 65–85) years were followed for a mean of 39.1 (range, 30–81) months. Patients with follow-up periods of < 24 months were excluded from this study to investigate the mid-term clinical outcomes. The Mayo wrist score (MWS), grip strength and wrist range of motion were retrospectively reviewed at 12 months, 24 months and the latest follow-up (mean 39.1 months). Osteoarthritis status according to the system of Knirk and Jupiter was assessed at 24 months. Results: Significant improvements in MWS and grip strength were observed between 12 and 24 months but not between 24 months and the final follow-up. There was no significant difference in wrist range of motion between 12 and 24 months. The MWS of 14 patients with radiographic signs of osteoarthritis was not significantly different from that of 18 patients without radiographic signs of osteoarthritis. Conclusions: Elderly patients treated with the volar locking plate showed improved MWS and grip strength postoperatively after 12 months. Improvement in grip strength was slower than range of motion.

scholarly journals Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

2018 ◽  
Vol 07 (05) ◽  
pp. 409-414
Author(s):  
J. Hill ◽  
Gabriel Bouz ◽  
Ali Azad ◽  
William Pannell ◽  
R. Alluri ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Outcome Measures ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Dash Score ◽  
Radius Fractures ◽  
Volar Plate Fixation

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

COMPARISON BETWEEN CAST IMMOBILIZATION VERSUS VOLAR LOCKING PLATE FIXATION OF DISTAL RADIUS FRACTURES IN ACTIVE ELDERLY PATIENTS, THE ASIAN PERSPECTIVE

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 19-23 ◽  
Author(s):  
Ying-Ho Chan ◽  
Tun-Lin Foo ◽  
Chong-Jin Yeo ◽  
Winston Yoon-Chong Chew
Keyword(s):  
Elderly Patients ◽  
Internal Fixation ◽  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Current Evidence ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Cast Immobilization

Displaced distal radius fractures in active elderly patients with high functional demand present a clinical dilemma because current evidence is equivocal in the recommendation of treatment. Internal fixation is an increasingly popular option with proposed superior results. Our study aims to evaluate the results among a population of active elderly patients with displaced fractures managed with either cast immobilization or internal fixation with volar locking plate. Seventy-five patients (35 cast immobilization and 40 internal fixation) with mean age of 74 ± 7.5 years with minimum of 12 months follow-up were studied. The radiological and clinical parameters were assessed at three, six, and 12 months. Functional outcomes (DASH, Green-O'Brien) were assessed at 12 months. Patients who underwent surgery regain wrist motion and grip strength earlier, but this was not statistically significant after six months.

scholarly journals Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study

2017 ◽  
Vol 3 (5) ◽  
pp. 1004 ◽  
Author(s):  
Sunil Kumar Dash ◽  
Manish Kumar Sharma ◽  
Sanket Mishra ◽  
Hatia Marandi ◽  
Aurobinda Das ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Functional Recovery ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Dash Score ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Group I

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An attempt was made to analyze patients treated with Ex-Fix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Ex-fix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective trial was undertaken at our hospital with 35 patients,all aged &gt;20 yrs with closed distal radius fracture and divided into two groups: group I (Ex-fix with or without percutaneous k-wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year, 6 months average</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Group I consumed significant less operative time, fluoroscopic exposure, reduced hospital stay, quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with Ex-Fix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &amp;1 case of pin tract infection with ex-fix application was observed</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext-fixation can be considered as a primary treatment modality in the extra-articular fractures in young or even intra-articular fractures in the elderly</span><span lang="EN-IN">.</span></p>

scholarly journals 1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Hafez ◽  
A Shaat ◽  
M Zain ◽  
M A Sajid ◽  
A Butt
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Open Reduction ◽  
Group Versus ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Volar Approach ◽  
Normal Ranges ◽  
Significant Difference ◽  
The Impact

Abstract Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

scholarly journals Comparison of functional outcome of extra-articular distal radius fractures treated by volar locking plate versus percutaneous pinning in adults-a retrospective study

2021 ◽  
Vol 7 (3) ◽  
pp. 611
Author(s):  
Shushrut B. Bhavi ◽  
Amith Shanmukgouda Kallanagoudar ◽  
Deepak Kaladagi ◽  
N. B. Sanakal
Keyword(s):  
Retrospective Study ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Volar Locking Plate ◽  
Percutaneous Pinning ◽  
Radius Fractures ◽  
Plate Group

<p><strong>Background</strong>: Distal radius fractures are one of the most common fractures in an adult population and accounts for 17.5% of all the fractures. The management of distal radius fractures remains debatable despite the availability of different methods of treatment. The aim of this study is to assess the functional outcomes of extra-articular distal radius fractures treated with percutaneous pinning or internal fixation with volar locking plate in adults.</p><p><strong>Methods: </strong>A retrospective study of 40 patients diagnosed with distal radius fracture with AO classification were treated either with percutaneous pinning (n=20) or open reduction and internal fixation with volar locking plate (n=20) were included in study. DASH score and radiographs at 6<sup>th</sup> month was assessed for functional outcome and radiological union.</p><p><strong>Results: </strong>Mean age in plate group was 40 and 45 years in K wire group. The mean passive wrist ROM at the final follow-up evaluation in plate group was 63.8<sup>o</sup> extension and 70.5<sup>o </sup>flexion, 81.7<sup>o</sup> supination and 79<sup>o</sup> pronation, compared with 56.75<sup>o</sup> extension and 65.25<sup>o</sup> flexion, 74.7<sup>o</sup> supination and 85.5<sup>o</sup> pronation in patients treated with K wire group. Patients with plate group and K wire group had DASH score of 19.85 and 18.49 respectively (p=0.07) at 6 months follow-up.</p><p><strong>Conclusions:</strong> The use of ORIF with plate resulted in stable fixation of the unstable extraarticular fractures, allowing early post-surgical wrist motion and has good radiological outcome whereas K wire also has advantages of being minimal invasive, reduced hospital stay and minimal cost.</p>

Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures

2021 ◽  
pp. 1-7
Author(s):  
Tim Coughlin ◽  
Alan R. Norrish ◽  
Brigitte E. Scammell ◽  
Paul A. Matthews ◽  
Jessica Nightingale ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Secondary Outcome ◽  
Dash Score ◽  
Radius Fractures ◽  
Face To Face ◽  
Significant Difference ◽  
One Year

Aims Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. Methods Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. Results A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). Conclusion Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy.

scholarly journals Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches

2019 ◽  
Vol 09 (01) ◽  
pp. 052-057
Author(s):  
Christopher M. Jones ◽  
Roshan Melvani ◽  
Keith T. Aziz ◽  
Pooyan Abbasi ◽  
Kenneth R. Means
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Flexor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Flexor Tendons ◽  
Flexor Carpi Radialis ◽  
Significant Difference ◽  
The Impact ◽  
Contact Pressures

Abstract Background Flexor tendon irritation or rupture following open reduction and volar plate fixation of distal radius fractures can cause significant morbidity and necessitate additional surgical intervention. Objectives To compare the impact of the extended flexor carpi radialis (e-FCR) and standard flexor carpi radialis (FCR) approaches on contact pressures between the flexor tendons and volar distal radius plates. Methods Eight matched pairs of fresh frozen cadavers had each limb randomized to undergo either the e-FCR or standard FCR approach. After the approach, a locking plate was applied to the volar distal radius more distally than ideally to create a worst-case scenario for the digital flexor tendons. Electronic pressure sensors were secured to the volar aspect of each locking plate. Each wrist was pinned in 20 degrees of extension during testing. Using a computer-controlled stepper motor system attached to the digital flexor and extensor tendons, the digits were taken through 4,000 cycles simulating 12 weeks of active flexion and extension. Results There were no statistically or clinically significant differences when comparing the contact pressures of the e-FCR approach with the standard FCR approach at any time intervals. The e-FCR had statistically significantly higher radial-sided contact pressures than ulnar-sided contact pressures during early-to-intermediate testing intervals. These differences resolved at late and final testing intervals. Conclusions When comparing the standard FCR approach with the e-FCR approach, with the wrist in 20 degrees of extension, there is no significant difference in contact pressures that occur between the digital flexor tendons and volar distal radius plates. Clinical Relevance Further study and technique modifications may eventually lead to better methods of avoiding flexor tendon rupture during the volar plating of distal radius fractures.

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