TREATMENT OF DISTAL RADIAL FRACTURES WITH THE DVR-A PLATE — THE EARLY BRISTOL EXPERIENCE

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 159-167 ◽  
Author(s):  
J. Loveridge ◽  
N. Ahearn ◽  
C. Gee ◽  
D. Pearson ◽  
S. Sivaloganathan ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radial Fracture ◽  
Consecutive Series ◽  
Dash Score ◽  
X Rays ◽  
Radial Inclination ◽  
Sagittal Tilt ◽  
Radial Length ◽  
The Mean

Aim: The aim of the study was to assess how adequately distal radial fracture reduction was reproduced and maintained with the distal volar radius anatomic DVR-A (Biomet, Inc) locking plate. Methods: We looked at a consecutive series of 111 patients treated with the DVR-A plate at our institution from 2007–2010. The preoperative, intra-operative, and postoperative films were reviewed. The AO and Frykman classification was recorded. The sagittal tilt, radial inclination, and radial length were measured on intra-operative X-rays and compared with final follow-up X-rays. The last recorded range of motion at follow-up and a functional assessment using the Disabilities of the Arm, Shoulder, and Hand (DASH) score was recorded. Results: At final follow-up a mean radial inclination of 22.22 degrees (11 to 38 degrees), radial height of 11.85 mm (6 to 18 mm), and sagittal tilt of 6.71 degrees volar (-9 to 19 degrees) was achieved. From initial post-operative films, to final follow-up X-rays there was a mean increase of 0.17 degrees in radial inclination, a mean loss of 0.36 mm radial height, and a mean loss of 2.17 degrees volar tilt. The mean extension was 46.8 degrees, flexion 48.3 degrees, pronation 77.4 degrees, supination 74.8 degrees, radial deviation 15.3 degrees and the ulnar deviation 19 degrees. The mean DASH score was 12.8 (0–68). Conclusion: The DVR-A plate achieved a highly satisfactory reduction of radial length and radial inclination, with a small loss of volar sagittal tilt at final follow-up. A good functional outcome was reported, with a satisfactory range of motion achieved. The DVR-A plate is a safe and effective treatment for unstable and intra-articular displaced distal radius fractures, particularly in younger patients, in the short term.

Surgical treatment of fractures of the distal radius – ORIF vs external fixation with ligamentotaxis

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Locking Plates ◽  
X Rays ◽  
Ao Classification ◽  
Radial Inclination ◽  
First Choice ◽  
Sagittal Tilt ◽  
Radial Length ◽  
The Mean

Introduction: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification. Methods: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and O’Brien score at 6 and 12 months after surgery. Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13°, the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and O’Brien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient. Conclusion: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.

scholarly journals Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

2017 ◽  
Vol 06 (04) ◽  
pp. 294-300 ◽  
Author(s):  
Avanthi Mandaleson ◽  
Michael Wagels ◽  
Stephen Tham
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Pinch Grip ◽  
The Mean ◽  
Therapeutic Study

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.

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.

Four-Corner Arthrodesis Using the Quad Memory Staple

2009 ◽  
Vol 34 (2) ◽  
pp. 252-255 ◽  
Author(s):  
E. A. VAN AMERONGEN ◽  
A. H. SCHUURMAN
Keyword(s):  
Range Of Motion ◽  
Compressive Property ◽  
Dash Score ◽  
Ulnar Deviation ◽  
Non Union ◽  
Radial Deviation ◽  
Pin Fixation ◽  
The Mean ◽  
Simple Fixation

Range of motion, pain, consolidation and complications were evaluated for nine patients who underwent four-corner arthrodesis using the Quad Memory Staple (QMS) at a mean follow-up of 44 months. The mean pre-operative range of motion was 50° extension, 62° flexion, 9° radial deviation and 24° ulnar deviation. The postoperative range of motion was similar to previous studies at 32° extension, 31° flexion, 15° radial deviation and 20° ulnar deviation. The grip strength was 28 kg pre-operatively and 26 kg postoperatively. The mean pain score improved from 41 to 23 and the Disabilities of Arm, Shoulder, and Hand (DASH) score from 24 to 20. Non-union, haematoma and wound infection were not seen and eventually all four-corner fusions were consolidated. The main advantages of the QMS are its compressive property and the simple fixation technique. It gives good stability, enables early rehabilitation and avoids the risks of pin fixation methods.

Closed Reduction and Percutaneous Pinning for Treatment of Proximal Interphalangeal Joint Pilon Fractures

Hand ◽  
2021 ◽  
pp. 155894472199077
Author(s):  
Farid Najd Mazhar ◽  
Paniz Motaghi
Keyword(s):  
Range Of Motion ◽  
Closed Reduction ◽  
Pinch Strength ◽  
Dash Score ◽  
Wide Range ◽  
Pip Joint ◽  
The Mean ◽  
Quick Dash ◽  
Pilon Fractures

Background: Proximal interphalangeal (PIP) joint pilon fractures are among the challenging hand injuries, which are often associated with a wide range of complications. This study aimed to report the clinical and radiological outcomes of closed reduction and percutaneous Kirschner wire (KW) insertion with or without bone cement application (for the fabrication of an external fixator) in the treatment of PIP joint pilon fractures. Methods: Twenty pilon fractures underwent closed reduction and percutaneous KW fixation through a modified technique. At the end of the follow-up period, 3 questionnaires—Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Visual Analogue Scale for pain, and Patient-Rated Wrist Evaluation—were completed. The radiological outcome was assessed by radiography. Range of motion, and grip and pinch strength were measured. Results: The mean follow-up period was 14.57 ± 4.03 months (range, 12-20 months). The mean range of motion of PIP at the end of the follow-up period was 89.64° ± 10.82° (range, 65°-100°). The mean difference in the range of motion in the contralateral side was 21.4° ± 13°. The mean of the Quick DASH score was 13.50 ± 2.92 (range, 11-21). Two patients had residual articular malalignment, and 3 patients had angular or rotational malunion. Conclusion: By treating pilon fractures with the proposed technique, we achieved a satisfactory outcome. The acceptable articular and axial alignment was achieved in 75% of patients, and complications were low. The flexibility of percutaneous KW insertion and handmade external fixators makes these approaches convenient for treating PIP joint pilon fractures.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

2021 ◽  
pp. 112070002110107
Author(s):  
Eustathios Kenanidis ◽  
Panagiotis Kakoulidis ◽  
Panagiotis Anagnostis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis
Keyword(s):  
High Risk ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Consecutive Series ◽  
Revision Thas ◽  
Hip Stability ◽  
Functional Scores ◽  
Revision Tha ◽  
The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

2015 ◽  
Vol 41 (3) ◽  
pp. 322-327 ◽  
Author(s):  
J. K. Thillemann ◽  
T. M. Thillemann ◽  
B. Munk ◽  
K. Krøner
Keyword(s):  
Rating Scale ◽  
Revision Rate ◽  
Numerical Rating Scale ◽  
Elevated Serum ◽  
Consecutive Series ◽  
Dash Score ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Thumb Carpometacarpal

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23&deg;; increased proximal articular angle (PAA&gt;8&deg;), and range of motion of the metatarsophalangeal joint in flexion and extension &gt;40&deg;. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8&plusmn;1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7&plusmn;2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1&plusmn;2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6&deg; (pre-operative mean value: 37.5&deg;) which was statistically significant (p&lt;0.01). The IMA improved by an average of 5.96&deg; from a pre-operative mean value of 15.4&deg; (p&lt;0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

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