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.

scholarly journals The relationship between radiological alignment of united distal radius fractures and functional and patient-perceived outcomes in elderly patients

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668497 ◽  
Author(s):  
Erik Hohmann ◽  
Mahendrakumar Meta ◽  
Vasudev Navalgund ◽  
Kevin Tetsworth
Keyword(s):  
Elderly Patients ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Pinch Strength ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Perceived Outcomes ◽  
The Relationship

Purpose: The purpose of this study was to investigate the relationship between radiological alignment and functional outcomes including strength, range of motion (ROM), and disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores in elderly patients with united distal radius fractures. Methods: We reviewed 118 patients (mean age of 76.2 ± 9.5 years, mean follow-up 36.3 ± 17.6 months). Outcome measures included the DASH and PRWE scores, ROM, and grip and pinch strength were measured using a validated mobile hand-held dynamometer. Radial height, radial inclination, ulnar variance, and palmar tilt were measured on standard radiographs. Results: The mean total score for DASH was 4.9 ± 7.4 and 6.9 ± 11 for the PRWE. There were significant differences in ROM for palmar flexion and ulnar deviation between the affected wrist and the normal wrist. Linear regression revealed significant relationships for the following variables: between DASH and radiological palmar tilt, between PRWE and radiological palmar tilt, between grip strength and radial inclination, between grip strength and radial height, and between grip strength and ulnar variance. Conclusion: This study suggests that minor deformities of the distal radius following distal radius fractures treated with either operative or nonoperative treatment are unlikely to be clinically relevant and have no impact on patient perceived outcomes for elderly patients.

scholarly journals A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients Following Distal Radius Fractures Treated With 4- and 6-Week Cast Immobilization

2021 ◽  
Vol 10 (24) ◽  
pp. 5774
Author(s):  
Jarosław Olech ◽  
Grzegorz Konieczny ◽  
Łukasz Tomczyk ◽  
Piotr Morasiewicz
Keyword(s):  
Muscle Strength ◽  
Elderly Patients ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Cast Immobilization ◽  
The Mean

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: 1) muscle strength, 2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

scholarly journals Volar Locking Plate for Distal Radius Fractures: Functional Outcomes and Complication Rates with a Minimum of One Year Follow-Up

2021 ◽  
Vol 6 (05) ◽  
pp. 358-365
Author(s):  
Kastanis G ◽  
Pantouvaki A ◽  
Kapsetakis P ◽  
Spyrantis M ◽  
Magarakis G ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
One Year ◽  
Quick Dash

Distal radius fractures (DRF) are the most common type of fractures of the upper extremities with an incidence of 44% of all types of forearm and hand fractures. In unstable DRF, the aim of surgical treatment is to restore a functional wrist. Volar locking plate is supported in literature as a promising surgical method in treatment of these fractures. The aim of this study is to analyze the type and complication rate with applied volar locking plate, the percentage of revision surgery and the functional outcomes in a minimum of one year follow up. Material &Methods: 104 fractures in 98 patients with a mean range of 48,5 years-old age underwent for unstable distal radius fractures with volar locking plate. The main cause was simple fall to an outstretched hand. In ten cases the fracture was open while in 28 cases the DRF was accompanied with ulnar styloid. All fractures classified by AO/OTA in A2-3 27 cases, B1-3 in 45 and C1-3 in 32 cases. The majority of patients were operated within 48-72 hours after injury. In all cases an extended flexor carpi radialis approach was performed and a volar locking plate was applied in all DRF’s. In sixteen cases with base of ulnar styloid fractures, low profile locking plates were applied, while in the rest of patients Kirschner wires were used. Postoperatively all patients followed a standard protocol rehabilitation program with passive and active motion of fingers and wrist. Results: Patients were evaluated according to complication (type and rate), time to fracture union, range of motion, Visual analogue pain scale, Quick Dash Score and patients-rated wrist evaluation score. Complications were distinguished in major and minor. Patients under 60 years-old with type fracture A2-3 and B1-3 showed better range of motion and grip strength than patients over 65 years old. In cases with type fractures C1-3 and age over 65 years old, ROM and grip strength decreased compared with the unilateral side. The percentage of complication and reoperation appeared more increased in type C1-3 related to the other two types of fractures. Finally the mean Quick DASH was 11,1±12,8, RPWE was 9.8±13,6 and the range of motion was in extension 75,2±7,3, in flexion 74±8,9, in pronation 85,6±1,9, in supination 88,5±2,4 in radial deviation 9,8±1,2 and in ulnar deviation 41,1±4,6 and grip strength was an average of 84,7% of uninjured hand. Conclusion: Unstable fractures required operative treatment with volar locking plate to be the gold standard in recently years. Unfortunately VPL presents postoperative complications related with plate and screw position with comminuted fracture or soft tissue damage which cannot be ignored, and for these reasons may be inadequate for all types of distal radius fractures.

The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life

2017 ◽  
Vol 43 (2) ◽  
pp. 131-136 ◽  
Author(s):  
M. Å. Wadsten ◽  
G. O. Sjödén ◽  
G. G. Buttazzoni ◽  
C. Buttazzoni ◽  
E. Englund ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Pain Visual Analogue Scale ◽  
Level Of Evidence

Late displacement of distal radius fractures, still in acceptable radiological position after 1–2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10–14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires. Level of evidence: II

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.

scholarly journals Solitary ulnar shortening osteotomy for malunion of distal radius fractures: experience of a centre in the UK and review of the literature

2019 ◽  
Vol 101 (3) ◽  
pp. 203-207
Author(s):  
S Hassan ◽  
R Shafafy ◽  
A Mohan ◽  
P Magnussen
Keyword(s):  
Distal Radius ◽  
Simple Procedure ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
The Uk

Introduction Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. Materials and methods Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability. Patients were treated with a short oblique ulnar shortening osteotomy, using a Stanley jig and small AO compression plate system. Pre- and postoperative radiographical measurements of inclination, dorsal/volar angulation and ulnar variance were made. Patients were scored pre- and postoperatively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation scores by two orthopaedic surgeons. Mean follow-up was 24 months after surgery. Results Radiographical analysis revealed a change in the ulnar variance with an average reduction of 5.74 mm. Mean preoperative scores were 61.1 (range 25–95.5) for QuickDASH and 70.4 (range 33–92) for Patient-Rated Wrist Evaluation. At the latest follow-up, mean postoperative QuickDASH scores were 10.6 (range 0–43.2) and 17.2 (range 0–44) for Patient-Rated Wrist Evaluation. Differences in scores after surgery for both QuickDASH and Patient-Rated Wrist Evaluation were statistically significant (P < 0.01). Conclusions The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna–carpal impaction.

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

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 357-362 ◽  
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.

DORSAL PLATING FOR COMMINUTED INTRA-ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS

Hand Surgery ◽  
2004 ◽  
Vol 09 (02) ◽  
pp. 181-190 ◽  
Author(s):  
D. Osada ◽  
K. Tamai ◽  
A. Iwamoto ◽  
S. Fujita ◽  
K. Saotome
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Articular Fractures ◽  
Radial Length ◽  
Comminuted Fractures ◽  
Dorsal Plating

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry® plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23°, volar tilt 7°, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5° during follow-up in ten patients. Use of dorsal Symmetry® plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.

USE OF THE VOLAR FIXED ANGLE PLATE FOR COMMINUTED DISTAL RADIUS FRACTURES AND AUGMENTATION WITH A HYDROXYAPATITE BONE GRAFT SUBSTITUTE

Hand Surgery ◽  
2011 ◽  
Vol 16 (01) ◽  
pp. 29-37 ◽  
Author(s):  
Akira Goto ◽  
Tsuyoshi Murase ◽  
Kunihiro Oka ◽  
Hideki Yoshikawa
Keyword(s):  
Elderly Patients ◽  
Bone Graft ◽  
Distal Radius ◽  
Bone Graft Substitute ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Fixed Angle ◽  
Radial Inclination ◽  
Metaphyseal Comminution

Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone.We treated elderly patients suffering from distal radius fractures with metaphyseal comminution, using both volar fixed angle plate with or without augmentation with a hydroxyapatite bone graft substitute to investigate the benefit of augmentation for maintaining a fracture reduction. We evaluated the differences among radiographic parameters including palmar tilt, radial inclination, and ulnar variance on immediate postoperative and final follow-up radiographs to analyse the maintenance of the initial reduction.There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05).It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.

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