scholarly journals Reconstruction of the Distal Radius following Tumour Resection Using an Osteoarticular Allograft

Sarcoma ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Katharina Rabitsch ◽  
Werner Maurer-Ertl ◽  
Ulrike Pirker-Frühauf ◽  
Thomas Lovse ◽  
Reinhard Windhager ◽  
...  
Keyword(s):  
Distal Radius ◽  
Functional Result ◽  
Functional Results ◽  
Tumour Resection ◽  
Dash Score ◽  
Bone Resection ◽  
Osteoarticular Allograft ◽  
Autologous Bone Grafting ◽  
Flexion Extension ◽  
The Mean

Reconstruction of the distal radius following tumour resection is challenging and various techniques are recorded. We retrospectively analysed the outcome of five patients (one male and four females) after reconstruction of the distal radius with osteoarticular allograft, following tumour resection. Mean followup was 32 months (range, 4–121). In three of the five patients the dominant limb was affected. Mean bone resection length was 6.5 centimetres (range, 5–11.5). Two grafts developed nonunion, both successfully treated with autologous bone grafting. No infection, graft fracture, or failure occurred. Mean flexion/extension was 38/60 degrees and mean pronation/supination was 77/77 degrees. The mean Mayo wrist score was 84 and the mean DASH score was 8, both representing a good functional result. Therefore we state the notion that osteoarticular allograft reconstruction of distal radius provides good to excellent functional results.

Vascularized Medial Femoral Condyle Bone Graft for Resistant Nonunion of the Distal Radius

2017 ◽  
Vol 22 (01) ◽  
pp. 23-28 ◽  
Author(s):  
Mark Henry
Keyword(s):  
Distal Radius ◽  
Femoral Condyle ◽  
Difficult Problem ◽  
Medial Femoral Condyle ◽  
Dash Score ◽  
Structural Block ◽  
Surgical Interventions ◽  
Paired Student ◽  
Co Morbidity ◽  
The Mean

Background: Nonunion involving the metaphyseal region of the distal radius is exceedingly rare, usually involving co-morbidity. Patients that have failed multiple prior conventional surgical interventions represent an even more difficult subset to treat; this investigation examined the utility of a specially designed free vascularized medial femoral condyle flap consisting of a central structural block graft with an extended corticoperiosteal sleeve to wrap around the junctions. Methods: Six patients (5 males, 1 female) with a mean age of 52 years had failed to achieve union involving the distal radius metaphysis after a mean of 3.7 prior surgeries occurring over a mean period of 24 months. Comorbidities included smoking, alcoholism, chronic nutritional deficiency, and prior osteomyelitis. The unique descending genicular artery medial femoral condyle flap designed to address these patients consisted of a central structural block graft in continuity with an extended corticoperiosteal sleeve. The structural block filled the bone defect, and the corticoperiosteal sleeve wrapped around the bone junctions and the neighboring bone margins. The mean flap size was 5.3 (+/- 1.3) cm long by 4.5 (+/- 0.9) cm wide. Pre-operative to post-operative DASH scores were compared using the paired student’ s t-test, with p < 0.05. Results: All flaps achieved union at a mean of 6.8 (+/- 2.1) weeks following surgery, using the criteria of bridging trabeculae on all 3 radiographs: coronal, sagittal, and oblique. The mean pre-operative DASH score of 63 (+/- 10) was statistically significantly different compared to the mean post-operative DASH score of 18 (+/- 8). Conclusions: With few alternative solutions able to address this unique and difficult problem, the structural block of vascularized bone with the extended corticoperiosteal sleeve proved able to achieve a union that had failed multiple previous attempts and able to resist reactivation of infection, in a challenging group of patients with comorbidities.

Outcomes of Supplementary Spring Wire Fixation With Volar Plating for Volar Lunate Facet Fragments in Distal Radius Fractures

Hand ◽  
2020 ◽  
pp. 155894472097640
Author(s):  
Nathaniel Fogel ◽  
Lauren M. Shapiro ◽  
Allison Roe ◽  
Sahitya Denduluri ◽  
Marc J. Richard ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Wrist Flexion ◽  
Volar Plating ◽  
Radius Fractures ◽  
Locked Plating ◽  
Spring Wire ◽  
Flexion Extension ◽  
Wire Fixation ◽  
The Mean

Background Intra-articular distal radius fractures with small volar lunate facet fragments can be challenging to address with volar plate fixation alone. Volar locked plating with supplementary spring wire fixation has been previously described in a small series but has not been further described in the literature. We hypothesized that this technique can provide adequate fixation for volar lunate facet fragments smaller than 15 mm in length, which are at risk of displacement. Methods We completed a retrospective chart review (2015-2019) of patients who underwent volar locked plating with the addition of supplementary spring wire fixation for intra-articular distal radius fractures with a volar lunate facet fragment (<15 mm). Postoperative radiographs were assessed to evaluate union, evidence of hardware failure, escape of the volar lunate facet fragment, and postoperative volar tilt. Clinical outcome was assessed with wrist flexion/extension, arc of pronosupination, and Quick Disabilities of the Arm, Shoulder, and Hand Score ( QuickDASH) scores. Results Fifteen patients were identified, of which all went on to fracture union. There were no hardware failures or escape of the volar lunate facet fragment at final follow-up. One patient underwent hardware removal for symptoms of flexor tendon irritation. The mean wrist flexion was 59°, wrist extension was 70°, pronation was 81°, and supination was 76°. The mean QuickDASH score was 18.5. The mean postoperative volar tilt was 3.6°. Conclusions Supplementary spring wire fixation with standard volar plating provides stable fixation for lunate facet fragments less than 15 mm. This technique is a safe and reliable alternative to commercially available fragment-specific implants.

FACTORS AFFECTING THE FUNCTIONAL RESULTS OF OPEN REDUCTION AND INTERNAL FIXATION FOR FRACTURE-DISLOCATIONS OF THE PROXIMAL INTERPHALANGEAL JOINT

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 107-114 ◽  
Author(s):  
Kentaro Watanabe ◽  
Yoshitake Kino ◽  
Hiroki Yajima
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
Fracture Dislocation ◽  
Factors Affecting ◽  
Flexion Extension ◽  
Motion Exercise ◽  
Fracture Dislocations ◽  
Pip Joint ◽  
The Mean

To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.

scholarly journals Correlation between functional and radiological outcome after surgical stabilization of volar Barton fracture with plating: a comparative study

2020 ◽  
Vol 6 (4) ◽  
pp. 666
Author(s):  
Vikram Goud ◽  
Manoj Kanamarlapudi
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Result ◽  
Dash Score ◽  
Statistical Relationship ◽  
Radiological Outcome ◽  
Distal Extremity ◽  
The Mean ◽  
Barton Fracture

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.</p><p class="abstract"><strong>Methods:</strong> Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p&lt;0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.</p><p class="abstract"><strong>Conclusions:</strong> The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.</p>

ISOLATED SCAPHOTRAPEZIOTRAPEZOID OSTEOARTHRITIS: PRELIMINARY RESULTS OF TREATMENT USING A PYROCARBON IMPLANT

Hand Surgery ◽  
2007 ◽  
Vol 12 (02) ◽  
pp. 73-77 ◽  
Author(s):  
A. K. Low ◽  
I. A. Edmunds
Keyword(s):  
Good Alternative ◽  
Pinch Strength ◽  
Dash Score ◽  
Wrist Flexion ◽  
Interposition Arthroplasty ◽  
Results Of Treatment ◽  
Post Surgery ◽  
Flexion Extension ◽  
The Mean ◽  
Pyrocarbon Implant

The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58–76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3–35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126° and radioulnar deviation was 43°. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.

scholarly journals No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252667
Author(s):  
Aldo Okamura ◽  
Vinícius Ynoe de Moraes ◽  
Jorge Raduan Neto ◽  
Marcel Jun Tamaoki ◽  
Flavio Faloppa ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Distal Radius ◽  
Primary Outcome ◽  
Dash Score ◽  
Functional Evaluation ◽  
Radius Fractures ◽  
The Mean ◽  
Objective Functional ◽  
Dash Questionnaire

Purpose For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. Methods This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. Results The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19–0.94); p = 0.033 at the end of six-month follow-up. Conclusions This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.

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

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.

Long-Term Results of Arthroscopic Capsular Shrinkage for Palmar Midcarpal Instability of the Wrist

2021 ◽  
Author(s):  
Matthew Ricks ◽  
Peter Belward ◽  
David Hargreaves
Keyword(s):  
Long Term Results ◽  
Lead Author ◽  
Grading System ◽  
Dash Score ◽  
Anterior Drawer ◽  
Anterior Drawer Test ◽  
Flexion Extension ◽  
The Mean

Abstract Background Midcarpal instability is a term for a collection of poorly understood conditions where the proximal row of the carpus is unstable. The most common type of midcarpal instability is palmar midcarpal instability (PMCI). Treatment for PMCI includes nonoperative proprioceptive retraining of the wrist, splints, and strengthening. If this fails, various authors have suggested several different fusions, tenodesis procedures, or capsular shrinkage. There are no long-term case series in the literature. Objective The aim of this study is to assess the long-term results of arthroscopic capsular shrinkage when used for PMCI of the wrist. Methods A prospective cohort study of patients who underwent arthroscopic capsular shrinkage for PMCI was performed. Ethical board approval was given for this study. All patients were followed up and reviewed independently from the operating surgeon. Assessment included a structured questionnaire, disabilities of the arm, shoulder and hand (DASH) questionnaire, and clinical examination using a goniometer. PMCI was assessed objectively with the anterior drawer test and radiological imaging was only performed if clinically relevant to the residual symptoms. Results Thirteen patients (15 wrists) underwent arthroscopic capsular shrinkage for PMCI. Twelve patients (14 wrists) were available for clinical review with a follow-up rate of 92.3%. The mean time from index procedure to final review was 12 years (range: 10–14years). The symptoms of instability had completely resolved in nine wrists (7 patients). Only 2 of the 14 wrists had symptoms that were reproduced with a positive anterior drawer test. All other wrists were stable on objective assessment. The mean DASH score had improved from pre op of 34 to post op of 12.1 and at 12-year follow-up this had deteriorated minimally to 15.3. Assessment of the range of motion showed an average increase in range of flexion/extension by 22 degrees. Patient satisfaction was excellent. The patients rated that nine wrists were much better than presurgery, three as better, one unchanged, and one worse. Discussion/Conclusion There are no studies looking at the long-term natural history of treatments for PMCI. The lead author proposes a grading system for symptomatic PMCI that has been retrospectively applied to this cohort. It is a grading system from 1 to 4 and is based on a treatment algorithm. This is the first long-term study from any joint, where the results of capsular shrinkage have been maintained over time. In this series, we have not seen any deleterious effect from possible mechanoreceptor injury. We suspect that functioning mechanoreceptors are more relevant in the unstable joint, than the structurally stable joint. The authors propose that thermal capsular shrinkage is an effective and durable option for use in mild-to-moderate forms of PMCI.

Primary excision of the ulnar head for fractures of the distal ulna associated with fractures of the distal radius in severe osteoporotic patients

2013 ◽  
Vol 39 (3) ◽  
pp. 293-299 ◽  
Author(s):  
H. Yoneda ◽  
K. Watanabe
Keyword(s):  
Distal Radius ◽  
Contralateral Side ◽  
Fracture Site ◽  
Wrist Flexion ◽  
Distal Radial Fractures ◽  
Ulnar Head ◽  
Flexion Extension ◽  
Ulna Fractures ◽  
The Mean ◽  
Short Time

We performed primary excision of the ulnar head on 23 patients over 70 years of age with severe comminuted fractures of both the distal radius and ulna. The distal radius fracture was fixed rigidly with a volar locking plate, and the ulnar head was resected at the fracture site. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 122°, the mean pronation/supination arc was 164°, and grip strength was 69% of that on the contralateral side. All patients returned to their daily activities within a short time without any additional surgical treatment. For elderly patients, primary excision of the ulnar head is an effective treatment for comminuted distal radius and ulna fractures.

scholarly journals Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists)

2017 ◽  
Vol 07 (01) ◽  
pp. 011-17
Author(s):  
Tahir Sügün ◽  
Murat Kayalar ◽  
Yusuf Gürbüz
Keyword(s):  
Distal Radius ◽  
Screw Fixation ◽  
Functional Results ◽  
High Energy ◽  
Activity Level ◽  
Type B ◽  
Fixation Technique ◽  
Scaphoid Fractures ◽  
Surgical Fixation ◽  
The Mean

Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19–82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert–Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results The average follow-up period was 25 (range: 12–97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0–8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence Level IV.

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