Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

Introduction. Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods. Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results. We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions. We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.

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Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835516400051 ◽

2016 ◽

Vol 21 (02) ◽

pp. 133-139 ◽

Cited By ~ 8

Author(s):

Tsuyoshi Murase

Keyword(s):

Bone Graft ◽

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Corrective Osteotomy ◽

Extensor Tendon ◽

Radius Fracture ◽

Soft Tissue Release ◽

Dorsal Plate ◽

Volar Locking Plate

The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius.

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Clinical and Functional Outcome of Volar Locking Plate Fixation for Distal Radius Fracture

Orthopedics & Traumatology ◽

10.5035/nishiseisai.58.283 ◽

2009 ◽

Vol 58 (2) ◽

pp. 283-286 ◽

Cited By ~ 1

Author(s):

Shoichi Kuba ◽

Itaru Furuichi ◽

Masakazu Murata ◽

Takeshi Miyaji ◽

Noriaki Miyata ◽

...

Keyword(s):

Functional Outcome ◽

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Radius Fracture ◽

Volar Locking Plate ◽

Locking Plate Fixation

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Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-018-2925-x ◽

2018 ◽

Vol 138 (6) ◽

pp. 879-885 ◽

Cited By ~ 14

Author(s):

S. Erhart ◽

S. Toth ◽

P. Kaiser ◽

T. Kastenberger ◽

C. Deml ◽

...

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Radius Fracture ◽

Volar Locking Plate ◽

Locking Plate Fixation

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The Role of Early Post-Operative Radiographs Following Distal Radius Fracture Fixation with a Volar Locking Plate: Time for Change?

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500553 ◽

2019 ◽

Vol 24 (04) ◽

pp. 435-439

Author(s):

Vivek Sharma ◽

Caroline Witney-Lagen ◽

Samuel Cullen ◽

Edward Kim ◽

Zakir Haider ◽

...

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Clinical Information ◽

Median Number ◽

Radius Fracture ◽

Volar Locking Plate ◽

Articular Fractures ◽

Fracture Management

Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient’s first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9–16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

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