Sparing the pronator quadratus for volar plating of distal radius fractures: a comparative study of two methods

Objectives The objective of this study was to compare the results of two methods for sparing the pronator quadratus in volar plating of distal radius fractures. Methods A total of 110 patients were randomized to volar plating with sparing of the pronator quadratus either by a transverse incision along the distal border of the pronator quadratus (Group A, 55 people) or by the brachioradialis splitting method (Group B, 55 people). The operative and radiation time, range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Visual Analog Scale (VAS) scores, and complications were recorded. Results There were no significant differences in the mean operative time, radiation time, mean bone union time, or total complication rate between the groups. We found no significant differences in range of motion, grip strength, VAS scores, and DASH scores at any of the study intervals between the groups. Although neurapraxia of the superficial branch of the radial nerve was more common in Group B than in Group A (6.7% vs. 0%), the difference was not significant. Conclusions Both methods were efficient approaches for sparing the pronator quadratus and had similar clinical outcomes, but they had different indications.

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Hematoma block for distal radius fractures – prospective, randomized comparison of two different volumes of lidocaine

Journal of International Medical Research ◽

10.1177/0300060518799883 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4535-4538 ◽

Cited By ~ 1

Author(s):

Hagay Orbach ◽

Nimrod Rozen ◽

Barak Rinat ◽

Guy Rubin

Keyword(s):

Distal Radius ◽

Analgesic Efficacy ◽

Fracture Site ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Vas Score ◽

Significant Difference ◽

Group A ◽

Vas Scores ◽

Group B

Objective This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. Methods Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. Results Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. Conclusion VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

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The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating

Hand ◽

10.1007/s11552-012-9420-6 ◽

2012 ◽

Vol 7 (3) ◽

pp. 276-280 ◽

Cited By ~ 35

Author(s):

Zahab S. Ahsan ◽

Jeffrey Yao

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Pronator Quadratus

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Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

Journal of Wrist Surgery ◽

10.1055/s-0038-1667302 ◽

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.

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Effects of active isolated stretching on exercise-induced muscle damage in untrained subjects: a randomized controlled trial

Journal of the Pakistan Medical Association ◽

10.47391/jpma.494 ◽

2020 ◽

pp. 1-12

Author(s):

Muhammad Mustafa Qamar ◽

Muhammad Shahid Javed ◽

Muhammad Zahoor ul Hassan Dogar ◽

Ayesha Basharat

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Muscle Damage ◽

Muscle Soreness ◽

Early Recovery ◽

Pain Pressure Threshold ◽

Group A ◽

Exercise Induced ◽

Group B ◽

Wrist Flexors

Abstract Objective: To investigate the prophylactic effect of the active isolated stretching technique on exercise-induced muscle damage of wrist flexors. Method: The mixed model randomised controlled interventional study was conducted at the University of Sargodha, Sargodha, Pakistan, from November 2018 to May 2019, and comprised young adults who were untrained, sedentary and healthy who were randomly divided into intervention group A and control group B. Group A participants received self-assisted active isolated stretching before inducing muscle soreness of wrist flexors by eccentric exercises. Group B did not receive any intervention. The outcome measures were pain intensity, muscle soreness, pressure pain threshold, range of motion, and grip strength. Data were collected at baseline, after one hour, and daily from day 1 to 7 after inducing muscle soreness. Data were analysed using SPSS 21. Results: Of the 60 subjects, there were 30(50%) in each of the two groups. There were 14(23.3%) males and 46(76.7%) females. The overall mean age was 21.47±1.9 years. Group A showed early recovery in pain and muscle soreness compared to group B (p<0.05). Also, a limited deficit in the range of motion, grip strength, and pain pressure threshold was found in group A compared to group B (p<0.05). Conclusion: Active isolated stretching before strenuous, unaccustomed exercise was found to be useful in ameliorating the symptoms of muscle soreness. Key Words: Active isolated stretching, Muscle soreness, Exercise-induced muscle damage, Eccentric exercises. Continuous...

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Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

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

10.1142/s0218810417500447 ◽

2017 ◽

Vol 22 (04) ◽

pp. 423-428 ◽

Cited By ~ 1

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.

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A comparative study between variable and fixed angle volar locking plates in management of unstable intra-articular distal radius fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204588 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1222

Author(s):

Chhagan Lal Regar ◽

Siddharath Sharanappa Parmeshwar ◽

Ramesh Chandra Meena ◽

Shyoji Lal Sharma ◽

Jitesh Kumar Jain

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Fixed Angle ◽

Radial Inclination ◽

Variable Angle ◽

Group A ◽

Group B

Background: The current study is conducted to assess and compare the radiological and functional outcomes between variable and fixed angle volar plating in unstable intra-articular distal radius fractures.Methods: A prospective study was conducted from May 2018 to May 2020. A total of 156 patients were randomised into two groups A and B of 78 patients each. The plates were T or oblique fixed angle volar plate in group A and variable angle volar plate in group B. Patients were followed up for minimum 12 months. The functional outcome was measured by patient rated hand wrist evaluation score (PRHWE) and radiological outcome by radial height, volar tilt and radial inclination. The secondary objective was to correlate complications.Results: In our study average PRHWE score was better in group B (p<0.05). Radial height, volar tilt, radial inclination was much closer to anatomical wrist radiology was seen in group B. The most common complication was finger and wrist stiffness in group A.Conclusions: Patients treated with variable angle volar plate showed better results in functional and radiological outcomes at 12 months follow-up but limitations include short duration of follow up.

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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

Journal of Clinical Medicine ◽

10.3390/jcm10245774 ◽

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.

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Do We Need to Suture the Pronator Quadratus Muscle When We do Open Reduction and Internal Fixation for Fracture of the Distal Radius

10.21203/rs.3.rs-25399/v1 ◽

2020 ◽

Author(s):

kaibin fang ◽

Xiaocong Lin ◽

Xiaolin Liu ◽

Shaojian Shi ◽

Zhangsheng Dai

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Distal Radius ◽

Open Reduction ◽

Muscle Fibers ◽

Steel Plates ◽

Pronator Quadratus ◽

Functional Scores ◽

Group A ◽

Pronator Quadratus Muscle

Abstract Background: For fracture of the distal radius, open reduction and internal fixation are often used for treatment. In the process of open reduction and internal fixation, it is often necessary to open the pronator quadratus muscle to achieve sufficient exposure. So it's important to know if it's necessary to suture the pronator quadratus muscle. Purpose: To see if suturing the pronator quadratus during the treatment of fracture of the distal radius would improve limb function. Methods: 126 patients were selected for our study. These patients had open reduction and internal fixation.During the procedure, the pronator quadratus is cut open to allow the plate to be placed.Before the surgery was completed, the pronator quadratus muscles of these patients were stitched together. After the fracture healed, the patients underwent surgery to remove the internal fixation. These patients received wrist function scores prior to removal of internal fixation.The healing of the pronator quadratus was investigated during surgery. These patients were grouped according to the healing of the pronator quadratus. Functional scores were compared between the two groups Results: 23 patients were considered to have muscle healing during surgery. However, in these patients, the PQ muscles were obviously atrophic, with scar hyperplasia and fibrosis.The muscle fibers were loose and thin, and the number was reduced. At the same time, the remaining muscle fibers have different degrees of adhesion with radial carpal flexor muscles, steel plates and interosseous membrane. According to the intraoperative situation,23 patients were included in group A and 103 patients were included in group B. There were no statistically significant differences in age and fracture type between group A and group B.At the same time, there were no statistically significant differences in isokinetic forearm pronation strength and clinical outcomes including grip strength, wrist ROM, and PRWE scores between the two groups.Conclusions: this study demonstrates that whether the PQ muscle healing or not does not affect the outcomes of volar plating for distal radius fractures in terms of isokinetic forearm rotation strength, grip strength, wrist ROM, and PRWE scores.

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