scholarly journals Strain as a Function of Time in Extrinsic Wrist Ligaments Tensioned Through External Fixation

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 60-64
Author(s):  
Joseph P. Rectenwald ◽  
K. Ashley Bentley ◽  
Peter M. Murray ◽  
Subrata Saha
Keyword(s):  
Stress Relaxation ◽  
External Fixation ◽  
Distal Radius ◽  
Kirschner Wire ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Fracture Length ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Average Loss

Background: The objective of this study is to determine the time-dependent dissipation of extrinsic wrist ligament tension following the application external fixation with axial distraction of the wrist in a cadaveric model. Methods: Six paired fresh-frozen cadaveric specimens underwent mechanical testing simulating external fixation with 1 arm of each pair osteotomized to simulate a distal radius fracture. The change in tension was then recorded over 24 hours. Results: The rate of stress relaxation decreased with time. The average loss in tension in the control arms and osteotomized arms was 55% and 59%, respectively, over a 24-hour period. There was no statistically significant difference in the stress relaxation behavior between the 2 groups. Conclusion: This study further supports the recommendation that comminuted distal radius fractures treated with an external fixator should have Kirschner wire augmentation or other additional means of fixation to help maintain fracture length and alignment. The results of this study call in to question the efficacy of ligamentotaxis alone through external fixation as the sole means of maintaining reduction of displaced, unstable distal radius fractures.

scholarly journals Dorsal Bridge Plating versus External Fixation for Distal Radius Fractures

2019 ◽  
Vol 09 (02) ◽  
pp. 177-184
Author(s):  
William L. Wang ◽  
Asif M. Ilyas
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Meta Analysis ◽  
Pain Syndrome ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Hardware Failure ◽  
Pubmed Database ◽  
Significant Difference ◽  
Bridge Plating

Abstract Background External fixation and dorsal bridge plating are wrist spanning fixation options for distal radius fractures; however, their comparative effectiveness is not well understood. A meta-analysis was conducted to compare the clinical outcomes between these two techniques. Materials and Methods A PubMed database query of all distal radius fracture cases managed with spanning external fixation or dorsal bridge plating was performed. A total of 28 articles met inclusion criteria, yielding 895 patients for data extraction and comparative analysis. Results Dorsal bridge plating demonstrated lower rates of infection (2 vs. 10%, p = 0.05) and complex regional pain syndrome (1 vs. 4%, p = 0.04) but higher rates of hardware failure (4 vs. 1%, p = 0.026). Bridge plating also demonstrated higher rates of excellent/good ratings under the Gartland and Werley outcome score (91 vs. 83%, p = 0.016). There was no significant difference in DASH (Disability of the Arm, Shoulder, and Wrist) scores, radiographic parameters, or unplanned reoperations between the two spanning fixation options. Conclusion Bridge plating and external fixation both appear to be comparable for spanning fixation constructs for distal radius fractures, but with bridge plating having a potentially lower complication profile.

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mulrain ◽  
K Joshi ◽  
F Doyle ◽  
A Abdulkarim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Volar Plating ◽  
Radius Fractures ◽  
Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

scholarly journals Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis

2013 ◽  
Vol 8 (2) ◽  
pp. 67-75 ◽  
Author(s):  
J. C. Goslings ◽  
Monique M. J. Walenkamp ◽  
Abdelali Bentohami ◽  
M. Suzan H. Beerekamp ◽  
Rolf W. Peters ◽  
...  
Keyword(s):  
Functional Outcome ◽  
External Fixation ◽  
Distal Radius ◽  
Locking Plate ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Plate Versus ◽  
Volar Locking Plate ◽  
Radius Fractures

scholarly journals Technique for Intramedullary Stabilization of Ulnar Neck Fractures

Hand ◽  
2017 ◽  
Vol 13 (5) ◽  
pp. 563-571
Author(s):  
Jack Abboudi ◽  
Scott M. Sandilands ◽  
C. Edward Hoffler ◽  
William Kirkpatrick ◽  
William Emper
Keyword(s):  
Distal Radius ◽  
Kirschner Wire ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Percutaneous Approach ◽  
Intramedullary Stabilization ◽  
Ulna Fractures ◽  
Neck Fracture ◽  
Reproducible Method

Background: Distal ulna fractures at the ulnar neck can be seen in association with distal radius fractures, and multiple techniques have been described to address the ulnar neck component of these injuries. We have found that treatment of ulnar neck fractures can be challenging in terms of anatomy and fracture fixation. We present a new percutaneous fixation technique for ulnar neck fractures commonly seen with distal radius fractures. Technique: Fixation of the ulnar neck fracture is performed after fixation of the distal radius fracture. Our technique uses anterograde intramedullary fixation to stabilize the fracture with a 1.6-mm (0.062 inch) Kirschner wire or a commercially available metacarpal fixation intramedullary nail. The fixation is introduced into the intramedullary space of the ulnar shaft 4 to 6 cm proximal to the fracture at a separate surgical site along the subcutaneous border of the ulna. The fixation is also supported with a sugar-tong splint for the first few weeks after surgery and requires removal of the ulnar implant approximately 10 weeks after implantation. Conclusion: Our technique utilizes a percutaneous approach with minimal fracture exposure. It provides a relatively simple and reproducible method to address ulnar neck fractures commonly seen in association with distal radial fractures.

Biomechanical Analysis of Pin Placement and Pin Size for External Fixation of Distal Radius Fractures

1990 ◽  
Vol &NA; (251) ◽  
pp. 207???212
Author(s):  
WILLIAM H. SEITZ ◽  
AVRUM I. FROIMSON ◽  
DENNIS B. BROOKS ◽  
PAUL D. POSTAK ◽  
RICHARD D. PARKER ◽  
...  
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Biomechanical Analysis ◽  
Radius Fractures

Clinical Outcomes in Distal Radius Fractures Accompanied by Volar Lunate Facet Fragments: A Comparison between Dorsal and Volar Displaced Fractures

2020 ◽  
Vol 25 (04) ◽  
pp. 417-422 ◽  
Author(s):  
Hiroyuki Obata ◽  
Kiyohito Naito ◽  
Ayaka Kaneko ◽  
Keniji Goto ◽  
Yoichi Sugiyama ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius ◽  
Fragment Size ◽  
Perioperative Complications ◽  
Postoperative Outcome ◽  
Distal Radius Fractures ◽  
Bone Fragment ◽  
Radius Fractures ◽  
Mayo Score ◽  
Significant Difference

Background: The treatment strategy for distal radius fractures accompanied by volar lunate facet fragment is controversial. In most cases, only the bone fragment size was discussed and a plate for distal placement is selected due to the accompanying volar lunate facet fragment regardless of the direction of bone fragment displacement. In this study, we divided distal radius fractures accompanied by volar lunate facet fragment into dorsal and volar displaced fractures, and treated these surgically based on different treatment strategies. Methods: The subjects were 25 patients with distal radius fractures accompanied by volar lunate facet fragment treated by reduction and fixation using a volar locking plate (VLP) (male: 14, female: 11, mean age: 57.8 years old). A proximal VLP (PVLP) was selected for 13 dorsal displaced fractures and a distal VLP (DVLP) was selected for 12 volar displaced fractures. The range of motion, VAS, Q-DASH, and Mayo score were evaluated at 12 months after surgery, and compared. Results: No significant difference due to the difference in the direction of displacement was noted in the range of motion, VAS, Q-DASH, or Mayo score at 12 months after surgery and there were no perioperative complications. In addition, no re-displacement of volar lunate facet fragment was noted after surgery in any patient and bone fusion was observed. Conclusions: Reduction and fixation with a PVLP are possible even for dorsal displaced distal radius fractures accompanied by volar lunate facet fragment. For the volar displaced distal radius fractures, a favorable postoperative outcome is possible by applying a DVLP to the distal ulnar.

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