scholarly journals Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction

Hand ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Eric G. Huish ◽  
John G. Coury ◽  
Mohamed A. Ibrahim ◽  
Marc A. Trzeciak
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Plate Removal ◽  
Radiographic Outcomes ◽  
Study Results ◽  
Marginal Impaction

Background: The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results with prior publications for both external fixation and internal fixation with volar locked plates. Methods: Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (M.A.T. and M.A.I.) from May 30, 2013, to December 29, 2015, were identified and included in the study. Retrospective chart and radiograph review was performed on 19 patients, 11 male and 8 female, with mean age of 47.83 years (22-82). No patients were excluded from the study. Results: All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49-129). Follow-up radiographs showed average radial inclination of 20.5° (13.2°-25.5°), radial height of 10.7 mm (7.5-14 mm), ulnar variance of −0.3 mm (−2.1 to 3.1 mm), and volar tilt of 7.9° (−3° to 15°). One patient had intra-articular step-off greater than 2 mm. Conclusions: Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt.

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.

Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽  
2021 ◽  
pp. 155894472199973
Author(s):  
Nicholas Munaretto ◽  
Adam Tagliero ◽  
Raahil Patel ◽  
Peter C. Rhee
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Functional Classification ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Ipsilateral Hemiparesis

Background Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia. Methods Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union. Results There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries. Conclusions Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

scholarly journals External and internal fixation for comminuted intra-articular fractures of distal radius

1970 ◽  
Vol 7 (4) ◽  
pp. 369-373 ◽  
Author(s):  
RL Pradhan ◽  
S Lakhey ◽  
BK Pandey ◽  
RR Manandhar ◽  
KP Rijal ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
External Fixation ◽  
Distal Radius ◽  
Open Reduction ◽  
Distal Radius Fractures ◽  
High Rate ◽  
Volar Plating ◽  
Radius Fractures ◽  
Articular Fractures

Background: Distal radius fractures are a common injury and without proper treatment leads to high functional impairment and frequent complications. Objective: The aim of this study was to see the functional outcome in patients with comminuted distal radius fractures treated with combined external fixation and open reduction with volar plating. Materials and methods: All comminuted distal radius fractures classified as type C in AO/OTA classification were enrolled for the study from 2005 till 2008. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome. Results: There were twenty-two patients with the average age of 42.18 years (range 19-60) with 15 male and 7 females. The follow-up period was from 14 to 46 months. Accordingly, there were 11 (50%) excellent, 7 (31%) good, 2 (9%) fair and 2 (9%) poor results. There were very few complications in our series. In three patients additional K-wire supplementation was necessary along with external and open internal fixation. Conclusions: Comminuted intra-articular fractures of distal radius should be treated by open reduction and combined internal and external fixation to achieve a high rate of patient satisfaction and satisfactory functional outcome. Key words: distal radius fractures; volar plating; external fixationDOI: 10.3126/kumj.v7i4.2756 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 369-373

scholarly journals 859 Follow up of distal radius volar plating – No role for post-operative radiographs

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M S Cheruvu ◽  
J J Edakalathur ◽  
S J Pickard
Keyword(s):  
Distal Radius ◽  
Image Intensifier ◽  
Distal Radius Fractures ◽  
Implant Removal ◽  
Volar Plating ◽  
Radius Fractures ◽  
Radiographic Findings ◽  
Operative Care ◽  
Operative Indications

Abstract Aim There is no consensus on the follow up for distal radius fractures after fixation. All patients receive intra-operative image intensifier screening to check the adequacy of reduction and implant position. We propose that if a patient is asymptomatic, you do not require post-operative radiographs. Method We conducted a retrospective review of all distal radius fractures operated in our hospital over the last 10 years. Data was collected from electronic records for revision surgery or metalwork removal. Records were assessed for patient symptoms, radiographic findings, and indications for implant removal. Patients had a minimum follow up of 6 months. Results 900 distal radius fixations were performed over a 10-year period, of which 747 were volar plating. 49 patients had volar plates removed. 14 patients had metal work removal and joint release for stiffness. 6 had the plate removal and carpal tunnel neurolysis with release. 11 implant removals for screw prominence. Other operative indications included reduction failure (n = 2), infection (n = 2) and removal in paediatric patients (n = 3). 47 of the 49 patients for implant removal were symptomatic at follow up. Only two patients had implant removal following isolated radiographic evidence of metalwork mal position. Conclusions Intra-operative intensifiers reduce the risk of implant and fixation errors. Routine post-operative radiographs altered the management of only 2 out of 700 (0.3%) patients. We suggest that radiographs have no role in routine post-operative care of distal radius fractures, where patients are asymptomatic with appropriate intra-operative intensifier images.

scholarly journals A comparative study of functional outcome of external fixation and volar plating in unstable distal radius fractures

2019 ◽  
Vol 5 (2) ◽  
pp. 326 ◽  
Author(s):  
Anil Kumar Mishra ◽  
Ajay Deep Sud ◽  
Manish Prasad ◽  
Rajiv Kaul ◽  
Chander Mohan Singh
Keyword(s):  
Functional Outcome ◽  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Time Intervals ◽  
Post Surgery ◽  
Volar Plate Fixation

<p class="abstract"><strong>Background:</strong> Distal radius fractures are amongst the most common injuries seen in the emergency department. It is imperative to restore the anatomy as much as possible in order to restore wrist function. Identifying a fracture as ‘unstable’ is critical in predicting the final outcome of treatment. The present study compares two primary modalities of treatment: external fixation and volar plating in terms of the functional outcome post-surgery.  Aim of the study was to compare the functional outcome of fixation of unstable distal radius fractures by external fixation to that of volar plating by the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system and analysis of recovery of grip strength and range of motion. Settings and design: Hospital-based; randomized control trial.</p><p class="abstract"><strong>Methods:</strong> 80 patients presenting with unstable distal radius fractures were randomized into two groups of 40 each. One group received external fixation and the second received open reduction with volar plate fixation as the primary intervention. DASH scores were obtained and compared at specified time intervals following surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> The results of our study show a better improvement in the mean DASH scores at 3, 6 and 12 months in the volar plating group as compared to the external fixation group.</p><p><strong>Conclusions:</strong> Volar plating, with its definitive advantage of direct fracture visualization, has an overall better functional outcome with greater postoperative wrist motion and a lower incidence of complications. </p>

Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies

2021 ◽  
Author(s):  
Julia Beyer ◽  
Emily Wynkoop ◽  
Jiayong Liu ◽  
Nabil A. Ebraheim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Dorsal Plate ◽  
Dash Score ◽  
Volar Plating ◽  
Radius Fractures ◽  
Treatment Methods ◽  
Dorsal Plating

Abstract Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.

scholarly journals A modified intrafocal pinning technique with three-dimensional planning to facilitate volar plating in dorsally comminuted AO/OTA C2 and C3 distal radius fractures

2020 ◽  
Author(s):  
Xue-yang Gui ◽  
Hong-fei Shi ◽  
Jin Xiong ◽  
Yi-xin Chen ◽  
Jun-fei Wang ◽  
...  
Keyword(s):  
Distal Radius ◽  
Three Dimensional ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Volar Plating ◽  
Radius Fractures ◽  
Computed Tomographic ◽  
Dorsal Aspect ◽  
Clinical And Radiological Outcome

Abstract Backgrounds: The aim of this study was to assess the efficacy of a modified intrafocal pinning technique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures.Methods: In total 35 AO/OTA type C2 and C3 fractures were finally included. The 3D digital model of the fracture was reconstructed based on preoperative computed tomographic (CT) images, with the displacement of the comminuted dorsal fragment and the intra-articular fragment analyzed for preoperative planning. During operation, a modified intrafocal pinning technique was applied percutaneously from the dorsal aspect of the radius to reduce the collapsed intra-articular fragment following volar plating. Adequate reduction was confirmed in all of patients considering radial height, radial inclination and volar tilt in postoperative radiographs.Results: No significant fracture re-displacement was observed in most of the cases during a mean follow-up period of 17.4 months, except for two patients with the C3 fracture. All of the patients achieved adequate clinical ROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achieved an excellent (n = 21) or good (n = 12) Gartland and Werley wrist score.Conclusions: Our modified intrafocal pinning technique with 3D planning contributes to a satisfactory clinical and radiological outcome in dorsally comminuted intra-articular distal radius fractures fixed with a volar locking plate.Trial registration: Not applicable because the design of the study is retrospective.

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