Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

2017 ◽  
Vol 43 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Daniel Martinez-Mendez ◽  
Alejandro Lizaur-Utrilla ◽  
Joaquin de-Juan-Herrero
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Distal Radius ◽  
Articular Surface ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

Classification and Management of Failed Fixation of the Volar Marginal Fragment in Distal Radius Fractures

2021 ◽  
Author(s):  
M. Carolina Orbay ◽  
Jorge L. Orbay
Keyword(s):  
Distal Radius ◽  
Patient Characteristics ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Fracture Patterns ◽  
Loss Of Reduction ◽  
Operative Fixation ◽  
Specific Fracture

AbstractGreater understanding of specific fracture patterns following distal radius fractures has arisen with the advent of volar plating. The volar marginal fragment (VMF) is a small peripheral piece of bone which is critical to carpal stability. Failure to achieve good fixation of the VMF can result in volar subluxation of the carpus and distal radioulnar joint instability. Due to its small, distal nature, this fragment can be easily missed and difficult to fix. Loss of reduction of the VMF following operative fixation presents specific challenges and surgical considerations dictated by patient characteristics and timing. Our goal of this review is to present a classification system for these failed VMFs which can help guide surgical treatment as well as expected outcomes.

scholarly journals Volar Plating: Imaging Modalities for the Detection of Screw Penetration

2019 ◽  
Vol 08 (06) ◽  
pp. 520-530
Author(s):  
Minke Bergsma ◽  
Katharina Denk ◽  
Job N. Doornberg ◽  
Michel P. J. van den Bekerom ◽  
Gino M. M. J. Kerkhoffs ◽  
...  
Keyword(s):  
Distal Radius ◽  
Imaging Modality ◽  
Distal Radius Fractures ◽  
Imaging Modalities ◽  
In Vivo Studies ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Additional Imaging ◽  
Screw Penetration

Abstract Background Volar plating for distal radius fractures exposes the risk of extensor tendon rupture, mechanical problems, and osteoarthritis due to protruding screws. Purposes The purpose of this review was to identify the best intraoperative diagnostic imaging modality to identify dorsal and intra-articular protruding screws in volar plating for distal radius fractures. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for this review. In vitro and in vivo studies that analyzed the reliability, efficacy, and/or accuracy of intraoperatively available imaging modalities for the detection of dorsal or intra-articular screw protrusion after volar plating for distal radius fractures were included. Results Described additional imaging modalities are additional fluoroscopic views (pronated views, dorsal tangential view [DTV], radial groove view [RGV], and carpal shoot through [CST] view), three-dimensional (3D) and rotational fluoroscopies, and ultrasound (US). For detection of dorsal screw penetration, additional fluoroscopic views show better results than conventional views. Based on small (pilot) studies, US seems to be promising. For intra-articular screw placement, 3D or 360 degrees fluoroscopy shows better result than conventional views. Conclusion Based on this systematic review, the authors recommend the use of at least one of the following additional imaging modalities to prevent dorsal protruding screws: CST view, DTV, or RGV. Tilt views are recommended for intra-articular assessment. Of all additional fluoroscopic views, the DTV is most studied and proves to be practical and time efficient, with higher efficacy, accuracy, and reliability compared with conventional views. Level of Evidence The level of evidence is Level III.

scholarly journals The Radiographic Quality of Distal Radius Fracture Reduction Using Sedation Versus Hematoma Block

2017 ◽  
Vol 26 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Lior Koren ◽  
Eyal Ginesin ◽  
Shahem Elias ◽  
Ronit Wollstein ◽  
Shlomo Israelit
Keyword(s):  
Conservative Treatment ◽  
Distal Radius ◽  
Closed Reduction ◽  
Soft Tissue Injury ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Surgeon Experience ◽  
Sedation Group

Introduction: Distal radius fractures (DRFs) are treated in the emergency department (ED) with a closed reduction in order to decrease neurovascular and soft tissue injury and as a first definitive step in conservative treatment. The type of anesthesia used may affect the ability to reduce the fracture and remains controversial. Objective: The purpose of this study was to compare the quality of radiographic reduction achieved in the ED of DRF reduced using sedation anesthesia to those reduced with hematoma block anesthesia. Methods: A retrospective case–control study of 240 DRF reductions, 30 treated with sedation and 210 with a hematoma block, was performed. Complications and time spent in the ED were documented. Pre- and postreduction radiographs were reviewed for volar tilt, radial angulation, radial height, and ulnar variance. Results: Both groups were similar in gender, background illnesses, concomitant injuries, surgeon experience, and fracture radiographic classification. Postreduction values of volar tilt were better in the sedation group ( P = .03). Volar tilt and ulnar variance improved more in the sedation group ( P = .001). The sedation group spent more time in the ED ( P = .001). Discussion: Sedation seemed to be more efficient than hematoma block in supporting closed reduction of distal radius fractures in the ED. However, this method requires specialized personnel and more time spent in the ED. Conclusion: We suggest using this method when the patient is planned to continue with conservative treatment.

scholarly journals Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

2019 ◽  
Vol 08 (06) ◽  
pp. 482-488 ◽  
Author(s):  
Peter Kaiser ◽  
Hannes Gruber ◽  
Fanny Loth ◽  
Gernot Schmidle ◽  
Rohit Arora ◽  
...  
Keyword(s):  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Distal Radius Fractures ◽  
Ultrasound Images ◽  
Flexor Pollicis Longus ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
X Ray ◽  
Flexor Pollicis Longus Tendon

Abstract Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.

scholarly journals Management of Unstable Distal Radius Fractures: A Survey of Hand Surgeons

2018 ◽  
Vol 08 (04) ◽  
pp. 335-343 ◽  
Author(s):  
Ara A. Salibian ◽  
Karl C. Bruckman ◽  
Jonathan M. Bekisz ◽  
Joshua Mirrer ◽  
Vishal D. Thanik ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Current Evidence ◽  
Evidence Based ◽  
Years Of Experience ◽  
Volar Plating ◽  
Radius Fractures ◽  
Fixed Angle ◽  
Operative Fixation

Background Length of immobilization after operative fixation of unstable distal radius fractures and management in elderly patients is an area of debate. Purpose The purpose of this study is to delineate common practices of fellowship-trained hand surgeons and how they compare with current evidence-based protocols. Methods Surveys were distributed to American Society for Surgery of the Hand members on preferred methods of fixation, postoperative immobilization, and variations in treatment of elderly patients with unstable distal radius fractures. Responses were analyzed in comparison to a literature review. Subgroups were compared with regard to training, practice type, and years in practice. Results Four-hundred eighty-five surveys were analyzed. Volar fixed-angle plating was the most common choice of fixation (84.7%). Patients are most often immobilized for 1 to 2 weeks (40.0%) with range of motion (ROM) therapy begun most commonly between 1 and 4 weeks (47.2%). The majority of surgeons do not treat fractures differently in patients more than 65 years old. Physicians with more than 20 years of experience were significantly more likely to begin wrist ROM sooner with volar plating versus other fixation techniques compared with physicians with less than 20 years of experience (40.7% vs. 34.2%, respectively). Also, physicians in academic-only practices were more likely to immobilize patients for a shorter time after volar plating compared with those in privademics. Conclusion Volar fixed-angle plating is the dominant fixation method for unstable distal radius fractures among fellowship-trained hand surgeons. Elderly patients are not treated more conservatively and rigid immobilization after operative fixation remains the treatment of choice despite current evidence-based protocols.

The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life

2017 ◽  
Vol 43 (2) ◽  
pp. 131-136 ◽  
Author(s):  
M. Å. Wadsten ◽  
G. O. Sjödén ◽  
G. G. Buttazzoni ◽  
C. Buttazzoni ◽  
E. Englund ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Pain Visual Analogue Scale ◽  
Level Of Evidence

Late displacement of distal radius fractures, still in acceptable radiological position after 1–2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10–14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires. Level of evidence: II

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.

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