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

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xue-yang Gui ◽  
Hong-fei Shi ◽  
Jin Xiong ◽  
Yi-xin Chen ◽  
Jun-fei Wang ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Preoperative Planning ◽  
Three Dimensional ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Volar Plating ◽  
Radius Fractures ◽  
Radial Inclination

Abstract Backgrounds Theaim of this study was to assess the efficacy of a modified intrafocal pinningtechnique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures. Methods Intotal 35 AO/OTA type C2 and C3 fractures were finally included.The 3D digital model of the fracture was reconstructed based on preoperative computedtomographic (CT) images, with the displacement of the comminuted dorsalfragment and the intra-articular fragment analyzed for preoperative planning. During operation, amodified intrafocal pinning technique was applied percutaneously from thedorsal aspect of the radius to reduce the collapsed intra-articular fragmentfollowing volar plating. Adequate reduction was confirmed in all of patientsconsidering radial height, radial inclination and volar tilt in postoperativeradiographs. Results No significant fracture re-displacement wasobserved in most of the cases during a mean follow-up period of 17.4 months, exceptfor two patients withthe C3 fracture. All of the patients achieved adequate clinicalROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achievedan excellent (n = 21) or good (n = 12) Gartland and Werley wrist score. Conclusions Ourmodified intrafocal pinning technique with 3D planning contributes to a satisfactoryclinical and radiological outcome in dorsally comminuted intra-articular distalradius fractures fixed with a volar locking plate. Trialregistration Notapplicable because the design of the study is retrospective.

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.

scholarly journals Comparison of functional outcome of extra-articular distal radius fractures treated by volar locking plate versus percutaneous pinning in adults-a retrospective study

2021 ◽  
Vol 7 (3) ◽  
pp. 611
Author(s):  
Shushrut B. Bhavi ◽  
Amith Shanmukgouda Kallanagoudar ◽  
Deepak Kaladagi ◽  
N. B. Sanakal
Keyword(s):  
Retrospective Study ◽  
Distal Radius ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Volar Locking Plate ◽  
Percutaneous Pinning ◽  
Radius Fractures ◽  
Plate Group

<p><strong>Background</strong>: Distal radius fractures are one of the most common fractures in an adult population and accounts for 17.5% of all the fractures. The management of distal radius fractures remains debatable despite the availability of different methods of treatment. The aim of this study is to assess the functional outcomes of extra-articular distal radius fractures treated with percutaneous pinning or internal fixation with volar locking plate in adults.</p><p><strong>Methods: </strong>A retrospective study of 40 patients diagnosed with distal radius fracture with AO classification were treated either with percutaneous pinning (n=20) or open reduction and internal fixation with volar locking plate (n=20) were included in study. DASH score and radiographs at 6<sup>th</sup> month was assessed for functional outcome and radiological union.</p><p><strong>Results: </strong>Mean age in plate group was 40 and 45 years in K wire group. The mean passive wrist ROM at the final follow-up evaluation in plate group was 63.8<sup>o</sup> extension and 70.5<sup>o </sup>flexion, 81.7<sup>o</sup> supination and 79<sup>o</sup> pronation, compared with 56.75<sup>o</sup> extension and 65.25<sup>o</sup> flexion, 74.7<sup>o</sup> supination and 85.5<sup>o</sup> pronation in patients treated with K wire group. Patients with plate group and K wire group had DASH score of 19.85 and 18.49 respectively (p=0.07) at 6 months follow-up.</p><p><strong>Conclusions:</strong> The use of ORIF with plate resulted in stable fixation of the unstable extraarticular fractures, allowing early post-surgical wrist motion and has good radiological outcome whereas K wire also has advantages of being minimal invasive, reduced hospital stay and minimal cost.</p>

Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients

2013 ◽  
Vol 3 (1) ◽  
pp. 93-98
Author(s):  
Leonid I Katolik ◽  
Douglas P Hanel ◽  
Daniel A Wartinbee ◽  
David Ruch
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
The Elderly ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Trauma Centers ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Internal Distraction

ABSTRACT Purpose To evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures. Materials and methods A retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained. Results Thirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32. Conclusion In the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures. Level of evidence Therapeutic, Level IV (Retrospective case series). Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.

scholarly journals Three-dimensional evaluations of preoperative planning reproducibility for the osteosynthesis of distal radius fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yuichi Yoshii ◽  
Takeshi Ogawa ◽  
Atsuo Shigi ◽  
Kunihiro Oka ◽  
Tsuyoshi Murase ◽  
...  
Keyword(s):  
Distal Radius ◽  
Reference Point ◽  
Preoperative Planning ◽  
Three Dimensional ◽  
Reference Points ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
3D Images ◽  
Radial Inclination ◽  
Preoperative Plan

Abstract Background Three-dimensional preoperative planning was applied for the osteosynthesis of distal radius fractures. The objective of this study was to evaluate the reproducibility of three-dimensional preoperative planning for the osteosynthesis of distal radius fractures with three-dimensional reference points. Methods Sixty-three wrists of 63 distal radius fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. After taking preoperative CT scans of the injured wrists, 3D images of the distal radius were created. Fracture reduction, implants choices, and placements simulation were performed based on the 3D images. One month after the surgery, postoperative CT images were taken. The reproducibility was evaluated with preoperative plan and postoperative 3D images. The images were compared with the three-dimensional coordinates of radial styloid process, volar and dorsal edges of sigmoid notch, and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. The reproducibility of radial inclination and volar tilt on three-dimensional images were evaluated by intra-class correlation coefficient (ICC). Results The distances between the preoperative plan and the postoperative reduction for each reference point were (1) 2.1±1.3 mm, (2) 1.9±1.2 mm, and (3) 1.9±1.2 mm, respectively. The distance between the preoperative plan and postoperative reduction for the barycentric coordinate was 1.3±0.8 mm. ICCs were 0.54 and 0.54 for the volar tilt and radial inclination, respectively (P<0.01). Conclusions Three-dimensional preoperative planning for the osteosynthesis of distal radius fracture was reproducible with an error of about 2 mm for each reference point and the correlations of reduction shapes were moderate. The analysis method and reference points may be helpful to understand the accuracy of reductions for the three-dimensional preoperative planning in the osteosynthesis of distal radius fractures. Trial registration Registered as NCT02909647 at ClinicalTrials.gov

Evaluation of Patient-Reported and Clinician-Reported Outcomes of Volar Locking Plate Fixation for Distal Radius Fractures

2020 ◽  
Vol 25 (03) ◽  
pp. 359-363
Author(s):  
Nana Nagura ◽  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Hiroyuki Obata ◽  
Kenji Goto ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius ◽  
Clinical Evaluation ◽  
Locking Plate ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Patient Reported

Background: Postoperative evaluation of wrist joint trauma is divided into patient-reported outcomes (PROs) and clinician-reported outcomes (CROs). We investigated the association of the Q-DASH score as the postoperative PROs and the Mayo wrist score as the postoperative CROs with clinical evaluation in patients with distal radius fractures surgically treated using a volar locking plate (VLP). Moreover, whether PROs and CROs are correlated to the clinical evaluation was investigated. Methods: The subjects were 109 patients surgically treated for distal radius fractures at our hospital between June 2013 and May 2017. Forty-one patients were male, 68 patients were female, and the mean age was 61.4 (19–86) years old. The fracture type was AO classification A type in 30 patients (A2: 25, A3: 5), B type in 5 (B2: 1, B3: 4), and C type in 74 (C1: 50, C2: 11, C3: 13). All patients were surgically treated using VLP. The range of motion of the wrist, grip strength the Visual Analog Scale (VAS), the Q-DASH score (PROs), and the Mayo wrist score (CROs) were investigated. Each evaluation was compared as the clinical outcome between at 3 months after surgery and the final follow-up. In addition, the correlations of the postoperative PROs and CROs with the clinical evaluation were analyzed. Results: Each evaluation was significantly improved compared with that at 3 months after surgery. There was a significant correlation between PROs and CROs at 3 months after surgery and the final follow-up. However, the range of motion of the wrists was not significantly correlated with PROs or CROs at 3 months after surgery or at the final follow-up. Conclusions: On evaluation after surgery for distal radius fractures, PROs and CROs improved early after surgery (3 months after surgery) before the final follow-up, and an inverse correlation was present between these scores.

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 The treatment of distal radius fractures accompanying dorsally displaced free fragments beyond the watershed line with turning radius and distal volaris radius system plate fixation via the distal palmar approach

2020 ◽  
Author(s):  
Zhaofeng Jia ◽  
Shijin Wang ◽  
Wei Jiang ◽  
Chuangli Li ◽  
Jiandong Lin ◽  
...  
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Postoperative Recovery ◽  
Distal Radius Fractures ◽  
Therapeutic Effects ◽  
Dash Score ◽  
Radius Fractures ◽  
X Ray ◽  
Palmar Approach

Abstract Background: Although distal radius fractures (DRFs) are clinically common, DRFs accompanied by dorsally displaced free fragments beyond the watershed line are much less so. At present, it is very difficult to fix and stabilize the displaced free fragments far away from the watershed line with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. Methods: From 2015 to 2019, 25 patients with distal radius fractures associated with dorsally displaced free fragments beyond the watershed line were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures. Results: X-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61 to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62 to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3). Conclusion: Treatment of distal radius fractures with accompanying dorsally displaced free fragments beyond the watershed line with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.

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.

Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

2019 ◽  
Vol 24 (01) ◽  
pp. 30-35 ◽  
Author(s):  
Takeshi Katayama ◽  
Hiroshi Ono ◽  
Shohei Omokawa
Keyword(s):  
Clinical Outcomes ◽  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Wrist Flexion ◽  
Radius Fractures ◽  
Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

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

2017 ◽  
Vol 22 (04) ◽  
pp. 423-428 ◽  
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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