scholarly journals Functional outcomes following fixation of a marginal distal radius fracture with two commonly used volar locking plates: a retrospective cohort study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Yin-Ming Huang ◽  
Chun-Yu Chen ◽  
Kai-Cheng Lin ◽  
Yih-Wen Tarng ◽  
Ching-Yi Liao ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Flexor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Mayo Wrist Score ◽  
Patient Reported

Abstract Introduction The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, marginal distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on marginal distal radius fractures. This study compared functional outcomes in patients with marginal distal radius fractures treated with two different implants. Materials and methods A retrospective study was conducted, all patients who received a Synthes 2.4 mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The marginal distal radius fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa’s joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and grip strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius’s volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating marginal distal radius fractures.

scholarly journals Functional Outcomes Following Fixation of an Ultra-distal Radius Fracture with Two Commonly used Volar Locking Plates: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yin-Ming Huang ◽  
Chun-Yu Chen ◽  
Kai-Cheng Lin ◽  
Yih-Wen Tarng ◽  
Ching-Yi Liao ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Flexor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Mayo Wrist Score ◽  
Patient Reported

Abstract Introduction: The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, ultra-distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on ultra-distal radius fractures. This study compared functional outcomes in patients with ultra-distal radius fractures treated with two different implants.Materials and Methods: A retrospective study was conducted, all patients who received a Synthes 2.4mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The ultra-distal fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and gripping strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions: Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating ultra-distal radius fractures.

scholarly journals Acute Isolated Flexor Tendon Laceration Associated With a Distal Radius Fracture

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. NP39-NP42 ◽  
Author(s):  
J. Ryan Hill ◽  
Ram K. Alluri ◽  
Alidad Ghiassi
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Flexor Tendon Rupture ◽  
Tendon Laceration

Background: Subacute rupture of the flexor tendons secondary to distal radius fractures is well documented. Recently, accounts of flexor tendon rupture following open reduction internal fixation have been associated with volar plate fixation. However, discovery of an occult traumatic flexor tendon laceration during fixation of an acute distal radius fracture is not well described. This case indicates the importance of careful preoperative and intraoperative examination of the flexor tendons in the setting of comminuted distal radius fractures. Methods: A forty-seven-year-old male sustained a comminuted, dorsally displaced distal radius fracture. Initial and post-reduction examinations revealed no gross functional abnormalities. Upon operative fixation of the fracture, laceration of the flexor digitorum profundus (FDP) tendon to the index finger was incidentally noted at the level of the fracture site. Results: Due to extensive dorsal comminution, shortening, and the presence of a lunate facet fragment, we performed volar fragment-specific and dorsal spanning bridge plate fixation. The proximal and distal ends of the FDP tendon were marked, but repair was deferred until implant removal. This allowed for proper informed consent and avoided potential compromise of the repair given the presence of a volar implant. Conclusions: Acute flexor tendon rupture secondary to closed distal radius fractures may go unnoticed if a high index of suspicion is not maintained. Delayed diagnosis of these ruptures convolutes the mechanism of injury and disrupts the recovery process. Hand surgeons should be vigilant in examining flexor tendon function during the preoperative evaluation, especially in the setting of acute high-energy injury.

scholarly journals Partially Healed Malaligned Distal Radius Fracture. Surgical Treatment in Patients older than 70 Years

2020 ◽  
Vol 48 (01) ◽  
pp. 020-026
Author(s):  
Marcos Cruz-Sánchez ◽  
Jaime De la Torre-Rojo ◽  
Cristóbal Martínez-Andrade
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
High Rate ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Mayo Wrist Score

Abstract Introduction Management of distal radius fractures remains controversial despite their high frequency. Elderly patients specifically present a high rate of secondary displacement, sometimes requiring a complex reconstructive surgery. The surgical treatment of displaced fractures evolving for several weeks in elderly patients has not been clearly reflected in the literature. This study aims to show clinical and radiological outcomes from this particular situation. Material and Methods Retrospective study of 31 cases of distal radius fractures with more than 2 weeks of evolution. Fractures were graded according to the Fernández's classification. Pre- and postoperative radiological studies were carried out to evaluate the degree of correction achieved. A clinical evaluation was performed using the Mayo Wrist Score. Data on arthroscopy and bone substitutes use, specific surgical tips and complications were also collected. Results Thirty-one patients with a mean age of 76 years old were operated for distal radius fracture with a delay in surgical treatment of 22 days. The most frequent fracture pattern was Fernández type III (38.7%). The clinical outcome according to the Mayo Wrist Score was 81.94 points with no relationship to fracture pattern or arthroscopic assistance. A statistically significant improvement was achieved for the correction of radial inclination, joint gap and ulnar variance. No statistically significant improvement was achieved in volar tilt correction. Complications were observed in 12.9% of the cases. Conclusions Delayed surgical treatment of distal radius fracture in elderly patients provides similar results to those observed in other age groups and time of evolution. Despite not being the ideal scenario for the surgeon, it should be considered to avoid functional deterioration in this fragile age group.

scholarly journals A study of Kapandji intrafocal pinning for the treatment of unstable extra articular distal radius fractures

2017 ◽  
Vol 7 (2) ◽  
pp. 28-32
Author(s):  
Titjhendra Khadka ◽  
Rudra Prasad Marasini ◽  
Dirgha Raj KC ◽  
Rojan Tamrakar ◽  
Prakash Bahadur Thapa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Full Range ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Point System ◽  
Functional Evaluation ◽  
Kirschner Wires ◽  
Radius Fractures

Intrafocal pinning of distal radius fracture is indicated in unstable distal radius fractures without significant intra-articular displacement. It is a simple and effective, minimally invasive method of fixation for achievement of alignment and stability of unstable fractures. The study was conducted between November 2013 and October 2016. Patients attending the emergency and outpatient departments with history of trauma followed by pain and swelling of wrist, were evaluated clinically & radiologically. Patients with distal radius fracture who met the criteria were enrolled in the study. The operation was performed either under regional anaesthesia or intra venous anaesthesia. Reduction was carried out under image intensifier guidance and intrafocal pinning was undertaken with 2 Kirschner wires as described by Kapandji. Above elbow slab was applied for 3 weeks. Kirschner wires were removed at 6th week. Follow ups were done with radiological and functional evaluation on 1st week, 3rd week, 6th week, 12th week and 6 month. Of the 30 cases enrolled in our study, the age ranged from 40 to 72 years and the mean age of the patients was 54.77 years. The female/male ratio was 5:1 and the majority (83%) of patient sustained injury due to trivial trauma. All fractures united by 6 weeks. In the final follow up at 6th month, assessment of range of motion showed almost full range of motion. Functional evaluation was carried out with Gartland & Werleys Demerit point system (modified by Sarmiento et al). According to the score, 9 patients had excellent, 19 had well and 2 had fair results. None of the patient had poor results. Kapandji intrafocal pinning provides a stable fixation and good functional outcome in extraarticular distal radius fractures with few complications only.

scholarly journals Social Support Contributes to Outcomes following Distal Radius Fractures

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Caitlin J. Symonette ◽  
Joy MacDermid ◽  
Ruby Grewal
Keyword(s):  
Social Support ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Significant Proportion ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Evaluation Scores ◽  
Patient Reported ◽  
One Year

Background. Distal radius fractures are the most common fracture of the upper extremity and cause variable disability. This study examined the role of social support in patient-reported pain and disability at one year following distal radius fracture.Methods. The Medical Outcomes Study Social Support Survey was administered to a prospective cohort of 291 subjects with distal radius fractures at their baseline visit. Pearson correlations and stepwise linear regression models (F-to-remove 0.10) were used to identify whether social support contributes to wrist fracture outcomes. The primary outcome of pain and disability at one year was measured using the Patient Rated Wrist Evaluation.Results. Most injuries were low energy (67.5%) and were treated nonoperatively (71.9%). Pearson correlation analysis revealed that higher reported social support correlated with improved Patient Rated Wrist Evaluation scores at 1 year,r(n=181)=-0.22,P<0.05. Of the subscales within the Social Support Survey, emotional/informational support explained a significant proportion of the variance in 1-year Patient Rated Wrist Evaluation scores,R2=4.7%,F(1, 181) = 9.98,P<0.05.Conclusion. Lower emotional/informational social support at the time of distal radius fracture contributes a small but significant percentage to patient-reported pain and disability outcomes.

scholarly journals The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures

2016 ◽  
Vol 6 (1) ◽  
pp. 56-60
Author(s):  
Alexander J Lampley ◽  
Priyesh D Patel ◽  
Riikka EK Nomides ◽  
Suhail K Mithani
Keyword(s):  
Functional Outcome ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Anatomical Reduction ◽  
Radiographic Measurements ◽  
Outcome Scores

ABSTRACT Background While there have been multiple studies published that have stressed the importance of restoring various different radiographic parameters to improve functional outcome scores, there is no consensus on the parameter that correlates most with patients’ functional outcomes. We hypothesize that obtaining near anatomical reduction of the palmar lunate facet is critical to improving functional outcome scores. The purpose of this study is to determine the effects of reduction and stabilization of the palmar lunate facet on functional outcomes in patients with intra-articular distal radius fracture. Materials and methods We prospectively collected clinical examination data, radiographic measurements, and functional outcome scores on 157 patients who were treated operatively for multifragmentary intra-articular fractures of the distal radius (AO Type C3) between 1996 and 2006. Prospective data were acquired at 3, 6 months, and 1 year postsurgical intervention in clinical follow-up. Based on radiographic measurements, patients were designated into a nondisplaced palmar lunate facet group and a displaced palmar lunate facet group. Clinical and functional outcomes were then compared between the groups. Results Patients without displacement had a significantly higher value of wrist extension and forearm supination when compared with the patients with displacement. In addition, the Gartland and Werley score was significantly higher in patients with displacement of the palmar lunate facet. Conclusion This study demonstrates that patients with near anatomical reduction of the palmar lunate facet after surgical treatment of an intra-articular distal radius fracture had improved range of motion and better functional outcome scores compared with patients with residual displacement of the palmar lunate facet. Richard MJ, Lampley AJ, Patel PD, Nomides REK, Mithani SK, Leversedge FJ, Ruch DS. The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures. The Duke Orthop J 2016;6(1):56-60.

Influence of Smoking in the Clinical Outcomes of Distal Radius Fractures

2020 ◽  
Author(s):  
Ayaka Kaneko ◽  
Kiyohito Naito ◽  
Hiroyuki Obata ◽  
Nana Nagura ◽  
Yoichi Sugiyama ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Bone Healing ◽  
Fracture Fixation ◽  
Healing Process ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures

Abstract Introduction There are various studies that reviewed the effect of cigarette smoking in fracture healing process. Nonunion, delayed union, and residual pain are the significant risk factors associated with smoking and fracture healing. Little has been known about the impact of smoking in distal radius fracture healing. We intend to explore in brief the effect of smoking in distal radius fracture healing and comparing it with nonsmokers having the same fracture fixation and analyze the outcomes with respect to fracture healing and return of function. Materials and Methods Of the total 186 patients, 92 were included in the study with (n = male: 31, female: 61) mean age of 60.2 years. They were divided into two groups: smoking (n = 43) and nonsmoking (n = 49). All had surgical fixation of the distal radius with volar locking plate and started on early mobilization. The range of motion of the wrist, grip, visual analog scale, quick disabilities of the arm and shoulder and hand score, Mayo wrist score, and bone healing period were noted between these two groups and compared with statistical analysis. Results The mean follow-up period was 8.7 months. There was a significant association of young age and male patients having distal radius fractures in the smoking group (p < 0.05). All fractures healed well in both groups without complications. There was no significant difference between these two groups in terms of range of motion, grasp, bone healing period, and functional outcomes. Conclusion Despite the well-known fact that, smoking has negative implications in the fracture healing process, we found group of patients (smoking and nonsmoking) with distal radius fractures treated by volar locking plates healed well with good radiological union and excellent functional outcome There is no significant influence of smoking in distal radius fracture fixation.

scholarly journals Distal Radius Fractures: Evaluation of Closed Reduction and Percutaneous Kirschner Wire Pinning

2018 ◽  
Vol 10 (03) ◽  
pp. 134-138
Author(s):  
Sezai Özkan ◽  
Ritsaart Westenberg ◽  
Lydia Helliwell ◽  
Chaitanya Mudgal
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Closed Reduction ◽  
Kirschner Wire ◽  
The United States ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Urban City

Abstract Objective Closed reduction and percutaneous pinning (CRPP) is losing popularity as a treatment modality for distal radius fractures. However, in select cases, CRPP may have advantages relative to open reduction and internal reduction. We aimed to retrospectively assess the outcomes after CRPP for the treatment of distal radius fractures. Study Design This is a retrospective cohort study. Methods We used billing records to identify all skeletally mature patients with a distal radius fracture who were treated with CRPP by a single surgeon at a level I trauma center in an urban city in the United States. We assessed the medical charts and recorded demographics, trauma and treatment characteristics, radiographic characteristics, and outcomes. Results All patients had a good or excellent range of motion regarding forearm rotation, and almost 80% had good or excellent range of motion regarding flexion or extension of their wrist. One patient had a concern for pin tract infection, and one had subcutaneous migration of a pin, which were both treated by pin removal. Conclusion CRPP is a good option in patients with few and sizeable fracture fragments in patients with a distal radius fracture, and it should be considered as an effective tool to restore radiographic parameters and functional outcomes.

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.

The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex

2016 ◽  
Vol 41 (5) ◽  
pp. 516-520 ◽  
Author(s):  
K. Kasapinova ◽  
V. Kamiloski
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Triangular Fibrocartilage Complex ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Wrist Arthroscopy ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage ◽  
A Prospective Study

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. Level of evidence: III

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