scholarly journals Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Mariya Hadzhinikolova ◽  
Ivan Zderic ◽  
Daniel Ciric ◽  
Jan P. Barcik ◽  
Dian Enchev ◽  
...  
Keyword(s):  
Distal Radius ◽  
Biomechanical Study ◽  
Neutral Position ◽  
Volar Plating ◽  
Radius Fractures ◽  
Group 3 ◽  
Group 2 ◽  
Dorsal Plating ◽  
Double Plating ◽  
Group 1

AbstractComplex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.

Surgery for Cerebral Palsy: Part 1. Classification and Operative Procedures for Pronation Deformity

1992 ◽  
Vol 17 (4) ◽  
pp. 391-395 ◽  
Author(s):  
C. GSCHWIND ◽  
M. TONKIN
Keyword(s):  
Cerebral Palsy ◽  
Full Range ◽  
Neutral Position ◽  
Pronator Quadratus ◽  
Pronator Teres ◽  
Group 4 ◽  
Active Transfer ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

32 patients with cerebral palsy underwent operations for pronation deformity. The deformity is classified into four groups. Patients in group 1 are capable of supination beyond neutral. No surgery is necessary. Those in group 2 are able to supinate to the neutral position. A pronator quadratus release is advised and may be combined with a flexor aponeurotic release. In group 3, patients have no active supination. However a full range of passive supination is readily achieved. A pronator teres transfer is advised. Patients in group 4 have no active supination. Full passive supination may be present, but is tight. A flexor aponeurotic release and a pronator quadratus release may unmask active supinator activity. An active transfer for supination is possible as a secondary procedure.

Cutting or Round-Bodied Needles for Tendon Repair

2003 ◽  
Vol 28 (5) ◽  
pp. 475-477 ◽  
Author(s):  
W. L. LAM ◽  
A. GARRIDO ◽  
J. VANDERMEULEN ◽  
M. J. FAGAN ◽  
P. R. W. STANLEY
Keyword(s):  
Tensile Strength ◽  
Tendon Repair ◽  
Biomechanical Study ◽  
Suture Repair ◽  
Longitudinal Stress ◽  
The Core ◽  
Group 3 ◽  
Group 2 ◽  
Repair Group ◽  
Group 1

We carried out a biomechanical study comparing tensile strength after using round-bodied or cutting needles for tendon repair. Swine tendons were repaired in three groups: Group 1 core suture repair only; group 2 core and circumferential suture repair; and group 3 isolated circumferential suture repair. The tendons were tested at longitudinal stress to failure at 5 mm/minute. No significant differences were found between the round-bodied and cutting needles in any group. Equal numbers in the core suture repair group failed by suture pullout when comparing cutting and round-bodied needles. We conclude that the choice of needle has no effect on the outcome of tendon repair if there is consistency of surgeon’s skill and experience.

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.

Open Reduction Internal Fixation of Distal Radius Fractures: Retrospective Cohort Analysis of the Geriatric Population Using the NSQIP Database

Hand ◽  
2020 ◽  
pp. 155894472091571
Author(s):  
Anna Skochdopole ◽  
Sami Tarabishy ◽  
Steven Hermiz ◽  
Brian Mailey ◽  
Fernando A Herrera
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Open Reduction ◽  
Open Reduction Internal Fixation ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Geriatric Population ◽  
Patient Demographics ◽  
Group 2 ◽  
Group 1

Background: Distal radius fractures (DRFs) are the most common upper extremity fractures with more than 600 000 cases per year in the United States and account for up to 18% of fractures in the geriatric population. The purpose of our study was to identify the influence of age on 30-day postoperative outcomes while adjusting for patient demographics and comorbidities. Methods: The National Surgery Quality Improvement Program database was queried for patients having undergone open reduction internal fixation (ORIF) of DRFs. Current Procedural Terminology codes 25607, 25608, and 25609 between the years 2007 and 2016 were collected and analyzed. Patients were divided into 2 groups: group 1, 18 to 64 years; and group 2, 65 years and older. Patient demographics; preoperative, perioperative, and postoperative variables; and complications were recorded and analyzed. Results: In all, 5894 patients were identified; group 1 consisted of 4056 patients aged <64 years, and group 2 consisted of 1838 patients aged 65 years and older. The total complication rate was 2.7% for all patients, 2.2% for group 1, and 3.4% for group 2. The most common complications included surgical site infection for group 1 and urinary tract infection for group 2. Univariate analysis demonstrated association between age ≥65 years and complication (hazard ratio, 1.55; 95% confidence interval, 1.12-2.14; P = .009). However, after controlling for statistically significant factors, age was not an independent predictor of complications ( P = .685). Admission status, American Society of Anesthesiologists classification, operative time, renal failure, and bleeding disorders were independent predictors of 30-day complications across all patients. Conclusion: Our data suggest that patients aged 65 years and older without high-risk comorbidities should be offered ORIF of DRFs as their complication risk remains low.

scholarly journals Long Volar Plating for Metadiaphyseal Fractures of Distal Radius: Study Comparing Minimally Invasive Plate Osteosynthesis versus Conventional Approach

2017 ◽  
Vol 06 (03) ◽  
pp. 227-234 ◽  
Author(s):  
Emilie Pire ◽  
Juan Hidalgo Diaz ◽  
Santiago Salazar Botero ◽  
Sybille Facca ◽  
Philippe Liverneaux
Keyword(s):  
Minimally Invasive ◽  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Conventional Approach ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Dash Score ◽  
Volar Plating ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background Minimally invasive plate osteosynthesis (MIPO) has been used in wrist surgery for several years. The purpose of this retrospective study was to compare clinical and radiologic outcomes of MIPO technique with those of a conventional approach in the treatment of metadiaphyseal distal radius fracture by long volar plating. Materials and Methods Our series consisted of 32 fractures in 31 patients, mean age 63.9 years, including 16 men and 15 women. MIPO technique was used in 15 wrists (group 1) and conventional approach (> 60 mm of skin incision) in 17 wrists (group 2). In group 1, a long volar plate was inserted under pronator quadratus through a 15- to 30-mm distal incision then fixed to the epiphysis of the distal radius. Then, through a 15- to 30-mm proximal incision, the plate was fixed to the diaphysis of the radius, thus reducing the fracture. Results In group 1, mean distal incision size was 23.5 and 16.9 mm for proximal one. Mean total scar size (sum of both distal and proximal incisions) was 40.0 mm in group 1 and 84.1 mm in group 2. Mean tourniquet time was 58.4 minutes in group 1 and 68.9 minutes in group 2. At latest follow-up, no significant difference was noted in both the groups concerning pain, quick-DASH score, grip strength, ROM, and radiologic data. One extensor pollicis longus rupture treated by tendon transfer was done in group 1. Conclusion The MIPO technique for metadiaphyseal fractures of the distal radius by long volar plating has cosmetic and economic advantages compared with the conventional approach. Conversion to conventional approach is possible at any time in case of technical difficulties. Level of Evidence III.

scholarly journals Comparison of Complication Rates, Fluoroscopy Exposure Time, and Functional Results of Two K-wire Fixation Methods in Distal Radius Fractures in Pediatric Patients: Could Mini-incision Technique Feasible for Orthopedic Surgeons?

2021 ◽  
Author(s):  
ERSIN TASATAN ◽  
Ali Cagrı TEKIN
Keyword(s):  
Distal Radius ◽  
Functional Results ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Radius Fractures ◽  
Wire Fixation ◽  
Group 2 ◽  
Incision Technique ◽  
Mini Open ◽  
Group 1

Abstract Background: In this study, we aimed to compare the complications rates especially such as neuropraxia, and tendon irritation after percutaneous K-wire fixation and K-wire fixation with mini-open techniques in pediatric distal radius fractures. Secondly, we wanted to observe the differences between the functional results of the patients. Methods: In this retrospective design study, we enrolled 117 patients who were treated between March 2016- January 2019 for completely displaced fracture of the distal radius. One-hundred patients were evaluated in terms of demographic data, radiological and functional evaluations, and complications. In the first group, 50 patients were treated by closed reduction and percutaneous K wire application. In the second group; 50 patients were treated close reduction and K-wire fixation using mini-incision. In the 6th week, following the removal of the splint and pins, the range of motion (ROM) was evaluated. Additional radiographic evaluation was used to confirm remodeling, according to the amount of angulation in the fracture line. Patients were called in for functional and radiological evaluation at the 18th month. Results: There were 36 (72%) boys, 14 (28%) girls in Group 1, and 38 (76%) boys, 12 (24%) girls in Group 2. The mean ages were 11,95±1,34 years and 11,75±1,25 years in Group 1 and 2 respectively. The mean fluoroscopy time was 28,6 ±7,1 seconds in Group 1 while, 15,4±5,3 seconds in Group 2. The fluoroscopy time was significantly low in Group 2 (p=0.002). Re-displacement rates were 10% in K-wire fixation percutaneously and 4% in K-wire with mini-open group respectively and it was significantly lower in mini-open group (p=0.026).Conclusions: The mini-open incision technique had lower complication rates and fluoroscopy durations. Based on the results of this study, K-wire fixation with mini-open technique can be recommended as an alternative method for pediatric distal radius fractures.

scholarly journals Adult Closed Distal Radius Fracture Reduction: Does Fluoroscopy Improve Alignment and Reduce Indications for Surgery?

Hand ◽  
2016 ◽  
Vol 12 (6) ◽  
pp. 557-560
Author(s):  
Efi Kazum ◽  
Assaf Kadar ◽  
Zachary T. Sharfman ◽  
Hila Otremsky ◽  
Roy Gigi ◽  
...  
Keyword(s):  
Distal Radius ◽  
Medical Records ◽  
Radius Fractures ◽  
Radiographic Images ◽  
Significant Difference ◽  
Group 2 ◽  
Fracture Stability ◽  
Radiographic Alignment ◽  
Stability Results ◽  
Group 1

Background: This study compared the radiological outcomes of adult closed distal radius fractures (DRFs) reduction with and without fluoroscopy. We hypothesized that fluoroscopy-assisted reduction would not improve radiographic alignment or decrease the need for surgery. Methods: Hospital medical records and radiographic images of all patients who presented with DRFs between April to June 2009 and April to June 2013 were reviewed. All patients underwent closed reduction and immobilization with or without fluoroscopic assistance. Reduction attempts were noted and pre- and postreduction posteroanterior and lateral radiographs were reviewed for fracture stability. Results: Eighty-four patients underwent reduction without fluoroscopy (group 1), and 90 patients underwent reduction with the aid of fluoroscopy (group 2). According to accepted radiographic guidelines, nonsurgical treatment was indicated for 62% of patients in group 1 and 56% of patients in group 2 ( P = .44). In addition, no significant difference between the groups was observed in any postreduction radiographic parameters ( P > .53) or postreduction alignment of unstable fractures ( P = .47). Conclusions: Reduction without the use of fluoroscopy demonstrated noninferiority when compared with fluoroscopy-assisted reduction in the emergency department for closed adult DRFs.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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