Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures

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.

Download Full-text

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

Journal of Wrist Surgery ◽

10.1055/s-0041-1735885 ◽

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.

Download Full-text

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417727139 ◽

2017 ◽

Vol 43 (2) ◽

pp. 142-147 ◽

Cited By ~ 27

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

Download Full-text

The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating

Hand ◽

10.1007/s11552-012-9420-6 ◽

2012 ◽

Vol 7 (3) ◽

pp. 276-280 ◽

Cited By ~ 35

Author(s):

Zahab S. Ahsan ◽

Jeffrey Yao

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Pronator Quadratus

Download Full-text

Concomitant Carpal Injuries in Distal Radius Fractures: Retrospective Analysis by Plain Radiographs and Computed Tomography

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2015.28.1.1 ◽

2015 ◽

Vol 28 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Chul-Hyun Cho ◽

Eun-Seok Son

Keyword(s):

Computed Tomography ◽

Retrospective Analysis ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Plain Radiographs

Download Full-text

A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.202078 ◽

2019 ◽

pp. 53

Author(s):

Sitthiphong Suwannaphisit ◽

Saowapar Yoykaew ◽

Chitchaya Suwanraksa ◽

Varah Yuenyongviwat ◽

Porames Suwanno ◽

...

Keyword(s):

Computed Tomography ◽

Distal Radius ◽

Distal Radius Fractures ◽

Observer Agreement ◽

Ct Scans ◽

Radius Fractures ◽

Plain Radiographs ◽

Observer Reliability ◽

Computed Tomography Scans ◽

Mobile Ct

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure.

Download Full-text