Does the location of short-arm cast univalve effect pressure of the three-point mould?

Purpose Forearm and distal radius fractures are among the most common fractures in children. Many fractures are definitively treated with closed reduction and casting, however, the risk for re-displacement is high (7% to 39%). Proper cast application and the three-point moulding technique are modifiable factors that improve the ability of a cast to maintain the fracture reduction. Many providers univalve the cast to accommodate swelling. This study describes how the location of the univalve cut impacts the pressure at three-point mould sites for a typical dorsally displaced distal radius fracture. Methods We placed nine force-sensing resistors on an arm model to collect pressure data at the three-point mould sites. Sensory inputs were sampled at 15 Hz. Cast padding and a three-point moulded short arm fibreglass cast was applied. The cast was then univalved on the dorsal, volar, radial or ulnar aspect. Pressure recordings were obtained throughout the procedure. Results A total of 24 casts were analyzed. Casts univalved in the sagittal plane (dorsal or volar surface) retained up to 16% more pressure across the three moulding sites compared with casts univalved in the coronal plane (radial or ulnar border). Conclusion Maintaining pressure at the three-point mould prevents loss of reduction at the fracture site. This study shows that univalving the cast dorsally or volarly results in less pressure loss at moulding sites. This should improve the chances of maintaining fracture reductions when compared with radial or ulnar cuts in the cast. Sagittal plane univalving of forearm casts is recommended.

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Minimally angulated pediatric wrist fractures: Is immobilization without manipulation enough?

CJEM ◽

10.1017/s1481803500014676 ◽

2007 ◽

Vol 9 (01) ◽

pp. 9-15 ◽

Cited By ~ 27

Author(s):

Khalid Al-Ansari ◽

Andrew Howard ◽

Brian Seeto ◽

Solina Yoo ◽

Salma Zaki ◽

...

Keyword(s):

Distal Radius ◽

Sagittal Plane ◽

Normal Function ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Post Injury ◽

Radiographic Findings ◽

Fractures In Children ◽

Plaster Immobilization

ABSTRACT Background: Emergency department (ED) manipulation of complete minimally angulated distal radius fractures in children may not be necessary, due to the excellent remodeling potential of these fractures. Objectives: The primary objective of this study was to determine the proportion of minimally angulated distal radius fractures managed in the ED with plaster immobilization that subsequently required manipulation. Our secondary objective was to document, at follow-up, changes in angulation for each wrist fracture. Methods: This retrospective cohort study reviewed consecutive records of all children with bi-cortical minimally angulated (≤15° of angulation in the sagittal plane and ≤0.5 cm of displacement) distal metaphyseal radius fractures, alone or in combination with distal ulnar fracture. Details of treatment, radiographic findings, and clinical outcomes during the subsequent orthopedic follow up were recorded. Results: Of 124 patients included in the analysis, none required manipulation after their ED visit. All but 14 (11.3%) fractures were angulated ≤20° within the follow-up period. Two (1.6%) fractures that were initially angulated ≤15° progressed to 30°–35°, but remodeled within 2 years to nearly perfect anatomic alignment. By 6 weeks post-injury, no patients had clinically apparent deformity and all had normal function. Conclusions: Minimally angulated fractures of the distal metaphyseal radius managed in plaster immobilization without reduction in the ED are unlikely to require future surgical intervention.

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Residents position volar plate evaluation for the fractures of the distal radius /Avaliação do posicionamento da placa volar para fraturas do rádio distal

Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo ◽

10.26432/1809-3019.2020.65.007 ◽

2020 ◽

Vol 65 (1) ◽

pp. 1

Author(s):

Leandro Viecili ◽

Antonio Carlos Da Costa ◽

Diego Figueira Falcochio ◽

Valdênia Das Graças Nascimento ◽

Ivan Chakkour

Keyword(s):

Distal Radius ◽

Public Hospital ◽

Sagittal Plane ◽

Average Distance ◽

Cross Sectional Study ◽

Sectional Study ◽

Radius Fractures ◽

Cross Sectional ◽

Metaphyseal Fracture ◽

Volar Surface

ABSTRACTBackground: At the end of the residency, the orthopedic surgeon will have access to other types of plate’s osteosynthesys for treating distal radius fractures that may be unknown to them. The aim was to assess and compare the outcomes from positioning the plate on the volar surface of the radius obtained by residents at the Department of Orthopedics and Trauma. Methods: Cross-sectional study at public hospital. Thirty positions were analysed, performed by residents, of blocked volar plates in a cadaveric left radius prepared with a simulated simple distal metaphyseal fracture. Results: 17 plate positioning (56.66%) were correct and, among these, the average distance between the end of the plate and the watershed line was +0.91 mm distal to it; the average proximal coronal positioning of the plate was 0.69 mm radial to the midline of the radius; and the average distance between the plate and the bone surface in the sagittal plane was 0.97 mm. Conclusions: Slightly more than half of residents correctly identified the plate’s laterality. There was astatistically significant a correlation between the plate-bone distances, in the sagittal plane, and between the plate’s distal end and the watershed line, in the coronal plane.Keywords: Radius fractures; Orthopedics; Surgical procedures, operative; Radius; Orthopedic proceduresRESUMOObjetivo: Ao término da residência, o ortopedista terá acesso a outros tipos de placas muitas vezes desconhecidas por ele. O objetivo foi avaliar e comparar os resultados do posicionamento da placa na superfície volar do rádio entre os residentes dos três anos de Ortopedia e Traumatologia deste departamento. Métodos: Estudo transversal realizado em um hospital público. Foram analisados trinta posicionamentos, realizados por residentes, de placas volares bloqueadas em um rádio esquerdo preparado de cadáver com fratura simples metafisária distal simulada. Resultados: Houveram 17 (56,66%) posicionamentos corretos da placa e, destes, a distância média entre o final da placa à linha divisora de águas foi de +0,91 mm distal a esta; a média do posicionamento coronal proximal da placa foi de 0,69 mm radial à linha média do rádio; e a média da distância entre a placa e a superfície óssea no plano sagital foi de 0,97 mm. Houve correlação de significância estatística entre as distâncias placa-osso no plano sagital e da linha divisora de águas ao limite distal da placa no plano coronal. Conclusões: Pouco mais da metade dos residentes identificou corretamente a lateralidade da placa. Existe relação entre as distâncias placa-osso no plano sagital e entre o limite distal da placa e a linha divisora de águas, no pano coronal.Palavras Chave: Fraturas do rádio, Ortopedia; Procedimentos cirúrgicos operatórios, Rádio (Anatomia), Procedimentos ortopédicos

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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.

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“COMPARATIVE STUDY OF DISTAL END RADIUS FRACTURE TREATED BY PERCUTANEOUS 5 PIN TECHNIQUE V/S CLOSED REDUCTION AND CASTING METHOD”.

10.36106/6900913 ◽

2021 ◽

pp. 29-31

Author(s):

Vibhor Khandal ◽

Ashwani Kumar Mathur ◽

Mohit Kumar ◽

Rajkumar Bairwa

Keyword(s):

Distal Radius ◽

Closed Reduction ◽

Soft Tissues ◽

Hand Function ◽

Early Mobilization ◽

Fracture Site ◽

Distal Radius Fractures ◽

Point System ◽

Casting Method ◽

Radius Fractures

Introduction: Distal end radius fractures crush the mechanical foundation of most useful tool, the hand. No other fracture has a such potential to devastate hand function, and no other metaphysis of bone is embraced by more soft tissues. Closed reduction and percutaneous pinning is one of the standard treatments for management of distal radius fractures, and its modication 'The percutaneous 5 pin technique improves the reliability of xation thus combining the benets of non-invasiveness as in casting and stability achieved is comparable to open reduction and plating. Material and method: This prospective study was done between December 2018 to December 2020 in department of orthopedics, including 60 patients with fracture of distal radius Among them 30 patients subsequently underwent ve pin xation and 30 patients were treated with closed reduction and casting method. Result: Radiological analysis of the data was done using Sarmiento's Modication of Lidstrom Criteria. Activities of daily life (ADL) were examined by using the demerit point system of Gartland and Wereley based on objective and subjective criteria, residual deformity and complications. Radiological parameters were assessed for at the end of 6months. There was signicant difference in all the three parameters i.e, Volar tilt, Radial length, Radial inclination between both groups at the end of 6 months. Closed reduction with ve pinning technique group had shown not only better but also statistically signicant anatomical reduction compared to other groups. Functional outcome was better in patients treated with percutaneous 5 pinning technique. Conclusion: The ve pin technique carries the advantage of early mobilization, DRUJ stability. Radio Ulnar pins and the pins across the fracture site provide enough stability to permit early mobilization leading to less post operative stiffness in joint. Although the study series is small and further research is essential to provide directions for treatment, it is safe to conclude that the ve pin technique is a technically less demanding, lessinvasive and an effective way of treating displaced distal radius fractures without severe articular or metaphyseal comminution

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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

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Most surgeons still prefer to reduce overriding distal radius fractures in children

Acta Orthopaedica ◽

10.1080/17453674.2020.1854502 ◽

2020 ◽

pp. 1-5

Author(s):

Topi Laaksonen ◽

Jani Puhakka ◽

Jussi Kosola ◽

Antti Stenroos ◽

Matti Ahonen ◽

...

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Fractures In Children

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Analysis of loss of reduction as risk factor for additional secondary displacement in children with displaced distal radius fractures treated conservatively

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2019.10.013 ◽

2020 ◽

Vol 106 (1) ◽

pp. 193-198 ◽

Cited By ~ 3

Author(s):

Vito Pavone ◽

Andrea Vescio ◽

Ludovico Lucenti ◽

Emanuele Chisari ◽

Federico Canavese ◽

...

Keyword(s):

Risk Factor ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Loss Of Reduction ◽

Secondary Displacement

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Distal Radius Fractures in Children

Distal Radius Fractures ◽

10.1007/978-3-642-54604-4_47 ◽

2014 ◽

pp. 403-415

Author(s):

Per-Henrik Randsborg

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Fractures In Children

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Hematoma block for distal radius fractures – prospective, randomized comparison of two different volumes of lidocaine

Journal of International Medical Research ◽

10.1177/0300060518799883 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4535-4538 ◽

Cited By ~ 1

Author(s):

Hagay Orbach ◽

Nimrod Rozen ◽

Barak Rinat ◽

Guy Rubin

Keyword(s):

Distal Radius ◽

Analgesic Efficacy ◽

Fracture Site ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Vas Score ◽

Significant Difference ◽

Group A ◽

Vas Scores ◽

Group B

Objective This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. Methods Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. Results Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. Conclusion VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

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