scholarly journals INTRA-ARTICULAR FRACTURES OF DISTAL RADIUS;

2018 ◽  
Vol 21 (04) ◽  
pp. 649-653
Author(s):  
Waqar Alam ◽  
Faaiz Ali Shah ◽  
Khalid Mahmood Qureshi ◽  
Shams Ur Rehman ◽  
Shahid Hussain ◽  
...  
Keyword(s):  
Distal Radius ◽  
External Fixator ◽  
Functional Results ◽  
Distal Radius Fractures ◽  
Monthly Interval ◽  
Point System ◽  
Functional Evaluation ◽  
Radius Fractures ◽  
Articular Fractures

Objective: To assess the radiological and functional outcome of external fixator inthe treatment of intar-articular fractures of distal radius. Study design: Descriptive case series.Place and duration of study: Orthopaedic unit District Headquarter Hospital Temargarha LowerDir from March 2013 to March 2014. Material and methods: Twenty five patients of intra-articularfracture distal radius fulfilling the inclusion criteria were treated with AO external fixator byligamentotaxis. Preoperative and postoperative radiograph measurements were taken of radialinclination, radial tilt, and radial length, and fractures were classified according to the AO system.The fixator was removed after 6-8 week and functional assessment was done using Gartland andWerely point system at monthly interval for six months. Results: Eighteen male (72%) and 7(28%)females mean age 43.1 years with intra-articular distal radius fractures were treated with externalfixator. Preoperative mean radial inclination(10.5 degree) radial tilt(29 degrees dorsal) and radiallength(6.3 mm) were reported postoperatively as 18.8 degrees,8 degrees volar and 10 mmrespectively at final follow up visit. The functional evaluation by Gartland and Werley's pointsystem reported excellent (60% patients) ,good(20%) and fair(12%) at final follow up visit. One(4%) patient could not achieve union while one (4%) malunion was reported. Conclusions:Bridging external fixator(static) yields excellent radiological and functional results in majority ofintra-articular distal radius fractures.

Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial

2012 ◽  
Vol 37 (8) ◽  
pp. 765-771 ◽  
Author(s):  
A. S. Gavaskar ◽  
S. Muthukumar ◽  
N. Chowdary
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Distal Radius Fractures ◽  
First Year ◽  
Functional Evaluation ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Functional Scores ◽  
Radial Length ◽  
Specific Fixation

The goal was to evaluate the efficacy of 2.4 mm column-specific plating for intra-articular distal radius fractures. In total, 105 patients with AO type C distal radius fractures were operated on using the locking distal radius system, Synthes. Follow-up assessments including clinical (wrist and forearm range of motion, grip strength), radiological (articular step, radial length and inclination, volar tilt, and ulnar variance), and functional scores (Disabilities of the Arm, Shoulder, and Hand; Patient Rated Wrist Evaluation) were made at regular intervals until 1 year. Union was obtained in all patients. Articular surface was anatomically reconstructed in 74 patients (70.5%). Clinical and functional evaluation showed significant continuous improvements over the first year. C1 fractures had a better chance of anatomical reduction compared with C2 and C3 fractures. Fracture type, quality of reduction, and presence of degenerative changes did not show a significant effect on functional outcome scores. Column-specific fixation of the distal radius can achieve satisfactory results in complex intra-articular fractures.

Fixation of Distal Radius Fractures Using AO Titanium Volar Distal Radius Plate

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 7-15 ◽  
Author(s):  
H. C. Lee ◽  
Y. S. Wong ◽  
B. K. Chan ◽  
C. O. Low
Keyword(s):  
Distal Radius ◽  
Tendon Rupture ◽  
Open Reduction Internal Fixation ◽  
Distal Radius Fractures ◽  
Titanium Plate ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Effective Treatment Modality ◽  
Wrist Function

This study is to assess the effectiveness and outcome of the AO titanium volar distal radius plate (Synthes) in the treatment of peri-articular volar rim fractures of the distal radius. It was conducted on 22 patients with distal radius fractures who underwent open reduction, internal fixation using the AO titanium volar distal radius plate between July 1998 and December 1999 at the Changi General Hospital. The radiographs of the patients were analysed upon fracture union and assessment of wrist function was done using Gartland and Werley criteria. There were four extra-articular AO Type A2(1) and A3(3): the remaining 18 intra-articular fractures consisted of AO B3(2), AO C1(11), AO C2(2) and AO C3(3). The average follow-up period was 12.6 months (range 7–23). Radiological review showed bone healing in 21 patients (95.5%) and good articular congruity for all intra-articular fractures with less than 2 mm step-off. Three patients defaulted follow-up. Complications were few with one wound infection, one tendon rupture and three neuropraxia of the superficial radial nerve. Wrist function was excellent in three patients, good in 12 and fair in four. The AO titanium plate with its distal buttressing ability is an effective treatment modality in patients with distal radius fractures involving the peri-articular volar rim.

LOCKING PALMAR PLATE FIXATION FOR DORSALLY DISPLACED FRACTURES OF THE DISTAL RADIUS: A PRELIMINARY REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 263-269 ◽  
Author(s):  
Koji Moriya ◽  
Hidehiko Saito ◽  
Yuji Takahashi ◽  
Hiroyuki Ohi
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Functional Results ◽  
Wrist Pain ◽  
Point System ◽  
Articular Fractures ◽  
Palmar Plate ◽  
Ulnar Wrist Pain

We reviewed a series of 62 consecutive patients with dorsally displaced fractures of the distal radius, including 20 extra-articular and 42 intra-articular fractures. All patients were treated with palmar locking plate systems at our institution between 2002 and 2006. After a minimum follow-up time of 12 weeks, the fractures had healed with satisfactory radiographic and functional results. According to the demerit point system of Gartland and Werley, 35 patients were rated excellent, 26 good, and one fair. In the good and fair groups, the demerit points were almost all for ulnar wrist pain. Our results suggest that palmar locking plate systems enable early functional mobilization with good reproducible radiographic and clinical outcomes. Since nine out of 62 patients had residual ulnar wrist pain at the final follow-up evaluation, further investigation of the pathogenesis of ulnar wrist pain is necessary to obtain better functional outcomes.

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 Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

2021 ◽  
Author(s):  
Xue-yang Gui ◽  
Zhao-hui Cheng ◽  
Hongfei Shi ◽  
Yi-xin Chen ◽  
Jin Xiong ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Locking Plate Fixation ◽  
Articular Fractures ◽  
Metaphyseal Comminution

Abstract Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

scholarly journals The spanning plate as an internal fixator in complex distal radius fractures – a prospective cohort study

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
R Liechti ◽  
R Babst ◽  
U Hug ◽  
B -C Link ◽  
B van de Wall ◽  
...  
Keyword(s):  
Distal Radius ◽  
The United States ◽  
Distal Radius Fractures ◽  
Outcome Analysis ◽  
Dash Score ◽  
Initial Operation ◽  
Radius Fractures ◽  
Articular Fractures ◽  
The Mean

Abstract Objective Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Methods Indication for SP fixation included DRFs with severe metaphyseal comminution, radiocarpal luxation fractures with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. Post-operative assessments included radiological, functional and patient-rated outcomes at a minimum of 12 months follow-up. Results In the mentioned timeframe, a total of 508 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). The mean follow-up time was 14.5 months (range 12-24 months). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced oligosymptomatic non-union. Complications included 2 patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8 (range 0-10) and mean visual analogue scale for resting pain was 0.9 (range 0-9). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Conclusion The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.

scholarly journals Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Paritosh Gogna ◽  
Harpal Singh Selhi ◽  
Rohit Singla ◽  
Ashish Devgan ◽  
Narender Kumar Magu ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Point System ◽  
Functional Evaluation ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Loss Of Reduction ◽  
Comminuted Fractures

Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n=19)/3.5 mm (n=14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n=26), good in 18% (n=6), and fair in 3% (n=1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.

scholarly journals Functional Evaluation of Surgical Fixation of Distal Radius Fractures

2020 ◽  
Vol 7 (48) ◽  
pp. 2825-2830
Author(s):  
Madhu R.G. ◽  
Manikumar C.J.
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Distal Radius ◽  
Road Traffic ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Functional Evaluation ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Quick Dash

BACKGROUND Distal radius fracture is the most common orthopaedic injury in adults. It has an approximate incidence of 1:10,000 people and 16 % are of skeletal and 74 % of forearm fractures. Many fractures of the distal radius are relatively uncomplicated and can be effectively managed with closed reduction and immobilization in a cast. Over the past twenty years, more sophisticated internal and external fixation techniques and devices for the treatment of distal radius fractures have been developed keeping up with the demands of the modern day. Functional outcome seems to follow the surgical treatment which results in more anatomical results. METHODS A total of thirty (n = 30) distal radial fractures were treated surgically by various methods at Government General Hospital, Kakinada. They were evaluated functionally with Quick Dash score at one and half, 3 and 6 months duration. Twenty cases were treated with a volar plate through Henry’s approach. Six cases were treated with per cutaneous k wire fixation and four cases were treated with forearm external fixator application (Ligamentotaxis). Final outcome was evaluated by QUICK DASH evaluation questionnaire. In each patient Quick Dash score were taken at 6 weeks, 3 months & 6 months interval along with range of motion at 6months interval up to 2 years. RESULTS There were 22 (73.3 %) males and 8 (26.6 %) females. The age group ranged between 15 - 80 years. Eleven (36.6 %) patients had right side involvement. Nineteen (63.3 %) had left side involvement. Of the 30 cases, mode of injury was fall on outstretched hand in 21 (70 %) patients and road traffic accident in 9 (30 %) patients. Functional outcome correlated positively with the degree of anatomical reduction. CONCLUSIONS Functional outcome correlated positively with the degree of radial length, volar tilt and radial inclination achieved when compared to normal side. The method of internal fixation with volar locking plate appears to be favoured by many akin to its ability to sustain the reduction. Comminuted intra articular fractures fared less well with more number of complications. However, fracture union time seems to be unaffected by the method of fixation. KEYWORDS Radius A02.835.232.087.090.700, Orthopaedic Procedures E02.718, Range of Motion, Articular E01.370.600.700

Intramedullary Nail Fixation for Displaced and Unstable Distal Radial Fractures in Patients Aged 65 Years or Older

2016 ◽  
Vol 21 (01) ◽  
pp. 59-63 ◽  
Author(s):  
Takuma Wakasugi ◽  
Ritsuro Shirasaka
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
Functional Results ◽  
Distal Radius Fractures ◽  
Bony Union ◽  
Wrist Flexion ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Intramedullary Implant ◽  
Intramedullary Implants

Background: Distal radius fractures in elderly patients are now commonly treated with a volar locking plate, but flexor pollicis longus dysfunction caused by stripping of the muscle and tendon irritation and rupture caused by prominence of the implant have been reported. Intramedullary implants can stabilize distal radius fractures while minimally affecting the flexor and extensor tendons and muscles around the site, but osteoporosis in elderly patients might affect the radiographic and functional results of distal radius fractures treated by intramedullary implants. We investigated the radiographic and functional results of intramedullary implants for distal radius fractures in patients ≥65 years of age.Methods: We reviewed medical records of 40 patients with extra-articular or simple intra-articular fractures with the sagittal fracture line treated by an intramedullary implant.Results: All fractures achieved bony union, with an average radial inclination of 24.9 degrees, volar tilt of 9.2 degrees, and ulnar variance of 0.7 mm. We encountered one case of postoperative volar displacement of the distal fragment due to the small size of the intramedullary implant. The average range of motion was 69.8 and 59.9 degrees for dorsal and palmar wrist flexion, respectively. Average percentile grip strength of the uninjured side was 97%. The average Mayo modified wrist score at final follow-up was 91.9 points, with 20 patients graded as excellent, 16 as good, and 4 as fair.Conclusions: The findings of this study indicate that intramedullary implants for dorsally displaced extra-articular or simple intraarticular distal radius fractures may offer good radiological and functional outcomes without hardware irritation in elderly patients. Distal radius fractures with an osteoporotic, large medullary canal should be stabilized by implants of an appropriate size.

scholarly journals Treatment of Distal Radial Fracture Fixation Using Volar Rim Distal Radius Plate:A Prospective Study

2021 ◽  
Author(s):  
Yang Liu ◽  
Muhammad Zeeshan Waheed ◽  
Dong Wang ◽  
Junlin Zhou
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Fixation Method ◽  
Distal Radial Fracture ◽  
Functional Evaluation ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Volar Approach ◽  
Radiological Parameters

Abstract Background: Unstable distal radial fractures are difficult to manage and so various treatment and management modalities have been introduced and described. The use of Volar Rim Distal Radius Plate is promoted for the management of such fractures. Objective: This study aimed to to investigate the clinical effect and functional output of Volar Rim Distal Radius Plate in the treatment of distal radius fractures. The purpose of this study is to evaluate the functional and radiological results of treating distal radial fractures with Volar Rim Distal Radius Plate Methods: In our study from March 2017 to may 2019, the clinical efficacy of Volar Rim Distal Radius Plate in the treatment of distal radius fractures was retrospectively analyzed. Case Description: During the study period, 23 patients met the inclusion criteria. According to the AO lassification of distal radius, there were 9 patients with Ao-23b3 and 14 patients with Ao-23c3. The follow-up ime was 13-17 months (average 14.6 months). All patients achieved bony union without internal fixation failure or racture displacement. The Garland and Werley functional system score was used to evaluate the limb function. Among them, 9 cases were evaluated as excellent, 13 cases as good, and 1 case as fair. Radiological parameters such as radial inclination, length, tilt, and ulnar variance were measured at six weeks and at the final follow-up. The functional evaluation was conducted by measuring the range of motion at the wrist joint as well as the grip strength. Gartland and Werley’s demerit scoring system was used to assess the final outcome. Literature Review: Results without nonoperative treatment of these fractures are not satisfactory and may often require a subsequent corrective osteotomy.Good and Satisfactory results Can be achieved with operative treatment of the fracture when the fragments are well reduced by using theVolar Rim Distal Radius Plate。 Results: There was a significant improvement in the functional indices from six weeks to the final follow-up, while the radiological parameters were maintained. According to Gartland and Werley, excellent results were reported in 65% cases, while good results were present in 35% cases. Clinical Relevance: Volar Rim Distal Radius Plate can give an adequate buttress to volar projection of the lunate facet and it do not interfere with wrist mobility. More-ever, the dorsal fragments can be fixed through the volar approach which may eliminate our need for a secondary posterior incision. Furthermore, patients would be informed for the potential problems and let them know about the need of the removal of the plate if unfortunately symptoms develop. Conclusions: The use of Volar Rim Distal Radius Plate is an effective fixation method to treat distal radius fractures which can provide more firm stability, meet the needs of early functional exercise and improve the prognosis with excellent to good functional outcomes with minimal complications.

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