Evaluation of Results of Fixation of Unstable Distal Radial Fractures by Volar Locking Plating System

Distal radial fractures are most common fractures accounts 15% of whole skeletal injuries, as high as 40% to 49% are considered to be unstable that requires surgical fixation. The purpose of the study was to ascertain good functional hand by using volar locking plate & screws, as with locking system, distal screws are locked to the plate, which stabilized the screws against lateral movement (toggle effect), thus providing a "single bone-plate-screws construct" which producing a scaffold in the mostly cancellous distal radial metaphysis, so preventing from collapse. This study was done from January 2007 to December 2008 at National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR). Total numbers of cases were 17. All patients were admitted in hospital & most of them returned home within 4 days. Most patients were managed early within 1-10 days of injury. Most patients were Fernandez type 1, type 2, and type 3. Most patients were in the age group of 4th decade. All patients were followed up for a period of at least 3 months, mean follow up period was 6 months. Results showed that wrist pain, wrist stiffness, reduced grip strength were minimum with volar locking plate & screws as there is minimal radial shortening, radial angulation, volar tilt & ulnar variance and wrist flexion, wrist extension, ulnar deviation, supination, pronation were very good. So, the trauma surgeons can safely use this procedure.Faridpur Med. Coll. J. Jul 2016;11(2): 62-66

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A Prospective Study on Treatment of Distal Radial Fractures Using Volar Locking Plate

10.33140/ijor.03.01.07 ◽

2020 ◽

Vol 3 (1) ◽

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Open Reduction ◽

Locking Plate ◽

Small Sample ◽

Care Hospital ◽

Volar Locking Plate ◽

Distal Radial Fractures ◽

Compression Plating

Introduction: Distal radius fractures are one of the most common injuries which come to the orthopaedic surgeons. Displaced extra-or intra-articular fractures require anatomical reduction for a good outcome. Historically, these fractures were treated with manipulation and casting, with or without Kirschner (K) wire fixation. Modern plating techniques have been advocated to restore anatomical alignment and allow early mobilisation. Despite the wide variety of treatment options available there is still debate about the best way to treat these fractures. The aim of this study was to evaluate fifty cases of fracture distal end radius treated by open reduction and internal fixation using locking compression plating (LCP). Methods: The present study was carried out on 50 cases of acute fracture distal radius admitted at a tertiary care hospital treated by open reduction and internal fixation using locking compression plating (LCP) between January 2018 and December 2018. Functional results were rated at the end of the study as excellent, good or poor as criteria laid down by Gartland and Werley’s combined subjective and objective criteria. Results: 50 cases of fracture distal radius were selected for study that fulfill the inclusion criteria, were operated and studied. 10 fractures were fixed using Extra-articular Locking Compression T-Plates, 40 fractures were fixed using Juxtaarticular Locking Compression T-Plates. According to the Gartland and Werley’s rating scale, 20 had excellent results, 23 good results, and 07 fair results during latest follow up. Conclusion: Notwithstanding a very small sample size and a short follow up, Volar locking plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist.

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Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500061 ◽

2019 ◽

Vol 24 (01) ◽

pp. 30-35 ◽

Cited By ~ 1

Author(s):

Takeshi Katayama ◽

Hiroshi Ono ◽

Shohei Omokawa

Keyword(s):

Clinical Outcomes ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Wrist Flexion ◽

Radius Fractures ◽

Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

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Complications following volar locking plate fixation for distal radial fractures: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413511936 ◽

2013 ◽

Vol 39 (7) ◽

pp. 745-754 ◽

Cited By ~ 46

Author(s):

A. Bentohami ◽

K. de Burlet ◽

N. de Korte ◽

M. P. J. van den Bekerom ◽

J. C. Goslings ◽

...

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Locking Plate ◽

Assessment Tool ◽

Plate Fixation ◽

Assessment Tools ◽

Volar Locking Plate ◽

Locking Plate Fixation ◽

Distal Radial Fractures ◽

Level Of Evidence

The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group’s former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were ‘minor’ complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.

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Arthroscopic assistance does not improve the functional or radiographic outcome of unstable intra-articular distal radial fractures treated with a volar locking plate

The Bone & Joint Journal ◽

10.1302/0301-620x.97b7.35354 ◽

2015 ◽

Vol 97-B (7) ◽

pp. 957-962 ◽

Cited By ~ 23

Author(s):

H. Yamazaki ◽

S. Uchiyama ◽

M. Komatsu ◽

S. Hashimoto ◽

Y. Kobayashi ◽

...

Keyword(s):

Locking Plate ◽

Volar Locking Plate ◽

Radiographic Outcome ◽

Distal Radial Fractures

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Characterisation of macular neovascularisation in geographic atrophy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-318820 ◽

2021 ◽

pp. bjophthalmol-2021-318820

Author(s):

Riccardo Sacconi ◽

Maria Brambati ◽

Alexandra Miere ◽

Eliana Costanzo ◽

Vittorio Capuano ◽

...

Keyword(s):

Fundus Autofluorescence ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

First Year ◽

Age Related ◽

Treatment Naïve ◽

Type 3 ◽

Endothelial Growth Factor

AimTo characterise macular neovascularisation (MNV) developing in eyes affected by geographic atrophy (GA).MethodsIn this multicentric longitudinal study involving three retina referral centres, patients previously affected by GA who developed an active MNV were included. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography and dye angiographies. Patients were treated with ProReNata antivascular endothelial growth factor (VEGF) injections and were revaluated after treatment.ResultsAmong 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm2) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 to 10.13, 95% CIs) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3 and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material with or without evidence of subretinal/intraretinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV.ConclusionsMNVs in GA showed different features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (ie, GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.

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A Prospective Randomized Trial Comparing Nonoperative Treatment with Volar Locking Plate Fixation for Displaced and Unstable Distal Radial Fractures in Patients Sixty-five Years of Age and Older

Orthopedics ◽

10.3928/01477447-20111122-22 ◽

2012 ◽

Vol 35 (1) ◽

pp. 50-51 ◽

Cited By ~ 1

Keyword(s):

Randomized Trial ◽

Locking Plate ◽

Plate Fixation ◽

Nonoperative Treatment ◽

Prospective Randomized Trial ◽

Volar Locking Plate ◽

Locking Plate Fixation ◽

Distal Radial Fractures

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High-pressure balloon dilatation in children: our results in 30 patients with POM and the implications of the cystoscopic evaluation

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2020.214 ◽

2020 ◽

Vol 42 (1) ◽

Author(s):

Francesca Destro ◽

Giorgio Selvaggio ◽

Federica Marinoni ◽

Andrea Pansini ◽

Giovanna Riccipetitoni

Keyword(s):

High Pressure ◽

Balloon Dilatation ◽

Invasive Procedure ◽

Definitive Treatment ◽

Ureteral Stenting ◽

Diagnostic Modalities ◽

Almost All ◽

Type 3

Primary Obstructive Megaureter (POM) is a common cause of hydronephrosis in children with spontaneous resolution in most cases. High-Pressure Balloon Dilatation (HPBD) has been proposed as a minimally invasive procedure for POM correction in selected patients. The aim of the paper is to review our experience with HPBD in patients with POM. We performed a retrospective study in a single Centre collecting data on patients’ demographics, diagnostic modalities, surgical details, results and follow-up. In particular, the endoscopic aspect of the orifice permitted the identification of 3 patterns: adynamic ureteral segment, stenotic ureteric ring and pseudoureterocelic orifice. We performed HPBD in 30 patients over 6 years. We had 23 patients with adynamic distal ureteral segment (type 1), 4 with stenotic ring (type 2) and 3 with ureterocelic orifice (type 3). In 3 patients (10%) the guidewire did not easily pass into the ureter requiring ureteral stenting or papillotomy. Post-operative course was uneventful. Five patients (3 pseudoureterocelic) required open surgery during follow-up. HPBD for the treatment of POM is a safe and feasible procedure and it can be a definitive treatment of POM. Complications are mainly due to double J stent and none of our patients had symptoms related to vescico-ureteral reflux. The aspect of the orifice, identified during cystoscopy, seems to correlate with the efficacy of the dilatation: type 1 and 2 are associated with good and excellent results respectively; type 3 do not permit dilatation in almost all cases requiring papillotomy. HPBD can be performed in selected patients of all paediatric ages as first therapeutic line. The presence of a pseudoureterocelic orifice or long stenosis might interfere with the ureteral stenting and seems associated with worse outcomes.

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Associations Between the Fracture Type and Functional Outcomes After Distal Radial Fractures Treated With a Volar Locking Plate

Medicina ◽

10.3390/medicina49090062 ◽

2013 ◽

Vol 49 (9) ◽

pp. 62

Author(s):

Kęstutis Braziulis ◽

Rytis Rimdeika ◽

Rima Kregždytė ◽

Šarūnas Tarasevičius

Keyword(s):

Locking Plate ◽

Hand Function ◽

Linear Regression Analysis ◽

Type A ◽

Dash Score ◽

Volar Locking Plate ◽

Fracture Type ◽

Type C ◽

And Gender

Objective. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. Material and Methods. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. Results. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. Conclusions. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact.

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