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

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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Comparison of functional outcome of extra-articular distal radius fractures treated by volar locking plate versus percutaneous pinning in adults-a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211618 ◽

2021 ◽

Vol 7 (3) ◽

pp. 611

Author(s):

Shushrut B. Bhavi ◽

Amith Shanmukgouda Kallanagoudar ◽

Deepak Kaladagi ◽

N. B. Sanakal

Keyword(s):

Retrospective Study ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Volar Locking Plate ◽

Percutaneous Pinning ◽

Radius Fractures ◽

Plate Group

Background: Distal radius fractures are one of the most common fractures in an adult population and accounts for 17.5% of all the fractures. The management of distal radius fractures remains debatable despite the availability of different methods of treatment. The aim of this study is to assess the functional outcomes of extra-articular distal radius fractures treated with percutaneous pinning or internal fixation with volar locking plate in adults.Methods: A retrospective study of 40 patients diagnosed with distal radius fracture with AO classification were treated either with percutaneous pinning (n=20) or open reduction and internal fixation with volar locking plate (n=20) were included in study. DASH score and radiographs at 6th month was assessed for functional outcome and radiological union.Results: Mean age in plate group was 40 and 45 years in K wire group. The mean passive wrist ROM at the final follow-up evaluation in plate group was 63.8o extension and 70.5o flexion, 81.7o supination and 79o pronation, compared with 56.75o extension and 65.25o flexion, 74.7o supination and 85.5o pronation in patients treated with K wire group. Patients with plate group and K wire group had DASH score of 19.85 and 18.49 respectively (p=0.07) at 6 months follow-up.Conclusions: The use of ORIF with plate resulted in stable fixation of the unstable extraarticular fractures, allowing early post-surgical wrist motion and has good radiological outcome whereas K wire also has advantages of being minimal invasive, reduced hospital stay and minimal cost.

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Evaluation of Patient-Reported and Clinician-Reported Outcomes of Volar Locking Plate Fixation for Distal Radius Fractures

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

10.1142/s2424835520500411 ◽

2020 ◽

Vol 25 (03) ◽

pp. 359-363

Author(s):

Nana Nagura ◽

Kiyohito Naito ◽

Yoichi Sugiyama ◽

Hiroyuki Obata ◽

Kenji Goto ◽

...

Keyword(s):

Range Of Motion ◽

Distal Radius ◽

Clinical Evaluation ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Volar Locking Plate ◽

Radius Fractures ◽

Patient Reported

Background: Postoperative evaluation of wrist joint trauma is divided into patient-reported outcomes (PROs) and clinician-reported outcomes (CROs). We investigated the association of the Q-DASH score as the postoperative PROs and the Mayo wrist score as the postoperative CROs with clinical evaluation in patients with distal radius fractures surgically treated using a volar locking plate (VLP). Moreover, whether PROs and CROs are correlated to the clinical evaluation was investigated. Methods: The subjects were 109 patients surgically treated for distal radius fractures at our hospital between June 2013 and May 2017. Forty-one patients were male, 68 patients were female, and the mean age was 61.4 (19–86) years old. The fracture type was AO classification A type in 30 patients (A2: 25, A3: 5), B type in 5 (B2: 1, B3: 4), and C type in 74 (C1: 50, C2: 11, C3: 13). All patients were surgically treated using VLP. The range of motion of the wrist, grip strength the Visual Analog Scale (VAS), the Q-DASH score (PROs), and the Mayo wrist score (CROs) were investigated. Each evaluation was compared as the clinical outcome between at 3 months after surgery and the final follow-up. In addition, the correlations of the postoperative PROs and CROs with the clinical evaluation were analyzed. Results: Each evaluation was significantly improved compared with that at 3 months after surgery. There was a significant correlation between PROs and CROs at 3 months after surgery and the final follow-up. However, the range of motion of the wrists was not significantly correlated with PROs or CROs at 3 months after surgery or at the final follow-up. Conclusions: On evaluation after surgery for distal radius fractures, PROs and CROs improved early after surgery (3 months after surgery) before the final follow-up, and an inverse correlation was present between these scores.

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Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications

Journal of Orthopaedic Surgery ◽

10.1177/2309499020972204 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902097220

Author(s):

Jun Sung Park ◽

Sang Hyun Ko ◽

Taek Ho Hong ◽

Dong Jin Ryu ◽

Dae Gyu Kwon ◽

...

Keyword(s):

Patient Satisfaction ◽

Plate Fixation ◽

Type A ◽

Dash Score ◽

Fracture Type ◽

Patient Satisfaction Score ◽

Significant Difference ◽

Functional Scores ◽

Implant Selection ◽

Type C

Background: The best strategy for implant selection in midshaft clavicular fractures (MCF) remains controversial. The present study aims to determine the optimal strategy for implant selection by comparing plate and Titanium Elastic Nail (TEN) with respect to outcomes and related complications and analyze the results based on fracture patterns. Methods: A total of 97 patients with MCF who underwent plate (48 patients) or TEN (49 patients) fixation were retrospectively reviewed. Both groups were divided into three subgroups by fracture type using the AO Foundation/Orthopaedic Trauma Association classification: simple fracture (type A), wedge fracture (type B), and multi-fragmentary fracture (type C). The observed outcome measures were bone union rate, related complications, functional scores, and patient satisfaction score. These outcomes were analyzed based on the fracture classification. Results: Both groups demonstrated excellent union rates (p = 0.495) and similar functional scores (p > 0.05). Visual analog scale (VAS) for satisfaction was better in TEN than plate fixation (p < 0.001). In type A and B subgroups, there were no significant difference in functional scores between plate and TEN fixation (p > 0.05). In type C subgroup, however, both VAS for pain and DASH score in TEN fixation were significantly worse than in plate fixation at 2 and 6 weeks postoperatively (p < 0.05). The incidences of clavicle shortening and skin irritation are higher especially in type C subgroup of TEN fixation (p < 0.05). Conclusion: Patient satisfaction of TEN fixation was higher than that of plate fixation, but TEN fixation had a higher incidence of early postoperative pain and migration in type C fractures. Therefore, type A and B fractures can successfully be treated with plate or TEN fixation, but type C fractures should be treated with plate fixation.

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MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420983213 ◽

2021 ◽

pp. 175319342098321

Author(s):

Anyuan Wang ◽

Jian Ding ◽

Long Wang ◽

Tinggang Chu ◽

Zhipeng Wu ◽

...

Keyword(s):

Type A ◽

Surgical Reconstruction ◽

Mri Findings ◽

Level Of Evidence ◽

Type D ◽

Type Iv ◽

Secondary Operations ◽

Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

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Abstract 19622: Trans-apical Off-pump Mitral Valve Repair With Neochords Implantation: One Year Clinical and Echocardiographic Follow-up

Circulation ◽

10.1161/circ.132.suppl_3.19622 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Andrea Colli ◽

Laura Besola ◽

Lorenzo Bagozzi ◽

Erica Manzan ◽

Eleonora Bizzotto ◽

...

Keyword(s):

Mitral Valve ◽

Type A ◽

Mitral Valve Regurgitation ◽

Disease Type ◽

Reverse Remodeling ◽

Off Pump ◽

Single Centre Study ◽

Type C ◽

One Year

Introduction: TOP-MINI is a new micro invasive surgical procedure to treat degenerative mitral valve regurgitation due to flail/prolapse. Hypothesis: This prospective single centre study sought to assess the safety and effectiveness of the TOP-MINI procedure up to one year follow-up. Methods: Clinical and Echocardiographic outcomes were evaluated at 1, 3, 6 months and 1 year follow-up for all patients underwent TOP-MINI procedure from November 2013 to March 2015. Procedural success was defined as residual MR≤2+ at any time. Results: Sixty-one patients were treated during study period. One year survival was 96.7±2.3%. Freedom from MR>2+ is shown in figure 1 Panel A, Freedom from MR>2+ according to valve anatomy (Type A isolated P2 disease, Type B posterior multisegment disease, Type C anterior or bileaflet and/or calcified disease) is shown in Figure 1 Panel B. Freedom from MR>2+ according to STS risk profile is shown in Figure 2. The trend of Echocardiographic parameters is shown in Figure 3. Conclusions: TOP-MINI is a safe and effective procedure at 1 year FU. Residual MR is influenced by valve anatomy showing good results in Type A and B patients. Future techniques refinements are needed in order to improve outcomes of Type C patients. The lack of annuloplasty procedure does not influence negatively left ventricle reverse remodeling.

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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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Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

BioMed Research International ◽

10.1155/2018/5786089 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Pengbo Luo ◽

Jinjie Lou ◽

Shengwu Yang

Keyword(s):

Pain Management ◽

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Rehabilitation Program ◽

Radius Fracture ◽

Dash Score ◽

Volar Locking Plate ◽

Vas Scores ◽

Pain At Rest

Introduction. Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods. Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results. We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions. We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.

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THE RECALL DASH SCORE — A NOVEL RESEARCH TOOL

Hand Surgery ◽

10.1142/s0218810413500020 ◽

2013 ◽

Vol 18 (01) ◽

pp. 11-14 ◽

Cited By ~ 5

Author(s):

Nicholas Reynolds ◽

Sunil Thirkannad

Keyword(s):

Statistical Analysis ◽

Patient Population ◽

Hand Function ◽

Hand Surgery ◽

Clinic Visit ◽

Research Tool ◽

Time Interval ◽

Dash Score ◽

Pre Treatment

The DASH score is a universally accepted method for assessment of hand function. However, there are occasions when a pre-treatment DASH score is unavailable. This study provides a solution to this situation. An initial DASH score was obtained from all patients at the time of their first clinic visit. A second score was obtained at the time of final follow-up asking the patient to "Recall" their pre-treatment status. The two scores were compared with appropriate statistical analysis. Thirty-eight patients were included in the study and scores were obtained at an average time interval of 32 weeks (6–121 weeks). Excellent agreement was noted for the ability of the patient population to recall their scores with a group correlation of 0.86. This proves that the Recall DASH score is an excellent and useful research tool for use in hand surgery.

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Study of clinicoradiological and functional outcomes in intraarticular distal end radius fractures managed by volar locking plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192092 ◽

2019 ◽

Vol 5 (4) ◽

pp. 599

Author(s):

Pravin Agrawal ◽

Samadhan Mundhe ◽

Sajal Mitra

Keyword(s):

Functional Outcomes ◽

Locking Plate ◽

Volar Locking Plate ◽

Radius Fractures ◽

Interventional Study ◽

Volar Approach ◽

Mayo Score ◽

Locking Compression Plates ◽

The Mean

Background: Various modalities of fixation are available for management of distal end radius fractures. Assessment of the functional and radiological outcomes of intra-articular distal end radius fractures managed with volar locking plate was attempted with the present study.Methods: In this prospective interventional study, thirty adult patients with closed distal radius fractures with intra-articular extension were comprehensively evaluated and managed. Open reduction and internal fixation (ORIF) was performed via volar approach (modified Henry`s approach) using 2.7mm volar locking compression plates (LCPs). Patients were followed up at 2 weeks, 1 month, 3 months and 6 months after surgery. The patients were evaluated functionally by Mayo score and radiologically by Lidstrom classification.Results: There were 18 (60%) patients having excellent, 8 (26.7) good, 2 (6.7%) fair and 2 (6.7%) with poor result according to Mayo scoring. According to Lidstrom scoring, at the last follow up, 16 (53.3%) patients had excellent, 11 (36.7%) patients good, 2 (6, 7%) patients fair and 1 (3.3%) patient had poor result. The functional status of the patient improved significantly from at 1month (20±3.47) to 6 months post-operative follow up (23.67±2.91). The mean range of motion improved significantly at 1 month, 6 months and last post-operative follow-up.Conclusions: Volar locking plate gives good to excellent clinico-radiological and functional outcomes in most of the fractures of the distal end radius with intraarticular extension.

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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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