Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation. Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs. Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75). Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.

Radiographic Assessment of Distal Radius Fracture Treatment Outcomes Following Various Types of Fracture Stabilization in Elderly Patients

Background: Distal radius fractures pose a serious problem due to their high incidence and can be treated with various methods. No specific distal radius fracture treatment is acknowledged to be the gold standard by orthopedic surgeons. The aim of study was to conduct a comprehensive radiographic assessment of treatment outcomes in patients with distal radius fractures following various types of stabilization in elderly patients. Methods: We retrospectively assessed 122patients who underwent treatment for distal radial fracture in the years 2017and2018.There were three study groups: closed reduction with K-wire fixation (37patients),open reduction with volar plate fixation (42 patients),and closed reduction with cast immobilization (43patients).The mean age at the beginning of treatment was 73years.The mean follow-up period was 2 years and 7months.The following radiological parameters were evaluated: union rate, time to union, time of fracture immobilization, fracture stabilization failure, and the development of adjacent-joint arthritis. Results: There were no significant differences between the study groups in terms of union rate, time to union, and the development of adjacent-joint arthritis. After treatment, the lowest rates of posttraumatic intercarpal and carpometacarpal arthritis and the lowest rates of fracture stabilization failure in our study were observed in the plaster-cast group. Volar plate fixation was associated with the shortest duration of fracture stabilization. In comparison to the status from before treatment, all study groups showed increased rates of intercarpal and carpometacarpal arthritis after treatment. Conclusions: Our radiographic assessments demonstrated similar outcomes, regardless of the stabilization method. In treating distal radius fractures, we achieved good radiographic treatment outcomes irrespective of the fracture stabilization method used.

Early Plain Film After Volar Plate Fixation for Distal Radius Fractures: Is Reallly Useful?

Background: The value of early postoperative radiographs is generally questioned after volar plate fixation(VLP) for distal radius fractures(DRFs). The purpose of this study was to evaluate the utility of early routine radiographs following volar plate fixation.Methods:A restropective study was developed on distal radius fractures treated with volar plate fixation between 1 January 2016 and 1 January 2020 in our hospital. We obtain relevant information from patient electronic records including basic patient information and treatment information.Reoperation or further checking after early postoperative radiographs was defined as management change，which illustrates early postoperative radiographs influence postoperative treatment.Results: A total of 213 patients treated with VLP were included. There are 179 patients having early postoperative radiographs in included patients. Two out of 179 patients were altered management,which underwent further imaging with computed tomography(CT) due to pain and swelling.This two patients were in line with Type C(AO/OTA classification). No patient has surgery again.Conclunsion: Early postoperative radiographs can not bring about an adjustment in postoperative management with VLP after DRF.But intra-articular fractures may still benefit from early postoperative radiographs compared with extra-articular fractures.

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

Background Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Recently, locked volar plate fixation has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or secondary nonunions. Purpose The purpose of this meta-analysis was to compare union rates and clinical outcomes between locked volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions. Methods A literature search was performed for studies documenting treatment outcomes for scaphoid nonunions from 2000 to 2020. Inclusion criteria consisted of (1) average age > 18 years, (2) primary study using screw fixation, plate fixation, or both, with discrete data reported for each procedure, and (3) average follow-up of at least 3 months. Exclusion criteria consisted of studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using a generalized linear model or binomial distribution. Results Following title and full-text review, 23 articles were included for analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery and were more likely to have failed prior surgical intervention. There was no significant difference between union rates at 92 and 94% for screw and plate fixation, respectively. However, plate fixation resulted in longer time to union and lower modified Mayo wrist scores. Conclusion Patients treated with locked volar plate fixation were more likely to be used for recalcitrant or secondary nonunions. There was no statistically significant difference in union rates between screw and plate fixation. The results from this meta-analysis support the select use of locked volar plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical repair.