Case Series-Open Reduction Internal Fixation With Plating Of Distal Radius Fracture

Background: Fractures of the distal radius are one of the common fractures for which pediatric orthopedic consultations are sought. The usual mechanism of injury is fall on outstretched hand seen following a road traffic accident or fall. Most of these fractures are treated either conservatively or by closed reduction and immobilization in cast. In some cases, internal fixation by K-wiring may be required. We conducted this study to analyzed outcome of distal end radius fracture in pediatric age group who were treated by immobilization alone, by closed reduction and immobilization and closed reduction with internal fixation by K-Wire and immobilization in cast. Aims and Objectives: 1. To analyze outcome of distal end radius fracture in pediatric age group. 2. To study complications in children presenting with distal end radius fracture. Materials and Methods: This was an observational study conducted in the department of orthopedics of a tertiary care medical college. 60 pediatric patients with distal radius fractures and treated either by conservative management or by surgical intervention were included in this study on the basis of a predefined inclusion and exclusion criteria. Gender distribution, mean age and mechanism of injury in the affected cases were analyzed. Patients were treated either by immobilization alone, by closed reduction and immobilization and closed reduction with internal fixation by K-Wire and immobilization in cast. Patients were followed up for 8 weeks. Complications and time for complete union was assessed during follow up visits. Functional outcome was assessed by QuickDash Score. Results: Out of these 60 patients there were 52 (86.66%) males and 8 (13.33%) females with a male to female ratio of 1:0.15. The mean age of affected cases in Boys and Girls was found to be 13.09 +/- 2.93 years and 12.5+/- 3.64 years respectively. Dominant hand was involved in 41 (68.33 %) whereas non-dominant hand was involved in remaining 19 (31.66 %) cases. In 16 (26.67%) patients only casting was required whereas closed reduction and casting was done in 25 (41.67%) patients in remaining 19 (31.67%) patients closed reduction and K-Wire fixation was done. 42 (70%) patients had excellent functional outcome whereas 9 (15%) patients had good functional outcome and 9 (15%) patients were found to have satisfactory outcome. 4 (6.66%) patients developed pressure sores, 1 (1.67%) patient had stiffness and there was 1 (1.67%) case of pin site infections. All these complications were successfully managed by conservative means. Conclusion: Fractures of distal end of radius in pediatric age group can be managed successfully either by immobilization alone or by closed reduction and casting. Internal Fixation by K-Wires may be required in some cases.

Background: Distal radius fracture is the most common fracture of upper extremity. There are wide variety of treatment options including plaster, ligamentotaxis, percutaneous pinning and plating for the treatment of displaced distal end radius fracture in the adult. Each option has got its own pros and cons. This study was designed with an objective of assessment of functional and radiological outcome of displaced distal end radius fracture treated with volar locking plate. Methods: This was a retrospective study of closed displaced fracture of distal end radius managed with volar locking plate from January 2018 to September 2020. Data were collected from the case chart and included patient’s demography, fracture characteristics, radiological parameters, range of motion and complications. Data analysis was done using Statistical package for social science 20.0 software. Descriptive statistics for categorical variable was used and mean of the continuous data was compared using student’s t-test. P-value <0.05 was considered as statistically significant. Results: The mean age of patient was 35.87 years after analysis of total of 30 patients with mean follow up of 12.87 months. Road traffic accident (76.7%) was the most common mode of injury. There were 36.7% Association of Osteosynthesis (AO) type B and C injuries, each. The mean Quick Disabilities of Arm, Shoulder and Hand (DASH) score was 1.13 (range 0 - 6.81) at the final follow up. The mean union time of the fracture was 6.6 weeks. One patient had stiffness and one developed reflex sympathetic dystrophy. Conclusions: Functional and radiological outcome of the displaced distal end radius in adult treated with open reduction and internal fixation with locking plate was found good to excellent in most of the cases.

Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.

Introduction Distal radius fractures are considered the most common fractures in orthopedic practice. There are many different fracture patterns and injuries associated with articular cartilage and neighboring soft tissue that are found in different patient populations. Fractures of the distal radius are caused by high-energy trauma in young patients and by low-energy trauma in the elderly. Disruption of the ligaments and the displacement of the carpus and/or the triangular fibrocartilage complex will equally influence the functional outcome. Many methods have been established for the treatment of fractures of the distal radius. The main principle is to obtain anatomical reduction with rigid fixation to allow early mobilization. Comparison between the results of closed reduction and internal fixation by percutaneous Kirschner wires and open reduction and internal fixation (ORIF) by self-locked plates and screws in the treatment of recent intra-articular distal radial fractures was made in 30 patients in El-Menoufia University Hospital during a 33-month period. Objectives This study compared clinical outcomes and complications in patients with recent intra-articular distal radius fractures treated using two methods of fixation: percutaneous pinning and self-locked plating. Background While selecting treatment, a technique that makes alignment of articular surfaces a priority and restores more normal joint mechanics should be used. Closed reduction and percutaneous pinning is a good option, which preserves soft tissue as it is a minimal invasive procedure. On the other hand, open reduction and self-locked plate fixation is a unique option in supporting articular surface and preventing its collapse. Materials and methods Thirty patients were analyzed and divided into two groups. Patients in group A (n = 17) were treated with percutaneous pinning and patients in group B (n = 13) were treated with ORIF by self-locked plating. The major characteristics of the two groups in terms of age, sex, mode of injury, fracture location, and associated injuries were similar. Results Primary union was achieved in all patients. The mean time to union was similar in the two groups. The mean operation time in the percutaneous pinning group (25 min) was shorter than that in the ORIF group (80 min). There were complications in four cases (13.33%). One case was treated by self-locked plates and screws and had extensor tendon irritation (3.33%). Three cases that were treated by percutaneous pinning had complications; one case had pin-tract infection (3.33%), one case had loss of reduction and complex regional pain syndrome (3.33%), and one case had pin-tract granuloma (3.33%). Functional outcome was satisfactory in both groups. Conclusion Percutaneous pinning technique achieves comparable results with the ORIF by self-locked plating method in intra-articular distal radial fractures. Percutaneous pinning reduces operation time and soft-tissue dissection. Self-locked plating reduces collapse and loss of reduction rates.

Rationale:Distal radius fracture with simultaneous ipsilateral radial head fracture is a very rare pattern of injury. This type of injury is referred to as ‘radius bipolar fracture’. Treatments for this injury pattern can be challenging because both the wrist and elbow need to be considered. There are currently no guidelines for the treatment of this specific type of injury. We report two cases of this unusual pattern of injury treated in our hospital.Patient concerns:Case 1 was a 78-year-old female patient and case 2 was a 19-year-old female patient who visited our emergency department with left elbow and wrist pain after slipping and falling.Diagnosis:Plain radiography and computed tomography revealed radius bipolar fracture. Case 1 had an AO type C3 distal radius fracture, a Mason type III radial head fracture. Case 2 had an AO type B2 undisplaced distal radius fracture and a Mason type III radial head fracture.Interventions:In case 1, open reduction and internal fixation (ORIF) was performed for the distal radius fracture and radial head replacement arthroplasty for the radial head fracture. In case 2, distal radius fracture was treated conservatively and ORIF was performed for the radial head fracture.Outcomes:Bony union as achieved in both cases. At 1-year follow-up, case 1 showed slight limited range of motion of the wrist. Case 2 showed no radius shortening and full range of motion of the wrist and elbow. The Quick disabilities of the arm, shoulder and hand score was 18 and 16, respectively.Lessons:After this type of injury, the radius length can be changed, and as a result, ulnar variance can be affected. When radial head replaced is considered, it would be better to operate on the wrist first, and then perform radial head replacement. In this way, radiocapitellar overstuffing or instability can be prevented. However, if ORIF is planned for proximal radius fracture, either the proximal or distal radius can be fixed first. Surgeons should try to preserve radial length during treatment to optimize patient outcomes.

Although isolated distal radius and radial head fractures are common injuries, simultaneous ipsilateral fractures are uncommon. They can range from simple undisplaced fractures at either end to severely comminuted ipsilateral proximal and distal radial fractures. Few cases have been reported with concomitant comminuted distal radius and radial head fractures, and no treatment guidelines are available. Decisions are often based on personal recommendations. The purpose of our study is to increase awareness of this injury pattern and to discuss the mechanism of injury, treatment approach, and functional outcome. Skeletally mature patients with comminuted simultaneous ipsilateral fractures of the distal and proximal radius from 2016 to 2021 were identified and studied retrospectively. Demographic information, mechanism of injury, treatment approach, and complication rate were analyzed. Radiographic assessment for inadequacy or loss of reduction and radiographic parameters of the distal radius, including radial inclination, radial length, and palmar inclination, was performed immediately postoperatively and at the final follow-up. Clinical outcomes were determined by calculating the Visual Analog Scale (VAS) score, measuring the range of motion in both joints, and using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at the final follow-up. A total of 11 patients met the inclusion criteria. All had ipsilateral Mason III radial head fractures and type C (according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification) intra-articular distal radius fracture. On-table radial head reconstruction and fixation with a proximal radius plate were used for radial head fractures, and osteosynthesis with an anatomic volar locking plate was used for distal radius fractures. The mean follow-up duration was 32 months (range 12-65 months). At the final follow-up, osseous union of both the radial head and distal radius was observed in all patients. The mean VAS score was 1.5 (range 0-7) at rest and 3.9 (range 0-9) with activities, while the mean QuickDASH score was 32 (range 12-65). No significant complications were recorded. Simultaneous comminuted fractures of the ipsilateral distal radius and radial head represent a distinct injury pattern, most likely resulting from high-energy trauma, such as falling from a height onto an outstretched hand. Greater emphasis should be placed on clinical examination and radiological imaging of the elbow in cases of wrist injuries and vice versa. Treatment involving on-table reconstruction of the radial head and open reduction and internal fixation with a volar plate can lead to good radiological and functional outcomes.

Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

Background Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches. Purpose This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously. Materials and Methods Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Patient demographics, injury mechanism, scaphoid and distal radius fracture pattern, treatment approach, and radiographic healing were studied. Results Twenty-three patients were identified. Nineteen of the 23 (83%) were males, and 19 of 23 (83%) of the injury mechanisms were considered high energy. Twenty-two of the 23 (96%) scaphoid fractures were nondisplaced, all treated with screw fixation. Most distal radius fractures were displaced and comminuted, 17 of 23 (74%) were intra-articular. All distal radius fractures were treated surgically with internal and/or external fixation. Three patients were lost to follow-up. Average follow-up of the remaining 20 was to 19.8 weeks. Nineteen of the 20 (95%) scaphoids healed, one scaphoid went on to nonunion with avascular necrosis. All 20 radius fractures healed, 16 of 20 (80%) in anatomic alignment. Conclusion Ipsilateral fractures of the distal radius and scaphoid are rare and are usually result of high-energy mechanisms. The scaphoid fracture is usually a nondisplaced fracture at the waist. The distal radius fracture pattern varies but most are displaced and comminuted. The union rate of the scaphoid is high, even if subjected to radiocarpal distraction required for distal radius management. Level of Evidence Therapeutic level IV study.

Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures. Glickel SZ, Catalano LW, Raia FJ, Barron OA, Grabow R, Chia B. J Hand Surg Am. 2008;33:1700–1705.

Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Proper preoperative evaluation is a must to know the orientation of the fracture. Treatment must be based on displacement of the fracture. If fracture is displaced, internal fixation is needed but if its stable with minimal displacement, we can conserve it. A patient with displaced distal radius fractures and displaced scaphoid fracture on one side, along with displaced distal end radius fracture and undisplaced scaphoid fracture on the other side, was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating on the right side and below elbow cast in cup holding position on the left side which was non-dominant. The approach to treating fractures hinges on several factors: the specific location and alignment of the fracture, the patient's characteristics, and the surgeon's expertise. For fractures in the distal radius and scaphoid, employing a rigid internal fixation method allows for the early initiation of active wrist rehabilitation, eliminating the necessity for wrist immobilization using a plaster cast or external skeletal fixation. On the other hand, a conservative treatment approach involving a below-elbow cast offers certain advantages, such as minimal blood loss and fewer complications related to wound healing, particularly for undisplaced fractures, especially when they occur in the non-dominant hand.

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

To compare final functional and radiographic outcomes of closed reduction and casting (CAST) with open reduction and internal fixation (ORIF) with palmar locking plate for unstable Colles type distal radius fractures (DRFs) in low-demand patients older than 70 years. Retrospective, clinical study. Level 1 university trauma center. Over a mean period of 4 years and 7 months, 130 consecutive patients older than 70 years were treated for an unstable dorsally displaced DRF of which 114 or 87% were followed for 1 year or longer. ORIF (n = 53) using volar locking plate or closed reduction and casting (n = 61). Objective and subjective functional results (active range of motion; grip strength; disabilities of the arm, shoulder and hand (DASH) score; patient-rated wrist evaluation (PRWE) score; visual analog scale; and Green and O'Brien score) and radiographic assessment (dorsal tilt, radial inclination, radial shortening, fracture union, and posttraumatic arthritis) were assessed. At final follow-up, there was no significant difference between the 2 groups for mean ranges of motion, grip strength, DASH score, PRWE score, and Green and O'Brien score. Pain level was significantly less for the patients in the CAST group. An obvious clinical deformity was present in 77% of cast group and none in the ORIF group. At final follow-up, in the ORIF group, there was a mean loss of dorsal tilt of 1.3 degrees, radial inclination of 0.3 degrees, and radial length of 0.5 mm compared with the postoperative measurements. No primary acceptable reduction was achieved in 44% of the CAST group. At final follow-up, in the CAST group, dorsal tilt, radial inclination, and radial shortening averaged -24.4 +/- 12 degrees, 19.2 +/- 6.5 degrees, and +3.9 +/- 2.7 mm, respectively. Malunion occurred in 89% primarily reduced fractures. Dorsal tilt, radial inclination, and radial shortening were significantly better in the ORIF group. Radiographic results (dorsal tilt, radial inclination, and radial shortening) after unstable dorsally displaced DRFs are significantly better in patients treated by ORIF using a volar fixed-angle plate rather than those treated by cast immobilization (P < 0.05). At a mean follow-up time of 4 years and 7 months, the clinical outcomes of active range of motion, the PRWE, DASH, and Green and O'Brien scores do not differ between the 2 methods of treatment. The pain level was significantly less in the CAST group (P < 0.05), and this group experienced no complications. There was no difference between the subjective and functional outcomes for the surgical and the nonsurgical treatments in a cohort of patients older than 70 years. Unsatisfactory radiographic outcome in older patients does not necessarily translate into unsatisfactory functional outcome. Nonoperative treatment may be the preferred method of treatment in this age group.

Outcomes of Open Reduction and Internal Fixation of Bilateral Fractures of the Distal Radius

Background- Fractures of lower end radius are most common fractures of the upper extremity, encountered in practice.Increased awareness of the complexity of the distal end radius fractures have stimulated a growing interest and promoted new ideas regarding their management. Closed reduction and cast immobilisation had been the mainstay of treatment of the DER fractures but complications resulting in poor functional and cosmetic results is usually the outcome. The volar plate system has been shown to be reliable for the fixation of distal radius fractures. As open reduction and volar plating ensure more consistent correction of displacement and maintenance of reduction, this prospective study evaluates the anatomical and functional outcome of open reduction and plate fixation in the management of fracture distal end radius. Objectives: This study was done to evaluate the role of the volar plate in the treatment of fractures of distal end of radius and to evaluate the functional results of this treatment in terms of deformity, disability, movements and grip strength. Assessment of complications that occurred with the surgical procedure was also done. Material and Methods: The study was done in Department Of Orthopedics and Traumatology at USSC, Indore from may 2013 to may 2015. 40 patients with distal end radius fractures were included in the study. Informed consent was taken. Clearance from the ethical committee of the institute was taken. The study was Prospective, interventional and observational for the methods used for management of the fracture. Patients were evaluated pre operatively and post operatively at the end of first,fourth,sixth week,3 months and then once in 3months upto 12 months. Results: In the prospective study conducted with forty patients,88% anatomical and 93% functional, excellent to good results suggests that stabilizing the fracture fragments with volar plateand screws in the management of the fractures of distal radius, is an effective method to maintain the reduction till union and prevent collapse of the fracture fragments, even when the fracture is grossly comminuted/intra-articular/unstable and/or the bone is osteoporosed. Conclusion: The study emphasizes that open reduction and internal fixation with volar platinghas excellent functional outcomewith minimal complications thus proving that volar plating is the prime modality oftreatment for distal end radius fractures. The procedure is applicable for all types of Frykman fractures in young patients with a good bone stock as well as in elderly osteoporotic patients. Keywords: VolarPlating, Distal Radius Fractures,distal end radius.

Distal radius fractures (DRFs) are one of the most common injuries in orthopaedics, accounting for up to 20% of all fractures seen in the emergency room. At present, the optimal treatment of these fractures remains controversial. Although most DRFs can be treated non-operatively, such as immobilized by plaster, splint or brace, surgical management has become more and more popular with people's living standards improved and expecting better functional outcome. Surgical treatments for DRFs include percutaneous fixation with Kirschner wires, skeletal external fixation, open reduction and internal fixation, intramedullary nails, fixation using the miniinvasive approach, arthroscopy, and total wrist arthroplasty. Currently, open reduction with volar plate fixation is the most popular and widely way for DRFs, while a mini-invasive approach is a new reliable and reproducible procedure with few complications. Despite recently surgical treatment has become more and more popular, it is also unclear whether surgical intervention will produce better long-term outcomes. The aim of this paper is to present the studies in the literatures about the treatment for DRFs and an update of existing techniques.