Comminuted Fractures Of Distal Radius Research Articles

Does simultaneous comminuted fracture of both radial ends represent a distinct fracture pattern?

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.

A Prospective Observational Clinical and Radiological Study of a Modular Bridging External Fixator for Unstable Distal Radius Fractures.

Introduction:Distal Radius Fractures (DRFs), with a reported annual incidence of 600,000, are common injuries treated by trauma surgeons. This prospective observational study aims to assess the efficacy of a modular external fixation system in the treatment of unstable distal radius fractures at 12-months follow-up.Materials and methods:Between December 2014 and December 2016, 35 patients (female: 21, male:14; mean age: 62.5), with unstable DRFs, treated with modular external fixation system, were selected for this prospective observational study. All the patients underwent clinical and radiological reviews at follow-up.Results:At 12-month follow-up, a mean DASH score of 15.73 and a mean PRWE score 20.10 were recorded. Mean radial inclination was 19.92°; mean ulnar variance was 1.12 mm and mean palmar inclination was 9.76°.Conclusion:Modular external fixator system revealed clinically and radiologically effective in the treatment of unstable and comminuted DRFs. Additional K-wires should be used to complement the fracture fixation, when there is unacceptable fragment reduction only with external fixator.

Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment.

Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.

Study the functional outcome of Barton’s fracture treated with open reduction and internal fixation by volar plating: A prospective study

Aims: To study the functional outcome and duration of union of surgical management of Barton’s fracture of distal radius with volar locking compression plate fixation.Settings and Design: Prospective studyMethods and Material: 56 cases presenting with Barton’s fracture which satisfies inclusion and exclusion criteria admitted in Shri B.M. Patil college, hospital and research centre vijayapura from 2017-2020 who are treated with volar locking plate.Results: In our study 56 cases, there were 29 males, 27 females with mean age of 39.52 years. 85.7% were admitted due to fall on outstretched hand, left side was more common according to 57.1% cases, associated ulnar fractures were found in 76.8% cases. 89.3% cases didn’t have any co-morbidity. 89.3% of the patient had no complication following surgery. Most common complication was wrist stiffness in 7.1% cases followed by surgical site infection 1.8% and complex regional pain syndrome in 1.8% cases according to Disability of Arm, Shoulder and Hand (DASH) score.Conclusions: Initial reduction and stable fixation is the key in prevention of late collapse of distal radius fractures. Stabilizing the fracture fragments with volar locking compression plate and screws in the management of fractures of distal radius is an effective method to maintain reduction and prevent collapse of the fracture fragments. The technique emphasizes that open reduction and internal fixation with volar plating has excellent functional and satisfactory radiological outcome with minimal complications. Hence volar approach and locking compression plate should be the preferred implant for treatment of intra- articular unstable, comminuted fractures of distal end radius.

A STUDY ON MANAGEMENT OF COMMINUTED DISTAL RADIUS FRACTURES BY LIGAMENTOTAXIS WITH EXTERNAL FIXATOR

Back Ground : The primary goals of distal radius fracture fixation are to put the pieces back where they belong and, most importantly, to do so by a method that does not compromise hand function. Displaced comminuted intraarticular fractures of the distal radius are difficult to treat successfully by traditional nonoperative methods. Thus, external fixation plays a very distinct role. External fixator is simple and inexpensive. Displaced, severely comminuted intraarticular fractures should be treated with an external fixator. It effectively stabilises fractures yet allowing for hand and prevents stiffness. AIM: To studythe functional outcome and complications following external fixation for comminuted intral articular fractures of distal radius. Material And Methods : Thirty adult patients with closed comminuted intraarticular fractures of the distal radius were treated by closed reduction and immobilization with an external fixator during 2 year period (September 2017 to July 2019) Six weeks later, the fixator was removed. The patients then were observed for an average of 6 months to 1year. Results: An excellent outcome was seen in 5 patients (17%) good outcome in 17 patients (57%) and a fair outcome in 7 patients (23%) and poor outcome in 1 patient (3%). Minor complication, pin tenderness were present but recovered completely after removal of the fixator. Conclusion: External fixation appears to have benefits that outweigh associated complications and, as such, make it an attractive treatment option for fractures of the distal radius that require surgical treatment Keywords: Radial Inclination, Radial Length, Road Traffic Accident, Triangular fibrocartilage, Triangular fibrocartilage complex, Ulnar Variance, Volar tilt

The use of dorsal distraction plating for severely comminuted distal radius fractures: A review and comparison to volar plate fixation

IntroductionOptimal fixation for highly comminuted distal radius fractures remains a major treatment challenge for orthopaedic surgeons. Dorsal distraction plating can serve as an improved fixation technique by allowing reduction under ligamentotaxis, providing a dorsal buttress, addressing proximal comminution, and allowing for early weightbearing in polytrauma patients. The aim of this study was to review current literature regarding treatment of distal radius fractures treated with dorsal distraction plating. MethodsWe performed a literature search in Pubmed and EMBASE databases to identify all studies analyzing use of dorsal distraction plating. Case reports, biomechanical and anatomic cadaver studies were excluded from analysis. Primary outcome measures were range of motion (ROM) at final follow up, grip strength, and radiographic parameters. ResultsEight studies were included in the final analysis. Pooled mean ROM after dorsal distraction plating was found to be 47.6° of flexion, 50.5° of extension, 76.0° of pronation, and 74.2° of supination. Pooled mean grip strength was 79.1% compared to the uninjured contralateral limb. Pooled mean volar tilt was 3.6°. Overall radial height was maintained at an average of 10.5 mm with a pooled mean loss of only 3.8 mm in length. Mean radial inclination was found to be 19.4 mm with patients having a mean ulnar variance of 0.5 mm. Discussion & conclusionTreatment of comminuted intra-articular distal radius fractures with dorsal distraction plating yielded excellent outcomes with very low complication rates, and has several advantages over volar plating and/or external fixation for these fractures. Necessity of plate removal remains a negative feature of this technique.

Functional outcome of comminuted intra-articular distal radius fractures managed by Ligamentotaxis

Distal radius fracture is one of most common fractures seen in clinical practice. Comminuted intra articular fractures are usually associated with road traffic accidents, fall from height in young patients. In old age groups it is associated with severe osteoporosis due to trivial fall. All intra articular fractures need good reduction for better functional outcome. K-wire fixation with plaster application, open reduction and internal fixation with locking plate, external fixator application (Ligamentotaxis) are various described methods for treating this fractures. When there is severe commination k-wires and screws cannot perch age the small fragments and there is high chances of loss of reduction. Also when there is severe soft tissue swelling and in case of open fractures open reduction and internal fixation is not possible. Materials and Methods: This is a prospective study conducted in our hospital from January 2017 to October 2018. Inclusion criteria include close and open comminuted intra-articular fractures of distalradius in skeletally mature patients. All patients treated by Ligamentotaxis (external fixator application). Exfix removal done after six weeks and started on physiotherapy. Every patient functional outcome assessed 4months after exfix removal using Mayo wrist scoring. Results: Overall 30 patients of comminuted intra-articular distal radius fractures treated by Ligamentotaxis. Non dominant hand involved in 10 patients and dominant hand involved in 20 patients. All patients under went removal of exfix after 6 weeks of application. All patients subjected to vigorous physiotherapy after exfix removal for 3 weeks. Functional outcome of every patient measured using mayo wrist score 4 months after exfix removal. Overall together the average mayo wrist score of operated wrist was 82 with excellent results in 46.66% of cases, good results in 36.66% of cases and satisfactory results in 10%of cases, poor results in 6.66% cases with a very significant p-value of

Comparison of the clinical efficacy of external fixator combined with Kirschner wire and volar locking plate in the treatment of comminuted fractures of the distal radius

Objective To investigate the clinical efficacy of external fixator combined with Kirschner wire and volar locking plate in the treatment of comminuted distal radius fractures. Methods From March 2012 to December 2015, 68 cases of comminuted distal radius fractures were treated with external fixator combined with Kirschner wire and volar locking plate. According to AO classification, there were 30 cases of C1 type, 24 cases of C2 type and 14 cases of C3 type. There were 34 cases in external fixator group and 34 cases in plate fixation group. The imaging results (palmar tilt, ulnar inclination and radial height) and wrist motion (dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination) of the two groups were compared at 3 and 12 months after the operation. And the wrist function was evaluated by modified Gartland-Werley (GW) score. Results All the patients were follow-up from 6 to 24 months with an average of 12 months. There was 1 case of second metacarpal fracture in external fixator group and 1 case of median nerve entrapment in plate fixation group. No complications occurred in the rest of the patients. At 3 and 12 months after the operation, the palmar tilt, ulnar inclination and radial height from plate fixation group were greater than those from external fixator group, and the difference was statistically significant (P 0.05). The modified GW score of plate fixation group was smaller than that of external fixator group at 3 months after the operation, and the difference was statistically significant (t=-3.270, P 0.05). Conclusion Both of the fixation methods can obtain better clinical efficacy in treating type C distal radius fractures. The imaging results of plate fixation group are better than those of external fixator group. The short-term effect is obvious, but the long-term effect is similar. External fixator combined with Kirschner wire is a good choice for some patients with severe comminuted distal radius fractures that cannot be fixed by plate, and some patients with osteoporosis or diabetes. Key words: Radius fractures; Fracture fixation,internal; External fixator; Comparative study

Volar plating versus nonoperative treatment for senile comminuted fractures of distal radius

Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius (AO types B and C) were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67.9±10.7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66.2±11.5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complications. Results There was no significant difference between the 2 groups in follow-up time (P>0.05). Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85.0% while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57.7%. A significant difference was shown between the 2 groups (P<0.05). At final follow-ups, the volar plating group had significantly lower Gartland & Werley wrist functional score (2.16±1.82) and complication rate (30.0%, 6/20) than the nonoperative group[6.62±3.78 and 53.8% (14/26), respectively] (P<0.05). Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoperative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen. Key words: Radial fractures; Fractures, comminuted; Fracture fixation, internal; Bone plates; Conservative treatment

Results of distal end radius volar plating

Background: Fractures of distal end of radius are one of the most common skeletal injuries treated by orthopaedic surgeons. Road traffic accidents are a major cause of fracture in young adults. In elderly fall on outstretched hand becomes a major cause. Road traffic accidents are a major cause of fracture in young adults. In elderly fall on outstretched hand becomes a major cause. For quite a long time, principle treatment of Colles’ fracture was forceful traction, manipulation and immobilization of wrist in flexion and ulnar deviation. The extremes of this position (cotton lodor) led to very high incidence of median nerve neuropraxia. The exact position of immobilization and plaster cast extent varied, nevertheless treatment essentially remained same. This study evaluates the results of distal radius fractures (volar barton) treated by open reduction and volar plating. Materials and Methods: A retrospective study of 40 patients of DISTAL END RADIUS FRACTURES operated with open reduction and internal fixation with volar plate with follow up of at least 6 months. The patients were operated with volar approach and fixation was carried out by AO principles. The patients were mobilized post operatively by active and assisted physiotherapy. Results: The mean age of the patients was 39.27 years with M:F ratio of 7:1. Right side was more involved than the left side and most common cause of injury was fall on an outstretched hand. Most fractures were of Frykman type 7. Post operative assessment was carried out in terms of range of movement, radiological parameters and functional outcomes were assessed in terms of Gartland and Werley scores and PRWE scores. Discussion and Conclusion: This is a study of 40 patients of distal end of radius fracture treated by volar plating. This study is essentially preliminary assessment. The technique emphasizes that open reduction and internal fixation with volar plating has excellent functional outcome with minimal complications. Hence volar approach and locking plate should be the preferred implant for treatment of intra articular (volar barton), unstable, comminuted fractures of distal end radius.

Treatment of highly comminuted distal radius fractures with temporary distraction plate

Surgical treatment of highly comminuted distal radius fractures in elderly patients with poor bone quality or in polytrauma patients is a technical challenge. Aim: The aim of this study was to evaluate the results of temporary bridge plating in these patients. Method: A retrospective review using data from 21 patients undergoing temporary bridge plating in our department was performed. All patients had fractures classified as type C3 by AO classification. To achieve optimal joint surface reduction, supplementary fixation was necessary in all cases. Data was evaluated for clinical and radiological parameters. Results: Radiological results showed a mean post-operative positive ulnar variance of 1.2 mm, mean radial inclination of 18° and a mean radial length of 10 mm. Furthermore, correlations between fracture patterns and ligament injuries were analyzed. Conclusion: Temporary bridge plating is indicated in the treatment of highly comminuted distal radius fractures in elderly patients with poor bone quality and young polytrauma patients. (Level of evidence: Level 4)

Clinical analysis of modified plaster external fixation in the treatment of the senile comminuted fractures of distal radius in elderly patients

Objective To explore the feasibility and clinical value of the modified plaster external fixation in the treatment of the senile comminuted fractures of distal radius. Methods The 547 patients with the senile comminuted fractures of distal radius were reviewed to clinically evaluate the modified plaster external fixation.The clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction was evaluated.All patients were divided into operation group, traditional plaster external fixation group and modified plaster external fixation group.The mean follow up time was 50 weeks.The comfort degree of patients during therapy was appraised by the score of wrist pain, the time of swelling disappearance, complications rates of palmaris pressure sores and acute carpal tunnel syndrome, and the average treatment costs.The efficacy and radiographic changes were assessed by PRWE score and Sanniento score modified by Stewart. Results The grade of wrist pain, the time of swelling disappearance, complication rates and the average treatment cost were less in the modified plaster external fixation group than in traditional plaster external fixation group(t=13.834、12.709、29.443、12.900, P 0.05). Based on radiologic evaluations, the improved Sarmiento score after 10 weeks of treatment was(2.62±2.83)in modified plaster external fixation group, (2.92±2.95)in traditional plaster external fixation group(t=0.544, P>0.05, between the two groups), and(1.29±2.13)in operation group(vs.two plaster external fixation group, t=5.518, P 0.05). Conclusions Modified plaster external fixation for the treatment of the senile comminuted fracture of distal radius has more advantages as compared with traditional plaster external fixation in raising comfort during the treatment and rapid recovery of wrist function.And it can reduce the complications and the economic burden of patients.It is worth popularizing to treat the elderly patients with the senile comminuted fractures of distal radius in primary care settings. Key words: plaster; surgery; radius fracture; comminuted fractures

Distal radioulnar synostosis after primary combined replacements for treatment of highly comminuted distal radius fracture in an elderly patient.

Distal radioulnar synostosis after primary combined replacements for treatment of highly comminuted distal radius fracture in an elderly patient.

A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures.

The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves "bridging" the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of complications associated with them. The current technique represents an alternative that provides union of the comminuted distal radius fracture with anatomical alignment, optimal range of motion and with minimal clinical disability.

Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases.

We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept.

Treatment of Comminuted Intra-articular Fractures of Distal Radius by External Fixator

Background: Treatment of comminuted intra-articular fractures of distal radius by external fixator is an important. Objective: The aim of study was to investigate the usefulness of external fixator as a treatment option for displaced comminuted intra-articular fractures of distal radius. Methodology: This case series was conducted in the Department of orthopaedic Surgery at Shaheed Suhrawardy Medical College&amp; Hospital, Dhaka during the period of November 2011 to July 2013. All the patients having comminuted intra-articular distal radial fractures were being treated with mini uniaxial external fixator under brachial plexus block. The average follow up was performed in about 6 month.Result: A total number of fifteen patients were enrolled for this study. The mean age with SD was 50.21±9.473. Patient outcomes were measured by modified Knirk and Jupiter score and were categorized as satisfactory and unsatisfactory groups. In this study satisfactory outcome was found in 86.0%. All fractures (100.0%) were united nicely. Few complications were encountered. Postoperative osteoarthritis was not found during follow up.Conclusion: The use of external fixator for treating the comminuted intra-articular distal radial fractures produces satisfactory result.DOI: http://dx.doi.org/10.3329/jcamr.v1i2.20516 Journal of Current and Advance Medical Research Vol.1(2) 2014: 30-34

Use of mineralized collagen bone graft substitutes and dorsal locking plate in treatment of elder metaphyseal comminuted distal radius fracture

Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen (MC) bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 (n = 12) were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 (n = 12) only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination (p = 0.80); however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation (p < 0.05). Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.

A New Single Volar Approach for Epiphyseal Ulnar and Radial-sided Comminutive Fracture of the Distal Radius

Articular comminuted distal radius fractures are still a surgical challenge. The development of volar locking plate device allows a stable and anatomic restoration of the distal radius. We propose a modification of the classic anterior approach for articular fracture of the distal radius with ulnar impaction. By a single incision, we realize 2 windows to expose the medial and lateral column of the distal radius. This technique is indicated for complex articular distal radius fractures associated with an ulnar comminution. The dissection is extended superficially to the ulnar side of the carpal tunnel elements by a blunt dissection of the anterior part of the wrist between the skin and the superficial layer of the flexor carpi radialis, in subcutaneous tissues and the antebrachial fascia to preserve the sensitive branch of the median nerve. This new approach allows reduction of each fragment of a comminutive articular fracture without exposing the flexor tendon and median nerve to excessive tension. In our surgical armatorium, we reserved this technique for distal radius fractures with articular ulnar damage because of the possible risk to the median cutaneus branch.

Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi-center trial

BackgroundFractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation.Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting.Methods/DesignORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius) is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool.The primary objective is to determine differences in the Short Form 36 (SF-36) Physical Component Score (PCS) between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH) instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery), as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture involves a central statistical unit, an independent monitoring institute, and a data safety monitoring board. Following approval by the institutional review boards of all participating centers, conduct and reporting will strictly adhere to national and international rules, regulations, and recommendations (e.g., Good Clinical Practice, data safety laws, and EQUATOR/CONSORT proposals)DiscussionTo our knowledge, ORCHID is the first multicenter RCT designed to assess quality of life and functional outcomes following operative treatment compared to conservative treatment of complex, intra-articular fractures of the distal radius in elderly patients. The results are expected to influence future treatment recommendations and policies on an international level.Trial registrationISRCTN: ISRCTN76120052Registration date: 31.07.2008; Randomization of first patient: 15.09.2008

External fixators combined with limited internal fixation for serious comminuted fractures of distal radius in young adults

目的 探讨外固定支架加克氏针内固定治疗青壮年桡骨远端粉碎骨折的临床疗效.方法 2000年1月～2005年8月采用外固定支架加有限内固定治疗桡骨远端粉碎性骨折30例,外固定支架在术后6～8周拆除,术后进行腕关节功能锻炼.结果 所有患者获得14～24个月(平均16个月)随访.所有患者2个月均达骨性愈合,关节功能评定:优24例,良4例,差2例,优良率为93.3%.结论 外固定支架固定加有限克氏针内固定对治疗青壮年桡骨远端粉碎性骨折,固定牢固、可靠,可有效防止骨折的再移位和丢失,但不能过早进行腕关节功能锻炼,必须选择合适的时机拆除外固定支架,便于早期腕关节功能锻炼。