Complications Of Distal Radius Fractures Research Articles

Post-traumatic carpal tunnel syndrome in children

BackgroundGiven limited information about acute carpal tunnel syndrome (CTS) in children, the purpose of this study is to describe the presentation and treatment results of CTS after traumatic wrist or forearm injury in a pediatric population. MethodsIn this retrospective single-center cohort study, all children with post-traumatic CTS were identified. Demographic and clinical presentation, treatment, and outcomes data were collected from the electronic medical record. Descriptive statistics were calculated for variables of interest, and Χ2 and independent sample t-tests were used for subgroup comparisons. Results18 patients (16 male, average age 12.8 ± 3.6 years) with post-traumatic CTS were identified. 13 presented acutely (<3 days) versus 4 subacutely (1–6 weeks) and one delayed presentation (>6 weeks) after injury. Of associated traumas, 83% (15/18) involved distal radius fractures, of which 40% (6/15) had an associated ulna fracture. The most common symptoms were numbness (78%), paresthesias (33%), and increasing pain (28%). Three patients had clinical concerns for concomitant compartment syndrome. 6 patients were initially monitored (2 acute, 3 subacute, 1 delayed). Ultimately, 16/18 underwent operative release (13/13 acute, 2/4 subacute, 1/1 delayed). At follow-up, 81% of the surgically treated patients had complete symptomatic relief. There was no statistically significant difference in treatment outcomes between acute versus subacute or delayed presentation (OR: 6.67, p = .214). Of patients with acute CTS, delayed surgery resulted in prolonged recovery (28.0 vs. 2.4 weeks, p < .001). ConclusionsPost-traumatic CTS more often presents acutely than as a delayed complication of distal radius fractures in children. The type of injury and clinical presentation can vary, but patients most often present with median neuropathy symptoms like numbness. Acute CTS should be treated urgently with carpal tunnel release. While patients with delayed presentation can trial observation, the patient will likely warrant surgery for complete symptom relief. Operative treatment for both acute and subacute cases generally results in positive outcomes. Key Concepts(1)Post-traumatic CTS may present acutely as a complication of distal radius fractures in children with symptoms of numbness, paresthesias, and increasing pain.(2)Acute CTS should be treated with urgent carpal tunnel release to avoid prolonged recovery.(3)Children with delayed presentation of CTS can be safely monitored, but the patient often needs surgery to experience complete symptom relief.(4)Operative treatment for post-traumatic CTS in children generally results in positive outcomes. Level of EvidenceIV Case Series

Predictive factors of distal radioulnar joint instability after surgical treatment of distal radius fractures.

Distal radioulnar joint (DRUJ) instability is a common postoperative complication of distal radius fractures, seriously impacting patients' quality of life. This study investigated its possible influencing factors to determine prognosis and to guide treatment better. We retrospectively included a series of patients with distal radius fractures that underwent volar locking plate fixation. Basic patient information and imaging parameters were collected. The incidence of DRUJ instability during follow-up was recorded, and factors associated with DRUJ instability were determined using univariate analysis and multifactorial logistic regression analysis. A total of 159 patients were enrolled in this study. At 6 months of follow-up, 54 patients (34.0%) had DRUJ instability, and multivariate analysis showed coronal plane displacement (OR, 1.665; 95% CI, 1.091-2.541), fracture classification (OR, 0.679; 95% CI, 0.468-0.984) and DRUJ interval (OR, 1.960; 95% CI, 1.276-3.010) were associated with DRUJ instability after volar locking plate. DRUJ interval, coronal plane displacement, and fracture classification are associated with DRUJ instability during follow-up. Therefore, preoperative risk communication and intraoperative attention to recovering relevant imaging parameters are necessary for these patients.

'Hook' Shape Lister Tubercle Is Associated with a Greater Incidence of Extensor Pollicis Longus Tendon Rupture after Distal Radius Fracture.

Background: A rupture of the extensor pollicis longus (EPL) tendon located close to the Lister tubercle is an uncommon complication of distal radius fractures. This study aimed to determine whether the size and shape of Lister tubercle in patients with EPL rupture differs from a matched group of patients with distal radius fractures without EPL rupture. Methods: We identified 15 patients with EPL rupture (3.5%) out of 426 with distal radius fractures treated conservatively at our hospital over 4 years. Out of the remaining 411 patients with distal radius fractures without EPL rupture, we selected patients using simple random sampling and pseudo-randomised them such that their age, sex and fracture type were matched with patients exhibiting EPL rupture. The size and shape of the Lister tubercle and the size of the EPL groove were measured in both groups using computed tomographic scans and compared. Results: There was no difference in the size of the Lister tubercle or the EPL groove between both groups. A 'hook'-shaped Lister tubercle was noted in 8 out of 15 patients with EPL rupture but in only 1 out of 15 matched patients without EPL rupture. Conclusions: A 'hook'-shaped Lister tubercle was seen more often in patients with EPL rupture following distal radius fracture. Level of Evidence: Level III (Therapeutic).

Reconstruction of intraarticular distal radius malunion with 3D printed guide and arthroscopic assisted intraarticular osteotomy.

IntroductionDistal radius fractures are one the most common upper extremity injuries, accounting for 25 % of pediatric fractures and up to 18 % of elderly fractures. Intraarticular malunion is one major complication of distal radius fractures and was reported in 0 to 33 % of total cases. It usually causes pain, deformity, limited range of motion (ROM), and loss of strength. Therefore, proper surgical management to satisfactorily unite the fragment is necessary.Case Illustrations: This is a case series of three adult male and female patients diagnosed with intraarticular distal radius fracture with malunion. They had been diagnosed based on clinical and radiological examinations. Preoperative and postoperative QuickDASH and ROM were measured. Three-dimensional printing was created for planning the osteotomy. Osteotomy was performed using arthroscopy. All patients showed QuickDASH and ROM improvement in all wrist movements.DiscussionThe primary goal of the procedure was to restore normal anatomic alignment to improve wrist function and reduce pain. Osteotomy guided by arthroscopy planned by 3D printed surgical guide successfully reduced the malunion fracture.ConclusionOsteotomy assisted by arthroscopy combined with the 3D-printed surgical guide is a promising technique to restore challenging intraarticular distal radius malunion.

Biomechanical Strength of a Novel Tendon Splicing Open Book Technique Compared to the Pulvertaft Method Using Unembalmed Human Cadaveric Tissue.

Background: Extensor pollicis longus (EPL) tendon rupture is a known complication of distal radius fractures. The Pulvertaft graft technique is currently used for tendon transfer of extensor indicis proprious (EIP) to EPL. This technique can produce unwanted tissue bulkiness and cosmetic concerns as well as hinder tendon gliding. A novel "open book" technique has been proposed, but relevant biomechanical data are limited. We designed a study to examine the biomechanical behaviours of the "open book" versus Pulvertaft techniques. Methods: Twenty matched forearm-wrist-hand samples were harvested from 10 fresh frozen cadavers (2 female, 8 male) with a mean age of 61.7 (±19.25) years. The EIP was transferred to EPL using the Pulvertaft versus "open book" techniques for each matched pair (sides randomly assigned). The repaired tendon segments were mechanically loaded using a Materials Testing System to examine graft biomechanical behaviours. Results: Mann-Whitney U test outcomes demonstrated that there was no significant difference between "open book" versus Pulvertaft techniques for peak load, load at yield, elongation at yield, or repair width. The "open book" technique demonstrated a significantly lower elongation at peak load and repair thickness, as well as significantly higher stiffness when compared with the Pulvertaft technique. Conclusions: Our findings support the use of the "open book" technique, producing comparable biomechanical behaviours compared to the Pulvertaft technique. Incorporating the "open book" technique potentially requires smaller repair volume, producing size and appearance that is more anatomic when compared with the Pulvertaft.

Analysis of Postoperative Complications and Related Factors Affecting Prognosis in 50 Patients with Distal Radius Fractures.

Objective To explore the postoperative complications of distal radius fractures and analyze the related factors that affect its prognosis. Methods The clinical data of 50 patients with distal radius fractures admitted to our hospital from October 2016 to September 2019 were retrospectively analyzed. All patients were followed up for 6–12 months, and their postoperative complications were recorded. Collect general patient information and related clinical data. During the follow-up process, Gartland and Werley wrist function scoring system was used to evaluate the prognosis of patients' joint function. Univariate analysis and multiple logistic regression models were used to analyze the related factors that affected the prognosis of patients. Results 15 patients with postoperative complications were found during the follow-up period, with an incidence rate of 30.00%. Univariate analysis showed that the patient's age, cause of injury, AO classification, shortened deformity, whether it was osteoporosis, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start postoperative exercise were all related to the distal radius. The prognosis of fractures is related (P < 0.05). Multivariate logistic analysis showed that age, AO classification, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start postoperative exercise were the independent factors affecting the prognosis of distal radius fractures (P < 0.05). Conclusion The postoperative complications of distal radius fractures are higher. The prognosis is related to the patient's age, AO classification, surgical method, whether it is combined with other fractures on the same side, whether it is comminuted fracture, and the time to start postoperative exercise. Therefore, choosing an appropriate surgical method and starting exercise in time can effectively improve the recovery of the patient's wrist function and reduce the occurrence of complications.

Trends in digital joint motion following surgical reconstruction of a tendon rupture after distal radius fracture

BackgroundTendon rupture has been recognized as a complication of distal radius fracture (DRF); however, the clinical outcome of reconstructive surgery for this injury remains unclear. We examined prognostic factors for the outcomes of reconstructive surgery in patients with a tendon rupture after DRF. MethodsThis study was a retrospective review of a case series. Seventy-five consecutive patients were treated at our institution for tendon rupture after DRF. The cohort included 14 males and 61 females with a mean age of 67.7 years at the time of tendon reconstruction. Sixty-four and eighteen tendon ruptures occurred after non-operative management for DRF and palmar locking plate fixation, respectively. Seven ruptured tendons received a free tendon graft from the palmaris longus tendon, and the others underwent tendon transfers. All patients were managed postoperatively by our hand therapy unit according to a controlled active mobilization regime. ResultsThe mean follow-up period was 28 weeks (range: 12–80 weeks). Patients with extensor tendon ruptures were significantly younger than those with flexor tendon ruptures regardless of the initial DRF treatment. The mean percentage active range of motion of the injured digits relative to normal active motion (%AROM) at the final follow-up was 70% (range: 30–101%) in all patients. The %AROM after flexor tendon reconstruction for patients after non-operative management was significantly inferior to that of other patients. Multiple regression analysis revealed that aging and non-operative management of DRF are independent risk factors for poor %AROM. ConclusionsThis study confirmed that advanced age and non-operative management of DRF were prognostic factors for digital joint motion following surgical reconstruction for tendon rupture. Our results suggest that it may be difficult to achieve good clinical outcomes in elderly patients with tendon ruptures (particularly flexor tendon ruptures) following non-operative management of DRF.

The rate and associated risk factors for acute carpal tunnel syndrome complicating a fracture of the distal radius

BackgroundAcute carpal tunnel syndrome (ACTS) is a known complication of distal radius fractures. This study aimed to document the demographics, range of presenting symptoms and risk factors of patients who develop ACTS following a fracture of the distal radius.MethodsA retrospective review of 1189 patients with an acute distal radius fracture treated in the study centre over a one-year period were identified. Demographic and clinical variables were collected and compared between controls (did not develop ACTS) and those patients who did develop ACTS to identify factors associated with developing ACS.ResultsThere were 51 (4.3%) distal radius fractures complicated by ACTS. The mean age of patients who developed ACTS was 56 years (range, 16–89) and 73% were female. The median time of onset post-injury was one week (range, 1–12). There was no association between patient background and comorbidities with the development of ACTS. AO-OTA Type C fractures had significantly increased rates of developing ACTS.ConclusionFour percent of distal radius fractures were complicated by ACTS. There was no association between patient background and comorbidities with the development of ACTS. AO-OTA type C complete articular fractures had a significantly higher rate of ACTS. A suggested treatment algorithm for patients presenting with ACTS has been presented.Level of evidence:III.

Manual passive rehabilitation program for geriatric distal radius fractures.

Limitation of wrist range of motion (ROM) is a common complication of distal radius fractures (DRFs) in geriatric patients. The present study aimed to evaluate the effectiveness of rehabilitation in the restoration of wrist ROM after geriatric DRF. Eighty-eight geriatric patients with DRF, 59 women and 29 men aged 71.69 ± 6.232 years participated in the study. The time from wrist immobilization to rehabilitation was 12.89 ± 5.318 weeks. Daily rehabilitation was performed 30 minutes a day for 8 weeks. Active wrist ROM was measured before and at 2, 4, and 8 weeks after rehabilitation. Data were analyzed by the repeated measures multivariate analysis of variance (MANOVA), one-way MANOVA, and analysis of variance (ANOVA). Repeated measures MANOVA suggested a significant time effect for ROM (Wilks Lambda = 0.002, F = 7500.795, P < .001). Compared with before rehabilitation, each wrist ROM was significantly improved at 2, 4, and 8 weeks after rehabilitation. The one-way MANOVA demonstrated that changes in ROM were significantly different between groups (Wilks Lambda = 0.007, F = 559.525, partial eta square = 0.993, P < .001), indicating that patients in the short-term stiffness group (≤3 months) had a significantly greater increase in ROM than patients in the long-term stiffness group (>3 months). The results of this study suggest an 8-week daily rehabilitation program for geriatric patients with limited ROM <3 months after DRF.

Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures

BackgroundComplex regional pain syndrome type I (CRPS I) is a chronic devastating condition and a relatively common complication of distal radius fractures (DRF). The purpose of this study was to investigate the relationship of vitamin D levels in surgically treated post-menopausal women with CRPS I occurrence in DRF.MethodsFrom February 2016 to March 2017, 158 surgically treated post-menopausal patients with DRF were enrolled. Exclusion criteria were (1) patients who had been taking vitamin D or osteoporosis medication at the time of injury; (2) patients with medical factors that may affect vitamin D levels; (3) patients who were reluctant to enroll in the study; and (4) patient with additional fractures, ligamentous injuries, or neuropathy. A total of 107 patients were available for final analysis. We compared the serum vitamin D levels in post-menopausal women with DRF with CRPS I (group 1) and without CRPS I (group 2). Bone mineral density (BMD) of the femur and spine, osteocalcin, alkaline phosphatase (ALP), body mass index (BMI) were also measured.ResultsThe average age at the time of surgery was 66.5 years (range, 39-86 years). The mean follow-up period was 16.3 months after surgery. Among the 107 surgically treated DRF patients, 19 (18%) met the Budapest criteria for CRPS I during the follow-up period. The mean serum vitamin D level in group 1 (15.2 ng/ml) was significantly lower than that in group 2 (20.5 ng/ml, p = 0.027). The mean values of osteocalcin, ALP, BMI, and BMD were not significantly different between the groups.ConclusionLower vitamin D levels in post-menopausal women can increase CRPS I occurrence in distal radius fractures.

Complications of distal radius fractures

Distal end radius fractures are the most common fracture encountered by orthopedic surgeons, accounting for 17.5% of all adult fractures. Numerous complications arising during the course of management of these fractures are broadly categorized as immediate (nerve injury, compartment syndrome, and skin injury), early (loss of reduction, tendon rupture, stiffness of joints, and infection), and late complications (maluinon, delayed/nonunion, complex regional pain syndrome, and joint arthropathy). It is imperative for a surgeon to have thorough knowledge of these complications and methods required to prevent and manage them.

Extensor pollicis longus tendon rupture caused by a displaced dorsal "beak" fragment of Lister's tubercle in distal radius fractures.

Ruptures of the extensor pollicis longus (EPL) tendon are a well-known complication of distal radius fractures (DRF). There are a lot of suspected mechanisms, including mechanical friction, vascular impairment, injury associated with reduction, and local adhesion. However, there have been limited reports about a closed rupture of the EPL tendon associated with a relatively large, displaced dorsal "beak" fracture fragment. We report about the management outcomes and clinical significance of closed ruptures of the EPL tendon caused by a displaced dorsal fracture fragment of beak-like appearance in DRF. Our study included 7 cases of a complete closed rupture of the EPL tendon after open reduction internal fixation. All cases showed a similar pattern involving a relatively large dorsal beak fragment originating from Lister's tubercle, and we treated them with a palmar locking plate within 7 days from the initial fracture without separate dorsal fragment management. All patients were diagnosed with a delayed EPL tendon rupture. The study included 5 female and 2 male patients. Mean patient age was 59 years. In all cases we explored the extensor compartment III to verify the exact cause of the EPL rupture. Six patients underwent an extensor indicis transfer and one patient underwent tendon grafting.Mean fragment width and length were 7.0 mm and 13.3 mm, respectively. The fragments were dorsally elevated (mean, 2.4 mm) and distally displaced (mean, 3.5 mm). At the last follow-up, the mean DASH score was 4.4. Mean thumb MP joint flexion and extension were 4 degrees and 62 degrees, respectively. We support the possibility of EPL tendon rupture caused by displaced sharp Lister's tubercle fracture fragments.

Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups.

Background The purpose of this study is to assess the epidemiology, population-specific treatment trends, and complications of distal radius fractures in the United States. Methods The PearlDiver database (Humana [2007-2014], Medicare [2005-2014]) was used to access US inpatient and outpatient data for all patients who had undergone operative and nonoperative treatment for a distal radius fracture in the United States. Epidemiologic analysis was performed followed by age-based stratification, to assess prevalence, treatment trends, and rates of complications. Results A total of 1,124,060 distal radius treatment claims were captured. The incidence of distal radius fractures follows a bimodal distribution with distinct peaks in the pediatric and elderly population. Fractures in the pediatric population occurred predominately in males, whereas fractures in the elderly population occurred more frequently in females. The most commonly used modality of treatment was nonoperative; however, the use of internal fixation increased significantly during the study period, from 8.75 to 20.02%, with a corresponding decrease in percutaneous fixation. The overall complication rate was 8.3%, with mechanical symptoms most frequently reported. Conclusions The last decade has seen a significant increase in the use of internal fixation as treatment modality for distal radius fractures. The impetus for this change is likely multifactorial and partly related to recent innovations including volar locking plates and an increasingly active elderly population. The implicated financial cost must be weighed against the productivity cost of maintaining independent living to determine the true burden to the healthcare system.

Corrective osteotomy of distal radius malunions using three-dimensional computer simulation and patient-specific guides to achieve anatomic reduction.

Malunion is a common complication of distal radius fractures, especially those treated conservatively. In clinical studies, a significant correlation between anatomic reduction and wrist function has been shown. Corrective osteotomy is the preferred treatment for symptomatic cases, notwithstanding the technical challenges. The use of computer simulation improves pre-operative understanding of the three-dimensional deformity. Patient-specific surgical guides, based on precise pre-operative planning, lead to superior perioperative accuracy and reproducibility. The pre-operative planning and surgical technique of distal radius corrective surgery using three-dimensional computer technology are described in detail. The preliminary results demonstrate the excellent clinical and radiographic outcome of this technique.

Distal Radius Malunion: A Cheap Surgery Case Report

Introduction: Malunion is a common complication of distal radius fractures. The incidence after conservative treatment is 25% and after surgery is 10% (1). After distal radius malunion, different surgical procedures have been described, such as fixation with K wire, plate, use of external fixator and frequent locking plate application (2-3). Case Report: In our case 32 year old patient who was operated by neurosurgery after traffic accident. Two months after the operation, the patient came to the orthopedics clinic. Distal radius dorsal angle malunion was detected after x-ray control.we choose dorsal aproach and using only k wire in surgery. Conclusion: In this case we understand that ,in distal radius extra articular malunion surgery, prefering dorsal approach and using only k wire can be good results like the other syrgery procedures.

Complications of Distal Radius Fractures in the Elderly: A Systematic Review and Meta-analysis

There is no financial information to disclose. Optimal treatment for elderly patients with distal radius fractures has remained controversial as the benefits and risks of surgical fixation are less clear than for a younger patient. Since complication rates can be unstable in small studies, synthesis may provide more accurate risk estimates. The purpose of this review was to assess the complications associated with the treatment of distal radius fractures in elderly patients through a systematic review and meta-analysis of the literature. A systematic review of the literature was conducted using the PubMed, Medline, and Cochrane databases to search for studies that satisfied predetermined inclusion and exclusion criteria. We compared the complications associated with each specified DRF treatment option. A validated complication checklist was used to grade the severity of each reported complication. The Structured Effectiveness Quality Evaluation Scale (SEQES) and the Sackett level of evidence scale was used to critically appraise the included studies. We identified 1,229 articles in the primary search, and 33 studies for full text evaluation. Based on our inclusion/exclusion criteria 20 studies were included for analysis. Sackett level of evidence (LOE) studies included were: 3 level one, 6 level two, 2 level three and 9 level four studies. There were 6 randomized control trials, 3 prospective cohorts, 2 case controls and 9 retrospective case series studies identified. The incidence of complications (i.e. requiring intervention) was significantly higher in the operative group (129/1095, 11.8%) versus the non-operative group (40/483, 8.3%) (P = 0.008). External fixation (51/227, 22.5%) had significantly higher complication rates when compared to other fixation methods except dorsal plating (3/15, 20%). Percutaneous pinning (1/83, 1.2%) had significantly lower major complications compared to volar locked plating (VLP) (14/86, 16.3%). Furthermore, percutaneous pinning (0/83, 0%) had significantly less reoperation rates when compared to the VLP group (11/86, 12.8%) (P = 0.006). •Elderly patients who underwent surgery had higher major complications than those treated conservatively.•Given that complication rates are less with percutaneous pinning than plating, this minimally invasive fixation may have advantages for fixation of fractures in older adults.•With equivocal outcomes shown among different treatment strategies, complication profiles should be considered when making treatment decisions in this population.

Traitements des cals vicieux extra-articulaires de l’extrémité distale du radius du sujet jeune actif

Malunion is a common complication of distal radius fractures despite new fixation devices. The authors discuss the surgical indications, preoperative management and the various surgical techniques used to treat distal radius extra-articular malunion, specifically in active young subjects. The treatment goals in this population group are anatomical restoration of the distal radius and distal radioulnar joint, short immobilization period, quick functional recovery and stable results over time, consistent with high functional demands.

Lésions nerveuses associées aux fractures de l’extrémité distale du radius

Nerve damage is a common complication of distal radius fractures. It may be a result of the injury event or be iatrogenic. It is the source of disability and potential handicap. There is little published data on this topic and no study has validated the strategies needed to prevent or manage these nerve-related complications. There is no consensus on treatment. Prevention requires a good knowledge of the various surgical approaches and rigorous fracture fixation technique. The objective of this article is to take stock of recent data from the scientific literature.

Corrective Osteotomy for Malunited Fractures of the Distal Radius Using Internal Fixation With Locking Plates

Objectives: Symptomatic malunion is still a major complication of distal radius fractures, which requires a surgical treatment. The corrective extra-articular or intra-articular osteotomy restores the anatomy of the distal radius and improves the wrist function. The purpose of this study was to evaluate the results and complications of the corrective osteotomy and locked plating for malunited extra-articular and intra-articular fractures of the distal radius. Methods: Out of 175 patients with malunions of the distal radius treated surgically in the period from July 2001 to July 2015, 147 were evaluated. There were 45 males and 102 females with the average age of 42.9 years (15-75). The time interval between the injury and surgery was from 1 to 31 months (approximately 2.2 months). According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO)/ Association for the Study of Internal Fixation (ASIF)-classification, there were 77 A (52.4%), 18 B (12.2%), and 52 C (35.4%) type fractures. In 133 cases, we performed a corrective wedge osteotomy of the distal radius with the iliac bone graft transfer (38), distal radius graft (11), and bone substitute—“ChronOs”/“Orthos” (34/1). In 10 patients with B and C malunited fractures, we performed the intra-articular osteotomy, and in 4 cases, we did the combined (intra-articular and extra-articular) procedure; we used the preoperative computer tomography and intraoperative fluoroscopy during the operations. The locking volar or dorsal plates were employed for the osteosynthesis via palmar (87), dorsal (48), and combined (12) approaches. The immediate mobilization of the wrist began on the second postoperative day. The mean follow-up was 24 months (6 months-8 years). We examined 147 patients after operation with the respect of the radiological parameters, active range of motion (AROM), grip strength, Disability of the Arm, Shoulder and Hand (DASH) questionnaire, Cooney-Krimmer score, and Martini score. Statistical Analysis was done using SPSS 21, paired t test, and paired Wilcoxon test. Results: In a year after the operation, 121 patients (82.3%) showed excellent and good outcomes on Cooney-Krimmer score, and 108 patients (73.5%) did the same on Martini score. The rates of DASH questionnaire prior to the operation were on average 57.43 ± 3.90 points; after the surgery −15.31 ± 2.54 points ( P &lt; .001). The preoperative total AROM of the wrist and forearm was 50.22 ± 3.46% of the other side, and the postoperative one was 81.65 ± 2.19% ( P &lt; .001). The preoperative grasping power was 24.45 ± 6.21%, and the postoperative one made up 88.55 ± 4.15% ( P &lt; .001) of the contralateral hand. The radioulnar inclination increased from preoperative 11.56 ± 0.64° to postoperative 23.15 ± 2.34°( P = .005). The palmar inclination increased from preoperative −17 ± 0.09° (−45° to 37.5°) to postoperative 4.9 ± 0.24° ( P = .020). The preoperative ulnar variance of +4.18 ± 0.29 mm was corrected to 1.06 ± 0.31 mm ( P = .001) postoperatively. Intra-articular steps were corrected from 2.35 ± 0.16 to 0.86 ± 0.05 mm ( P &lt; .001). Complications (17.3%) included 2 nonunions and 2 malunions after bone substitute, 3 postoperative carpal tunnel syndrome (CTS) 1 De Quervain syndrome, 1 superficial radial nerve injury, 5 posttraumatic arthroses, and 5 hardware failures. Fixators were removed from 17 patients (11.6%). Conclusions: Corrective extra-articular and intra-articular osteotomy is an effective and reliable method of the distal radius configuration restoration. The use of the locking plates ensures the rigid fixation of distal radius fragments, immediate postoperative mobilization, and improvement of the wrist function.

Complications of Distal Radius Fractures Treated by Volar Locking Plate Fixation.

The current study investigated the incidence of complications after surgery for distal radial fractures. This multicenter retrospective study was conducted at 11 institutions. A total of 824 patients who had distal radius fractures that were treated surgically between January 2010 and August 2012 were identified. The study patients were older than 18 years and were observed for at least 12 weeks after surgery for distal radius fractures with a volar locking plate. Sex, age, fracture type according to AO classification, implants, wrist range of motion, grip strength, fracture consolidation rate, and complications were studied. Analysis included 694 patients, including 529 women and 165 men, with a mean age of 64 years. The mean follow-up period was 27 weeks. The fracture consolidation rate was 100%. There were 52 complications (7.5%), including 18 cases of carpal tunnel syndrome, 12 cases of peripheral nerve palsy, 8 cases of trigger digit, 4 cases of tendon rupture (none of the flexor pollicis longus), and 10 others. There was no rupture of the flexor pollicis longus tendon because careful attention was paid to the relationship between the implant and the tendon. Peripheral nerve palsy may have been caused by intraoperative traction in 7 cases, temporary fixation by percutaneous Kirschner wires in 3 cases, and axillary nerve block in 1 case; 1 case appeared to be idiopathic. Tendon ruptures were mainly caused by mechanical stress. [Orthopedics.2016; 39(5):e893-e896.].