Distal End Of Radius Research Articles

Morphometry of distal end radius in the Indian population: A radiological study.

Introduction:The morphometry of distal end radius (DER) comprises the four necessary parameters: radial inclination, palmer tilt, radial height, and ulnar variance. The unblemished intellect about the morphometry is urged for the management of fracture of DER. The goal of our study was to determine the values of morphometric parameters of the DER from the adult Indian.Materials and Methods:It was a single hospital- based observational cross-sectional, prospective study. Radial inclination, radial height, and ulnar variance were measured on posteroanterior view, and the measurement of palmer tilt was accomplished on the lateral view. All the statistical analysis was done by Microsoft XL 2007 (data add in function were installed for data analysis). T-test was used for comparing the means of the parameters.Results:Two hundred and forty two (n = 242) X-rays were included in this study to analyze. The mean value (n = 242) of radial inclination was 23.27°± (standard deviation [SD]) 7.42° (range: 11.3–42.1°), palmer tilt 10.07° ± (SD) 5.28° (range: 1–16.9°), radial height 11.31 mm ± (SD) 4.9 mm (range: 7.1–30.4 mm), and ulnar variance 0.66 mm ± (SD) 2.46 mm (range: −2.4 to +4.1).Conclusion:This study may provide an inauguratory plinth to prosecute the further analytical research in the Indian population. Moreover, the data may also be used as a reference data for the anatomical alignment while treating the injuries of the DER in the Indian population.

Management of intra-articular fractures of distal end radius in adults

<p class="abstract"><strong>Background:</strong> Incidence of intra articular fracture L/3rd radius is significantly on rise due to high velocity accidents in young and adults. Painless wrist function is of vital importance for functioning of upper extremity in almost all activities of daily living and precise function of hand. Intra articular fracture of L/3rd radius has generally gross comminution and so also small articular fragments. Orthopaedic community differ about specific implants to fix this complex injury. The present study was undertaken to know efficacy of different modalities of treatment for different fracture pattern. Comminuted intra articular fracture geometry varies widely, to fix these small fragments to achieve stable anatomical reduction is a challenging task. </p><p class="abstract"><strong>Methods:</strong> It is a combined i.e. retrospective and prospective study conducted at Hardikar Hospital, Pune, India from 1999 to December 2000. Patients of intra-articular fracture of distal end radius by different modes of treatment are included in the study. 1 patient with unilateral fracture was lost for follow-up. Thus 50 fractures, in 49 patients. were included in study. Clinico-radiological assessment was carried out by Lidstrom's (1959) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Satisfactory early functional end results with plaster treatment is 72.2% whereas with other modality of treatment it rises to 87.5%, indicating superiority of other modalities of treatment as far as early functional end results are concerned.</p><strong>Conclusions:</strong> Manipulation and plaster cast method continues to be the treatment of choice in the stable intra articular distal radial fractures. Hence there is a need for a "differentiated therapy for distal radial fractures". The treatment plan for patients must be based not only on fracture pattern identified on plain radiographs but also on factors such as bone quality, bone comminution, energy of injury and associated soft tissue damage. Additional factors to be considered in individual patient are-life style associated medical conditions and compliance.

Ulnar styloid fracture in distal radius fractures managed with volar locking plates: to fix or not?

Distal radius fracture is usually associated with ulnar styloid fracture. Whether to fix the ulnar styloid or not remains a surgical dilemma as some surgeons believe that their repair is imperative while others feel that they should be managed conservatively. This prospective study involved 47 patients with unilateral fracture of the distal radius who met the inclusion criterion and underwent open reduction and internal fixation with volar locking plates; 28 patients (12 males and females = 16) had an associated ulnar styloid fracture (Group A) while 19 (7 males; 12 females) did not have any ulnar styloid fracture (Group B). At the time of final evaluation both the groups were compared clinically by measuring the grip strength and range of motion around the wrist and the radiologically by measuring radial angle, radial length, volar angle and ulnar variance. Subjective assessment was done using DASH score and final assessment using Demerit point system of Saito. In Group A, average time for consolidation was 9.4weeks, 17 patients developed non-union of the ulnar styloid, average DASH scores was 4.4 and according to Demerit point system of Saito, there were 78.5% excellent, 17.9% good and 3.6% fair results; there were 2 cases of loss of reduction out of which one had persistent ulnar sided wrist pain. In Group B the average time for consolidation was 10.2weeks, average DASH score was 3.8.and Demerit point system of Saito yielded 78.9% excellent, 15.8% good and 5.3% fair results. There was one case of loss of reduction and one case of carpal tunnel syndrome which was managed conservatively. Both groups attained excellent range of motion, grip strength and well maintained the post operative radiological parameters. The comparison of clinico-radiological parameters in both groups was found to be statistically insignificant. To conclude, ulnar styloid fracture or its non union does not affect the outcome of an adequately fixed distal end radius fracture. We urge caution in electing operative treatment of non-united fracture of the ulnar styloid until better scientific report for treatment of pain associated with these fracture is available.

Assessment of Functional Outcome in Distal End Radius Fractures Managed with Locking Plates

Aim: Present study was conducted to determine the functional outcome of operative treatment of distal radial fractures with volar locking plate system in a tertiary teaching hospital. Twenty five patients were included into the study between July 2015 to January 2016. Methodology: There were 14 males and 11 females, with a mean age of 49. A total of 18 patients had fractures in dominant upper limb. 24% (6) of the fractures were type A, 12% (3) were type B, and 64%(16) were type C. They were regularly followed up. Assessment of pain, range of motion and standard radiographs were performed. The Gartland and Werley functional scores were recorded. Result: The radiographic results at the final follow-up showed a mean of 17° of radial inclination, 2.5-mm radial shortening, and mean volar tilt of 3.4° and none of them had an articular step > 2mm. An excellent or good result was obtained in 23 (92 %) patients according to the Gartland and Werley score. Overall internal fixation of distal radial fractures with a locking plate system provided a stable fixation with good clinical outcomes for patients with unstable distal end radius fractures.

Different Modalities of Distal End Radius Fracture Treatment

Distal radius fractures are the most common long bone fracture. These were randomly treated by different methods. This retrospective study was conducted in the department of orthopaedic surgery in Mahatma Gandhi Memorial Hospital,Warangal, Telangana state, India. Over a period of 4 years data of all the patients with fracture of distal end radius who were admitted were recorded from case files, casuality admission register and operative records. A total of 412 patients were included in our study and mode of treatment was compared among the various available treatment modality such as cast/slab; percutation fixation with k-wire, external fixation & plate osteosynthesis. Out of the total number of cases (n=412) for fracture distal end radius, nearly 12% case were managed with cast , 22% with percutaneous fixation with k-wire , 24% with external fixature, 19% with both external fixator and k-wire and 23% with plate osteosynthesis. This study concludes that incidence of distal end radius fracture plating had increased over a span of time and plating was increased over a period of time as compared to cast, percutaneous k -wire fixation and external fixator.

Study of outcome after fracture reduction and internal fixation with volar locking plates in distal end radius fractures

Background: The distal end radius fractures are common in older age group patients with osteoporosis. There are many treatment modalities both operative and non-operative methods. In osteoporotic patients the volar locking plate fixation may be the best option after open reduction. Our study aim is to assess the functional outcome in a retrospective study.Methods:30 patients in age group of 50-70, with mean age of 60 years, with distal end radius fractures were selected and fixed with volar locking plates after open reduction by anterior incision. These patients were followed retrospectively for period of 12 months mean(24 months follow up).The modified MAYO score and DASH (disabilities of the Arm Shoulder and Hand) scores were used to assess the outcome -functional and fracture union. Results: About 80% got good to excellent, 15% satisfactory, and 5% poor results according to the mayo and dash scores.Conclusion: The volar locking plate fixation after open reduction yield good to excellent results, among the treatment options available for distal end radius fractures.

Effects of Malunited Fractured Distal End of Radius on the Morphometric Parameters of Distal Radioulnar Joint in Old Age Group

Background: Fifteen per cent of all upper limb fractures occur in distal end of the radius. Occurrence of such fracture has increased in last 50 years. Normal values of four radiographic distal radius parameters are commonly used for accurately evaluating malunions i.e., a radial length of 11to 12 mm, a radial inclination of 22 o to 23 o, an ulnar variance of ±1mm and a palmar inclination of approximately 11 o to12 o. Our clinical practice is based on western figure due to the absence of the local database. Methods: Study was carried out on seventeen elderly (>50yr) females. Invariably the patients have a unilateral radial fracture belonging to universal classification type-Π. Results: Data of normal and malunited distal radius for each parameter were compared. In old age mean differences showed by radial length, radial inclination, ulnar variance and palmar tilt were 2.47 mm, 9.36 o, 1.85 mm and 5.59 o respectively. Conclusion: Most of our patients with radial shortening and increased dorsal tilt have pain and diminished grip strength, therefore restoration of radial length has been considered the most important determinant of functional outcome.

Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes.

BackgroundUnstable distal end radius fractures are difficult to manage and so various treatment modalities have been described. The use of variable-angle locking plates is promoted for the management of these fractures.ObjectivesThis study aimed to evaluate the functional and radiological outcomes in unstable distal end radius fractures treated with variable-angle locking plates.Patients and MethodsWe reviewed 23 unstable distal end radius fractures that were treated at our institution with volar variable-angle locking plates. The mean age of the patients was 32.82 ± 11.81 years (range 19 to 62) and the mean duration of follow-up was 11.04 ± 2.47 months (range 6 to 15). All of the patients underwent open reduction and internal fixation with a variable-angle locking plate. Radiological parameters such as radial inclination, length, tilt, and ulnar variance were measured at six weeks and at the final follow-up. The functional evaluation was conducted by measuring the range of motion at the wrist joint as well as the grip strength. Gartland and Werley’s demerit scoring system was used to assess the final outcome.ResultsThere were two cases of superficial infection that responded to oral antibiotics. One patient had developed a hypertrophic scar, while another had carpal tunnel syndrome that was conservatively managed. There was a significant improvement in the functional indices from six weeks to the final follow-up, while the radiological parameters were maintained. According to Gartland and Werley, excellent results were reported in 65.2% cases, while good results were present in 35% cases.ConclusionsThe use of variable-angle locking plates in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with minimal complications.

Interobserver Agreement and Intraobserver Reproducibility of Barzullah Working Classification of Distal End Radius Fractures among Orthopaedic Residents.

The purpose of this study is to test the hypothesis of the new classification system of distal end radius fractures (Barzullah working classification) proposed by one of the author in a prospective cohort study, among the orthopaedic residents. The initial post-injury radiographs of 300 patients with distal radius fractures in a tertiary centre were classified by two junior residents (JR1 and JR2) and two senior residents (SR1 and SR2) in the emergency department over a period of two years. The collected data was analysed statistically by using Cohan's kappa for measuring Intraobserver reproducibility and Fleiss kappa for measuring Interobserver agreement. The mean kappa value for Interobserver agreement was 0.53 (moderate agreement) at the end of one year and the mean kappa value at the end of study period was 0.64 (substantial agreement). The mean kappa value for Intraobserver reproducibility of JR1 was 0.45 (moderate agreement), JR2 was 0.39 (fair agreement), SR1 was 0.62 (substantial agreement) and SR2 was 0.67 (substantial agreement). Barzullah working classification of distal radius fractures presented in this study has good characteristics compared to those of already studied classification systems among orthopaedic residents.

Management of fracture of distal radius by external fixator using the principle of ligamentotaxis a prospective study

Background and objectives: Fracture of distal end of radius continues to be one of the most common skeletal injuries since the description by Poteau in 1783 and by Colle’s in 1814. Management of these fractures is still a challenge for orthopaedic surgeon in achieving good functional results. Numerous techniques have been described and developed to treat the fracture in an effort to improve the outcome. A prospective study of management of fracture-distal radius by external fixator using the principle of ligamentotaxis was conducted at our institute to evaluate the clinical efficacy of external fixator with ligamentotaxis in distal radius fracture reduction, fracture healing, functional recovery after surgery and common complications encountered. Methods: A prospective study of 30 cases of fracture lower end of radius in age group 20-60 years was done who were treated with ligamentotaxis in the department of orthopaedics at our institute from June 2008-october 2011. Fracture was anatomically reduced and fixed with Joshi`s external fixator with ligamentotaxis. All patients were monitored for pin tract infection and other complications. Active finger movements were advised by the patient from second post operative day. Regular clinical examination, periodical check X-rays were taken to assess the union of fracture. Patients were followed up to 2years with average duration of 9 months. Results: We found that in all cases there was union of fracture on an average of 6weeks. There was no case of non union; there were 5 cases of acceptable malunion and 4 cases of joint stiffness and one case of pin tract infection. Interpretation and conclusion: With external fixation and ligamentotaxis the result in majority of cases was either excellent or good. Hence we concluded that external fixator with ligamentotaxis is a good method of treatment in fracture distal end of radius. Key words: Distal end radius, Colle’s fracture, ligamentotaxis, External fixation, closed reduction

Evaluation of Role of Vitamin D in Grip Strength in Post-Menopausal Women with Fracture of Distal End Radius Treated with Closed Reduction and Percutaneous K-Wire Fixation

Background: In the skin, under influence of ultraviolet radiation, 7-dehydrocholesterol is photoconverted to previtaminD3, which is converted to Vitamin D3 (cholecalciferol). In the serum, bound to a Vitamin D binding protein (VDBP), Vitamin D3 is transported to the liver, where it is hydroxylated to 25(OH)D3. In the kidneys, 25(OH)D3 is further metabolized to 1?,25-dihydroxyvitaminD3 [1,25(OH)D3], the biologically active form of Vitamin D . Vitamin D (Cholecalciferol) is known to contribute to muscular function. In the past decade, various cases of both young and elderly adults have been described, in whom prolonged vitamin D deficiency was associated with severe muscle weakness, often leading to marked disability that improved within several weeks of vitamin D supplementation. However, few studies have been conducted in which muscle strength was objectively quantified in relation to vitamin D status in elderly people. The purpose of this study was to determine whether the supplementation of vitamin D is associated with grip strength recovery in Post-Menopausal Women after a Distal End Radius fracture treated with Closed Reduction and Percutaneous K-wire fixation. Material and Methods: In this comparative study, Two groups were formed, First group as a case in which vitamin D was supplemented and second group as control in which Vitamin D was not supplemented, both the group had 25 number of post-menopausal women who had Vitamin D level between sufficient range (30-100ng/ml) and were treated with same mode of treatment (closed reduction and Percutaneous K-wire fixation) for Distal end radius fracture. Grip strength recovery (in %) was compared in both the group after a period of 6 months. Results: Final grip strength recovery of all patients came out to be 67%, out of which, in supplemented group it came out to be 73% while in non-supplemented group came out to be 60% with p value of statistically significance proving major difference in grip strength recovery

Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment

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.

Pattern of extremity fractures among patients with musculoskeletal injuries: A hospital based study from North India

Background: A study on the pattern of fracture is an important area of public health. Analysis of skeletal fracture data is the essence of fracture epidemiology. Objective: To find out the pattern of extremity fractures among patients with musculoskeletal injuries. Materials and Methods: The study was a prospective, descriptive hospital based, conducted over a period of 1 year at a tertiary care center in a rural area of Himachal Pradesh, a sub-Himalayan state of India. Results: The most common fracture in upper extremities was distal end radius (n = 150, 17.2%) followed by fracture both bone forearm (n = 59, 6.7%). The most common fracture in lower extremities was both bone leg (n = 68, 7.8%) followed by fracture metatarsals (n = 52:5.9%). Conclusions: Understanding pattern of fractures may help plan prevention and management strategies for fractures.

“A study of management of intra-articular fractures of distal end radius by external fixator”

A fracture of the distal radius is one of the commonest skeletal injuries treated by the orthopaedic surgeon. Thirty to forty years ago the distal radial fractures were considered benign and conservative treatment was the rule. Pain and disability have resulted from subsequent mal-unions of fractures of distal radius, which were managed by conservative methods like plaster cast alone. Recently surgical treatment has been widely recommended and performed to prevent sequelae of mal-union, like pain and disability. There were 16 male and 4 female patients, between the age group of 23 to 50 years with an average age of 38.2 years. The injury occurred due to low energy trauma like, fall on outstretched hand in 8 patients. In 12 (60%) patient's injury occurred due to high velocity trauma like road traffic accidents (in 10) and fall from height. The dominant (right hand) was affected in9 cases (45%) and left hand in 11 cases. Five patients had associated fractures and injuries; like, head injury and clavicle injury in one patient, ipsilateral Monteggia fracture-dislocation in another patient, the third patient had fracture L3 vertebra without neurological deficit, the fourth patient had contra lateral inter-trochanteric fracture and the fifth one had clavicle fracture. Two patients had bilateral intra-articular fractures but only right side was considered for the study. Three patients had open fractures, Grade I in one patient and Grade II (Gustilo and Anderson) in two patients. One patient had allergic dermatitis over left hand and forearm, which was treated by the dermatologist and then was operated. Pre-operative evaluation of all the patients and the fractures was done by clinical and radiological examination by taking X-rays of wrist in both antero-posterior and lateral views. The fracture fragments were analyzed, involvement of radiocarpal, radioulnar joints were assessed and were classified according to the Frykman's Classification of fractures of distal end of radius. There were 2 cases of Type III, 1 case of Type IV, 3 cases of Type VI, 9 cases of Type VII and 5 cases of Type VIII. Most of the fractures (70%) belonged to Type VII and Type VIII.

Osteosynthesis in Distal Radius Fractures with Conventional Bridging External Fixator; Tips and Tricks for Getting Them Right

Distal radius fractures are the commonest fractures occurring in the upper extremity, accounting for 15-20% of patients treated in emergency department. Although distal radial fractures were described 200 years ago, they still remain as unsolved fractures with no clear guidelines. It is often reported that anatomical reduction has a bearing on the functional outcome. To study the management of distal end radius fracture by utilizing the principle of ligamentotaxis where in the reduction obtained by closed means is maintained by external fixator till solid bony union occurs. A total of 26 cases were selected for study by scrutiny of the inclusion and exclusion criteria. Most of our cases were treated with external fixator within 8 hrs of injury. Small A.O external fixator (bridging ex-fix) with 2 pins each in radius and 2(nd) metacarpal percutaneously was used for all the cases. Selective k wire fixation was done in cases of instability. Fixator was removed after 6 weeks. Guided physiotherapy was ensured in all the cases. Patients were followed up for an average of 9 months. Modified Gartland and Werley scoring system was used to evaluate the overall functional results. Excellent to good results were achieved in 88.45% of our cases while fair result was in 11.54 %. One case had pin loosening and two other cases had malunion. External fixator used for ligamentotaxis is an effective method of treating unstable extraarticular and complex intraarticular fractures of distal radius. Improved anatomical restoration with early rehabilitation has produced favourable functional outcome in our series. The complications like pin tract infection is rare due to the availability of superior antibiotics and sterile surgical technique. complications like wrist and finger stiffness has improved with physiotherapy.

“Do Radiographic parameters predict Functional Outcome in Distal end Radius Fracture?”

Background: Lower end radius fractures are among the most common fractures of the upper limb and accounts for 15-20% of orthopedic admissions in hospitals. Management these fractures continues to be a therapeutic problem and challenge. Though there are various treatment options described so far; still there is lacunae in the literature, regarding accurate treatment modality, particularly in case of unstable fractures. Various clinical and biomechanical studies have shown the benefits of restoring anatomical reduction. However other studies have demonstrated that restoring normal anatomy does not offer better functional outcomes. While achieving good fracture alignment may be significant, the actual functional importance of anatomical reduction is controversial. The assumption that functional outcome is better by restoration of anatomy is argued. Most orthopaedicians accept the fact that anatomical alignment is preferable, but the threshold for acceptable malunion and the long-term outcome of anatomical reduction on functional outcome and patient related satisfaction remain to be evaluated. The study had been taken up to disclose the correlation between anatomical and functional outcome in these patients with distal radius fracture. Objective: To examine association of radiographic parameters of distal radius fracture and objective (ROM, Grip strength) and subjective (PRWE) functional outcome. Study design and setting: A observational study on management of adult patients with distal radial fractures presenting at Deenanath Mangeshkar Hospital and Research Centre, Pune from October 2013 to December 2015. Patients and methods: This study carried out on the patients with intra-articular and extra-articular fractures of the distal end radius as per selection criteria and after taking a written informed consent. Outcome measures were assessed both objectively and subjectively. Objective assessment included a radiographic score determined by measuring the radial length, r

Comparison between results of management of recent intra-articular fractures of distal end radius by percutaneous pinning and volar locked plate

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.

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.

Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

ObjectiveThe rapid expansion of knowledge regarding the functional anatomy of hand and wrist, increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner. The purpose of our study was to evaluate the difference in patients function among those treated by 1) closed reduction and Plaster of Paris cast, 2) distractor application, or 3) open reduction and internal fixation with a volar plate, and to assess the treatment choice for each particular fracture type. MethodsA prospective study was carried out on 60 patients with fractures of the distal end radius. Fractures were classified according to the AO classification into type A (extra-articular), type B (partial articular) and type C (complete articular). After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years. ResultsAnatomical results were evaluated according to the Sarmiento’s modification of Lindstrom Criteria, which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique. Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification, which was revealed to relate with the type of treatment techniques. ConclusionThere is no customized solution for all the fractures of the distal radius. The choice of treatment should be based on the fracture type, the patient’s characteristics, the patient’s demands and the treating surgeon’s experience and preference.

Functional outcome of en bloc excision and custom prosthetic replacement for giant cell tumor of the distal radius

BackgroundGiant cell tumors (GCT) of the distal radius at Campanacci grade II/III are particularly challenging to treat. Wide excision is the management of choice, but this creates a defect at the distal end of radius. We treated 11 cases of GCT of the distal radius by en bloc excision and custom prosthetic replacement. The purpose of this study was to present our experience and assess the functional outcomes of all patients treated with this surgery. Materials and methodsBetween 2005 and 2014, we followed up 11 patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score. ResultsMean follow-up period was 55.5months (24–83months); mean resected length of the radius was 7.9cm. One patient had tumor recurrence in the soft tissues after 15months (recurrence rate 9.09 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.9° of dorsiflexion, 30.0° of volar flexion, 46.4° of supination, and 38.2° of pronation. Mean grip strength was 71% (42–86%). Overall revised MSTS score averaged 80.3% (63.3–93.3%) with one being excellent, five good, and five satisfactory. ConclusionEn bloc excision and custom prosthetic replacement for a Campanacci grade II/III GCT of the distal radius results in reasonable functional outcome at intermediate follow-up evaluation. Although average ROM of the ipsilateral wrist is poorer than some studies with other techniques, this method can be considered a reasonable option.