Dorsal Fragment Research Articles

Is a Novel Fluoroscopic Intraoperative Reference System Superior to Conventional Management for Distal Radius Fracture Reduction? A Propensity-matched Comparative Study.

Is a Novel Fluoroscopic Intraoperative Reference System Superior to Conventional Management for Distal Radius Fracture Reduction? A Propensity-matched Comparative Study.

КОРРЕКЦИЯ ДЕФОРМАЦИИ ПЯТОГО ПАЛЬЦА СТОПЫ

Introduction. The analysis of literature data on the surgical treatment of fifth toe static deformity, as well as unsatisfactory results, was carried out. The disadvantages of the known methods were identified and a method for correcting the fifth finger varus deviation was proposed. Aim. The purpose of this article is to present own clinical observation of the fifth toe varus deviation operative correction by a proposed method with a detailed description of its methodology. Material and methods. A clinical case of successful surgical correction of isolated fifth toe varus deformity of the foot is presented. Results and discussion. A 22-year-old patient with a painful fifth toe varus deformity, which was diagnosed by a clinical and radiological examination and requiring surgical correction. Surgical treatment, by proposed method, included performing a diaphyseal osteotomy of the fifth metatarsal bone with formation of two bone «steps» on plantar fragment along precisely marked lines, medial displacement of the plantar fragment by a predetermined distance, interlocking fragments of the metatarsal bone and fixing them with one screw. The proposed method allows to shift the plantar fragment as much as possible, straighten the fifth finger, restore the congruence of the articular surfaces of the fifth metatarsophalangeal joint, eliminate pain, and tightly stabilize the plantar and dorsal fragments. The patient was observed for 1 year. The result of the treatment was the elimination of fifth toe varus deviation. Conclusion. Surgical treatment of fifth toe varus deformity by using new method with special markings and simple surgical techniques, ensures the achievement of a positive result, good fixation and consolidation of osteotomized fragments of the fifth metatarsal, relief of pain, restoration of the anatomical condition and statodynamic function of the foot, reducing the risk of fracture of the fifth metatarsal and recurrence of varus deformity the fifth toe.

A Dorsal Epidural Herniated Disc Fragment Initially Presenting as Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder that presents with neurological symptoms that can mimic other conditions. This mimicry can hide other important neurological diagnoses. Here, we present a rare case of thoracic myelopathy secondary to a sequestered dorsal epidural herniated disc fragment that initially presented with the classic findings of GBS.A 58-year-old female presented with progressing bilateral lower extremity weakness, paresthesias, and absent bilateral lower extremity deep tendon reflexes. Lumbar magnetic resonance imaging (MRI) findings were disproportionate to presentation, and lumbar puncture fluid analysis revealed clear, colorless fluid with albuminocytological dissociation. The patient was diagnosed with GBS and treated with a short course of intravenous steroids followed by intravenous immunoglobulin. The patient later developed new-onset ulnar distribution paresthesias, lower extremity spasticity, constipation, and urinary retention that caused a decline in functional progress. Further investigation prompted evaluation with cervical and thoracic MRIs, which revealed a left dorsal epidural lesion at the T9-T10 level causing severe cord compression. The patient was definitively treated with a T9-T10 laminectomy and excision of the offending lesion. Pathology revealed collagenous tissue with fibroblastic proliferation, consistent with a sequestered fragment of the herniated intervertebral disc. The patient was further treated with both acute and subacute rehabilitation. She was eventually discharged home and was able to ambulate independently with a walker.Dependency on positive albuminocytological dissociation in cases of potential GBS can lead to errors in diagnostic accuracy and delay appropriate treatment. Clinicians should remain mindful that GBS is a diagnosis of exclusion and MRI of the entire spine should be considered when the diagnosis of GBS is uncertain.

Caracterização clínica e artroscópica de equinos com fragmentação osteocondral em articulações metacarpofalangeana e metatarsofalangeana: estudo de 10 anos (2010-2019)

ABSTRACT This study aimed to characterize the clinical and arthroscopic presentations of horses with osteochondral fragmentation at the metacarpophalangeal and metatarsophalangeal joints at the Veterinary Hospital of the University of São Paulo in a 10-year period (2010-2019). The hind limbs were affected similarly to the plantar and dorsal fragments from the first phalanx, while the thoracic limbs had a more frequent occurrence on the dorsal aspect of the joint. The Brazilian Sport Horses were the most frequently observed breed. The degree of lameness was variable and might be related to fragment localization, animal age, and physical activity. There was a significant statistical difference between the joint effusion and degree of lameness; therefore, it can be considered that the joint effusion is related to degenerative joint processes and might be triggered by the presence of the osteochondral fragment. Surgical correction, especially when performed in young animals using an arthroscopic procedure is probably the best treatment option for most cases, possibly acting as a minimizer of the occurrence of secondary joint degeneration. Prospective studies of specific breeds with a larger number of animals can expand this clinical characterization and enable a better understanding of the animal’s recovery after surgical or conservative management.

Extension Block Pinning versus percutaneous Fragment Reduction with a Towel Clip and extension Block Pinning with direct Pin Fixation for Treatment of Mallet Fracture.

This study compared the clinical and radiographic results between extension block pinning (Group A) and percutaneous reduction of the dorsal fragment with a towel clip followed by extension block pinning with direct pin fixation (Group B) for the treatment of mallet fractures. A total of 69 patients (group A = 34 patients, group B = 35 patients) who underwent operative treatment for mallet fractures from June 2008 to November 2017 with ≥ 6 months post-surgical follow-up were analysed retrospectively. The extent of subluxation of the distal interphalangeal joint, articular involvement of fracture fragment, fracture gap, and articular step-off were examined on plain radiographs before and after surgery. The functional outcomes were evaluated with the Crawford rating system. The postoperative step-offs were 0.16 mm in group A and 0.01 mm in group B. Group B had a significantly better anatomical outcome than group A. Five patients in group A had a loss of reduction. Among them, two had malunion and post-traumatic arthritis. Meanwhile, no patients in group B presented with loss of reduction and nonunion. The mean extension lags were 4.2° in group A and 1.6° in group B. However, functional outcome did not differ between the two groups at the final follow-up. Fracture reduction using a towel clip and extension block pinning with direct pin insertion for mallet fracture facilitated the anatomical reduction of fragments, and allowed for stable fixation of fragments. Compared with extension block pinning technique, this technique has shown better anatomical results and stability, but not better clinical results.

The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures.

Background The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. Description of Technique We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. Patients and Methods We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. Results Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. Conclusion With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.

Comparison of interfragmentary pinning versus the extension block technique for acute Doyle type 4c mallet finger

The aim of this study was to compare the closed reduction interfragmentary pinning method (IPM) with the extension block technique (EBT) for bony mallet finger. Patients who underwent mallet finger operations were screened retrospectively for the following inclusion criteria: Doyle type 4c, age between 18 and 75 years, less than 4 weeks to surgery, and more than 1 year of follow-up time. Group I underwent a closed reduction IPM, and group II underwent the EBT. Lateral radiographs taken during the preoperative and final examination were used to evaluate the size and amount of displacement from the distal interphalangeal (DIP) joint and the dorsal fragment as well as the articular surface. Operation times were compiled from patient records. During the final examination, pain and DIP joint range of motion (ROM) were assessed and complications were recorded. The Crawford criteria were used for functional results. Fifteen patients in group I (8 men, 7 women) and 17 patients in group II (10 men, 7 women) were evaluated. Age, gender, time to surgery and follow-up time showed no statistically significant differences between the two groups. The differences in fragment size, preoperative and postoperative joint displacement, amount of dorsal displacement and DIP joint ROM were not statistically significant between the two groups. However, the operation time was significantly shorter time in group I than in group II (p=0.000). The average time to fracture union was significantly longer in group I (7.3 weeks) than in group II (6 weeks) (p=0.013). The EBT has faster time to union and is a safer method with lesser risk of arthritis and fragmentation. The IPM can be an alternative with shorter operation time, less pin bed infection and nail bed damage, especially in Doyle type 4c cases with large fragments.

Combined Approach for Intra-articular Distal Radius Fracture: A Case Series and Literature Review.

BackgroundThe purpose of this study was to classify the possible indications for a combined approach to distal radius fractures (DRFs) by investigating surgical outcomes of patients treated according to our treatment algorithm.MethodsA combined approach was performed in 32 patients. Patients who were thought to need a combined approach were classified into three types according to the combined injuries associated with loss of volar cortical buttresses in DRFs. The classifications included the following: type 1, free intra-articular fragments; type 2, distally migrated dorsal fragments located beyond the wrist joint; and type 3, centrally impacted articular fragments and displaced dorsal fragments, not reduced by indirect methods.ResultsSeven patients had type 1 fractures treated with volar plates and excision of the intra-articular fragments. Fourteen patients had type 2 fractures: 12 were treated with volar plates and excision of dorsal fragments, and 2 with relatively large unstable dorsal fragments were treated with combined volar and dorsal plates. The remaining 11 patients had type 3 fractures treated with combined volar and dorsal plates. At the latest follow-up, the radiographs revealed an average of 16.9° of radial inclination, an average of 4.2° of volar tilt, and an average of 7.5 mm of radial height. According to the Garland and Werley scores, the functional results were excellent for 3 patients, good for 25, and fair for 4.ConclusionsThe classification system indicated when an additional dorsal approach was needed in unstable DRFs, and it may establish useful guidelines for appropriate surgical decision-making.

Effectiveness of closed reduction and minimally invasive percutaneous fixation of dorsally displaced distal radius and associated fractures

Introduction: Distal radius fractures & associated wrist injuries are common. No doubt prevails for treatment of volar fragment intraatricular injuries. For dorsal comminution extraarticular & dorsal fragment intraarticular injuries various methods available & all have various implications on optimization of the treatment. Material & Methods: We treated (n=25) patients of distal radius dorsally displaced intraarticular & extraarticular fractures with percutaneous K wires fixation with or without external fixation ligamentotaxis at our unit. All were closed fractures. Age mean was 62.5 years. Preoperatively they were classified according to Frykman classification. Results: Postoperative evaluation by Sarmiento et al. modification of demerit point system of Gartland and Werley. 8% had Excellent, 48% had Good, 32% had Fair & 12% had Poor results. Non union rate was zero (n=0).Average union time was 4.5 weeks. Conclusion: Distal radius fractures treated with percutaneous pinning yields high union rate with closed reduction benefits like fracture hematoma prevention & low infection rates. It also provides mechanical stability with some allowable micromotion as far as dorsal comminution or intararticular dorsal fractures of distal radius concern. It provides cost effective & better alternative to closed reduction & cast treatment.

Volar Locking Plate Fixation for Distal Radius Fractures by Intraoperative Computed Tomographic–Guided Navigation

PurposeUnstable distal radius intra-articular fractures require restoration of alignment. Exact fixation of intra-articular fragments is ideal. Here, we employed intraoperative computed tomography (CT) navigation to insert screws accurately in the intra-articular dorsal fragments during treatment with a volar locking plate for distal radius intra-articular fractures. The main purposes of this study were to evaluate the accuracy of this procedure and the postoperative stability of the articular fragments through CT findings, as well as to assess clinical outcomes.MethodsThis study included 26 patients with distal radius fractures, who were treated with a volar locking plate using intraoperative CT navigation with a minimum follow-up of 12 months. Mean patient age was 63 years and mean follow-up was 16 months. We examined the position of the inserted distal screws and articular displacement on preoperative, intraoperative, and post–bone union CT images. The 3 distal ulnar screw positions that influence the stability of the dorsoulnar articular fragment were evaluated. The Mayo wrist score and Disabilities of the Arm, Shoulder, and Hand score were also clinically evaluated.ResultsComputed tomography evaluation revealed that the distal locking screws were appropriately inserted at the subchondral position, with sufficient length to stabilize the dorsal fragments, and reduction and stability of the articular fragment were acceptable. At the final follow-up, mean Mayo wrist score was 90.8 and mean Disabilities of the Arm, Shoulder, and Hand score was 9.6.ConclusionsIntraoperative CT navigation was successfully used for volar locking plate fixation of intra-articular distal radius fractures. Computed tomography evaluation revealed that the screws were precisely inserted for articular fragments and bone union was achieved, maintaining good intra-articular alignment. The findings demonstrate the accuracy of volar locking plate fixation assisted by intraoperative CT navigation and the good clinical outcomes of this procedure.Type of study/level of evidenceTherapeutic IV.

The insights into the systematic relationship of Gastrostyla-affinitive genera, with report on a new saline soil ciliate genus and new species (Protozoa, Ciliophora)

BackgroundHypotrichia are a group with the most complex morphology and morphogenesis within the ciliated protists. The classification of Gastrostyla-like species, a taxonomically difficult group of hypotrichs with a common ventral cirral pattern but various dorsal and ontogenetic patterns, is poorly understood. Hence, systematic relationships within this group and with other taxa in the subclass Hypotrichia remain unresolved.Results18S rRNA gene sequence of a new Gastrostyla-like taxon was obtained. Phylogenetic analyses based on the 18S rRNA gene sequences indicate that this ciliate represents a new genus that is closely related to Heterourosomoida and Kleinstyla within the oxytrichid clade of the Hypotrichia. However, the position of this cluster remains unresolved. All three genera deviate from the typical oxytrichids by their incomplete (or lack of) dorsal kinety fragmentation during morphogenesis. Morphology and morphogenesis of this newly discovered form, Heterogastrostyla salina nov. gen., nov. spec., are described. Heterogastrostyla nov. gen., is characterised as follows: more than 18 fronto-ventral-transverse cirri, cirral anlagen V and VI develop pretransverse cirri, and dorsal ciliature in Urosomoida-like pattern.ConclusionsSimilar to the CEUU-hypothesis about convergent evolution of urostylids and uroleptids, we speculate that the shared ventral cirral patterns of Gastrostyla-like taxa might have resulted from convergent evolution.

Melone\u2019s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping

BackgroundThere is no consensus in the literature about the ideal classification of the distal radius fracture for the clinical practice. The traditional Melone classification system divides the distal radius into four basic components, the shaft, radial styloid, dorsal medial fragment, and volar medial fragment. The aim of this study was to identify fracture lines in comminuted distal radius fractures using three-dimensional mapping of computed tomography (CT) images to test the hypothesis that fracture fragments can be divided according to the Melone classification.MethodsFifty-nine consecutive OTA/AO 23C3 fractures presented at the hospital between January 2018 and October 2019 were retrospectively reviewed. The fracture lines were characterized in the axial, sagittal, and coronal CT planes. After reducing the fractures in a three-dimensional (3D) model, the fracture lines were plotted from the CT images and were then superimposed on one another and oriented to fit a standard template. The area of articular surfaces was measured and compared to quantify the differences between the radial bone fragments.ResultsThirty-five cases (59.3%) in this study fit the Melone classification and 24 cases (40.7%) did not. On the radiocarpal surface, there was a greater concentration of fracture lines in the dorsal area of the radius than in the volar area. On the distal radioulnar joint (DRUJ), the fracture lines were focused around two specific concentrated regions. For the articular surface area, the mean area of the radial styloid, volar medial fragment, and dorsal medial fragment was 141.13 ± 90.16 mm2, 147.79 ± 75.94 mm2, and 79.05 ± 70.73 mm2, respectively. There was a significant difference in articular surface area for the Melone fragments (P = 0.002).ConclusionsThe Melone classification system is not suitable for characterizing all C3 fractures. The findings of this study confirm that the dorsal medial fragments are relatively comminuted and small. Extra care should be given to these small fragments when reducing the fracture.

Dorsal fracture-dislocation of the radiocarpal joint: a new classification and implications in surgical treatment.

Dorsal dislocations and fracture-dislocations of the radiocarpal joint are a spectrum of pathology involving both the bony and ligamentous structures that stabilize the radiocarpal joint. We retrospectively reviewed 63 dorsal radiocarpal dislocations treated in our Institute in order to propose a new classification and define surgical treatment. Preoperative CT-scan findings together with clinical and radiological outcomes were recorded. We identified four main types of lesions: Type I, pure dorsal radiocarpal dislocation; Type IIA, dorsal wall impaction and radial styloid avulsion; Type IIB, as IIA with additional intra-articular die punch; Type III, volar and dorsal marginal fragments; Type IV, larger volar and dorsal fragments. For each type of lesion, we propose specific options for treatment that are progressively more invasive. We believe that this classification adequately addresses the whole spectrum of bony and soft tissue injuries that occurs in dorsal radiocarpal fracture-dislocations giving a practical guide for surgical treatment.Level of evidence: IV.

Méthode « Stepwise » de réduction arthroscopique et de fixation par plaque des fractures intra-articulaires du radius distal — évolution de la technique et de l’instrumentation

Arthroscopic visualisation of articular fractures of the distal radius can allow accurate reconstruction of the articular surface whilst minimising disruption of the dorsal capsular structures. In minimising the iatrogenic injury, this may lead to improved outcomes, though this remains unproven. Technically, one of the most challenging problems is how to hold the reduction while definitive fixation is employed. Where a volar locking plate is used, typically the plate is applied with proximal fixation, prior to the arthroscopy and articular manipulation. Two technical difficulties often ensue. Firstly maintaining accurate reduction of volar fragments after applying traction. Secondly, inserting distal locking fixation whilst holding the articular reduction under arthroscopic visualisation with the wrist in traction. It is difficult to simultaneously maintain traction for arthroscopy, and retraction to allow safe introduction of the drill and screws. The stepwise technique and the newly evolved fixation are presented. A trans FCR approach is used. The volar cortex is reduced under direct vision. The plate is fixed proximally with screws. Interference K-wire sleeves are then applied to the distal locking screw holes. K-wires are then introduced only as far as the volar fragments, using II. The dorsal fragments remain free. Traction is applied, dry arthroscopy performed using 1 2, 3 4 and 6R ports. The articular surface is reduced by the surgeon and provisionally fixed by advancing the wires. Traction is removed, correct wire length assessed with II. Using the cannulated system, peg length is calculated, the sleeve removed, the wire overdrilled, and cannulated locking pegs inserted over the wires. Some cases will be briefly presented to illustrate the technique. The technique may bring this technically challenging method into the repertoire of most capable wrist arthroscopists. As each step of the surgery is completed, the articular surface is brought closer to anatomical alignment, with increasing stability. The chance of a backwards step is minimised, decreasing frustration and optimising the result. An evolution of surgical technique and instrumentation for arthroscopic reduction and stable fixation of exploded articular fractures of the distal radius is presented.

Supplemental Method for Reduction of Irreducible Mallet Finger Fractures by the 2–Extension Block Technique: The Dorsal Counterforce Technique

We suggest a method to achieve anatomical reduction in mallet finger fractures that are insufficiently treated by the 2-extension block wire technique. We performed a retrospective review of 18 patients who were found to have an irreducible dorsal fragment and distal interphalangeal joint incongruence owing to rotation of the dorsal fragment in the sagittal plane. In these cases, we additionally employed a dorsal counterforce technique to supplement the 2-extension block technique. An additional K-wire was used to apply counterforce against the distal part of the dorsal fragment and control rotation in the sagittal plane. All 18 fractures united. Congruent joint surfaces and anatomical reduction wereseen in all cases. The mean active flexion of the distal interphalangeal jointswas83.8° (range, 79°-88°) and the mean extension loss was 0.4° (range, 0°-4°). We believe that the dorsal counterforce technique effectively supplements the 2-extension block K-wire technique and aids control of dorsal fragment rotation in the sagittal plane. Therapeutic IV.

Three Year Review of Dorsal Plating for Complex Intra-Articular Fractures of the Distal Radius

The volar approach is commonly used for plating intra-articular fractures of the distal radius. Despite this, certain fracture configurations are more suitable for dorsal plate fixation. This technique has not gained favour due to the reported high incidence of extensor tendon irritation and attrition ruptures. With the advent of lower profile plates this risk has decreased. We report on forty-six cases performed in a tertiary hand centre between January 2011 and May 2014. Patients were identified from a database of distal radius fractures treated with open reduction and internal fixation. Pre-operative radiographs and computed tomogram (CT) scans were reviewed to classify fractures and evaluate fracture configurations. Dorsal displacement of fracture fragments was present in all cases. Records and imaging were reviewed to assess bony union and complications including tendon irritation, rupture and need for further surgery. Plate placement was dependent on the degree of comminution in each fracture component. The combination of a dorsal and radial styloid plate was used in 52% of cases. There were no cases of tendon rupture and one case of post-operative loss of reduction. Removal of metal was performed in ten patients, mainly to improve motion and for tendon irritation (four cases each). Even though technically challenging, dorsal plating is useful in cases of dorsal fragment displacement and comminution, as well as complex AO-23C3 fractures with involvement of the lunate fossa. It allows stable reduction of the dorso-ulnar fragment which is important to restore DRUJ anatomy. The rate of tendon irritation and rupture is lower when compared to earlier plate designs, and removal of metal is only necessary in a few cases.

Treatment of comminuted distal radius fractures with in situ autologous cancellous bone graft using intrafocal technique through the extended flexor carpi radialis approach

Objective To explore the clinical effect of fracture reduction, autologous cancellous bone graft and palmar double-tiered subchondral locking support plate fixation through the extended flexor carpi radialis approach for treatment of comminuted distal radius fractures. Methods From October 2015 to August 2016, a total of 18 cases of comminuted distal radius fractures (AO type C3)were treated. The extended flexor carpi radialis approach were applied by transection of radialis septum and brachioradialis tendon insertion. Proximal end of radius fractures were dissected subperiosteally and pronated to expand the exposure range. Proper reduction and autogenous cancellous bone graft harvested from the proximal radius were achieved by using the intrafocal technique. The fractures were fixed by a volar double-tiered subchondral support locking plate. The clinical effect was analyzed according to the amount of autologous cancellous bone, postoperative wrist activity, postoperative radiographic parameters and Gartland-Werley wrist score. Results The amount of autologous cancellous bone was 1.2 to 3.1 cm3, with an average of 2.3 cm3. All the patients were follow-up for 9 to 19 months, with an average of 12.4 months. All the fractures were healed. No extensor tendon and median nerve injury symptoms occurred. At 9 months after the operation, the activity of affected wrist was (51.24 + 4.72) ° on flexion, (48.86±6.32)° on extension, (15.58±3.72)°on radial deviation, (24.67±5.82)° on ulnar deviation, (76.34±11.54)° on pronation and (74.58±10.56)° on supination. According to the Gartland-Werley wrist score, the results were excellent in 7 cases, good in 8 cases, fair in 2 cases and poor in 1 case. The results of imaging examination showed that the ulnar deviation angle was 13.1° to 24.6° with an average of 23.8°, the volar tilt angle was 10.3° to 14.3° with an average of 13.2°, the radial height was 9.3 to 14.8 mm with an average of 13.1 mm. Conclusion The sufficient volar exposure by the extended flexor carpi radialis approach can facilitate the fracture reduction under direct vision and subchondral support with autogenous cancellous bone graft harvested from the proximal fragment using the intrafocal technique. And stable fixation of the dorsal, volar and central fragments with double-tiered subchondral support plate can also facilitate the functional restoration in the treatment of comminuted distal radius fractures. Key words: Radius fractures; Bone transplantation; Extended flexor carpi radialis approach; Intrafocal technique; Double-tiered subchondral support

Combined Volar and Dorsal Approach for Fixation of Comminuted Intra-Articular Distal Radial Fractures.

Purpose Multifragmentary intra-articular fractures displaced in multiple planes are a challenge. We use a reproducible technique of fracture and articular reduction using an initial volar approach targeting reduction in the volar lunate facet first with plate and unicortical locking screws. This creates a template for reduction in dorsal fragments through a dorsal approach. Our study investigated the radiological, clinical, and functional outcomes of patients treated with this technique. Materials and Methods We reviewed the postoperative radiographs and notes of 18 patients that had this method of fixation between the years 2008 and 2015, the mean age being 43. These patients were reviewed functionally on average 2 years and 3 months following their definitive operation. Results Normal alignment and length to the distal radius were restored with on average a 0.6 mm articular step. The average range of motion was 64% and preservation of grip strength was 71% compared with the uninjured wrist. Functional assessment averages were 29 for both the quick Disabilities of the Arm, Shoulder and Hand (DASH) and for Patient Rated Wrist Evaluation. The modified system of Green and O'Brien had results of good in 10, fair in 7, and poor in 1. With respect to the Gartland and Werley system, three patients had an excellent result, four had a good result, six had a fair result, and five had a poor result. The mean arthritic grading was 1 (grading 0-3) according to Knirk and Jupiter. Conclusion This reproducible technique provides an option for these devastating fractures providing a functioning wrist with all of the patients returning to their original form of employment.

Volar fracture-dislocation of the proximal interphalangeal joint: Four cases at an average follow-up of 3 years

Volar dislocation of the proximal interphalangeal joint associated with dorsal fracture of the base of the middle phalanx is a rare injury, with only 38 cases published. We report here four such cases: three treated surgically and one conservatively. Patients had a mean age of 19.5 years. At an average follow-up of 3 years, pulp-to-palm contact was obtained and no pain was reported with regular daily activities. All patients considered themselves cured and were very satisfied with the result. Incomplete reduction of the dorsal fragment or the presence of localized articular impaction warrant surgical treatment.

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Background: There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the “surgical modality of choice”. While outcomes with each modality are usually good to excellent, each has its share of shortcomings and complications. Thus, there is scope for improvements to existing modalities and/or introduction of new ones. Study Purpose: We introduce a novel modality, namely, the prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system, and investigated its plausibility. Experimental Procedures: The biomechanical performance of a construct comprising a synthetic distal radius (fourth-generation Sawbones?) on which a simulated fracture was created (4-mm wide osteotomy positioned 25 mm from the most distal end of the radius) and fixated with a placement of the IPBO system (SIPBO Construct) was compared to that when the fixation was with an approved Ti-6Al-4V alloy VLP system (SVLP Construct), under a clinically-relevant compressive loading protocol. Performance involved determination of quantitative parameters of the construct (initial longitudinal stiffness (ICLS), final longitudinal stiffness (FCLS), and load-to-failure (Pf)) and observation and recording of features of the construct at the fracture point. We also determined the quantitative parameters for the intact synthetic distal radius (control). Results: For each of the quantitative parameters, the range of values for SIPBO Construct was within that for SVLP Construct, suggesting that the IPBO System is a plausible modality. Also, for SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Construct, some failure features were fracture of the cortical wall and of the dorsal proximal fragments. Conclusion: The findings suggest that the IPBO system is plausible. As such, it merits further study; for example, determination of the influence of fracture gap fill ratio (defined as the proportion of the fracture gap that is filled by the expanding balloon as the polymer is injected into the balloon) on a large collection of quantitative biomechanical parameters.