Comminuted Intra-articular Fractures Research Articles

VARIABLE ANGLE LOCKING PLATE VERSUS MULTIPLE K WIRE FIXATION FOR INTRA-ARTICULAR DISTAL RADIUS FRACTURE: A PROSPECTIVE COMPARATIVE STUDY OF FUNCTIONAL OUTCOME IN ELDERLY

Distal radius fracture (DRF) is a common wrist injury and it accounts for about one-sixth of emergency department visits. In spite of availability of various treatment options, none is universally effective for comminuted intraarticular fracture, because of varied fractures patterns. Two commonly used surgical methods are multiple K-wire fixation and open reduction and internal fixation by variable angle locking plates. Objective of the study was to compare functional outcomes of variable angle locking plate and multiple K wire fixation for intra-articular distal radius fracture in elderly. Prospective observational study was conducted among the patients of distal radius fractures with age more than 50 years. Patients were divided in to two groups with 24 cases in each group. Group one included patients treated with variable angle locking plate and group two included patients treated with multiple K-wires. Post surgery patients were assessed at 6 weeks, 3, 6 and 12 months. Evaluation was done clinically, and the outcomes were assessed by using the Disabilities Arm, Shoulder and Hand (quickDASH) score (primary outcome), Patient-Rated Wrist Evaluation (PRWE) score, range of motion, grip strength and were compared between the groups. Patients treated with variable angle locking plate was found to have better functional outcome than those treated with multiple K-wire initially during the study, but later by the end of the study at 12 months, both groups were found to be having similar outcomes, with no significant difference between the groups. This signifies that among variable angle locking plate and multiple K-wire fixation, no single procedure is superior to the other in long term.

The "Bag of Bones" Treatment of Comminuted Intra-articular Distal Humerus Fractures in the Elderly.

Extensively comminuted intra-articular distal humerus fractures in the elderly present a challenging therapeutic dilemma. The purpose of this study was to investigate the results of nonoperative treatment of these fractures in a select subset of patients. Patients treated with nonoperative management for a comminuted intra-articular distal humerus fracture between 2007 and 2018 were reviewed. Patients were administered 3 elbow-specific functional outcomes instruments. A total of 8 patients (2 men, 6 women) were treated with brief immobilization followed by early range of motion. All had fractures with extensive comminution of the articular surface such that open reduction and internal fixation was not feasible. Average age was 70 years. At an average of 33 months postinjury, average flexion was 124°, and extension was -27°, with full forearm rotation. No patients required pain medications at the latest follow-up. At 33 months of follow-up, the average Mayo Elbow Performance Score was 92/100 (100 optimal), Oxford Elbow Score was 43/48 (48 optimal), and Quick Disabilities of the Arm, Shoulder, and Hand Score was 10/100 (0 optimal). All patients were satisfied with the nonsurgical treatment that they received. Nonoperative treatment for comminuted intra-articular distal humerus fractures results in acceptable functional outcome in elderly patients and should be considered when the fracture is not amenable to internal fixation and in lower-demand patients with higher surgical risk.

A Novel Approach to the Treatment of Comminuted Mandibular Condyle Fractures

Introduction: A suture enlocation (SE) approach is proposed to manage comminuted intra-articular mandibular condyle fractures not amenable to open reduction internal fixation approaches. The SE approach is an effective operative option for the treatment of condylar fractures with the combination of fracture dislocation, malocclusion, comminution, and inadequate surface area for open fixation techniques. This study describes the SE approach, outcomes, and complications. Methods: The SE technique is described, and the health records of patients treated with the SE approach are reviewed. Outcome data were collected for diet, interincisal opening, occlusion, pain, and complications. Results: Technique: The SE approach involves reducing the fractured condylar fragment using a hole drilled through the fragment to secure it to the periosteum with a polydioxanone suture. This allows the reduced fragment to be managed as a nondisplaced fracture with mandibulomaxillary fixation and class 2 elastics. Outcomes: A chart review involving 8 patients (11 condyles) illustrates the outcomes of the SE approach from 2006 to 2021. Age at the time of injury ranged from 12 to 51 years and the follow up ranged from 2 to 68 months. At final follow up, 7 patients were eating a regular diet, 7 had normal interincisal opening, 4 had normal occlusion, and 4 reported ongoing mandibular discomfort. Failure of fixation occurred in 1 case, which required further operative management. Conclusions: The SE technique shows promise as an effective way to reduce fracture components, manage occlusion, and facilitate secondary bone healing in comminuted and displaced mandibular condyle fractures.

RADIAL HEAD ARTHROPLASTY USING “WIDE AWAKE LOCAL ANAESTHESIA NO TOURNIQUET” TECHNIQUE: CLINICAL REPORT AND LITERATURE REVIEW

Radial head fractures are among the most common fractures around the elbow. Radial head arthroplasty is one of the surgical treatment options after complex radial head fractures. This surgery is usually done under general anaesthesia. However, there is a recent anaesthetic technique - wide awake local anaesthesia no tourniquet (WALANT) - that has proven useful in different surgical settings, such as in distal radius or olecranon fractures. It allows a good haemostatic control without the use of a tourniquet and allows the patient to actively collaborate during the surgical procedure. Furthermore, there are no side effects or complications caused by the general anaesthesia and there's an earlier patient discharge.The authors present the case of a seventy-six-year-old woman who presented to the emergency department after a fall from standing height with direct trauma to the left elbow. The radiological examination revealed a complete intra-articular comminuted fracture of the radial head (Mason III).Clinical management: The patient was submitted to surgery with radial head arthroplasty, using WALANT. The surgery was successfully completed without pain. There were no intra or immediate post-operative complications and the patient was discharged on the same day. Six weeks after surgery, the patient had almost full range of motion and was very pleased with the functional outcome, with no limitations on her activities of daily living.The use of WALANT has been expanded beyond the hand and wrist surgery. It is a safe and simple option for patients at high risk of general anaesthesia, allowing similar surgical outcomes without the intraoperative and postoperative complications of general anaesthesia and permitting an earlier hospital discharge. Furthermore, it allows the patient to actively collaborate during the surgery, providing the surgeons the opportunity to evaluate active mobility and stability, permitting final corrections before closing the incision.

Clinical effect of closed reduction minimally invasive fixation in intra-articular comminuted fractures of the femoral condyle.

To evaluate the advantages of double reverse traction closed reduction combined with minimally invasive fixation in treating femoral condylar comminuted fractures. We retrospectively enrolled a total of 24 patients with femoral condylar comminuted fractures (AO = 33C3) admitted to Third Hospital of Hebei Medical University from March 2018 to February 2020. The patients were divided into two groups: experimental group (double reverse traction, n = 12) and control group (conventional surgery, n = 12). Patient demographics, fracture characteristics, operation time, incision length, and postoperative complications were then collected. The Hospital for Special Surgery (HSS) scores were recorded at the last follow-up visit. The average surgical time was 52.2 (41-73) min in the experimental group and 71.2 (45-103) min in the control group. In addition, the mean total incision length was 13.8 (11-17) cm in the experimental group and 16.3 (14-19) cm in the control group. The average HHS scores at the final follow-up were 86.3 (78-93) and 82.7 (76-90) in the experimental group and control group, respectively. It was found that double reverse traction closed reduction combined with minimally invasive fixation can provide good repositioning results and functional extremity. Moreover, patients tolerate postoperative functional knee exercises well.

ОПЫТ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ОТКРЫТОГО МНОГООСКОЛЬЧАТОГО ВНУТРИСУСТАВНОГО ЧРЕЗМЫЩЕЛКОВОГО ПЕРЕЛОМА ПЛЕЧА СО СМЕЩЕНИЕМ ОТЛОМКОВ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Complex intra-articular fractures require active patient management tactics and almost always the use of surgical treatment. For intra-articular fractures, it is extremely important to restore the normal anatomical structure, precise reposition and fixation of the fracture, without which it is impossible to restore the full function of the joint and limb. Surgical treatment should be carried out as early as possible in order to prevent the development of contractures. The purpose of this publication is to demonstrate the successful experience of treating a patient with an open comminuted intra-articular transcondylar fracture of humerus with displaced fracture fragments and the validity of the choice of an operative method of treatment of this pathology. Materials and methods : description of a clinical case and a brief analysis of the literature on this issue. Presented case of open reposition of a comminuted intra-articular transcondylar fracture of the shoulder and extra-cortical osteosynthesis with two reconstructive plates is successful. The effectiveness of treatment was evaluated based on the data of X-ray examination methods, as well as assessing the function of the limb and the amplitude of movement in the elbow joint. Results : performed open reposition of a comminuted intra-articular transcondylar fracture of shoulder and extra-cortical osteosynthesis with two reconstructive plates. Complete restoration of limb function and anatomical integrity of the distal metaepiphysis of the humerus has been achieved, the patient’s ability to work has been restored.

Comparison of the Outcomes of Treatment on Comminuted Distal Radius Intraarticular Fracture by Volar Locking Plate Fixation and External Fixator

Introduction: Intra-articular fractures of the distal radius represent high-energy, complex, unstable injuries. An anatomical reduction of the joint surface with rigid fixation is the main goal in the treatment of intra-articular distal radial fractures, but the optimal method of treatment remains controversial. The treatment strategies to achieve anatomical reduction for intra-articular fractures and possible surgical treatment methods are external fixation and open reduction and internal fixation (ORIF) by volar locking plate has become increasingly popular. This study aimed to analyze a comparison of the outcomes of treatment on comminuted distal radius intraarticular fracture by volar locking plate fixation and external fixator. Methods: This cross-sectional comparative study was conducted in the Department of Orthopedics, Sylhet M A G Osmani Medical College Hospital, Sylhet during the period from 1st July 2014 to 30th June 2016. A total of 24 cases of a distal radial comminuted intra-articular fracture. They were divided by random allocation into group-A and group B each comprising 12 patients. Every odd number of patients was taken as group-A and an even number of patients was taken as group B. The patients of group-A were treated with a volar locking plate and patients of group B were treated with an external fixator. Result: The age of the patients ranged from 21 to 50 years with a mean age of 33.7 (SD 9.4) years in group-A; while it was 25 to 60 years and 37.1 (SD 9.2) years respectively in group B. Outcome was measured using Quick DASH score and it was significantly lower in group-A than that of group-B [16.9 (SD 1.1) versus 21.5 (SD 4.5); t=-3.428; p<0.01). The outcome was also measured using O’Brien scoring system. The recorded Green O’Brien scoring score was significantly higher in group-A than that of group B [86.7 (SD 6.9) versus 77.9 (SD 10.3); t=2.446; p<0.05). There were 4 (33.3%) excellent, 7 (58.3%) good, and 1 (8.3%) fair in group-A; whereas ....

Treatment of distal radius intra-articular comminuted fractures with external fixator: Is it a good option?

Background. In this study, it was aimed to evaluate the treatment results of distal radius intra-articular comminuted fractures treated with closed reduction and external fixation. Material and Methods. This study included 46 patients who underwent closed reduction and external fixation with the diagnosis of distal radius intra-articular comminuted fracture. According to the AO classification, 21 patients had type C1, and 25 patients had type C2 fractures. Patients were evaluated with the radiological criteria developed by Lindstrom and the clinical scoring system developed by Gartland and Werley. Results. Mean union time was 7 weeks (6-8 weeks). All patients were followed for 12 months. As a result of Lindstrom radiological-anatomical evaluation 10 (21,73%) patients were evaluated as moderate, 16 (34.7%) patients as good, and 20(43.4%) patients as excellent. When these 46 cases were evaluated according to the modified Gartland and Werley functional evaluation scheme, a satisfactory result (excellent and good) was obtained in 42 cases (91.3%), and unsatisfactory (moderate and poor) results were obtained in a total of 4 (8.7%) cases. Conclusion. The closed reduction and external fixator application is a treatment method that can be preferred in the treatment of unstable radius distal intra-articular comminuted fractures in the right indication and in the right patients, under appropriate conditions.

Circular External Fixator Assisted Open Reduction Combined With Locking Plate Fixation for Intra-articular Comminuted Fractures of the Calcaneus

Comminuted fractures of the calcaneus are relatively common and generally require surgical treatment. The quality of fracture reduction is crucial. The extended lateral approach (ELA) can better expose the fracture end and facilitate the reduction of the fracture, while it has a higher risk of postoperative skin complications. In this study, the ELA was adopted, and the calcaneal comminuted fractures were treated with circular external fixator assisted reduction to achieve the purpose of good reduction of the fracture and fewer skin complications. During 64 months, a total of 61 cases of unilateral calcaneal fractures were treated by the same surgeon and followed up for 19.28 ± 5.28 months. During the operation, a circular external fixator was employed to fix the midfoot and the distal end of the tibia, and the calcaneal tubercle; then, the calcaneal tubercle was distracted to restore the 3-dimensional structure of the calcaneus. The ELA was utilized to reduce the articular surface fracture. The fracture was fixated with a locking plate. Postoperative radiographs were regularly reviewed. Meanwhile, Böhler's angle and Gissane's angle were measured. Visual analogue scale and American Orthopedic Foot and Ankle Society Score assessments were performed at the final follow-up. All fractures healed. The mean preoperative Böhler's angle was 9.3 ± 10.1 degrees; the mean Gissane's angle was 110.5 ± 14.7 degrees; the immediate postoperative mean Böhler's angle was 31.3 ± 5.5 degrees; mean Gissane's angle was 110.9 ± 5.9 degrees. Local superficial necrosis of surgical incision occurred in 2 cases, which healed well after dressing changes. Skin necrosis appeared in 1 case, where debridement and local flap transfer were performed. At the final follow-up, the mean visual analogue scale score was 1.48 ± 1.30, and the mean American Orthopedic Foot and Ankle Society Score was 90.16 ± 7.19. The ELA combined with a circular external fixator to assist in the reduction of calcaneal fractures achieved good reduction quality and effectively reduced postoperative complications.

Primary subtalar arthrodesis in the treatment of comminuted calcaneal fractures: a functional and quality of life analysis

Objective: To survey literature findings on primary arthrodesis in Sanders type III and IV fractures and analyze functional and quality of life outcomes in patients submitted to this initial surgical procedure. Methods: This study described the profile of 12 patients diagnosed with severe comminuted intra-articular calcaneal fractures of Sanders type III and IV operated by a foot and ankle team. Patients attended from January 2016 to August 2021 with pre-/postoperative follow-up and application of the Orthopedic Foot and Ankle Score (AOFAS) questionnaire and Short Form Health Survey 36 (SF-36) quality of life questionnaire, along with clinical evaluation, were included. Data search was performed using the following online databases: PUBMED, MEDLINE, LILACS, and SCIENCE. Results: Most patients had a good range of motion, a mean AOFAS score of 81.71 points, and high mean scores in the domains physical functioning (84.44 points), role-physical (5.55 points), bodily pain (23 points), and general health (96.11 points) according to the SF-36 questionnaire. In general, there was bone consolidation after primary arthrodesis of the subtalar joint, and the functional status of patients was satisfactory. Conclusion: Primary arthrodesis is a relevant choice in fractures with more than three fragments, with a better postoperative outcome, including pain and maintenance of the hindfoot axis. Larger studies should be performed to assess more results of primary arthrodesis as a first treatment option for Sanders type III and IV fractures. Level of Evidence IV; Therapeutic Study; Case Series.

Clinical Results of Distal Radius Intraarticular Comminuted Fractures in the Elderly: A Retrospective Comparative Analysis of Different Fixation Methods.

IntroductionDistal radius intraarticular fractures in the elderly population are likely to cause impaired clinical outcomes. Intraarticular fracture treatment in the literature is a debatable issue with mixed results. Here, we aimed to present a tertiary trauma center experience with plate fixation and K wire-assisted external fixator in elderlies over 60 years old.Material and methodsPatients who were diagnosed with an unstable intraarticular distal radius fracture and received surgical treatment with plate fixation or K wire-assisted external fixator between 2016 January and 2020 January were included in the study. Patients were evaluated retrospectively in terms of radiologic stability criteria and clinical outcomes.ResultsThere were 27 patients; 14 in the volar plate group (group 1) and 13 (group 2) in the external fixator group. The mean age was 64.2 (60-72) in group 1 and 67.7 (60-76) in group 2. The mean follow-up time was 31.6 (12-63) in group 1 and 28.8 (12-59) in group 2. The mean quick disabilities of the arm, shoulder, and hand (Q-DASH) score was 25.7 (5-75) in group 1 and 24.4 (10-87) in group 2. The mean patient-reported wrist evaluation (PRWE) was 27.1 (6-87) in group 1 and 31.4 (10-87) in group 2. There was no statistical difference between groups in terms of clinical scores, hospital stay, follow-up, and complications. (p>0.05).ConclusionAlthough open reduction and plate fixation and K wire-assisted external fixator are viable options for providing radiologic union, unsatisfactory clinical outcomes were maintained independently of the fixation method in elderly patients.

A Comparison of the Outcomes of Fiber-Wire® versus Stainless Steel Wire in Transosseous Wiring for Intra-Articular Fractures of the Distal Interphalangeal Joint.

Background: Different surgical techniques have been described for the treatment of intra-articular fractures involving extensor tendon insertion of the distal interphalangeal joint (DIPJ), including acute and chronic bony mallet injuries. We have been using transosseous stainless-steel wire (SSW) in select patients. In 2015, we started using a non-absorbable polyester suture (2-0 Fiber-Wire®, Arthrex, Naples, FL, USA) instead of SSWs. The aim of this study is to compare the outcomes of SSW and Fiber-Wire® (FBW) in transosseous wiring for intra-articular fractures of the DIPJ. Methods: This is a retrospective review of patients who underwent fixation of intra-articular fractures, including extensor tendon insertion of the DIPJ using a transosseous wiring technique, in the period from 2013 to 2018. SSW was used in the period from 2013 to 2014, and FBW was used from 2015 to 2018. Outcomes with regard to age, gender, time to union, range of motion at the DIPJ and complications were recorded and compared between the SSW and FBW groups. Results: Nine patients (mean age: 38 years) underwent fixation with SSW and 10 patients (mean age: 31 years) with FBW. The operative time was significantly lower in the FBW group, and all the fractures united. There were no statistically significant differences between both groups with regard to time to union or range of motion at the DIPJ. Similar complication rates were observed in both groups. Conclusions: The use of FBW in transosseous wiring for intra-articular fractures of the DIPJ can reduce operative time and provide functional results similar to that of SSWs. It can be considered as an alternative fixation technique for difficult intra-articular comminuted fractures of the DIPJ, including acute and chronic bony mallet injuries with joint subluxation. Level of Evidence: Level III (Therapeutic).

The use of bioresorbable implants in combined osteosynthesis of an intra-articular fracture of the distal humerus (case report)

Intra-articular fractures of the elbow joint are severe for the treatment of damage. Methods of treatment of intra-articular fractures of the distal humerus are  immersion osteosynthesis with spokes and screws, bone and transosseous osteosynthesis. However, the percentage of complications and unsatisfactory outcomes of surgical treatment of these injuries remains high. The unsatisfactory results of  treatment include contractures, ossification, post-traumatic arthrosis, as well as purulent-inflammatory complications of surgical treatment. Our accumulated experience of osteosynthesis of intra-articular fractures of the distal humerus with the help of submersible implants, experience of hardware treatment of joint injuries and their consequences (developed in the Department of Adult Orthopedics of the National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov), allowed us to offer surgical techniques for the combined use of these methods. The article presents a case of successful surgical treatment of a patient with a comminuted intra-articular fracture of the distal humerus by osteosynthesis with bioresorbable implants in combination with a hinge-distraction apparatus for  external fixation by  O.V.  Oganesyan. A detailed description of the technique of osteosynthesis, postoperative rehabilitation is given. The described clinical case shows the effectiveness of the combined osteosynthesis technique and the advantages of using bioresorbable fixators over metal implants. 

Assessment of Functional and Radiological Outcomes of Comminuted Intra-Articular Distal Radius Fracture Treated With Locking Compression Plate.

BackgroundDistal radial fractures (DRFs) are a prevalent form of skeletal injuries that hinder a person from performing daily living activities. Although several treatment modalities have been established to manage DRF, an optimal intervention has not been identified for comminuted fractures. The use of locking compression plates (LCPs) is gaining popularity for fractures that cannot be anatomically reduced because they offer better stability and early recovery. Thus, this study aims to investigate the surgical outcome of comminuted intra-articular DRFs treated with LCPs.MethodologyWe performed open reduction and internal fixation in 30 patients (18 males and 12 females) with DRF and were followed up at regular intervals following the surgery (at three, six, twelve, and twenty-four weeks). The surgical outcome was assessed both from functional and radiological standpoints. The influence of LCP on functional outcome was evaluated based on the modified Mayo wrist score and the quality of reduction based on the Lindstrom criteria by observing volar tilt and radial inclination.ResultsFor radiological outcome, there was no variation in tilt/inclination of more than two degrees even after three months, which was a satisfactory result. Moreover, patients of all age groups showed early range of motion and functional benefit from LCP treatment. After six months of treatment, the patients experienced no pain and were able to return to their pre-injury jobs with little difficulty. Range of motion, work status, and grip strength after six months showed improvement of 15%, 7.8%, and 56%, respectively, compared to immediate postoperative assessments at three weeks. Although the end outcome with any treatment modality may yield similar results, when using LCPs, most patients experienced early functional improvement nearly six months after surgery.ConclusionsBy offering a lower risk of complications and early functional mobility, LCPs tend to restore the articular architecture of the fractured joint that results in the desired range of motion, grip strength, improved pain management, and functional status. Thus, LCPs appear to be a better alternative for distal end radial fractures than other treatment modalities.

A Case of Intra-articular Comminuted Fracture of the Basal Phalanx of the Thumb Treated with the Pins and Rubbers Traction System

A Case of Intra-articular Comminuted Fracture of the Basal Phalanx of the Thumb Treated with the Pins and Rubbers Traction System

The Syringe External Fixator: Short- and Medium-Term Functional Outcomes From This Inexpensive and Customizable Treatment for Comminuted Intra-Articular Fractures of the Hand

Comminuted intra-articular fractures and fracture dislocations of the metacarpophalangeal (MCP) and interphalangeal joints are challenging. Dynamic external fixation, permitting early joint motion while still minimizing forces across the healing joint, can result in acceptable postoperative active range of motion (AROM). However, some fractures are not initially stable enough for early dynamic motion; further, many available dynamic external fixation systems are costly and cumbersome. We reviewed our experience using an external fixator made from a 1-mL syringe and K-wires and report outcomes using it as a static fixator, dynamic fixator, or configured as a static fixator and then converted to a dynamic fixator in the clinic. Patients with intra-articular fractures and fracture dislocations of the MCP and proximal interphalangeal (PIP) joints treated between 2014 and 2020 using syringe external fixators were retrospectively reviewed. We reviewed demographics, mechanisms, treatment types and durations, and postoperative AROM, as well as complications including infection, pin loosening, nonunion, hardware failure, and need for further surgery. Patients were analyzed by the level of joint injury (MCP versus PIP) and by treatment pattern. After excluding 23 patients with 25 joint injuries who were lost to follow-up or had inadequate outcome data, 27 patients with 29 joint injuries were reviewed. The average follow-up was 171 days after surgery. The postoperative AROM at the MCP level averaged 55° for static fixation and 30° for static-to-dynamic fixation. The postoperative AROM at the PIP level averaged 64° for static fixation, 66° for static-to-dynamic fixation, and 80° for dynamic fixation. Three pin site infections and 2 loose pins were reported. The syringe external fixator is an inexpensive, effective, and customizable treatment for intra-articular MCP and interphalangeal fractures and fracture dislocations, and results in acceptable postoperative AROM outcomes and complication rates. Therapeutic IV.

Management of Highly Comminuted Intra-articular Fracture Subluxations at the Proximal Interphalangeal Joint by Subchondral Buttress Fixation and Early Mobilization.

This article describes our technique of managing highly comminuted intra-articular fracture subluxations at the proximal interphalangeal joint by subchondral buttress fixation followed by early mobilization. This technique has proven to be reliable and all patients have been able to return to their preinjury level of activity.

Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review

This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal radius fractures. A literature search performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 206 articles, 12 of which met inclusion criteria, accounting for 310 patients. Included articles contained the results of DBP for treatment of distal radius fractures with reported outcomes between 1988 and 2018. Data were pooled and analyzed focusing on patient demographics, as well as 3 primary outcomes of complications, range of motion (ROM), and Disabilities of the Arm, Shoulder, and Hand (DASH) and QuickDASH scores. Average age was 55 years, median follow-up was 24 months, and the most common use was in comminuted (92%) intra-articular (92%) distal radius fracture caused by fall (58%), or motor vehicle collision or motorcycle collision (27%). A minority of patients had open fractures (16%) and most were cases of polytrauma (65%). Median time from placement to DBP removal was 17 weeks (mean, 119 days). At final follow-up, mean wrist ROM was 45° flexion, 50° extension, 75° pronation, and 73° supination. Mean DASH score was 26.1, and mean QuickDASH score was 19.8. The overall rate for any complication was 13%; the most common was hardware failure (3%) followed by symptomatic malunion or nonunion (3%), and persistent pain after hardware removal (2%). Dorsal bridge plating was found to be used most commonly in intra-articular, comminuted distal radius fractures with overall functional wrist ROM, moderate patient-reported disability, and a 13% complication rate at follow-up. Therapeutic IV.

A Comparison of Pronator Quadratus Preservation and Dissection Approaches for Volar Plating of Comminuted Intra-articular Distal Radius Fracture.

Although the pronator quadratus (PQ) preservation approach for volar plating of distal radius fracture has been commonly used recently, its superiority to the conventional PQ dissection approach, especially for comminuted intra-articular distal radius fractures, has not been well established. The purpose of this study was to assess the efficacy of PQ preservation for comminuted intra-articular fractures and to evaluate the healed PQ during hardware removal surgery. From January 2014 to March 2019, 86 patients who underwent both volar plating for AO Foundation/Orthopedic Trauma Association classification type C2 or C3 distal radius fractures and subsequent hardware removal were assessed in this study. Radiographic measurements, clinical outcomes at each follow-up, and the integrity of healed PQ during hardware removal were compared between the PQ dissection (group D) and PQ preservation (group P) groups. Complete union with acceptable reduction on radiographic measurements was achieved in both groups. Group P showed a statistically significant earlier recovery of clinical outcomes at 2 weeks and 1 month postoperatively and improved anatomical restoration of PQ muscle covering the plate, which was identified during hardware removal surgery. Flexor tendon rupture was identified in 2 patients (5%) and tenosynovitis in 6 patients (14%) in group D; no patient had flexor tendon rupture (0%), and 2 patients (5%) had tenosynovitis in group P. Pronator quadratus preservation approach for volar plating is easily applicable and useful even for comminuted intra-articular distal radius fractures and is helpful for earlier restoration of wrist function and in preventing flexor tendon problems in the latter postoperative period.

Dynamic Traction Splint as an Alternative Surgical Treatment for Comminuted Intraarticular Fracture of Metacarpophalangeal Joint.

Comminuted intraarticular fractures of the metacarpophalangeal joint (MPJ) are difficult to treat. We evaluated the clinical outcomes of using a dynamic traction splint to treat comminuted intraarticular fracture of MPJ. We conducted a retrospective chart review on patients with comminuted intraarticular fracture of the MPJ treated with a dynamic traction splint at National Cheng Kung University Hospital between March 2014 and February 2018. The surgical procedures consisted of a transverse Kirschner wire insertion and treatment for concomitant injuries. The patients then received staged regular rehabilitation programs under a hand therapists' supervision for 14 weeks. Active range of motion (ROM) of injured digits, Visual Analog Scale score for pain, and return-to-work status were recorded to evaluate functional outcomes. A total of 10 patients were included. All were male patients and aged 8 to 66 years. The most common injury mechanism was motor vehicle accident (70%). The locations of fractures were 1 at the metacarpal head and 9 at the proximal phalangeal bases. Half of the fractures were open. Concomitant injuries were 1 digital nerve severance, 1 extensor tendon rupture, and 3 dorsal skin avulsions. There were no postoperative complications. The active ROM of the MPJ ranged from 40° to 90° with a median ROM of 80°. The Visual Analog Scale score for pain was 0 in 8 patients and 1 in the other 2 patients. All patients returned to their original workplace after rehabilitation. Dynamic traction splints and postoperative rehabilitation programs could be an alternative treatment for comminuted intraarticular fracture of the MPJ.