Intra-articular Distal Radial Fractures Research Articles

To compare the functional and radiological outcome between external fixation and volar plating for the treatment of intraarticular distal end radius fractures

Background: Fracture of distal radius may be stable that is extra-articular, non-comminuted without distal radio ulnar joint disruption or unstable that is intra-articular, comminuted displaced with distal radio ulnar joint disruption. Complications of unstable fractures are shortening due to bone loss or due to resorption of the cancellous bone from metaphysis, resistant deformity, residual pain, late collapse, radio carpal arthritis and gross functional impairment. Aims and Objective: The purpose of this study to compare the relative efficacy of external fixation versus plating with regard to functional and radiological outcome. Materials and Methods: Total of 60 patients having intraarticular distal end radius fracture were included in this study and was equally divided into two groups, one group treated by external fixator other group with volar locking compression plate with or without augmentation by k-wire. Follow-up was done after 2 weeks, 4 weeks, 6 weeks and 3 ,6 and 12 months. The radiological evaluation was performed with Sarmiento’s Modification of Lindstrom’s Criteria. With the Modified Mayo Wrist Score, the patient’s functional outcomes were assessed and both groups were compared. Results: In this study we found that volar plate group had good to excellent outcome in 73% cases and 07% with fair outcome however with external fixator group found good to excellent in 50% cases and poor in 17% cases. Conclusion: In our study, we showed that the use of an external fixator and a volar locking plate for the treatment of intraarticular distal radial fractures were reliable. The relative simplicity of use, low surgical exposure, and decreased surgical trauma are benefits of external fixation. Despite these volar locking plates augmented with or without k wire had a good to excellent results in terms of early rehabilitation and less complications related to wrist joint. External fixator with ligamentotaxis provide significant good results in communited intraarticular distal end radius fracture.

Radiographic Analysis in Extra-Articular and Intra-Articular Distal Radius Fractures Treated with Variable-Angle Volar Locking Plate Fixation.

(1) Background: Different distal radial fracture types have different prognosis after fixation. Our study aim is to evaluate the differences in radiographic parameters by using variable-angle volar locking plate (VAVLP) fixation according to extra-articular and intra-articular distal radial fracture. (2) Methods: There are two groups: extra-articular group (21) and intra-articular group (25). Forearm radiographs immediately after surgery and at 3 months after operation were reviewed for analyzing radial height (RH), ulnar variance (UV), radial inclination (RI), volar tilt (VT), tear drop angle (TDA), distal dorsal cortical distance (DDD), and Soong classification (SC). (3) Results: There were no significant differences in the above parameters between two groups at either immediately post-operative or at 3-month follow-up, except for TDA (p = 0.048). Most patients in both groups were at low risk of flexor tendon rupture, except for two cases. We observed a positive correlation between post-operative DDD and 3-month change in the intra-articular group, but not the extra-articular group. (4) Conclusions: Our study demonstrates that VAVLP fixation is effective in maintaining the stability of most radiographic parameters and reduces the risk of tendon rupture in both extra-articular and intra-articular distal radial fractures. Post-operative DDD can be used to predict the degree of subsequent displacement in patients with intra-articular fractures fixed with VAVLP.

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

Evaluation of functional outcome by modified mayo wrist score in intra- articular distal end radius fracture managed by plate osteosynthesis

<p class="abstract"><strong>Background:</strong> Fractures of distal end of radius continue to pose a therapeutic challenge. Intra articular and extra articular malalignment can lead to various complications like post traumatic osteoarthrosis, decreased grip strength and endurance, as well as limited motion and carpal instability.</p><p class="abstract"><strong>Methods:</strong> A prospective study of forty patients with intra-articular distal end radial fractures treated under the department of orthopaedics, PIMS, Udaipur, were included in this study. All patients managed by plate osteosynthesis were followed up to 9 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> When outcome according to modified Mayo wrist scoring system was assessed, only one patient (2.50%) scored with poor grade. 11 (27.50%) were graded as excellent, 19 (22.50%) as grade good, 9 (22.50%) as grade fair. 32 (80%) patients had union within 2-3 months and 06 (15%) patients had union in 3-4 months. There were 2 (5%) case of delayed union.</p><p class="abstract"><strong>Conclusions:</strong> Assessment of functional outcome by modified mayo wrist score in intra-articular distal end radius fracture managed by plate osteosynthesis gives an excellent scoring system to assess outcome of communited intrarticular distal radius fractures with reference to function of the hand and wrist of the individual. Also, it will help to predict the likely functional outcome in relation to fracture pattern of distal radius.</p><p> </p>

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 ....

The Association Between the Volar Aspect of the Distal Radial Diaphysis and the Lunate Rotation Center on Lateral View X-ray of the Wrist

For the treatment of severe distal radius fracture dislocations or malunions, especially those accompanied by intra-articular fractures, radiographic indexes based on the relationship between the carpus and radius are occasionally needed to achieve the ideal radiocarpal reconstruction. This study defined a reference point on the lunate and examined whether this point was located on a line extending along the volar aspect of the distal radial diaphysis on lateral radiographs of the wrist. Two hundred one lateral wrist radiographs of adults were obtained, and the center of a circle passing through 3 selected points on the proximal articular surface of the lunate was defined as the lunate rotation center. Thereafter, the distance between the rotation center and a line extending along the volar aspect of the distal radial diaphysis was measured. Additionally, the distance between the rotation center and the midpoint of the distal articular surface of the lunate was measured. The mean distance between the lunate rotation center and the line extending along the volar aspect of the distal radial diaphysis was-0.01 ± 0.09 mm. The difference in this distance between both wrists in the same patient was 0.3 ± 0.12 mm. The distance between the rotation center and the midpoint of the distal articular surface of the lunate was 0.3 ± 0.05 mm. This study demonstrated that the lunate rotation center was located on a line extending along the volar aspect of the distal radial diaphysis and at the midpoint of the distal articular surface of the lunate. This study demonstrates that this association could become an important index for preoperative planning of corrective osteotomy for complicated intra-articular distal radial fracture malunions. Additionally, it may aid in confirming the reduced position during or after surgery for wrist fracture dislocations.

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.

Functional outcome of open reduction and internal fixation of intra-articular distal radial fractures by volar locking plate

Background: Intra-articular fracture of the distal end of the radius can be treated by various methods. The purpose of this study is to evaluate the functional outcomes of open reduction and internal fixation (ORIF) by volar locking plate (VLP) of intra-articular distal radial fractures. Materials and Methods: This is a single centre retrospective study conducted from April 2017 to May 2019 on adult patients having intra-articular distal radius fractures, who were treated by ORIF with VLP. As per medical records, the number of such patients for the study was 12. The fractures were classified as per the Frykman classification system. After operation, patients were followed up for a minimum of 24 weeks. Functional evaluation of the patients was done at the last follow-up according to the demerit point system of Gartland and Werley. Results: Twelve adult patients of intra-articular distal radius fractures were analysed retrospectively for functional outcomes of ORIF with VLP. The age ranged from 22 to 54 years, and males outnumbered females by a ratio of 2:1. The commonest mode of injury was found to be road traffic accidents (75%). The fractures were classified as per the Frykman classification system. Type III was the most common (50%), followed by Type IV (25%). The majority of the cases (58.3%) were operated in 2–5 days following injury. The mean time for union was 8 weeks. Functionally 11 (91.3%) patients had satisfactory (excellent + good) result at the final follow-up. Conclusion: ORIF with volar locking plate is a reliable, efficient, and rewarding procedure for intra-articular fracture of distal radius as it allows stable fixation with restoration of anatomy and function.

206 Audit of Time to Surgical Fixation of Distal Radial Fractures Compared to British Orthopaedic Association Standard for Trauma (BOAST) Guidelines at Busy District General Hospital

Abstract Aim BOAST guidelines state that intra-articular distal radial fractures should be operated on within 72 hours of injury and extra-articular distal radial fractures which require surgical management should be operated on within 7 days. The aim of this audit was to see how the orthopaedic department at a busy district general hospital compared to these guidelines. Method Retrospectively looked at operations carried out over a 10-month period. All Manipulation Under Anaesthesia, K wire and Open Reduction Internal Fixations of distal radial fractures were included. Results Over the 10-month period, 49 intra-articular and 60 extra-articular fractures were operated on. 65% of intra-articular fractures were fixed within 72 hours and 82% of extra-articular fractures were fixed within one week. Mean time from date of injury to operation was 3.88 days for intra-articular and 2.98 days for extra-articular fractures. Mean time from decision of surgery to operation was 2.32 days for intra-articular and 2.18 days for extra-articular fractures. Conclusions Clearly, the management of extra-articular fractures is closer to the standards set by BOAST guidelines. It can be difficult to establish from an x-ray whether a fracture is extending into a joint surface - this can delay the fracture clinic appointment and the operation. The difference between the mean time of injury to operation and mean time of decision of surgery to operation for intra-articular fractures show that once the decision to operate has been made, it is carried out quickly. Educating A+E and orthopaedic staff on recognising intra-articular fractures could expedite the time to surgery.

Intra-articular fibromembranous septum after intra-articular distal radial fracture: Arthroscopic excision and factors associated with formation of the septum

BackgroundIntra-articular fibromembranous septum in the radiocarpal joint can cause wrist contracture after distal radial fracture, but the mechanism underlying the formation of the septum is unknown. This study examined the clinical outcomes in patients treated with arthroscopic excision of the septum and the factors associated with formation of the septum in patients with and without a septum. MethodsFifty-three patients (22 with septum and 31 without septum) treated for intra-articular distal radial fracture with arthroscopy using a volar locking plate and secondary removal of the plate were included. Clinical outcomes and radiological assessments were analyzed. ResultsIn patients with a septum, the range of wrist flexion and total wrist arc before the second operation were significantly more limited than in those without a septum (p < 0.01 and p = 0.03, respectively). The improvement rate (improvement in wrist arc divided by the wrist arc of the healthy side) after arthroscopic excision of the septum and plate removal was greater in patients with a septum than in those without a septum (6.1% vs. 2.0%, p = 0.08). The significant factors affecting formation of the septum were the residual articular gap and the height of the midradial ridge on computed tomography images. ConclusionsIntra-articular fibromembranous septum after surgically treated intra-articular distal radial fracture affects limited range of motion and secondary arthroscopic excision of the septum improves the wrist range of motion. Anatomical reduction and maintenance of the articular fragment, as well as anatomical characteristics might be causes of septum formation.

A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

PurposeComminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation. MethodsA total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score. ResultsPatients in volar plate group had superior PRWE score and DASH score at each stage of follow-up. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group. ConclusionFixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.

Functional outcome of intra-articular fracture of distal end of radius treated by open reduction and internal fixation with locking distal radius system

Background: There is alays been a dilemma in the treatment of intra-articular distal radius fracture (DRF). Close reduction and cast application gives satisfactory result in extra-articular Distal Radial Fractures but there is alays been debate beteen open and close reduction in the intra-articular fracture. Hence, this study is to evaluate effectiveness of open reduction and internal fixation of intra-articular Distal Radial Fractures. Materials and Methods: This prospective observational study as carried out in the department of orthopedics, All India Institute of Medical Sciences, Patna, from August 2016 to March 2019. The patient ere included ho qualified the inclusion criteria. The included patient ere treated by open reduction and internal fixation ith distal radius plate. The outcome as assessed in term of anatomical variables (radial dorsal tilt, length, and angle), residual deformity, and subjective result evaluation using Sarmiento's modification of Lind Storm criteria. The complication if any as also noted. Results: This study included 30 cases of intra-articular DRF, 12 fractures of AO type B, and 18 fractures of AO type C. Anatomically, 24 patients (80%) had excellent restoration of anatomy, 4 patients (13%) had good restoration and 2 had fair (7%) restoration of anatomy. 93% of patients had excellent to good alignment of fragments and good reduction could not be achieved in 7% of patients resulting in fair or poor results. Functionally, 22 patients (73%) had excellent, 5 good (17%), and 3 patients had fair (10%) restoration of functions. Conclusion: Open reduction and internal fixation ith volar plate and scres fixation gives satisfactory (good to excellent) result in intra-articular Distal Radial Fractures.

Cost-Effectiveness of Volar Locking Plate Compared with Augmented External Fixation for Displaced Intra-Articular Wrist Fractures.

The purpose of the present study was to estimate the cost-effectiveness of treating displaced, intra-articular distal radial fractures with volar locking plate fixation compared with augmented external fixation. A cost-utility analysis was conducted alongside a randomized, clinical trial comparing 2 surgical interventions for intra-articular distal radial fractures. One hundred and sixty-six patients were allocated to either volar locking plate fixation (84 patients) or external fixation (82 patients) and were followed for 2 years. Health-related quality of life was assessed with the EuroQol-5 Dimensions and was used to calculate patients' quality-adjusted life-years (QALYs). Resource use was identified prospectively at the patient level at all follow-up intervals. Costs were estimated with use of both a health-care perspective and a societal perspective. Results were expressed in incremental cost-effectiveness ratios, and uncertainty was assessed with use of bootstrapping methods. The average QALY value was equivalent between the groups (1.70463 for the volar locking plate group and 1.70726 for the external fixation group, yielding a nonsignificant difference of -0.00263 QALY). Health-care costs were equal between the groups, with a nonsignificant difference of &OV0556;52 (p = 0.8) in favor of external fixation. However, the external fixation group had a higher loss of productivity due to absence from work (5.5 weeks in the volar locking plate group compared with 9.2 weeks for the external fixation group; p = 0.02). Consequently, the societal costs were higher for the external fixation group compared with the volar locking plate group (&OV0556;18,037 compared with &OV0556;12,567, representing a difference of &OV0556;5,470; p = 0.04) in favor of the volar locking plate group. Uncertainty analyses showed that there is indifference regarding which method to recommend from a health-care perspective, with volar locking plate treatment and external fixation having a 47% and 53% likelihood of being cost-effective, respectively. From the societal perspective, volar locking plate treatment had a 90% likelihood of being cost-effective. External fixation was less cost-effective than volar locking plate treatment for distal radial fractures from a societal perspective, primarily because patients managed with external fixation had a longer absence from work. Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.

Diagnosis of dorsal screw penetration after volar plating of a distal radial fracture.

The aim of this study was to investigate whether intraoperative 3D fluoroscopic imaging outperforms dorsal tangential views in the detection of dorsal cortex screw penetration after volar plating of an intra-articular distal radial fracture, as identified on postoperative CT imaging. A total of 165 prospectively enrolled patients who underwent volar plating for an intra-articular distal radial fracture were retrospectively evaluated to study three intraoperative imaging protocols: 1) standard 2D fluoroscopic imaging with anteroposterior (AP) and elevated lateral images (n = 55); 2) 2D fluoroscopic imaging with AP, lateral, and dorsal tangential views images (n = 50); and 3) 3D fluoroscopy (n = 60). Multiplanar reconstructions of postoperative CT scans served as the reference standard. In order to detect dorsal screw penetration, the sensitivity of dorsal tangential views was 39% with a negative predictive value (NPV) of 91% and an accuracy of 91%; compared with a sensitivity of 25% for 3D fluoroscopy with a NPV of 93% and an accuracy of 93%. On the postoperative CT scans, we found penetrating screws in: 1) 40% of patients in the 2D fluoroscopy group; 2) in 32% of those in the 2D fluoroscopy group with AP, lateral, and dorsal tangential views; and 3) in 25% of patients in the 3D fluoroscopy group. In all three groups, the second compartment was prone to penetration, while the postoperative incidence decreased when more advanced imaging was used. There were no penetrating screws in the third compartment (extensor pollicis longus groove) in the 3D fluoroscopy groups, and one in the dorsal tangential views group. Advanced intraoperative imaging helps to identify screws which have penetrated the dorsal compartments of the wrist. However, based on diagnostic performance characteristics, one cannot conclude that 3D fluoroscopy outperforms dorsal tangential views when used for this purpose. Dorsal tangential views are sufficiently accurate to detect dorsal screw penetration, and arguably more efficacious than 3D fluoroscopy. Cite this article: Bone Joint J 2020;102-B(7):874-880.

Metacarpal Position and Lunate Facet Screw Fixation in Dorsal Wrist-Spanning Bridge Plates for Intra-Articular Distal Radial Fracture

A dorsal wrist-spanning plate (DWSP) can be affixed to the second or third metacarpal, depending on the morphology of the distal radial fracture (DRF) and on surgeon preference, but comparative biomechanical analyses between these methods are limited. This biomechanical study compared fixation to the second metacarpal versus the third metacarpal as measured by lunate facet fragment displacement in a cadaveric model of an axially loaded intra-articular DRF. The construct rigidity with the addition of an intrafragmentary lunate facet locking screw was also evaluated. A sample size of 14 cadaveric matched pairs was calculated to achieve 81.7% power. The 28 limbs were randomized to DWSP fixation to the second metacarpal (Group 1) or third metacarpal (Group 2); each wrist underwent an osteotomy simulating an unstable intra-articular DRF. Limbs were tested at axial loads of 50, 100, 150, 200, 250, and 300 N. Lunate facet displacement from the metaphyseal fragment at each load was measured with use of differential variable reluctance transducers. After initial testing, a locking screw was placed through the plate into the lunate facet fragment in the third metacarpal group (Group 3). Displacement measurements were repeated for all loads. Paired 2-tailed t tests with Bonferroni correction (significance, p < 0.008) were performed to assess differences in fragment stability between groups. The average fracture displacement at 300 N was 0.8 mm in Group 1, 0.4 mm in Group 2, and 0.2 mm in Group 3. Plating to the third metacarpal more effectively resisted displacement compared with the second metacarpal at all axial loads (p < 0.008). The addition of a lunate facet screw further stiffened the construct at loads of ≥200 N (p < 0.008). Plate fixation to the third metacarpal with an intrafragmentary screw was the most biomechanically favorable construct, although other factors may favor an alternative distal fixation site. Mean displacement of the lunate facet fragment at 300 N was <1 mm in all groups. The present study demonstrated that a DWSP affixed to the third metacarpal with an intrafragmentary screw provides the most effective stabilization of the lunate facet fragment in intra-articular DRFs. This study validates the use of intrafragmentary screws to increase stability in DWSP fixation.

Functional Outcome of Open Reduction and Internal Fixation of Intra-articular Distal Radial Fractures by Buttress Plate

Introduction: Treatment of displaced, comminuted, intra-articular fracture of the distal end of the radius by a closed method, such as pins and plaster or external fixation, gives unsatisfactory outcome in most of the cases. The purpose of this study is to evaluate the efficacy of open reduction and internal fixation (ORIF) of intra-articular distal radial fractures by buttress plate. Materials and Methods: We conducted a prospective study from January 1, 2015, to June 30, 2016, on patients having intra-articular distal radius fractures aged above 18 years (20–58 years), who were treated by ORIF with buttress plate. Males outnumbered females by a ratio of 2.67:1. The most common mode of injury was found to be road traffic accident (68.2%). The fractures were classified as per the Frykman classification system. Type III was the most common (54.5%), followed by Type IV (27.3%). Majority of the cases (54.5%) were operated in 2–5 days following injury. The mean time for union was 8.04 weeks. Results: Functional evaluation was done according to the modified demerit point system of Gartland and Werley. Functionally, 14 patients (63.6%) had excellent, 6 had good (27.3%), and 2 had fair (9.1%) restoration of functions. Radiological assessment and the results were graded according to the Sarmiento's modification of Lindstrom criteria. Anatomically, 16 patients (72.7%) had excellent restoration, 4 (18.2%) had good restoration, and 2 had fair (9.1%) restoration. One case of superficial infection and one case of injury to the superficial branch of the radial nerve were noted. In later follow-up, two cases presented with joint stiffness, and in one case, loss of reduction was seen at final follow-up. Conclusion: Around 91% of the patients had excellent-to-good result, both anatomically and functionally. Hence, we conclude that ORIF with buttress plate is an excellent mode of treatment for displaced intra-articular distal radius fractures.

Comparing clinical outcomes of comminuted distal radial fracture treatment by pins and plaster with primary locking plate in elderly patients: a prospective comparative clinical study

Background: Distal radial fractures are common osteoporosis-induced fractures in elderly patients. In this study, we compared the treatment outcomes of pins and plaster with locking plates in elderly patients over 65 yr of age. Methods: In this prospective study, 204 elderly patients with distal radial fractures were examined from 2014 to 2018. Among these patients, only 94 had comminuted fractures and required surgery. The remaining 110 patients were excluded from the study. Among the 94 patients with comminuted distal fractures, 46 were treated with pins and plaster while 48 received open reduction and fixation with a locking plate. The patients were followed for 1 yr. Functional performance and quality of life were compared between groups. Complications, the need for reoperation, and radiographic findings were recorded. Results: Functional outcomes and general health of elderly patients treated with open reduction and fixation with a locking plate showed significant improvement in comparison to those treated by pins and plaster (P&lt;0.001). Grip power and acceptable radiographic findings were significantly different in patients treated with a locking plate (P&lt;0.001), and these patients were in better condition. Pin track infection, skin damage with rupture and dehiscence at the pin site, nonunion, and need for reoperation were 17.3% (8/46), 21.7% (10/46), 32.6% (15/46) and 39.1% (18/46) in patients treated with pins and plaster, respectively. In the locking plate group, infection was observed in 2% (1/48) of patients, and malunion and the need for reoperation was 4.1% (2/48) and 6.2% (3/48), respectively, which showed a significant difference. Conclusions: In elderly patients, application of a locking plate for comminuted intraarticular distal radial fractures resulted in better functional outcomes and improved quality of life. Level of Evidence: Level I.

A 3D CT-based fracture map study of intra-articular distal radial fractures

Objective To map OTA/AO type B and type C distal radial fractures according to three-dimensional (3D) CT scan data, and to describe the morphological distribution of fracture lines. Methods A total of 468 cases of distal radius fractures admitted to the Affiliated Hospital of Chengdu University from January 2016 to March 2019 were analyzed and AO classification were performed. AO type B and type C fractures meet the inclusion criteria and then CT data were 3D reconstructed, and morphological description were performed on the fracture lines of each joint surface, including fracture shape angle, fracture area and fracture ratio. At the same time, the articular surface fracture model was superimposed on the standard model, then fracture line and fracture area distribution map were drawn to create the fracture map of intra-articular distal radial fractures. Result Intra-articular fractures of the distal radius were 209 cases, accounting for 44.7% (209/468) of the distal radius fractures, among which 67 cases of AO type B fracture. In type B fractures, average fracture height were 20.30±11.26 mm, average fracture width were 12.24±6.83 mm, average fracture area were 189.61±101.84 mm2, average angle were 57.23°±14.95°, and average area ratio of fracture (fracture zone area/joint surface area ratio) were 32.42%±10.24%. 142 cases were OA type C fracture, the average fracture height were 24.43±11.37 mm, average fracture width were 20.38±7.59 mm, average fracture area were 425.26±314.31 mm2, average angle were 51.26°±13.17°, and average area ratio of fracture were 73.81%±26.29%. According to fracture map formed by main fracture lines, five different fracture areas were identified: ① 63 cases in central area; ② 25 cases in Lister's nodule area; ③ 59 cases in scaphoid area; ④ 36 cases in lumbar fossa area; ⑤ 26 cases in lower iliac area. Main fracture lines were concentrated in the area on the dorsal side of the central area and the scaphoid area. The fracture lines of type B fracture mainly concentrated in scaphoid region, which accounted for 29.85% (20/67), and dorsal side and central area accounted for 26.87% (18/67). The fracture lines of type C fracture accounted for 27.46% (39/142) in scaphoid area and 31.69% (45/142) in central area. The fracture line of type C fracture increased in the lumbar fossa region (17.61%, 25/142) and the lower ulnar region (12.68%, 18/142) compared with type B fracture (28.69%). Compared with the type B fracture, the overall distribution of the fracture line of the type C fracture is more central. Conclusion The map of intra-articular fracture of distal radius was drawn and morphological distribution of fracture lines were quantified. Fracture-prone site and shape of fracture line were visually recognized. At the same time, description of articular surface fracture line and fracture area of type B and type C fractures of OA classification were improved, which may help with new classification and diagnosis. Key words: Radius fractures; Intra-articular fractures; Imaging, three-dimensional; Maps

Three-dimensional analysis of displacement characteristics of dorsally angulated intra-articular distal radial fractures.

Understanding the complex fragmentation of intra-articular distal radial fractures contributes to achieving anatomical reduction during surgery. This study aimed to clarify three-dimensional displacement patterns of intra-articular fragmentation in dorsally angulated, intra-articular distal radial fractures. We identified five characteristic intra-articular fragments: a key fragment, dorsal ulnar corner, dorsal wall, radial column and anterior radial column. The key fragment was displaced with radial deviation, pronation and extension and with dorsal, proximal and radial translations. The dorsal ulnar corner displacement resulted in a gap, a step-off and a deepened concavity for the lunate facet and sigmoid notch. The dorsal wall displacement resulted in a deepened concavity, a gap and a step-off of the dorsal scaphoid facet. The displacements of the radial column and anterior radial column caused a step-off between the scaphoid and lunate facets. The five characteristic intra-articular fragments each created a characteristic gap and step-off in the articular surface. Level of evidence: IV.

Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing

To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1–4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.