Intra-articular Fractures Of Distal End Research Articles

COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF AUGMENTED EXTERNAL FIXATOR VERSUS VOLAR LOCKING PLATE IN INTRAARTICULAR FRACTURES OF DISTAL END RADIUS.

Introduction: Augmented external fixation and Open reduction with volar locking plate are two frequently used modalities in the management of intraarticular fractures of distal end radius. However, there is still controversy regarding the optimal surgical modality. The present study was performed to compare the functional and radiological outcomes of augmented external fixation (AEF) versus volar plate fixation (VPF) in the management of patients with intraarticular fractures of distal end of radius. This prospective study was done between December 2019 Materials and Methods: and December 2021. This study included 40 patients with intraarticular fractures of distal end of radius. All patients fulfilling inclusion criteria were randomly allocated into two groups. Group A was treated with an AEF and Group B with VPF. Functional assessment was done by measuring the wrist range of motion, hand grip strength and Mayo Wrist Score. The radiographic parameters included radial height, radial inclination, and volar tilt. Follow-up was done at 6 weeks, 3 months, and 6 months post-operatively. In our study at all follow-ups, the VPF group had a significa Results: ntly better Mayo wrist score and wrist flexion, wrist extension, forearm supination and pronation compared to the AEF group (p < 0.05). There were no significant differences in terms of hand grip strength and postoperative radiologic parameters (p > 0.05). VPF is a better surgical option as compared to AEF based on our short-term functional outcome Conclusion: in the management of patients with intraarticular fractures of the distal end of radius, on account of better wrist flexion and extension, forearm rotation and Mayo wrist scores, and fewer complication rates.

Surgical outcome of intra-articular fractures of distal end of radius managed by external fixator - our experience

Background & Objectives: Preservation of the articular congruity is the principle prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixation as a method of treatment for distal end of radius fracture has more than 60 yrs of documented clinical experience. The main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation.Methods: In a prospective controlled study, 30 cases of intra-articular fractures of distal end radius in adult patients were treated with uniplanar bridging type of external fixation using the principle of ligamentotaxis and augmentation by K wires. Mean age of the patients was 37.3years, External fixator was applied for a mean duration of 6 weeks and cases were followed up for an average of 37.0 weeks post operatively.Results: Assessed as per De merit point system of Gartland and Werley (modified by Sarmiento 1975) for functional results at the end of 6 months of follow up. Excellent to good functional result was noted in 83.3%.Conclusion: External fixation and ligamentotaxis provides better functional and anatomical results in intra-articular fractures of distal end radius. The success not only depends on the anatomical restoration of the articular surface. It also depends on the associated soft tissue injuries and articular damage.

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.

Intra-articular distal radius fractures treated with variable angle locking compression plates: An outcome analysis

Background: Methods for surgical fixation of intra-articular distal end radius fractures has been on an evolving course. One among the novel developments is the use of variable angle locking plate. Its multidirectional locking option facilitates fixation of even the most complex of the fractures, especially in osteoporotic bone. Aim: To study the functional and radiological outcome of operative management of intra-articular fractures of distal end of radius with variable angle locking compression plates. Material & Methods: 56 adult patients (36 males and 20 females) who had intra-articular distal radius fractures satisfying the study criteria & treated at Sunshine hospitals, Secunderabad, Telangana, India between October 2015 and September 2017 using variable angle locking compression plates were taken up for the study. The cases were followed up at 6 weeks, 3 months, 6months and 12 months postoperatively. During each visit, functional outcome was assessed using Demerit score system of Gartland and Werley. Radial height, radial angulation and palmar angulation were measured from the xray to assess the radiological outcomes. Results: There were 2 type B1, 8 type B2, 16 type B3, 13 type C1, 12 type C2 and 5 type C3 as per the AO classification. Functional assessment showed 29(51.78%) excellent results, 21(37.5%) good results, 6(10.71%) fair results and no poor results There was no significant difference in the radiological parameters between different follow-ups as signified by p value >0.05 implying that there was no loss of fixation. One patient had flexor pollicis longus tendon rupture at 13 months postop & was managed by Plate removal + transfer of Flexor Digitorum Superficialis tendon. Two patients developed superficial wound infection which susbsided with oral antibiotics. One patient developed Reflex Sympathetic Dystrophy which was managed medically. One patient had Screw malpositioning but remained asymptomatic through out the follow up period. Conclusion: Variable angle locking plate offers predictable and good outcome in intra-articular fractures of the distal end of the radius.

Surgical Management of Intra-articular Fracture Distal Radius by Multi axial Locked Plate

Background: Early wrist motion and adequate reduction and fixation of fracture fragments including radial styloid process achieved with volar multi axial locked plate have the advantage of minimizing the risk of joint stiffness and radio carpal joint incongruity present in other treatment modalities of distal radius fractures. The aim of this work was evaluation of surgical management of intra-articular fractures of distal end of radius with volar multi axial locked plate. Objective: To compare the radiological and clinical outcomes with volar multi-axial locked plate and other treatment modalities of multi-fragmentary and intra-articular distal radius fractures Patients and methods: This was a prospective study on 20 patients with intra-articular distal radius fractures operated with open reduction and internal fixation with volar multi axial locked plates from February 2018 to March 2020 via trans flexor carpi radialis tendon sheath (modified Henry approach) in 12 patients with radial column involvement, and ulnar (extensile carpal tunnel release approach) in 8 patients with ulnar column involvement. Follow up was carried out for six months. Results: The mean DASH score at 3rd month was 20.5 ± 6.9, while the mean DASH score at 6th month was 7.25 ± 4.1. The mean 3 months Modified MAYO Wrist Score was 81 ± 9.8 (median = 85), while the mean 6 months MMWS was 85.8 ± 12.5 (median = 90) which indicated a good ability of the patient to perform daily activities with minimal difficulty. At six months follow up 12 patients had excellent results, 6 patients had good results, one patient had fair result, and one patient had poor result. Conclusion: Multi axial locked plate has the advantage of purchasing small fracture fragments including radial styloid process, and also allowing for early range of motion exercises which prevent the occurrence of radio carpal joint arthritis or stiffness.

Conservative versus surgical management of intra-articular fractures of distal end of radius: A comparative clinical study

Conservative versus surgical management of intra-articular fractures of distal end of radius: A comparative clinical study

Distal femur fracture, a comparative study of locking compression plate versus distal femur nail

Background: Distal femoral fractures reportedly account for less than 1% of all fractures and comprise between 4%–6% of all femoral fractures. The current method of open reduction and internal fixation has become evident in the recent years with good results being obtained with the AO blade plate, dynamic condylar screw and other implant systems like intramedullary retrograde nails and recently locking compression plate. Controversy still remains regarding the optimum device for distal femur fixation. Objectives: To compare functional outcomes of fractures of distal femur operated with distal femur locking compression plate and distal femur nail using range of motion at knee and Neers knee scoring system and to compare rate of complications associated with both treatment modalities. Materials and methods: In this retrospective study, 60 patients with displaced distal femur fractures presented to our hospital were studied from January 2012-june 2017. 30 patients underwent fixation with locking compression plate and rest 30 underwent distal femur nailing. Outcomes were measured and assessed at 1 months, 3 months and 6 months using Neers knee scoring system.Results: Union was achieved in all patients with mean time to radiological union being 20 weeks in retrograde nailing patients and 24 weeks in locking compression plating. Neer scores were graded as excellent in 51.7 % in retrograde nailing patients and 56.6 % in plating patients. Mean range of motion was more (115 degree) in retrograde nailing patients compared to locking compression plating patients (114 degree) at the end of follow up.Conclusion: There were no statistically significant differences found in functional outcome of the patients between the two surgical methods. Locking compression plate is better implant in comminuted intra-articular fractures of distal end of femur, particularly in elderly patients with osteoporotic bone. Retrograde intramedullary nailing is a good operative technique for extra-articular distal third femoral fractures. However, both techniques require sufficient surgical experience and appropriate preoperative planning.

Comparison of clinical and functional outcome of intra-articular fractures of distal end of radius with conservative versus surgical treatment: A prospective study

A prospective study constituted a total of n = 90 subjects with intra-articular distal end of radius fractures was conducted in Kakatiya Medical College, Warangal, Telangana, India, for a period of eighteen months. The objective of the present study was management for a distal end radius fracture for accurate restoration of range of motion and grip strength and to achieve a good functional outcome with return to normal functional status of the patient at the earliest possible and to compare clinical and functional outcome with conservative and surgical management. The present study sample consisted of n = 90 subjects of which n = 44 subjects were treated with conservative management, n = 46 with surgical method. Among n = 46 cases treated surgically, n = 11 were managed by pinning, n = 11 by ligamentotaxis with external fixator and n = 24 with plating. Excellent results were observed in 30% of the cases in conservative group and 47.5% in surgical group. Excellent and good results were seen in 85% cases in plating group and 52.17% in K-wire in surgically managed group. Excellent and good outcome results in conservative group were observed in stable, minimally comminuted and minimally displaced fracture pattern. Excellent and good outcome results were seen in many of such fracture pattern among surgical group. The best outcome or results were seen among young individuals.

Evaluation of volar locking plate fixation for management of intra-articular fractures of distal end of radius

<p class="abstract"><strong>Background:</strong> With the increase in high velocity trauma, the incidence of intra-articular fractures of distal end of radius, particularly in adults- the working class of society is increasing. Normal functioning of wrist is of paramount importance for all activities of daily living and working. The present study was undertaken to evaluate the results of using volar locking plate for fixation of intra-articular fractures of distal end radius, with emphasis on return to pre-injury employment assessment.</p><p class="abstract"><strong>Methods:</strong> It is a combined prospective and retrospective study from January 2013 to June 2016. Twenty patients of intra-articular fractures of distal end of radius (AO type B2 and B3) were treated with volar locking plate through volar approach. The patients were regularly followed up for one year. The assessment of pain, range of motion, activity and grip strength were scored by Green and O’Brien’s system.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to scoring system of Green and O’Brien the patients were assessed at 1 year follow up. 17 patients (85%) showed excellent results (scores 90-100). 2 patients (10%) showed good result (scores 80-89) while 1 patient (5%) had fair outcome (score 65-79). No patient had poor result (score less than 65). 19 patients (95%) returned to their pre-injury employment at 1 year.</p><p><strong>Conclusions:</strong> Open reduction and internal fixation with volar locking plate is reliable and excellent methods of management of intra-articular fracture of distal end of radius especially shear type of injury (AO type B2 and B3) in adults. </p>

English

BACKGROUND: Seventy five patients who sustained simple intra articular fractures of distal end of the radius treated by open reduction and internal fixation and closed reduction and k - wire fixation during 2years. To assess the functional outcome of the wrist joint in intra-articular fractures of distal end of radius AIMS: To assess the functional outcome of the wrist joint in intra- articular fractures of distal end of radius by opting surgical intervention. METHODS AND MATERIALS: A total of 75 cases of intraarticular fractures of distal end of the radius were operated on by open reduction and internal fixation, closed reduction and k - wire fixation, at KIMS hospital. Records of 75 cases were available for study. The mean age of the 54 males and 21 females was 35.4 years (range, 20-72 years) Special care was taken during surgery to achieve articular congruity. The injury was caused by fall in 32patients, RTA in 37 patients and fall from height in 6 patients. All cases were Gartland and Werely type III. All cases were operated on within 7days from the day of injury. RESULTS: All patients were assessed clinically and radiographically after a follow-up duration of 6 months. The radiological union was acceptable. Result were evaluated according to modified Green O'Brein Score were excellent in 55 cases (73.3%), good in 13 (17.4%), and fair in 7(9.3%). CONCLUSION: Open reduction and internal fixation of intraarticular fractures of distal end of the radius can restore articular congruity and result in good to excellent results.

Clinico- Radiological and functional outcome after surgical fixation of intraarticular fractures of distal end of radius by external fixator verses locked volar plate: A prospective randomised study

Background: Intra- articular fractures of the distal radius represent high energy, complex, unstable injuries and the optimal method of treatment remains controversial. Study Design & Settings: Observational Randomized uncontrolled Study at a tertiary care hospital from September 2010 to August 2012. Material & Methods: Fifteen patients underwent open reduction and palmar locking plate fixation, and 15 patients underwent closed reduction and K-wire augmented external fixation on random basis. For functional and radiological assessments, Demerit score were used and grip strength was measured using a Dynamometer. Subjective functional assessment was made using the DASH scale. The follow-up period was at least 6 months. Statistics: Observational descriptive statistics, Student's unpaired 't' test and Chi-square test. Results: The radiological parameters at three and six months were better in patients treated with plate group. Patients in the plate group had better functional outcome score (DASH). The findings were statistically significant at three months period but did not show any significance at six months period. Functionally and radiologically (DEMERIT Score) plate group had better score. The findings were statistically significant in three months period, but did not show any significance at six months period. Patients in the plate group showed better grip strength. In patients whose right hand was involved the findings were statistically significant at three months but at six months there was no statistical significance. Conclusion: Treatment with open reduction and internal fixation for intra articular fractures of distal end of radius provides good radiological results. However, objective and subjective functional assessment showed no significant superiority between external fixation and volar plate fixation at 6 months follow-up. Keywords - DASH & DEMERIT Score, External fixator, Fracture distal radius, Functional assessment, Volar plate.

Evaluation of Ligamentotaxis in Management of Comminuted Intra-articular Fractures of Distal Radius Using Spanning Naseer–Awais (NA) External Fixator

Abstract Background: Comminuted intra-articular distal ra-dius fractures are the most common amongst the frac-tures of the upper limb. There are various methods of management of comminuted intra-articular fractures of distal radius published in the orthopaedic literature, these are closed reduction and plaster cast application, closed reduction and percutaneous pin fixation, closed reduction percutaneous pin fixation with plaster cast application, ligamentotaxis with application of exter-nal fixation across the wrist joint and open reduction and internal fixation. Objective: Objectives of this study were to evaluate the ligamentotaxis for the treatment of comminuted intra-articular fractures of distal radius and compare the prescribed data for comparison with similar series in the orthopaedic literature. Methodology: During this study 30 skeletally mature patients with comminuted intra-articular fractures of distal radius attending outpatient department or ortho-paedic emergency of Lahore General Hospital, Lahore, with less than one week duration were admitted in the hospital. They were examined clinically. Radiographs were taken and diagnosis was confirmed. Patients with open fractures or with multiple injuries were excluded from the study. Patients were administered general anesthesia. Skin distal to the elbow was prepared with antiseptic iodine solution and draping was done. Clo-sed reduction of the fracture was done and N. A exter-nal fixator was applied across the wrist joint. Distrac-tion force was applied across the fracture site by elon-gation of threaded rod of external fixator. This distrac-tion force was maintained till union of the fracture according to the principle of ligamentotaxis. All the patients were examined in outpatient department at regular intervals. Data of this study was recorded for comparison of similar series in recent orthopaedic lite-rature. Results: There were no serious complications in our study. Six patients (20%) developed mild pin tract in-fections these were treated by oral antibiotic therapy. One patient (3.3%) developed aseptic loosening of external fixator after three weeks. In this patient exter-nal fixator was replaced by plaster cast. One patient (3.3%) lost the reduction in which revision of external fixation was carried out. After removal of external fixator / plaster cast, a supervised programme of phy-siotherapy was started for restoration of the wrist and hand functions. Twenty two (73.3%) patients required physiotherapy for 1 week, 5 (16.7%) required for 2 weeks and 3 patient (10%) did not require it at all. Conclusion: We conclude that ligamentotaxis is an excellent method for the management of comminuted intraarticular fractures of distal end of radius. It obvi-ates the need of plaster cast application or open reduc-tion and internal fixation of the fracture and result of this study are comparable with similar series published in the orthopaedic literature. Keywords: Ligmaentotaxis distal radius fracture.

Arthroscopically Assisted Reduction of Intra-Articular Fractures of Distal End of Radius

Arthroscopically Assisted Reduction of Intra-Articular Fractures of Distal End of Radius