Intra-articular Radius Fractures Research Articles

Arthroscopic Management of Distal Radius Fractures and Malunions.

Articular congruity is the most important prognostic factor when dealing with a distal intra-articular radius fracture or the correction of intra-articular malunion. This article details our approach with tips and tricks for effectively managing these complex injuries with the aid of dry arthroscopy.

Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center

BackgroundTo investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries.MethodsRetrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1–2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate.ResultsFive hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence.ConclusionOsseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably.Trial registrationThe study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589).

Cast immobilization and addition of platelet rich plasma in intraarticular distal radius fracture resulting a better functional outcome to the internal fixation and radius union scorings system

Introduction: Intra-articular distal radius fracture is one of the most frequent injuries, especially in adults (20%). In this condition, anatomic reduction is required to reduce the possibility of complications, either with internal plate screw fixation (ORIF-PS) or conservatives such as the use of casting. Giving Platelet Rich Plasma (PRP) as one of the biologic agents to conservative management is expected to improve the outcome and become a promising alternative therapy.Methods: This study was an experimental study with a post-test control only group design on patients with intra-articular radius fractures at Sanglah General Hospital Denpasar during the period September 2019 to March 2020. The samples were selected by random sampling. Evaluation of the functional outcomes of the therapy given through DASH and RUSS scores was evaluated twice, namely at week 6 and week 12 post-therapy. Descriptive data analysis, General Linear Model (GLM) test and post hoc test were also carried out.Results: There were 45 patients divided into 3 groups; the first group of a plaster cast therapy and PRP injection, the second group of only plaster cast and the third group of ORIF. The first group showed better in DASH scores than the second group but not better than the third group, both at week 6 and 12. The results of the GLM and post hoc analysis also showed that the first group showed better RUSS scores than the second group.Conclusion: The addition of PRP has a better result than conservative therapy without PRP but ORIF still was the best therapy.

Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series

BackgroundIntra-articular fractures are associated with posttraumatic arthritis if inappropriately treated. Exact reduction of the joint congruency is the main factor to avoid the development of arthrosis. Aim of this study was to evaluate feasibility of computer-assisted surgical planning and 3D-printed patient-specific instrumentation (PSI) for treatment of distal intraarticular radius fractures.Method7 Patients who suffered a distal intraarticular radius fracture were enrolled in this prospective case series. Preoperative CT-scan was recorded, whereupon a 3D model was computed for surgical planning and design of PSI for surgical navigation. Postoperative accuracy and joint congruency were assessed. Patients were followed-up 3, 6 and 12 months postoperatively.ResultsMean follow-up was 16 months. Over all range of motion was restored and flexion, extension and pronation showed significant recovery, p < 0.05. Biggest intraarticular joint step-off and gap reduced from average 2.49 (± 1.04) to 0.8 mm (± 0.44), p < 0.05 and 6.12 mm (± 1.04) to 2.21 mm (± 1.16), p < 0.05. Average grip strength restored (3–16 months) from 20.33 kg (± 7.12) to 39.3 kg (± 19.55) p < 0.05, 100% of the healthy contralateral side. 3D-accuracy for guided fragments was 2.07 mm (± 0.64) and 8.59° (± 2.9) and 2.33 mm (± 0.69) and 12.86° (± 7.13), p > 0.05 for fragments reduced with ligamentotaxis.ConclusionComputer-assisted and PSI navigated intraarticular radius fracture treatment is feasible, safe and accurate. The benefits of this method, however, do not outstand the additional effort.Level of evidence IV.

Correlation of functional and radiological outcome of management of distal end radiud fractures using a trinary surgical treatment

The approach of surgical management of distal intraarticular radial fractures is gaining popularity in the current scenario, and there is no concluding evidence as to which method of surgery fares better than the other, this article attempts to compare the radiological and functional outcome of trinary surgical treatment (percutaneous pinning, ligamentotaxis and plate and screw fixation) for distal end radius intraarticular fractures. Materials and Methods: It was a prospective study involving 90 patients who presented with distal end intra-articular radius fractures, each of these patients were randomly assigned to be treated by ligamentotaxis and plate and screw fixation, percutaneous pinning, (n = 30) each who were operated between January 2016 to May 2017 and their data with respect to functional and radiological outcome were collected over one year. Results: In this research paper out of the 90 patients, the excellent scores were in 13 patients accounting 14.4%, good scores 47.8% in 43 patients and fair and the poor scores 25.6% and 12.2% functionally were seen in 23 and 11 patients respectively, The Cramer s V value was not found significant, the values noted are 0.84. A significant association between groups and Volar tilt, Radial angle and Radial shortening. Cramer’s V was found to be significant (P- value 0.0001) radiologically. The outcome with respect to radiology and the function was measured using werley and gartland scoring and the lidstorm scoring system. Conclusion: In this study the open reduction and internal fixation with plate and screws gave a restored radiological outcome compared to the ligamentotaxis and percutaneous pinning group but the functional outcome remained the same in all the three treatment groups. Keywords: Distal radius Intra articular fractures, Volar locking plate, Percutaneous Kirshner wire fixation, Ligamentotaxis.

Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types

The aim of this study was to evaluate the prevalence of arthroscopic scapholunate (SL) and/or lunotriquetral (LQ) laxity and triangular fibrocartilaginous complex (TFCC) injuries in patients who have an intraarticular fracture of the distal radius and to correlate these lesions with fracture type. Fifty-seven intraarticular radius fractures, whether or not they were associated with an ulnar styloid fracture, were evaluated and treated by arthroscopy. Scapholunate and lunotriquetral ligament injuries were classified according to the EWAS classification. TFCC lesions were assessed according to Palmer's classification. Each injury was documented through preoperative X-rays and a CT scan. Fracture type and soft tissue injury were not significantly associated one to another. Arthroscopic examination revealed at least one soft tissue injury in 39 intraarticular fractures of the distal radius (68.4%). Twenty-five percent of arthroscopic SL laxities (including severe EWAS 3 injuries) were not detected on standard radiographs. Arthroscopic SL laxity was present in 8 of 11 cases (72.7%) of radial styloid fracture and in 15 of 25 cases (60%) of fractures with at least one radial styloid component. There was no association between LQ integrity and fracture type. Ulnar styloid fractures (base or tip) and TFCC lesions were significantly correlated (P<0.0001). The prevalence of soft tissue lesions secondary to intraarticular fractures of the distal radius was 68.4%. However, there was no statistically significant relationship between the different types of radius fractures and soft tissue injuries. On the other hand, ulnar styloid fracture was predictive of TFCC injury.

Comparison of 2-year clinical and radiological outcomes between volar plating and external fixation with additional K-wires for AO Type C distal radius fractures.

Background/aimSurgical treatment of distal intraarticular radius fractures remains controversial. Our aim was to compare the clinical and radiological outcomes between volar plating (VP) and external fixation (EF) for distal intraarticular radius fractures two years postoperatively.Materials and methodsThis retrospective study included 59 patients with 62 intraarticular AO Type C distal radius fractures. We distinguished two groups: patients treated with internal fixation (volar locking plate, VP group: 41 fractures), and patients treated with an external fixator and K-wires (EF group: 21 fractures). The clinical assessment included range of motion, grip strength, disability of the arm, shoulder, and hand (DASH), and visual analog scale scores. Radiological measurements comprised flexion and extension, radial volar tilt, inclination, height, shortening, and ulnar variance.ResultsPostoperative grip strength and flexion angles were better after VP (P = 0.004, P = 0.009), but there was no difference in DASH scores (P = 0.341). Radial inclination was significantly different compared to that of the uninjured hand after VP (P = 0.0183), but not EF (P = 0.11). ConclusionVP and EF result in similar clinical and radiological outcomes after 2 years. Function is not restored to the functionality of the contralateral and noninjured hand.

To Compare the Functional Outcome of Intra Articular Distal end of Radius Fracture Treated by Conventional pop cast and External Fixatator Fixatation

Introduction: Distal end of radius fractures frequently have a high degree of comminution, instability, and associated with soft tissue injuries. Treatment of this distal radius fracture is controversial and there is no single definitive treatment method that is considered the standard of care.&#x0D; Objective: 1. To compare the functional results of the conventional POP cast and external fixator fixation of intra articular distal end of radius fracture. 2. To compare the radiological changes with that of functional outcome.&#x0D; Methodology: It was a prospective study comparing the functional outcome of distal intra-articular radius fracture when managed by conventional POP cast and external fixatator fixation. The final outcome was decided on the basis of modified Gartland and Werley scoring system. Total 50 patients (19 – 54 years) were recruited. 30 were treated by closed reduction and POP cast and 20 by external fixation. Radiological parameters were graded according to Schecks criteria and fracture comminution was classified according to Frykman's classification.&#x0D; Results: The functional outcome of the treatment was a subjective evaluation in which 80% of the patients had pain in external fixation as compared to 63% in closed reduction POP cast group. The restriction of activities was in 10% of the patient in external fixation group as compared with 33% in closed reduction POP cast group. The final scoring system as modification of Gartland and Werley point system had 5 ± 3 conventional pop cast group and 4 ± 4 in external fixation group. (p = 0.3764). On radiological evaluation, there was no significant difference in radial length, radial angle and volar tilt in two groups.&#x0D; Conclsion: The results show no statistically significant difference between the two modes of interventions. External fixation provides easy mobilization of fingers and reduces edema and stiffness of joints. The active ranges of movements at the wrist joints were significantly better in external fixation group.

Analyses of fracture line distribution in intra-articular distal radius fractures

PurposeTo assess the association between the fracture line distribution and the location of comminution in intra-articular distal radius fractures by building fracture mapping.Patients/methodsForty cases with intra-articular fractures of distal radius were enrolled in the current prospective clinical study. Fracture lines and comminution zones were identified by reduced three-dimensional computed tomography reconstructions and then graphically superimposed onto a standard template to create two-dimensional fracture maps, followed by the conversion into heating maps. Based on qualitative descriptive fracture mapping analyses, the patterns of intra-articular distal radius fractures were determined.ResultsIt was observed that the highest fracture line intensity was located as an inverted “T” shape zone in the dorsal aspect of the joint with high incidence of fractures and the prominently intense color in heat mapping. The keystone projected area, the radial styloid process and the metacarpal radial side articular surface were found to be the least involved parts of the fracture. According to the mapping of the number and distribution of fracture lines, a new classification method for intra-articular fractures of the distal radius was redefined. Different surgical approaches and internal fixation techniques were proposed for different types. In this paper, we retrospectively compared the preoperative X-ray findings between different types. Based on the preoperative X-ray prediction, the distal intra-articular radius fractures were classified, so as to develop effective surgical strategies. In this study, a new surgical approach was attempted, but due to the lack of evidence-based evidence, long-term postoperative complications and hand function should be further evaluated.ConclusionThis study redefines a new method for the classification of intra-articular fractures of the distal radius, which allows doctors to have a clearer understanding of the characteristics of distal radius fractures. Moreover, the application value in fracture diagnosis is more significant, and the best surgical approach is selected for different types.

Factors predicting adverse outcome in complete intra-articular distal radius fractures.

To determine risk factors associated with adverse functional and radiological outcome in complete intra-articular distal radius fractures (AO 23 C2-3) with a minimum follow-up of 1year. Retrospective case series of 87 consecutive patients with a complete intra-articular distal radius fracture (AO/OTA 23 C2-3) and a minimum follow-up of 1year between 2012 and 2016. Risk factors for adverse clinical [using the Patient-Rated Wrist Evaluation (PRWE) score] and radiological outcome (positive ulnar variance 1year postoperative) were analysed in a linear regression model. PRWE scored a median of 4.5 points (range 0-72.5) after a median follow-up of 31months (range 12-70months). A concomitant polytrauma was associated with a worse PRWE (β = 23.34, p < 0.01) and was also significantly associated with the use of a temporary external fixator (χ2 = 11.93; p < 0.01) and high-energy trauma (χ2 = 19.39; p < 0.01). Radiological outcome measures 1 year postoperative did not correlate with clinical outcome measures. This cohort of complete intra-articular distal radius fractures (AO/OTA 23 C2-3) shows a good clinical outcome at medium-term follow-up independent of the radiological outcome. A concomitant polytrauma was associated with worse functional outcome and a higher complication rate. This is most likely due to the associated injury severity. These factors help the treating physician in decision-making and informing patients when treating displaced intra-articular radius fractures.

Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study

Introduction: The purpose of the present study was to compare the results obtained by management of intra-articular fractures of distal end radius with closed reduction and external fixation versus open reduction and internal fixation with locking distal radius volar plate. Material and Method: The present study included 60 patients of distal intra-articular radius fractures. Patients were randomly divided into two groups: group I (close reduction and external fixator) and group II (open reduction and internal fixation with volar plating). Periodic clinical examination and x-ray review was carried out to find out functional outcome,range of motion, radiological outcome and complication. Patients were followed up for 6 month. Mean of all the quantitative variables was compared between two groups by unpaired 'T' test. Functional outcome was measured with Quick DASH score. Result: In present study palmer tilt,radial length and radial inclination was significantly greater in volar plate group.ulnar varience was more(-1.18mm) in volar plate group than external fixator group(-1.28mm). The mean QuickDASH scores and time to return to work were similar in patients treated with a locking plate and external fixator (QuickDASH score 2.4 ± 3.0 and 2.9 ± 5.4; 1.9 ± 0.5 months and 2.1 ± 0.7 months, respectively; P > 0.05).In present study Quick DASH score in ext fix group was 9.71 compaired to volar plating group 6.79 at the final followup. Complication rate were higher in close reduction and external fixation group as compared to open reduction and volar plating group. Conclusion: Open reduction and internal fixation with plate fixation had better functional outcome with less complication rate than close reduction and external fixation in management of intra-articular fractures distal end radius.

Distal radius fractures : Update on imaging

Distal radius fractures are associated with high individual and socioeconomic relevance. Optimized radiography and computed tomography (CT) imaging are essential for individualized therapy planning. Plain CT imaging with 3D reconstruction and digital removal of the carpus and ulna is helpful for choosing the surgical approach in the presence of intra-articular radius fractures. If the fracture line leads towards the scapholunate compartment, ligamentous injury requiring treatment can be detected or ruled out before surgery with the help of direct CT arthrography (CTA). Acquisition of imaging data and morphometrical analysis must be standardized and reproducible. In the diagnostics of distal radius fractures it is necessary for radiologists and surgeons to use aunified fracture classification.

Midterm results of volar plate fixation in intra-articular distal radius fractures

Intra-articular fractures of the distal radius represent a significant problem in terms of treatment and outcomes. We conducted a prospective study of patients with fractures of the distal radius managed by internal fixation using the volar locking plate between June 2014 and October 2016. Forty four patients including 32 males and 12 females with intra-articular distal radius fractures were included in this prospective study.Mean time for follow up was 30 months. Quick DASH score and the modified MAYO wrist score were used for functional outcome assessment. The median DASH score for all patients was 2.3 (IQR 0- 6.4) and the median MAYO score was 90 (IQR 75-100). Seven patients had complications including infection and CRPS. We concluded that ORIF with volar plating provide good functional outcome in midterm follow-up of intra-articular distal radius fractures.

A prospective study of functional &amp; radiological outcome of management of intra-articular distal radius fracture by plating

Aim: To analyze prospectively the functional & radiological outcome of management of intra-articular distal radius fracture by plating Materials & Methods: About 30 adult patients with intra-articular distal radius fracture admitted to Government Mohan Kumaramangalam medical college hospital from May 2013 to February 2015 were included in this study. Post operatively patients were assessed using MAYO score.Follow up: All patients had regular follow up every 4 weeks until union occurred after which patients had follow up every 3 monthsResults: Low energy fractures in the elderly are linked to favourable functional outcomes, although there are several complicating factors. The morphological reduction of the distal radius articular surface and attaining good distal radio ulnar congruity with early mobilisation for early recovery are the important components of the treatment. According to the Mayo wrist score and other research, our study's 72% of VLCP patients had very good results.Conclusion: We conclude from our study Following the foregoing debate, it has been determined that the use of a volar plate and screw system for fracture fixation is a preferable way to keep fracture fragments from collapsing, even in severely comminuted, unstable, and osteoporotic bones. Patients who have an unstable, dorsally or vertically misplaced The radiographic result of the intraarticular radius fracture was excellent to good, when used with a volar locking plate with a fixed angle. However, further research is required to confirm our findings over time.

Observation of curative effect of open reduction internal fixation combined with external fixation of intra-articular fractures of the distal radius

Objective To investigate the clinical effect internal fixation combined with external fixator incision in the treatment of intra-articular fractures of the distal radius.Methods 80 cases of intra-articular distal radius fracture patients underwent cut internal fixation combined with external fixator in the treatment of orthopedic were chosen,postoperative rehabilitation exercises,fracture healing after the removal of the external fixator.All patients were followed up for 8 months to 12 months,an average of 9.2 months.Results 80 patients were intraarticular fractures healed,the time required was 4 to 10 months,an average of 6.3 months.In accordance with the assessment of functional systems Dienst wrist,51 cases wrist function were excellent,21 cases were good,the good rate was 90％ (72/80).There were no clinical fractures common complication after surgery.Conclusion Open internal fixation combined with external fixator treatment of intra-articular fractures of the distal radius fractures not only makes reduction of fracture and immobilization satisfaction,but also conducive to the wrist of early postoperative functional rehabilitation exercise. Key words: Radius fractures ; Wrist joint; Fracture fixation, internal; External fixators

Comparison of accuracies of fracture assessment between plain X-ray films and 3D Cr images in intra-articular distal radius fractures

Objective To compare the accuracy of plain X-my fdms and reconstructed 3D CT images in assessing characteristics of intra-articular distal radius fractures.Methods X-ray films and reconstructed 3D CT images of 16 cases of intra-articular distal radius fractures were retrospectively analyzed using Paces System and MIMICS software.The parameters that were evaluated included the ability to detect intra-articular step and gap,fracture displacements,the number of articular fragments,stretch of the fracture line to the sigmoid notch and the extensor tendon tunnel.Resuts The average value for intm-articular step and gap were (0.92 ±0.75) mm and (0.71 ± 0.87) mm,respectively,on posteroanterior and lateral radiographys.The average value for intra-articular step and gap were (2.58 ± 1.23) mm and (2.89 ± 1.13) mm,respectively,on coronal and sagittal 3D CT images (P ＜ 0.05).The average number of artic~ar fragments was (3.25 ± 1.18) detected by X-ray and (4.68 ±0.49) detected by 3D CT images (P ＜0.05).The fracture line was found stretched to the sigrnoid notch and the extensor tendon tunnel in 2 cases and 4 cases,respectively,on radiographs.On 3D CT images it was found to be present in 14 cases and 15 cases,respectively(P＜0.05).Conclusion Standard radiographs (anteroposterior and lateral views) are not sugicient to measure anterior displacement nor accurate enough to measure medial displacement of distal radius fractures.Three-dimensional computed tomography improves both the mhability and the accuracy of radiographic characterization of the intra-articular distal radius fracture and influences treatment decisions. Key words: Radius fracture; Tomography; Three dimensional reconstruction image

Wrist arthroscopy: a clinical report of 89 cases

Objective To report our experience of treating wrist traumatic disorders with arthroscopy. Methods From January 2005 to January 2009,89 patients with wrist traumatic disorder were diagnosed and treated in our department with wrist arthroscopy.They were 51 men and 38 women,aged from 11 to 78 years (average,45.8 years).After arthroscopic debribment,fractures of the distal radius and the scaphoid were reduced and fixed,and injuries to the interosseous ligaments and triangular fibrocartilage complex were repaired.The Disability of Arm,Shoulder and Hand (DASH) questionnaire was used to investigate functional recovery of the wrist.Complaints,symptoms and signs of the patients were recorded at the postoperative follow-up. Results The patients obtained a mean follow-up of 16 months (from 13 months to 3 years) .Intra-articular distal radius fractures obtained a reduction of less than one mm and scaphoid fractures achieved complete reduction.Follow-ups revealed fine functional recovery.No obvious complications of the blood vessel,tendon and nerve were observed.The mean DASH score was 12.5 ± 18.4 points.Conclusion Because of minimally invasion and direct visualization,wrist arthroscopy can be an effective treatment for wrist traumatic disorders. Key words: Wrist; Arthroscopy; Wounds and injuries; Treatment

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.

Arthritis predicting factors in distal intraarticular radius fractures

Intra-articular malunion with step off and gap formation is claimed to be crucial for radiocarpal degeneration. In addition to well-defined intraarticular malunion, the shape of the distal radius is important for unaffected wrist function. In typical intra-articular fracture patterns with a dorsoulnar and palmar ulnar fragment, alterations of the shape of the articular surface, in a kind of a cavity, without obvious step off can be observed. The aim of the present study is to determine the residual articular deformity following intra-articular radius fractures and to analyze their impact on the final clinical and radiological outcome. Eighty one patients with dorsally displaced distal intraarticular radius fractures were followed up for a mean period of 9 years. Surgical treatment of all patients included open reduction, plate fixation and corticocancellous bone grafting. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance, intra-articular Stepps and the measurement of the anteroposterior distance of the radial joint surface. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand Score (DASH Score). Articular malunion in the form of a cavity in the sagittal plane measured 4.8mm, 1.3mm more than on the non-injured side. Anteroposterior distance measured 20.6mm, 2.1mm more than on the non-injured side. Articular step-off and gap was noticed in 11 patients. At the final follow-up examination, there was a significant difference in articular cavity depth and the anteroposterior distance between arthritis stage I and II. Arthritis stage was associated with the range of motion (ROM) in the sagittal plane, but had no significant influence on the DASH, pain level, grip strength and ROM in the frontal plane. ORIF leads to predictable results in the restoration of length and form of the distal radius. Increasing the articular cavity depth should be avoided to prevent degenerative arthritis at the radiocarpal joint at long-term follow-up visits.

Dorsal Double-Plate Fixation of the Distal Radius.

Restoration of the intra- and extraarticular anatomy of the distal radius. Stable internal fixation of fragments, with the possibility of early functional rehabilitation. Distal intraarticular radius fractures with impacted articular fragments and displaced dorsoulnar fragment. Distal intraarticular radius fractures with bony or ligamentous injury of the proximal carpal row. General medical contraindications for surgical intervention. Distal radius fractures with palmar tilt of the distal fragment. Dorsal longitudinal incision. Approach to the intermediate column via the third extensor compartment by detaching the extensor pollicis longus (EPL) tendon. Arthrotomy and revision of the proximal carpal row. Reconstruction of the radiocarpal articular surface and support with a plate applied to the dorsoulnar aspect. Approach to the radial column by subcutaneous preparation between skin flaps (cave: superficial branch of the radial nerve) and retinaculum, incision of the first extensor compartment and support of the radial column with a preshaped plate, which is pushed through under the tendons of the first compartment. Cancellous bone grafting is usually not necessary. Subcutaneous displacement of the EPL tendon with the aid of a small retinacular flap. Application of a removable velcro cuff. Immediate functional postoperative physiotherapy, without the cuff. No straining or forcing until first radiographic examination at 6 weeks after the operation. 25 consecutive patients were monitored following a double-plate fixation, with a minimum follow- up of 12 months. In all cases the reduction, in accordance with the Stewart Score, was very good, a loss of reduction was not observed. The range of motion was between 100° and 160° for flexion/extension and between 160° und 180° for pronation/supination. The average DASH Score was 7.2 points, the PRWE Score 8.0 points. No relevant loss of strength (JAMAR dynamometer) was found in any of the patients in comparison with the healthy side. Complications noted were a muscle adhesion in the region of the first extensor compartment as well as a mild reflex sympathetic dystrophy, which healed without consequences. Implants were removed from six of the patients.