Intra-articular Distal End Radius 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.

Unstable distal radius fractures fixation with a 2.4 mm volar variable-angle locking plate: radiological and functional assessment

Background: The main objective of this observational study was to evaluate the functional and radiological outcome of variable angle volar plates in intra-articular distal end radius fractures. Methods: Patients with distal end radius fractures (AO type 3C) treated operatively between Jan 2020 and Dec 2020 and then followed up for at least 12 months. A total of 32 patients (11 men and 21 women) with a mean age of 51.9 years were included in the study. The functional outcome was assessed by using modified Mayo wrist score (MMWS), disabilities of the arm, shoulder, and hand (DASH) score, wrist range of motion (ROM) and grip strength relative to the uninjured side and radiological assessment of radial height, volar tilt, and radial inclination. Results: MMWS and DASH scores improved postoperatively over time. Signs of radiographic union started around 12 weeks after surgery. The most common complication observed was finger and wrist stiffness, which was resolved with active wrist and finger movements. Non-union or hardware-related complications/ late complications such as tendon irritation/attrition were not observed with variable angle volar locking plates. Conclusions: Distal end radius fracture fixation with variable angle plate gives favourable radiological and clinical outcomes. These results can be owed to features such as low profile, variable locking, anatomical design and implant biomechanics. The surgeon determined angulation of the distal row of screw fixation may decrease the incidence of joint penetration and improve fixation of radial styloid and lunate facet stability.

Outcome of treatment of intra-articular distal end radius fractures by volar locking plate versus bridging external fixator augmented by single K-wire through radial styloid

Background: Distal radius fractures are common injuries occurring more frequently than any other fracture, and remain one of the most frequent skeletal injuries treated by orthopaedic or trauma surgeons. They are considered the most common fracture of the upper extremity. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low-profile internal fixation plates and implants, arthroscopically assisted reduction, and grafting techniques including bone-graft substitutes all have contributed to improving fracture stability and outcome. Methods: This is a prospective study consisting of 30 patients, who were treated with volar locking plate or K-wire augmented external fixation for intra-articular commented distal radius fractures (AO type C) at Rajendra institute of medical sciences between November 2020 and January 2023. The 15 patients were treated with open reduction using the volar approach and locking plate were used while 15 patients were treated with closed reduction under fluoroscopy, distraction with the external fixator (Joshi type external fixator) along with K-wire fixation for additional stability used. Result: The ORIF with plating group showed better functional outcomes in Green and O'Brien compared to ex fix group. The radiographic results in the ORIF group were more favorable than in the EF group. Conclusions: We found that both ORIF with plating and external fixation represent treatment choices for distal radius fractures. ORIF had better functional and radiological outcomes according to Green and O'Brien and Sarmiento scoring systems when compared to external fixation. ORIF had less incidence of complications compared with external fixation.

Functional outcome of intraarticular distal end radius fractures in adults fixed with external fixators: A modality of management

Functional outcome of intraarticular distal end radius fractures in adults fixed with external fixators: A modality of management

Comparison of External Fixation and Supplementary Kirschner-Wires Fixation With Volar Locking Plate for the Treatment of Intra- Articular Distal End Radius Fractures

Introduction: There are controversies regarding the benefit of open reduction and internal fixation with volar locking plates over closed reduction and external fixation along with supplementary Kirschner wires fixation for intra-articular distal end radius fracture. Therefore, this study aimed to compare the outcomes between external fixation along with supplementary Kirschner wires with volar locking plate in the treatment of intra-articular distal end radius fractures. Methods: This prospective, observational and analytical study was conducted over one and a half years. Forty-seven adults with displaced intra-articular distal end radius fracture were included in the study. Twenty-one cases were treated with closed reduction and external fixation along with supplementary Kirschner wires, whereas 26 patients were treated with open reduction and volar locking plate fixation. Results: At the end of three months, as per the Green and O’Brien scoring, the mean functional outcome score in the volar plate group was significantly better 80.77(±11.46) than the external fixation group 70.24(±10.66) (p=0.002). However, at the end of six months, the mean score in the volar plate group 86.15(±7.39) was not significantly different from the external fixation group 81.43(±9.63) (p= 0.63). Fracture reduction was achieved and maintained better in the volar locking plate group. Conclusion: Functional outcome of closed reduction and external fixation along with supplementary Kirschner wires is comparable with open reduction and internal fixation by volar locking plate in treatment of displaced intra-articular distal radius fractures. Radiological correction is achieved and maintained better with volar locking plates.

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.

A comparative study of volar locking plate versus external fixation for displaced intra articular distal end radius fractures: A prospective study

Background: Distal radius fracture is more common accounting for 1/6th of the all fractures. With this background, this study was carried out to compare the functional outcome of volar locking plate and external fixator to the displaced intra-articular distal end radius fractures using Modified Mayo Wrist Score (MMWS). Materials and methods: This study included those patients with distal radius fracture attending the Orthopaedic clinic at SIMS, during July 2018 till December 2018. Patients were randomised based on - even and odd day of the week. This included two set of group with twenty patients in each group- one with volar locking plating and other with external fixation. Patients were followed up at 6 months and 1 year. At each follow up, the pain and range of movements were assessed by MMWS score which was entered in Microsoft excel and analysed in SPSS 20. Results: At the end of one year after surgery, we observed that external fixation technique was superior for treating displaced intra-articular comminuted distal end radius fractures than volar locking plate. Conclusion: External fixator showed more advantageous than volar locking plates after 1year of follow up.

Study of clinicoradiological and functional outcomes in intraarticular distal end radius fractures managed by volar locking plate

<p class="abstract"><strong>Background:</strong> Various modalities of fixation are available for management of distal end radius fractures. Assessment of the functional and radiological outcomes of intra-articular distal end radius fractures managed with volar locking plate was attempted with the present study.</p><p class="abstract"><strong>Methods:</strong> In this prospective interventional study, thirty adult patients with closed distal radius fractures with intra-articular extension were comprehensively evaluated and managed. Open reduction and internal fixation (ORIF) was performed via volar approach (modified Henry`s approach) using 2.7mm volar locking compression plates (LCPs). Patients were followed up at 2 weeks, 1 month, 3 months and 6 months after surgery. The patients were evaluated functionally by Mayo score and radiologically by Lidstrom classification.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 18 (60%) patients having excellent, 8 (26.7) good, 2 (6.7%) fair and 2 (6.7%) with poor result according to Mayo scoring. According to Lidstrom scoring, at the last follow up, 16 (53.3%) patients had excellent, 11 (36.7%) patients good, 2 (6, 7%) patients fair and 1 (3.3%) patient had poor result. The functional status of the patient improved significantly from at 1month (20±3.47) to 6 months post-operative follow up (23.67±2.91). The mean range of motion improved significantly at 1 month, 6 months and last post-operative follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Volar locking plate gives good to excellent clinico-radiological and functional outcomes in most of the fractures of the distal end radius with intraarticular extension.</p>

To study the clinical and radiological outcome of patients with intraarticular or unstable lower end radius fractures treated with ligamentotaxis with external fixator and K wires

Introduction: Treatment for intraarticular lower end radius fractures has been conventionally with closed reduction with plaster /k wires / external fixator or open reduction internal fixation with plate. We thought that by combining external fixator with k wires better anatomical and thus functional results would be obtained.Material and methods: A prospective follow up study was carried out on 50 fresh closed intraarticular or unstable lower end radius at MIMER Medical College Talegaon from June 2014 to May 2018 after taking appropriate consents. Ligamentotaxis with external fixator was combined with k wires under C arm guidance. Patients were followed up at 3,6,9,12 weeks and 6 months clinically and radiographically.Results: Average time for surgery was 34.2 min, radial shortening was less than 4 mm, and hospital stay was 2.3 days. Anatomical assessment was grade l or ll in 96 % patients. Good to excellent results by Lindstrom's criteria was there in 78% patients.Conclusion: Combining external fixator with k wire fixation gives well to excellent results in majority of patients with unstable intraarticular distal end radius fractures without significant complications and with a short hospital stay.

A Long-Term Study of Application of Joshi's External Stabilizing System in Displaced Intra-articular Distal End Radius Fractures

Background Fractures of the distal end radius are a common upper extremity fracture. Intra-articular distal end radius fractures are recognized as very complex injuries with a variable prognosis. The aim of the study was to assess the long-term functional outcome of patients treated with Joshi's external stabilizing system (JESS) for displaced intra-articular distal end radius fractures. Materials and Methods A total of 170 patients with intra-articular distal end radius fracture were treated with JESS from 2014 to 2017. The patients were followed up at 2, 6 weeks, 6 months, 1, and 2 years (final) after the surgery. The assessment of pain, range of motion, grip strength, and satisfaction were assessed at 6 months, 1, and 2 years (final) follow-up and scored according to modified Mayo wrist scoring system. Results The good and/or excellent results were found in 82.2% of cases. We observed that patients with age less than 50 years had greater prognosis as compared with patients with more than 50 years of age. Final outcome was also found better in males as compared with females at 6 months, 1, and 2 years postoperatively. Conclusion JESS is an effective treatment technique for intra-articular distal end radius fractures in our community. On long-term follow-up of the patients treated with JESS for intra-articular distal end radius fractures, the functional and radiological outcomes were good with low complication rate.

Comparison study for internal and external modes of fixation for fractures of distal end radius

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fractures of the distal radius continue to be one of the most common skeletal injuries. The methods which are commonly practiced are closed manipulation and plaster cast, pins and plaster, percutaneous pinning, external fixation and open reduction and internal fixation with or without bone graft. Surgeons are increasingly faced with the dilemma of when to consider operative management and when cast immobilization is the optimal treatment.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">47 cases of distal end radius fractures were operated in the orthopedic department of a tertiary care centre. The purpose of the present study was to compare the results of external and internal fixation methods for the treatment of fractures of distal end of radius. Patients operated by external fixation were classified as Group A and those operated by internal fixation were classified as group B. Patients were classified according to AO Classification. Patients were followed at regular intervals depending on the case and time of operation and evaluated by Gartland and Werley score</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our study, 29 patients were of extraarticular type, of which 86.20% had an excellent score and 18 patients were of intraarticular type, of which 83.33% had an excellent score. But when compared to groups A and B, the percentage of excellent score obtained in group B was more than that in group A in both extraarticular and intraarticular fractures. Yuan-kun et al did a study on intraarticular distal end radius fractures and evaluated the patients by Gartland and Werley point system, concluding that plating gives better results than external fixation supplemented by K wiring. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We concluded that no method of fixation can be said superior to the other. Each method has fracture-specific indication. The results of open reduction and internal fixation can be better than external fixation in initial months, but in the long run, both the methods can have excellent score, provided the fixation is good and properly indicated.</span></p>

Locking Distal Radius Plate—Early Results From India

Restoration of wrist function to close to preinjury levels of patients with intra-articular distal end radius fractures is of concern. Open reduction and internal fixation with angular stable screw fixation implants is coming in vogue but little literature evidence supports it. The objectives of this study are to assess the ability of volar locking plates to maintain fracture reduction when used to treat dorsally displaced intra-articular distal radial fractures and to assess the patient-related outcome after this procedure. In a prospective study from March 2008 to September 2009, 23 cases of intra-articular distal radius fractures were included in the study. All these fractures underwent open reduction and internal fixation with 2.4 volar locking distal radius plates. Every patient was reviewed with a minimum follow-up of 36 weeks (9 months to 2 years). Radiographs were taken to assess fracture union or for any potential loss of fracture reduction. Functional outcome was assessed with evaluation of range of movements of the wrist and pain as per the Visual Analog Scale. Radiologic union was noted by the end of 18 weeks in 3 subjects, at the end of 24 weeks in 13 subjects and by 30th week in 6 patients. As for overall functional outcome, 4 patients had excellent outcome, 18 had good outcome, and 1 patient had poor outcome. None of our patients had neurovascular injuries or tendon ruptures during this period. Volar locking plate is a viable option for treating intra-articular distal radius fractures.