Modified Mayo Wrist Scoring System Research Articles

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>

SHORT TERM FUNCTIONAL OUTCOME OF CLOSED REDUCTION AND FIXATION OF COLLES FRACTURE USING MODIFIED-JOSHIS EXTERNAL STABALIZATION SYSTEM - A PROSPECTIVE STUDY

Colles fracture is the most common fracture seen in adult population. It is never an isolated fracture of the distal radius, but is associated with fracture of ulna styloid which may be displaced or undisplaced instability of the distal radio-ulnar joint complex and may be associated with injury to triangular fibro cartilaginous complex. The aim of study was to determine functional outcome of management of closed reduction and fixation of comminuted colles fracture using a rigid and stable modified-Joshis External Stabalisation System as soon as possible. In our study we have tried to bring associated soft tissue and bony injuries around the wrist joint as a highlighter and focused on fixation and restoration of anatomy to near normal with fixation of all the above mentioned injuries without exposing the joint, and as an immediate and definative management. Out of a total of 30 patients included, 26 patients had an excellent outcome as measured using quick-disability arm shoulder hand score and modified-mayo wrist scoring system. One patient had a superficial pin tract infection and was managed with oral antibiotics. The patients were able to resume the activities of daily living by end of eight weeks. It can be concluded that this method can be employed in immediate and definative management of comminuted colles fractures as it leads to a better functional outcome, lesser hospital stay, early mobilization of the joint, lesser exposure to radiation, avoids joint exposure, has a low learning curve, early resumption of activities of daily living and avoids re-surgery at a later date for implant removal.

Prognostic Factors Affecting Clinical Outcomes of Arthroscopic Assisted Reduction and Volar Plating through Preservation of Pronator Quadratus for Intra-Articular Distal Radius Fracture.

Background: This study aimed to evaluate the clinical and radiological outcomes following an arthroscopic-assisted reduction and volar plating (AR-VP) surgery through pronator quadratus (PQ) preservation for treating intra-articular distal radius fractures (IA-DRFs) and to assess prognostic factors that affect functional outcomes. Methods: Between March 2014 and February 2017, 54 patients who had intra-articular DRF and underwent AR-VP through the PQ preservation technique and completed 1-year follow-up were enrolled. Patients were divided into the satisfactory group (excellent and good results) and an unsatisfactory group (fair and poor results) based on the modified Mayo Wrist Scoring System (MMWS) scored at 1-year follow-up to determinate prognostic factors that affected clinical outcomes. Patients' demographics, clinical outcome measures (VAS, DASH, PRWE, etc.), and pre-and post-operative radiographic parameters were analyzed. Results: The outcomes according to MMWS were 10 excellent, 22 good, 14 fair, and 8 poor. A univariate analysis showed a significant difference between the groups (p < .05) for all radiographic parameters, sex, and the presence of an intra-articular comminution. In the multivariate analysis, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to uninjured wrist (> 20.1°) at trauma were considered as significant poor prognostic factors of functional outcome. Conclusions: AR-VP surgery through PQ preservation for intra-articular DRFs has reliable clinical and radiological outcomes. However, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to the uninjured wrist (> 20.1°) at initial injury were considered poor prognostic factors for AR-VP through PQ preservation for intra-articular DRF.

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.

A novel percutaneous achievement and maintenance of reduction and screw fixation for acute displaced scaphoid fractures: minimum two-year follow-up.

The purpose of this study was to introduce a novel method of percutaneous achievement and maintenance of reduction for acute displaced scaphoid fractures and evaluate the feasibility of this method in treating acute displaced scaphoid fractures as well as explore its indications. From February 2012 to March 2014, 15 patients with acute displaced scaphoid fractures were treated with our technique. Two Kirschner wires were used to achieve and maintain the reduction of the scaphoid fractures throughout the entire process of the traditional percutaneous screw fixation process. The following parameters including function scores according to modified Mayo wrist scoring system, range of motion (ROM) of the wrist, grip strength, pinch strength, healing time, time to return to work, and final outcomes were recorded. All patients were followed up with a mean period of 2.5years (range, 2-3.5years). All fractures healed with a mean of 9.3weeks (range, 7-11.5weeks). All patients returned to pre-injury level of activity within sixweeks. The functional scores averaged 90.3 (range, 80-100). ROM of the wrist was equal to that of the contralateral side at threemonths postoperatively. Grip strength and pinch strength compared with contralateral were 98% and 92%, respectively. All were satisfied with the final outcomes. Our technique is successfully performed in acute displaced scaphoid fractures resulting in shortened immobilization and prompt functional recovery. It broadens the indications of the percutaneous method, which means the advantages of the percutaneous method are maximally reserved whilst the drawbacks of open reduction were avoided.

Volar percutaneous screw fixation for scaphoid nonunion.

Percutaneous screw fixation is widely used in acute fractures of the scaphoid. In this study, we aimed to present our results with volar percutaneous screw fixation in patients with scaphoid nonunions. A total of 12 patients with scaphoid nonunion (≥13 weeks) that underwent volar percutaneous screw fixation were evaluated retrospectively. Two of the patients were female, and 10 were male. Mean age was 27 years (range = 19-41). The mean time that elapsed between the fracture and surgical procedure was 7.5 months (range = 4-12). According to the anatomic location, 33.3% were proximal pole, and 67.7% were waist fractures. All of the patients underwent percutaneous fixation with a headless cannulated screw from volar part under fluoroscopic guidance. Clinical evaluation was performed according to the modified mayo wrist scoring system (MMWS). The absence of a radiolucent fracture line on the radiographs was considered "union" on radiological evaluation. The mean follow-up time was 18 weeks (range = 8-36). Union was achieved in all patients (91.6%), except one. The mean time to union was 15.5 weeks (range = 8-30). Based on MMWS system, 8 patients were interpreted as excellent, 3 patients as good. Percutaneous fixation in appropriate patients provides satisfactory results with high union and minimal complication rates in scaphoid nonunions.

Comparison of two kinds of bone flap transplantation for treatment of old scaphoid fracture

Objective To compare surgical procedure and clinical effects of bone flap transplantation vascularized by recurrent branch of the radial artery and by descending genicular artery in the treatment of old scaphoid fracture. Methods From June 2009 to June 2015, a total of 49 patients with old scaphoid fracture were retrospectively reviewed. 22 cases were treated by internal fixation with transplantation of radial styloid bone flap pedicled on the recurrent branch of the radial artery, while the other 27cases by internal fixation with free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery. The operation time, fracture healing time and wrist function were compared between the two groups. Results The operation time of the descending genicular artery bone flap group (186.00±26.48) min was greater than that of the radial styloid bone flap group (107.00±25.18) min (t=10.617,P<0.001). However, the fracture healing time of the radial styloid bone flap group (16.90±3.58) weeks was longer than that of the descending genicular artery bone flap group (13.20±3.10) weeks (t=3.874,P<0.001). Modified Mayo wrist scoring system was used to evaluate the wrist function 6 months after the surgery. In the radial styloid bone flap group, the results were excellent in 12 cases, good in 9 cases, and fair in 1 case with the average score being 87. In the descending genicular artery bone flap group, the results were excellent in 12 cases, good in 13 cases, fair in 1 case, and poor in 1 case with the average score being 81. There was no significant difference between the two groups. Conclusion Both of the surgical procedures are effective methods for treating old scaphoid fracture. The free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery is faster in fracture healing, but more time-consuming and demanding. Key words: Scaphoid bone; Fractures,ununited; Vascularized bone flap

Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates.

Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento's modification of Lindstorm criteria respectively. There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento's modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius.

The Outcomes of Arthroscopic Repair Versus Debridement for Chronic Unstable Triangular Fibrocartilage Complex Tears in Patients Undergoing Ulnar-Shortening Osteotomy

The aim of this study was to compare the results of arthroscopic peripheral repair (AR) and arthroscopic debridement (AD) for the treatment of chronic unstable triangular fibrocartilage complex (TFCC) tears in ulnar-positive patients undergoing ulnar-shortening osteotomy (USO). A total of 31 patients who underwent arthroscopic treatments combined with USO for unstable TFCC tears and were followed-up at a minimum of 24 months were included in this retrospective cohort study. Fifteen patients were treated with AR, and 16 patients were treated with AD while at the same time undergoing a USO. Outcome measures included wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, and overall outcomes according to the modified Mayo wrist scoring system. In addition, a stress test to assess distal radioulnar joint (DRUJ) stability was performed before and after surgery to compare the 2 cohorts. Both respective cohorts showed significant improvements in grip strength and subjective scores at the final follow-up. Grip strength, DASH, and PRWE scores were better in the AR group than in the AD group. The recovery rate from DRUJ instability observed during the preoperative examination was superior in the AR group. Both AD and AR of the TFCC combined with USO are reliable procedures with satisfactory clinical outcomes for unstable TFCC tears in ulnar-positive patients. However, AR of the TFCC is suggested if DRUJ stability is concomitantly compromised. Therapeutic IV.

Scaphoid fracture combined with triangular fibrocartilage injury and radial head fracture: a new type of forearm injury triad

Objective To introduce a new triad of forearm injury: scaphoid fracture, triangular fibrocartilage (TFC) injury and radial head fracture, and discuss the similarities and differences comparing to Essex-Lopresti injury. Methods Six male patients of closed forearm injuries treated from October 2011 to May 2013 were involved in this study. They all had scaphoid and radial head fractures on the same side. Wrist arthroscopic examination was carried out in 3 cases that revealed injury to the radial rim of the TFC. One case had olecranon fracture on the contralateral side, while 5 cases had no other accompanying fractures.Two cases were non-surgically treated, while 4 cases were surgically managed where the scaphoid fracture was treated with percutaneous compressive cannulated screw fixation, and the laceration or perforation at the radial rim of the TFC revealed under wrist arthroscopy in 3 cases was treated with arthroscopic debridement. The radial head fracture in 3 cases was categorized as Mason type Ⅰ and treated with splint immobilization. Open reduction and internal fixation was used in 1 case of Mason type Ⅱ radial head fracture. Results All 6 patients were follow-up for 12 to 24 months. The mean follow-up period was 17 months. Fracture union was achieved in all six patients. Clinical evaluations using modified Mayo wrist scoring system and modified Morrey elbow score revealed excellent wrist and elbow functional results in all the patients. Conclusion Comparing to the typical Essex-Lopresti injury, the reported new triad of forearm injury has subtler clinical manifestations due to the relatively low energy impact despite of the similar injury mechanisms. Consequently, misdiagnosis or missed diagnosis is more likely to happen. Successful outcomes rely on prompt diagnosis and proper treatment. Key words: Scaphoid bone; Radius; Fractures, bone; Triangular fibrocartilage

Dorsal ligament reconstruction for old dorsal dislocation of distal radioulnar joint

Objective To evaluate the efficacy and safety of dorsal ligament reconstruction in treatment of old dorsal dislocation of distal radioulnar joint. Methods Seven patients with old dorsal dislocation of distal radioulnar joint were treated with dorsal ligament reconstruction using the palmaris longus tendon from March 2005 to May 2012 in our institute, including 4 males and 3 females with a mean age of 37 years. All patients had a history of wrist injury for more than 3 months and were diagnosed as isolated dislocation of distal radioulnar joint without fractures. During the operation a bone tunnel was made at dorsal ulnar side of radius near the ulnar notch, which was parallelized to long axial of ulna, two holes were drilled from dorsal to palmarulnaris side through the extensor carpi ulnaris sulcus of the ulna. The palmaris longus tendon was harvested and the strip of the tendon was penetrated through the radial hole. After the tips being crossed, put them through the holes of ulna, reduct the distal radioulnar joint by supinating the forearm, the strip of the tendon was sutured after being tightened, the reversed back the free end of the tendon to reconstruct the sheath of extensor carpi ulnaris tendon. Postoperatively, the upper extremity were kept in a long arm plaster in the position of elbow flexion 90° and forearm supination for 3 weeks, then the below elbow cast was replaced for another 3 weeks. Results Patients were followed-up for 1 year and 8 months-4 years and 2 months with the average of 2 years and 9 months. The rotation of wrist was improved and the handgrip strength was increased significantly. A functional evaluation was performed using the modified Mayo wrist scoring system. All patients had better wrists scores postoperatively(mean, 93) compared to preoperatively(mean, 68). All patients satisfied with the final result. Conclusion Dorsal ligament reconstruction should be a promise surgical modality for the old dorsal dislocation of distal radioulnar joint. Key words: Carpal joints, ulnoradial; Dislocations, dorsal; Ligament reconstruction

Résultats cliniques des cals vicieux scaphoïdiens après traitement chirurgical des pseudarthroses du scaphoïde : une étude à un recul minimum de cinq ans

BackgroundAlthough malunion resulting from reconstruction for scaphoid fracture nonunion is a typical complication, there has been little consideration regarding its clinical outcomes. HypothesisThe quality of restoration of the scaphoid anatomy may have little effect on clinical outcomes. Materials and methodsTwenty-five patients with scaphoid fracture nonunion underwent curettage and internal fixation with bone grafting performed by a single surgeon, and they were followed up for a minimum of 5 years. Some of these patients comprised the malunion group if the height/length ratio (H/L ratio) in the most central longitudinal computed tomographic image was more than 0.6. We compared the clinical outcomes of the malunion group with a well-union group based on various clinical scores (patient evaluation measure, disabilities of the arm, shoulder and hand, modified Mayo wrist scoring system). ResultsThe average follow-up period was 81 (range, 65–110) months, and 15 cases among the 25 patients were included in the malunion group. There were no statistical differences in the clinical scores between malunions (15 cases) and well unions (10 cases), and there was no correlation between the H/L ratios and the clinical outcomes. ConclusionThe clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up. Level of evidenceLevel IV, prognostic case series.

Clinical outcome of scaphoid malunion as a result of scaphoid fracture nonunion surgical treatment: A 5-year minimum follow-up study

BackgroundAlthough malunion resulting from reconstruction for scaphoid fracture nonunion is a typical complication, there has been little consideration regarding its clinical outcomes. HypothesisThe quality of restoration of the scaphoid anatomy may have little effect on clinical outcomes. Materials and MethodsTwenty-five patients with scaphoid fracture nonunion underwent curettage and internal fixation with bone grafting performed by a single surgeon, and they were followed up for a minimum of 5years. Some of these patients comprised the malunion group if the height/length ratio (H/L ratio) in the most central longitudinal computed tomographic image was more than 0.6. We compared the clinical outcomes of the malunion group with a well-union group based on various clinical scores (Patient Evaluation Measure, Disabilities of the Arm, Shoulder and Hand, modified Mayo wrist scoring system). ResultsThe average follow-up period was 81months (range: 65–110), and 15 cases among the 25 patients were included in the malunion group. There were no statistical differences in the clinical scores between malunions (15 cases) and well unions (10 cases), and there was no correlation between the H/L ratios and the clinical outcomes. ConclusionThe clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up. Level of evidenceLevel IV, prognostic case series.

Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly

Purpose: We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly. Materials and Methods: We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. Results: Using the MMWS, 13 cases were classified as ‘good’, 10 ‘fair’, and 5 ‘normal’. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p＞0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as ‘good’, 14 ‘fair’, and 7 ‘normal’. Conclusion: Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.

Distal capitate shortening with capitometacarpal fusion for management of the early stages of Kienböck's disease with neutral ulnar variance: case series

BackgroundThe aim of surgical management of Kienböck’s disease has been proposed to slow the progressive osteonecrosis and secondary carpal damage. The aim of this case series was to evaluate the results of a new technique, combining distal capitate shortening with capitometacarpal fusion for the treatment of Kienböck’s disease (Lichtman stage II or stage IIIA) in neutral ulnar variance patients.MethodsFrom 2009 to 2012, 12 patients (mean age: 25 ± 7.6 years) were enrolled in this series. Radiological and clinical evaluations using the modified Mayo wrist scoring system were performed both pre-operatively and 12 months post-operatively. In addition, values of the scapho-capitate angle were evaluated both pre-operatively and 12 months post-operatively. The mean follow-up was 20.7 ± 11.2 months. Statistical analysis was performed for comparisons between pre-operative and post-operative findings with the use of paired sample T test, Pearson’s correlation, independent sample T test, and Spearman’s rho correlation. Statistical significance was determined to be present at p <0.05.ResultsAll patients achieved bony union at the fusion site within a mean period of 11.5 ± 2.4 weeks. Regarding wrist pain, grip strength, total wrist arc of motion, practicing daily activities in a normal pattern, and the total modified Mayo wrist score, there were statistically significant differences between the pre-operative and post-operative results. For the differential arc of motion, the only non-significant results were at the ulnar/radial deviation range (p = 0.262). The mean pre-operative scapho-capitate angle was 29.75 ± 3.44 while the mean post-operative value was 33.67 ± 4.77 (p < 0.001). Both pre-operative and post-operative scapho-capitate angle values were positively correlated to post-operative pain, ulnar/radial deviation, and final score (p = 0.001, 0.027, 0.021 and p = 0.001, 0.004, 0.002, respectively). Other parameters had no correlation to this angle.Post-operative MRI (at 12 months follow-up) demonstrated better lunate revascularization in four patients; one of them was diagnosed as having Lichtman stage IIIA Kienböck’s disease. There were no patient-reported complications at the end of follow-up.ConclusionsDistal capitate shortening combined with capitometacarpal fusion represents a new reliable method in the treatment of early stages of Kienböck’s disease with neutral ulnar variance.

Functional outcome of arthroscopic assisted fixation of distal radius fractures

Background:Many studies in literature have supported the role of wrist arthroscopy as an adjunct to the stable fixation of unstable intraarticular distal radial fractures. This article focuses on the surgical technique, indications, advantages, and results using wrist arthroscopy to assess articular reduction and evaluates the treatment of carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries in conjunction with the stable fixation of distal radial fractures.Materials and Methods:We retrospectively evaluated 27 patients (16 males and 11 females), who underwent stable fixation of intraarticular distal radial fractures with arthroscopic evaluation of the articular reduction and repair of associated carpal injuries. As per the AO classification, they were 9 C 1, 12 C2, 2 C3, 3 B 1, and 1 B2 fractures. The final results were evaluated by modified Mayo wrist scoring system. The average age was 41 years (range: 18-68 years). The average followup was of 26 months (range 24-52 months).Results:Five patients needed modification of the reduction and fixation after arthroscopic joint evaluation. Associated ligament lesions found during the wrist arthroscopy were TFCC tears (n=17), scapholunate ligament injury (n=8), and luno-triquetral ligament injury (n=1). Five patients had combined injuries i.e. included TFCC tear, scapholunate and/or lunotriquetral ligament tear. There were 20 excellent, 3 good, and 4 fair results using this score.Conclusion:The radiocarpal and mid carpal arthroscopy is a useful adjunct to stable fixation of distal radial fractures.

The effects of osteoporosis on functional outcome in patients with distal radius fracture treated with plate osteosynthesis

The aim of this study was to evaluate the effect of osteoporosis on functional results in patients with distal radius fracture treated with plate osteosynthesis. The study included 37 female patients who underwent osteosynthesis using volar locking plate for distal radius fracture between 2006 and 2008. Diagnosis of osteoporosis was made with bone mineral density measurement. Patients were divided into two groups; Group 1 patients (20 patients; mean age: 56.5 years) had osteoporosis and a mean T-score of -2.6 SD, and Group 2 patients (17 patients; mean age: 37.1 years) did not have osteoporosis and had a T-score of -0.7 SD. Radiological results were evaluated according to the Stewart's criteria and activities of daily living were assessed with the modified Gartland and Werley score, the modified Mayo wrist scoring system, and the DASH scoring system. According to the Stewart's radiological evaluation criteria and modified Gartland and Werley scores, there was no statistically significant difference between Group 1 and 2 (p>0.05). However, a statistically significant difference was found between Group 1 and 2 according to the modified Mayo wrist scoring system and DASH scoring system (p<0.05). There was no radiological difference between the osteoporotic and non-osteoporotic patients with distal radius fractures treated with plate osteosynthesis. However, osteoporosis had a negative effect on the results and range of motion of the wrist, and activities of daily living were significantly restricted.

Treatment of Intra-articular Fractures of the Distal Radius using Wrist Arthroscopy

Purpose: The purpose of this study was to investigate the usefulness of wrist arthroscopy for treating intra-articular fractures of the distal radius. Materials and Methods: Twenty-two patients with intra-articular fracture of the distal radius received arthroscopic surgery. Fourteen patients with displaced intra-articular fractures were managed by arthroscopically assisted reduction and fixation. Three patients were treated with limited open reduction and fixation. We analysed the radiologic results, and measured the ranges of motion and grip strengths. Fuctional results were evaluated using the Modified Mayo Wrist Scoring System. The postoperative follow-up period averaged 16.8 months. Results: All showed articular step-off of less than 1 mm on wrist X-rays taken at the final follow-up (mean 0.3 mm; range, 0-1 mm). The mean arc of range of motion was 89.6% of that on the uninjured side, and the mean grip strength was 87.3% of that of the uninjured side. The average Modified Wrist Score was 91.8 (range, 75-100). Conclusion: Arthroscopic-assisted surgery is an useful method that provides excellent results with few complications in the treatment of intra-articular fractures of the distal radius.

UNSTABLE SCAPHOID FRACTURE NONUNION: A MEDIUM-TERM STUDY OF ANTERIOR WEDGE GRAFTING PROCEDURES

A retrospective review of 37 patients with scaphoid fracture nonunions treated by interpositional bone grafting and internal fixation was conducted at an average follow-up of 5.7 years. Solid radiographic union was achieved in 35 cases. Preexisting avascular necrosis was a major adverse factor for achievement of union and satisfactory outcome. Based on the modified Mayo wrist-scoring system, 15 patients had an excellent result, 11 had a good result, four had a fair result and seven had a poor result. Patients with preexisting degenerative changes had a significantly worse clinical outcome. The vast majority of the patients had satisfactory correction of scaphoid length and the associated dorsal intercalated segment instability (DISI). Although 30 patients showed radiographic evidence of mild or moderate degenerative changes at their latest follow-up, there was no significant progression of arthrosis and the scaphoid nonunion advanced carpal collapse deformity did not progress after healing of the fracture nonunion.