Patient-Related Wrist Evaluation Research Articles

Non- or minimally displaced distal radius fractures in adult patients < 50 years of age

BackgroundCurrently, non- or minimally displaced distal radius fractures are treated by 3 to 5 weeks of cast immobilisation. Many patients with a distal radius fracture suffer from long-term functional restrictions, which might be related to stiffness due to cast immobilisation. Current literature indicates that 1 week of immobilisation might be safe; however, no level 1 evidence is available. This trial aims to compare 1 week of brace immobilisation with 3 weeks of cast immobilisation in patients with distal radius fractures that do not need reduction.MethodsThe aim of this trial is to evaluate the non-inferiority of 1 week of brace immobilisation in patients with non- or minimally displaced distal radius fractures. A two-armed single blinded multicentre randomised clinical trial will be conducted in three hospitals. Adult patients, between 18 and 50 years old, independent for activities of daily living, with a non- or minimally displaced distal radius fracture can be included in this study. The intervention group is treated with 1 week of brace immobilisation, and the control group with 3 weeks of cast immobilisation. Primary outcome is the patient-reported outcome measured by the Patient-Related Wrist Evaluation score (PRWE) at 6 months. Secondary outcomes are patient-reported outcome measured by the Quick Disabilities of the Arm, Shoulder and Hand score at 6 weeks and 6 months, PRWE at 6 weeks, range of motion, patient-reported pain score measured by VAS score, radiological outcome (dorsal/volar tilt, radial height, ulnar variance, presence of intra-articular step off), complications and cost-effectiveness measured by the EuroQol 5 Dimension questionnaire, Medical Consumption Questionnaire and Productivity Cost Questionnaire.DiscussionThis study will provide evidence on the optimal period of immobilisation in non-operatively treated displaced and reduced distal radius fractures. Both treatment options are accepted treatment protocols and both treatment options have a low risk of complications. Follow-up will be according to the current treatment protocol. This study will provide level 1 evidence on the optimal period and way of immobilisation for non- or minimally displaced distal radius fractures in adult patients.Trial registrationABR 81638 | NL81638.029.22 | www.toetsingonline.nl. 18th of October 2023

Comparative Analysis of Radial Corrective Osteotomy and Sauvé–Kapandji Procedure for Malunited Distal Radius Fractures in Older Adults

Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé-Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults. Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores. The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups. Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO. Therapeutic II.

Effects of distal ulnar morphology on symptomatic extensor carpi ulnaris (ECU) subluxation and the clinical outcomes of anatomic ECU subsheath reconstruction: a retrospective observational study

Purpose: This study aimed to evaluate the association between distal ulnar morphology and symptomatic extensor carpi ulnaris (ECU) subluxation and assess the results of anatomic ECU subsheath reconstruction.Methods: To investigate the effects of distal ulnar morphology on symptomatic ECU subluxation, we compared distal ulnar morphology using magnetic resonance imaging among three groups: group 1 (symptomatic ECU subluxation, 12 cases), group 2 (non-symptomatic ECU subluxation, 24 cases), and group 3 (no ECU subluxation, 24 cases). Distal ulnar morphology was evaluated using ulnar variance, ulnar styloid length, and ECU groove depth. Clinical outcomes were evaluated using the Patient-Related Wrist Evaluation (PRWE) score, the Disabilities of the Arm, Shoulder, Hand (DASH) score, grip strength, and the range of motion of the wrist joint.Results: Ulnar variance showed a statistically significant difference between groups 1 and 2, and ECU groove depth showed statistically significant differences between groups 1 and 2 and between groups 2 and 3. Ulnar styloid length showed no statistically significant between-group differences. In patients with symptomatic ECU subluxation, there was a significant increase in the range of motion in supination and grip strength, and a significant decrease in the DASH score (from 40 to 9) and PRWE score (from 48 to 12). Conclusion: Negative ulnar variance was associated with symptomatic ECU subluxation, and shallow ECU groove depth was correlated to asymptomatic ECU subluxation, but unrelated to symptoms. Anatomic ECU tendon sheath reconstruction was identified as an effective surgical method.

A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population.

With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score. Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group. The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients.

Effectiveness of Physiotherapy Intervention in the Symptomatic Management of Hirayama Disease: A Case Report

Hirayama Disease (HD) is an infrequent condition. Due to its rarity and misdiagnosed nature, epidemiological data is limited. Therefore, the present study aimed to find the effectiveness of physiotherapy intervention in the symptomatic management of HD. The results of the present study provided evidence for the development of standardised protocol for treatment to manage the symptoms of HD. Hereby. the authors present a case of a 20-year-old male, who presented with the chief complaint of weakness in bilateral hands for the past 3 years. The patient was examined for upper limb motor functions using Nerve Conduction Velocity (NCV), Manual Muscle Testing (MMT), Patient-related Wrist Evaluation (PRWE) and Patientrelated Hand Evaluation, Quality of Life (QoL) Scale, Handheld Dynamometer (HHD) and Pinchmeter. Pre and post-intervention analysis of outcome measures were used to show the differences n the improvement of the patient’s symptoms. There was a clinical and symptomatic improvement in the scoring of PRWE from 29 to 6, NCV (30.17 m/s to 35.80 m/s on right side median nerve, 28.23 m/s to 32.06 m/s on right side ulnar nerve, 32.87 m/s to 37.23 m/s on left side median nerve, 32.13 m/s to 40.12 m/s on left ulnar nerve), MMT (from grade 2 or 3 to grade 3, 4 or 4+), QOL (72 to 99), HHD (0.3 lb to 0.5 lb of left side and 0.1 lb to 0.5 lb of right side) and Pinchmeter (0.5 lb to 3 lb of left and 0.2 lb to 1 lb of right side). The treatment given was effective in improving the patient’s symptoms. The results can be used to conduct further studies to add evidence-based literature in physiotherapy practice.

Surgical versus non-surgical interventions for distal radius fractures: a quantitative analysis of patient-rated wrist evaluation measures

Trials to assess differences in PRWE (Patient related wrist evaluation) over time, for both surgical and non-surgical interventions post DRFs (distal radius fractures) are rare. The DASH (Disabilities of the arm, shoulder and hand) questionnaire has been shown to be improved by a greater margin in the medium term for surgical interventions, than non surgical interventions. However, a study found that PRWE can be considered superior to the DASH questionnaire for DRFs, due to greater specificity to wrist pain and function. Conflicting data makes it difficult to determine surgical vs non-surgical superiority for DRF’s over time with PRWE as a recovery metric. PubMed and Cochrane were searched for randomised controlled trials up to 31.8.23, reporting PRWE over 3, and 12 months. Data was extracted by 2 researchers. The differences in PRWE over time post surgical and non-surgical interventions was assessed using unpaired T testing. 1226 records were screened. Four studies enrolling 817 participants met the eligibility criteria and were analysed. Significantly lower PRWE in surgical intervention has been identified at the 3 month mark (p&lt;0.001). There was greater significant change in non-surgical intervention between months 3 and 12 (p&lt;0.001). Change in PRWE over time may be a good indicator of functional outcomes in DRFs post surgical or non-surgical interventions. This could inform future clinical trial design and surgical decision-making. Further work is required to design even more user-friendly and digital patient-reported outcomes specifically for DRFs.

Osteoid Osteoma of the Hand: Surgical Treatment versus CT-Guided Percutaneous Radiofrequency Thermal Ablation.

(1) Background: Osteoid osteoma (OO) is one of the most common benign bone tumors. This type of osteogenic tumor is generally characterized by a well-defined lytic area with a vascularized central nidus surrounded by sclerosis and bone thickening. The wrist and hand bones are infrequent sites for osteoid osteoma: only 10% of the cases arise in these areas. Standard treatments are surgical excision and radio-frequency ablation (RFA), both with advantages and disadvantages. This study aimed to compare the two techniques to prove if RFA could be a potential alternative to surgery in the treatment of OO of the hand. (2) Methods: Patients treated for OO of the hand between January 2011 and December 2020 were evaluated and data was collected regarding the lesions' characteristics and the treatment outcome. Each patient was followed up for 24 months and VAS pain (Visual Analogue Scale), DASH (Disability of the Arm, Shoulder and Hand), and PRWE (Patient-Related Wrist Evaluation) scores were collected. (3) Results: A total of 27 patients were included in the study: 19 surgical and 8 RFA. Both treatments showed a significant improvement in pain and functionality. Surgery was associated with a higher complication rate (stiffness and pain), while RFA was associated with a higher recurrence rate (2/8 patients). RFA allowed for a speedier return to work. (4) Conclusions: We believe that osteoid osteoma treatment with RFA in the hand should be an available alternative to surgery as it allows rapid pain relief and a swift return to work. Surgery should be reserved for cases of diagnostic uncertainty or periosteal localization.

Evaluating Outcomes of Arthroscopic-assisted Treatment of Scaphoid Nonunion

Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as deformity, instability, and degenerative changes. Open reconstruction could jeopardize vascular supply and cause capsular contracture. Arthroscopic treatment of scaphoid nonunion is an effort to avoid such complications. Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion. Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surgery. Results: Based on radiographic findings, all patients' fractures were satisfactorily united after three months. Functional scores, motion range, and grip strength improved to an acceptable level. There was no complication, including infection or nerve damage. Conclusions: Arthroscopic treatment of scaphoid nonunion seems to be an effective method with low complications and favorable results.

Management of type 3 Kienbock's disease in manual workers by scaphocapitate fusion with minimum 7-year follow-up

BackgroundKienbock's disease results in altered wrist biomechanics producing debilitating pain at the wrist. The disease is staged according to radiological and clinical findings and the stage guides the treatment. Various treatment options have been described for stage 3, however, there is a lack of consensus over these treatment methods. Scaphocapitate fusion is the preferred surgical option for advanced Kienbock's disease. Previous studies had heterogeneous cohorts with a short duration of follow-up and a lack of uniform surgical technique. The purpose of the study was to show the long-term functional and radiological outcome of scaphocapitate arthrodesis (SCA) by using Herbert screw for the treatment of Kienbock's disease in manual workers. MethodsFor this single-centre, retrospective study, all consecutive patients who were manual workers and managed by SCA between January 2010 and Jan 2014 for Lichtman stage IIIA and IIIB with at least 7 years of follow-up were included. Patients were assessed using clinical and radiological parameters preoperatively and in the follow-up period. Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Related Wrist Evaluation (PRWE), and VAS for pain were assessed. ResultsOut of 27 patients, 4 lost to follow-up, therefore, 23 patients (14 women and 9 men) with 30 years of median age at the time of the surgery were included. DASH scores, PRWE scores, and VAS for pain significantly improved (p < 0.5) after surgery. Wrist range of motion and grip strength also improved significantly (p < 0.5). Postoperative radiological parameters were found to be within a normal range. ConclusionScaphocapitate fusion by Herbert screws gives good functional, clinical, and radiological outcomes, in stage 3 of Kienbock's disease with excellent rates of fusion with low complications. Even, in manual workers, scaphocapitate fusion can reliably provide good outcomes and this is maintained in the mid to long-term follow-up. Therefore, it should be considered as one of the procedures of choice. Level of evidenceRetrospective, Level 4.

Clinical and radiological evaluation of distal radio ulnar joint (DRUJ) in injuries around the wrist joint

Background & Method: This prospective, non randomised cohort study was carried out in the Department of Orthopaedics, Jawaharlal Nehru Medical College & Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute Of Medical Sciences (Deemed University) Wardha, with an aim to Clinico-radiological evaluation of distal radio ulnar joint (DRUJ) in injuries around the wrist joint. All patients who presented to our hospital were included in the study, Patients with compound wrist injuries were excluded from the study. In standardised format, data concerning patient’s history and clinical examination were collected. Those patients who fulfilled the inclusion criterion and gave a valid informed written consent were recruited in the study. Result: The wrist evaluation in cases of Acute DRUJ disruption were treated primarily along with associated wrist injuries was done after 24 week of treatment. PRWE (Patient Related Wrist Evaluation) score. However in patients of Chronic DRUJ disruption they slao evaluated using Mayo Wrist Score and PRWE Score. Conclusion: In our study total 132 patients of Acute DRUJ disruption and 28 patients of Chronic DRUJ disruptions were studied clinically and radiologically. Clinical and Radiological suspicion of DRUJ disruption should always be kept in mind while dealing with wrist, hand or forearm injuries. Distal Radio Ulnar Joint injury needs to be treated primarily along with the associated wrist, hand or forearm injury to restore near normal function of the Forearm and Wrist.

Interventions for Distal Radius Fractures: A Meta-analysis of Comparison Studies.

Background Distal radius fractures are one of the most frequent orthopaedic injuries. There are many effective treatment methods, such as volar plate, dorsal plate, percutaneous pins, external fixation, and casting; however, comparison of the treatment outcomes has not been thoroughly investigated. Our purpose is to determine if volar plating is the superior treatment method for distal radius fractures. We will address this through the following questions: First, is volar plating superior to dorsal plating, percutaneous pins, external fixation, or casting in terms of reported complications? Second, does volar plating produce superior functional outcomes to dorsal plating, percutaneous pins, external fixation, or casting? Third, are the radiographic outcomes superior for volar plating when compared with dorsal plating, percutaneous pins, external fixation, or casting? Methods MEDLINE, Academic Search Ultimate, Academic Search Complete, CINAHL Plus, and JSTOR databases, as well as manual search, were used to identify papers comparing complications and functional results of volar plating to other treatment methods for distal radius fractures published after the year 2000. Complication data and function scores were recorded. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data was analyzed for meta-analysis using Cochrane ReviewManager software. Results Compared with dorsal plate, volar plate performed significantly better in Gartland and Werley score. Volar plating outperformed percutaneous pins for loss of reduction, infection, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and ulnar deviation. Loss of reduction, malunion, Patient Related Wrist Evaluation (PRWE) score, DASH score, grip strength, ulnar deviation, and supination were significantly better for volar plating when compared with casting. When compared with external fixation, volar plating had significantly less cases of infection, lower QuickDASH score, and higher range of motion for flexion, pronation, and supination. All other complication and functional outcomes were not significantly different. Conclusions Distal radius fractures treated with volar plating showed relatively better measures of complications, function scores, and range of motion than other treatment methods; however, there was no significant difference in healing time when compared with percutaneous pins. More studies are needed to compare the rest of the treatment methods with each other.

A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis.

Surgical management of end-stage rheumatoid wrists is a contentious topic. The standard surgical treatment has traditionally been wrist arthrodesis. Wrist arthroplasty, however, offers an alternative that preserves some wrist motion. A systematic review of MEDLINE, EMBASE and CENTRAL databases was conducted. Data from 23 studies representing 343 cases of wrist arthrodesis and 618 cases of wrist arthroplasty were included. Complication rates were 17% for arthrodesis and 19% for arthroplasty, and both procedures were effective at alleviating pain and improving grip strength. Functional assessment by Disabilities of the Arm, Shoulder, and Hand and Patient-Related Wrist Evaluation of arthroplasty patients revealed clinically meaningful functional improvement compared with preoperative measurements. In contrast to previously published findings both procedures demonstrated comparable complication rates. While this can be speculated to be from advancements in prosthetics, robust long-term follow-up data on wrist arthroplasty are not available yet.

Movement Analysis with Inertial Measurement Unit Sensor After Surgical Treatment for Distal Radius Fractures.

Inertial measurement unit (IMU) has recently been used to evaluate a movement of a body segment to provide accurate information of movement's characteristics. IMU systems have been validated to successfully measure joint angle during upper limb range of motion (ROM). The study aimed to retrospectively evaluate, using an IMU, the ROM recovery of the wrist after surgical treatment for distal-radius fractures with Kirschner wire fixation (KWF) or with volar plate fixation (VPF) and screws. To assess pain in the wrist joint, muscle-fatigue (MF), and functional difficulties in activities of daily living, we evaluated the patients through patient-related wrist evaluation questionnaire (PRWE) scale, disability of the arm, shoulder and hand (DASH) scale, Hand Grip Strength (HGS), and surface electromyography (EMG). We used a single IMU composed of three-axis gyroscope, a three-axis accelerometer, and a magnetometer. We calculated the value of ROM as a percentage with respect to the unaffected wrist. We also recorded surface-EMG signals over biceps brachialis, flexor carpi radialis (FCR), extensor carpi radialis (ECR), and pronator teres muscles. Forty patients were recruited for our study. Ulnar deviation (UD) was significantly higher for VPF than for KWF (p = 0.017); supination was significantly higher for VPF than for KWF (p = 0.031). The percentage of decay of the median frequency of FCR of volar plate was significantly higher than KWF. The HGS of KWF was significantly higher than VPF. In literature, there were no significant differences between the two types of treatment at long-term follow-up. Our results demonstrate a superior efficacy of VPF in terms of ROM improvement in UD and supination, but for these patients, muscle fatigue is greater than the KWF group. Based on the data available, VPF is similar to KWF for the treatment of distal radius fractures. The IMU sensor could be used in the future to evaluate ROM after surgery during patient's rehabilitation and to compare the effects with stratified analysis regarding age and fracture type, paralleled with cost-effectiveness analysis.

Arthroscopic Foveal Reattachment of the Triangular Fibro Cartilaginous Complex.

Background Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair, providing a strong bony fixation in the fovea. Materials and Methods Through 3-4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture at its free end. It is then reattached to the fovea with an impacted anchor. Retrospective Study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluation was based on a compared measurement of the grip strength, pain on a visual analogic scale (VAS), different ranges of motion, and distal radioulnar joint (DRUJ) stability. We also used functional scores: Mayo modified wrist score (MMWS), Quick disability arm, shoulder and hand (DASH), and patient-related wrist evaluation (PRWE). The average follow-up was 29.4 months (range 9-42 months). Results On postoperative evaluation, pain was reduced by 5 points (range 1-9) and grip strength averaged 94% of the unaffected side. Range of motion averaged 92% on the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1, and satisfactory for 3 patients. Quick Dash averaged 17.68 (range 0-38.6) compared with preoperative average of 59.48 (range 45-77) with an amelioration of 43 (range 34-57). PRWE averaged 20 (range 1-41.5) compared with preoperative average of 60.3 (range 33.5-76.5) with an amelioration of 41 (range 32-58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Conclusions We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea. Repairs performed with this technique are simple and the results achieved seem to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow-up are required. It however became our first choice of treatment in European Wrist Arthroscopy Society (EWAS) 2 lesions of the TFCC.

Radioscapholunate Fusion for Radiocarpal Osteoarthritis: Prognostic Factors of Clinical and Radiographic Outcomes.

Background Radioscapholunate (RSL) fusion is a surgical option to manage radiocarpal osteoarthritis. Many authors upgrade the procedure by adding distal scaphoid excision with or without excision of the triquetrum. Our objective was to identify the prognostic factors for good clinical and radiographic outcomes of RSL arthrodesis. Purpose Distal scaphoid excision improves both scaphotrapeziotrapezoidal osteoarthritis and radiocarpal fusion, and excision of the triquetrum is not critical to achieving satisfactory outcomes. Methods In this retrospective and bicentric investigation, all wrists were managed with RSL fusion for posttraumatic radiocarpal osteoarthritis. A total of 85 patients were included and evaluated at the revision by clinical (pain, wrist motion, and strength), functional (Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Related Wrist Evaluation score, and Modified Mayo Wrist Score), and radiological (scaphotrapeziotrapezoidal, midcarpal osteoarthritis, and radiocarpal nonunion) examinations. We assessed prognostic factors for clinical and radiographic (osteoarthritis and nonunions) outcomes. Results The average follow-up was 9.1 years (1-21.4). Work-related accidents adversely impacted the clinical outcomes, and distal scaphoid excision significantly improved them and decreased scaphotrapeziotrapezoidal osteoarthritis and nonunion. Neither distal scaphoid excision nor excision of the triquetrum influenced midcarpal osteoarthritis. Radiocarpal fusion was significantly promoted by memory staples and bone grafting. Discussion Distal scaphoid excision should be preferred to improve the functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. Excision of the triquetrum appears to be an alternative to radioulnar resection-arthroplasty to solve ulnocarpal impaction syndrome. Strict surgical procedure must be observed to promote RSL fusion combining solid bone fixation and the use of bone graft. Level of evidence This is a level IV, case series, retrospective series.

Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter's degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

Comparison of Volar Henry and Extended Flexor Carpi Radialis Approaches in the Surgical Treatment of Distal Radius Fractures

Objectives: The aim of this study was to compare the clinical and radiological results of volar Henry (VH) and extended flexor carpi radialis (EFCR) approaches used for open reduction of distal radius fractures. Methods: We reviewed 85 patients with distal radius fractures treated with volar locking plates between 2014 and 2017. The EFCR approach was used in 30 (35.3%) patients, and the VH approach was used in 55 (64.7%) patients for open reduction. Clinical results were reviewed by the Quick Disability of the Arm, Shoulder and Hand; Patient-Related Wrist Evaluation; and Boston Carpal Tunnel Syndrome questionnaires. Bilateral wrist range of motion, grip, and pinch strengths were measured, and sensory evaluations were done with the Semmes-Weinstein monofilament test and static two-point discrimination tests. Radiological evaluations were done with final follow-up radiographs. Results: The mean age was 50.7, and the average follow-up time was 31.8 months. No differences were found between the two groups related to clinical and radiological outcome evaluations. In the VH group, six post-operative complex regional pain syndromes, one tendon rupture, three delayed carpal tunnel syndromes, and one osteomyelitis were observed. In the EFCR approach group, complex regional pain syndrome was observed in four patients. Conclusion: Similar clinical and radiological results were found with the EFCR approach and VH approach in the treatment of distal radius fractures. As the EFCR approach seems to be safe for routine open reduction of distal radius fractures, it should especially be kept in mind in cases with median nerve entrapment.

External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures-A 3-Year Follow-Up of aRandomizedControlled Study.

To determine if a volar locking plate (VLP) is superior to external fixation (EF) 3 years after surgery for unstable, dorsally displaced, distal radius fractures caused by low-energy injury in patients 50 to 74 years of age. During 2009 to 2013, 140 patients with an unstable dorsally displaced distal radius fracture were randomized to either VLP or EF. One hundred eighteen patients (EF 56, VLP 62) were available for a 3-year follow-up. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 3 years. Secondary outcomes were Patient-Related Wrist Evaluation (PRWE) score, EuroQol-5 Dimensions (EQ-5D) score, range of motion (ROM), grip strength, and radiological signs of osteoarthritis (OA) at 3 years. Moreover, reoperations and minor complications during the first 3 years were recorded. There were no differences regarding DASH, PRWE, EQ-5D, ROM or grip strength. The reoperation rate was 21% (13 of 62) in the VLP group compared with 14% (8 of 56) in the EF group. The OA rate was 42% (25 of 59) in the VLP group compared with 28% (15 of 53) in the EF group. Three years after surgery for unstable dorsally displaced distal radius fractures, the clinical and radiological results for VLP and EF were comparable. Therapeutic II.

Non- or Minimally Displaced Distal Radial Fractures in Adult Patients: Three Weeks versus Five Weeks of Cast Immobilization-A Randomized Controlled Trial.

Background Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome. Purpose We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks. Materials and Methods The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement. Results Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p = 0.045) and QuickDASH scores (0.0 vs. 12.5, p = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups ( p = 0.46). Conclusion Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning.

Désinsertion du muscle brachis radialis dans l’ostéosynthèse des fractures distales du radius de type C selon l’AO

IntroductionOpen reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, whether this common procedure makes the reduction and fixation easier and affects the elbow function has not been fully understood. HypothesisBrachioradialis (BR) release during volar plate fixation for type C distal radius fractures makes internal reduction and fixation easier, and it does not adversely affect wrist or elbow function. Material and methodsA total of 74 patients treated with 2.4mm volar locking compression column plate (VCP) were analyzed for type C distal radius fractures prospectively. The patients were divided into two groups, group A with BR release and group B without BR release. The two groups were compared in terms of “internal reduction and fixation time” during the operation, wrist and elbow function including the scores of Gartland and Werley (G-W), Patient-Related Wrist Evaluation Score (PRWE), Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) and a visual analogue scale (VAS) for pain at 6 and 12 months postoperatively. The radial inclination angle, palmar tilt angle and ulnar variance were also measured from the radiographs. ResultsAccording to the follow-up of the 74 patients, no significant differences were observed between the two groups on MEPS, DASH, G-W, PRWE, VAS and radiological outcomes at 6 and 12 months postoperatively. Mean time of reduction and internal fixation was significantly shorter in group A than that in group B. ConclusionRelease of the BR for type C distal radius fractures facilitated the surgical procedure and did not adversely affect elbow and wrist function. Level of evidenceII, prospective comparative study.