Plating Of Distal Radius Fractures Research Articles

Volar fixed plating of distal radius fractures: optimizing plate position for enhanced clinical outcomes

BackgroundThe precise influence of plate position on clinical outcomes in the context of volar fixed-angle plating for distal radius fractures is not fully understood. This article aims to investigate the influence of plate position on clinical results, and functional outcomes in patients treated with volar fixed plating for distal radius fractures.MethodsA total of 58 patients with 64 distal radius fractures were included in the study. Patient demographics, fracture characteristics, surgical details, and radiographic data were collected. Post-operative AP and Lat views of all patients taken on the first day after surgery were evaluated. Volar Tilt, Radial Inclination and Radial Height measurements were used as reduction criteria. In the follow-up, the patients were called for their last control, flexion and extension angles of the wrist and Mayo Wrist Scores, the distance of the plate to the joint line and the angle between the plate and the radial shaft were measured and recorded.ResultsA total of 64 distal radius fractures, with a mean age of 46.9 years, and the mean follow-up period 24.9 months were included in this study. There was a significant relationship between the Radial Inclination and Plate-Shaft Angle variables and the Mayo Wrist Score at a 99% confidence interval. Additionally, a relationship was observed between the Radial Height variable and the Mayo Score at a 90% confidence interval. A significant positive association was observed between radial inclination and achieving a Good-to-Excellent Mayo score (OR = 1.28, 95% CI [1.08–1.51], p = 0.004). Plate distance to joint line demonstrated a marginally significant positive association with a Good-to-Excellent Mayo score (OR = 1.31, 95% CI [0.97–1.77], p = 0.077). Univariate analysis revealed a significant negative association between plate-shaft angle and achieving a Good-to-Excellent Mayo score (OR = 0.71, 95% CI [0.52–0.99], p = 0.045). This negative association remained statistically significant in the multivariate analysis (p = 0.016).ConclusionRadial inclination, plate distance to joint line, and angle between plate and radius shaft were identified as significant factors associated with improved Mayo Wrist Scores.

The Outcome of under 10 mm Single-Incision Surgery Using a Non-Specialized Volar Plate in Distal Radius Fractures: A Retrospective Comparative Study.

The distal radius fracture is a common orthopedic injury. We aimed to share the surgical steps and investigate the outcomes of treating distal radius fractures with wounds ≤10 mm using a globally accessible locking plate. We collected 46 patients who underwent surgery via a <10 mm wound, with a control group consisting of 40 patients who underwent conventional procedures. Both groups were treated using the same volar plate. We compared the radiographic reduction quality, including volar tilt angle, radial inclination angle, and ulna variance. Additionally, clinical outcomes, such as pain assessed using VAS, Q-Dash score, and PRWE, were evaluated. Patient satisfaction with the wound was also analyzed. The follow-up time for the clinical outcomes was 24.2 ± 13.47 months. There were no differences in the quality of reduction in parameters such as the volar tilt angle (p = 0.762), radial inclination angle (p = 0.986), and ulna variance (p = 0.166). Both groups exhibited comparable results in pain VAS (p = 0.684), Q-Dash score (p = 0.08), and PRWE (p = 0.134). The ≤10 mm incision group displayed an increase in satisfaction with the wound (p < 0.001). Treating distal radius fractures with a <10 mm wound using a non-specialized locking plate is a feasible approach. It does not compromise the quality of fracture reduction or functional scores and improves wound satisfaction.

Wrist &amp; Hand

The December 2023 Wrist &amp; Hand Roundup360 looks at: Volar locking plate for distal radius fractures with patient-reported outcomes in older adults; Total joint replacement or trapeziectomy?; Replantation better than revision amputation in traumatic amputation?; What factors are associated with revision cubital tunnel release within three years?; Use of nerve conduction studies in carpal tunnel syndrome; Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis; Association between radiological and clinical outcomes following distal radial fractures; Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study.

Outcomes of Volar Plating Distal Radius Fractures Based on Surgical Timing.

While complexity of distal radius fractures varies, volar plating is the most prevalent surgical option in adult injuries. The time between date of injury and surgical intervention varies according to several factors, including the timing of presentation and the surgeon's availability. This study aims to understand the impact of a delay in surgical intervention on operative time, patient-reported outcomes, and reoperation rates. A retrospective review was performed on patients treated with volar plating of distal radius fractures from 2017 to 2020 at a single institution by multiple surgeons. Perioperative medical records were reviewed. Patients were divided into 2 groups using a cut-off date of surgery performed 12 days after injury. Descriptive analyses were used to compare demographics, fracture characteristics, operative information, and outcome data including postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and reoperation rates between groups. A total of 257 patients were included. There was no difference in age, gender, smoking status, fracture type, or postoperative QuickDASH scores between groups. Patients fixed at 12 days or more after injury had a higher rate of reoperation, higher American Society of Anesthesiologists scores, and more surgeon experience. Volar distal radius fixation at 12 or more days after injury had no discernible differences with fracture type, operative time, or tourniquet time; however, a higher rate of reoperation was found in this group compared to earlier intervention. These data may provide important prognostic information that can be used to educate patients who present in a delayed fashion.

Pronator Quadratus Muscle Flap for Prevention of Flexor Tendon Rupture after Distal Radius Volar Plating.

Flexor tendon rupture is a serious but rare complication that can occur after volar plating of distal radius fractures. This study aims to introduce a novel surgical technique that uses a pronator quadratus (PQ) muscle flap transposition to protect the flexor tendons from rupture or irritation and evaluate its outcomes. A retrospective review was conducted on 204 patients with unstable distal radius fractures who underwent a standard volar flexor carpi radialis approach with extended release of the PQ muscle during exposure. A PQ muscle flap was harvested and transposed over the distal edge of the plate after open reduction and internal fixation of the distal radius. Postoperatively, patients were evaluated for flexor tendon irritation and rupture. Patients who had this injury before the use of the PQ flap were compared with the patients who received the PQ flap. Of the 204 patients, 119 received the PQ flap, and 85 did not. The mean follow-up time was 30.4 months. Among the patients who did not receive the PQ flap, five (5.9%) required plate removal or conservative treatment for tendon irritation or rupture. In contrast, only one patient (0.8%) who received the PQ flap required plate removal for flexor tendon irritation. The PQ muscle flap is a quick and effective surgical technique that reduces the risk of flexor tendon rupture or irritation during distal radius fracture fixation. The PQ muscle flap acts as a buffer between the plate and tendon and is more effective than not transposing the muscle.

Pronator quadratus repair after volar plating for distal radius fractures: A systematic review and meta-analysis of randomized controlled trials.

The purpose of the current study is to meta-analyze the randomized controlled trials in the literature comparing pronator quadratus repair versus no repair alongside volar plating of distal radius fractures. A search of the PUBMED/MEDLINE, EMBASE, and The Cochrane Library databases was performed. Any randomized con- trolled trials comparing pronator quadratus repair versus no repair alongside volar plating of distal radius fractures were included. The relevant information was collected by 2 blinded reviewers using a predetermined data sheet. Clinical outcomes were compared, with all statistical analyses performed using Review Manager Version 5.3. Five randomized controlled trials with 273 patients were included. There was no significant difference in the range of motion in flexion-extension, ulnar-radial deviation, or pronation-supination. There was a significant difference in favor of the no repair group for Disabilities of the Arm, Shoulder and Hand (DASH) Score (MD [Mean Difference]: 2.63, P < .0001) and pronation strength (MD: 13, P < .0001). Furthermore, there was no significant difference in the visual analog scale score. There were 3 complications relating to pronator quadratus repair, in which patients developed carpal tunnel syndrome requiring a release. There was no significant difference in the re-operation rate. This study found that pronator quadratus repair when performing volar plating for distal radius fractures did not result in a significant improvement in functional outcome, range of motion, or strength. I, Systematic Review of Level 1 Studies, Level I, Therapeutic Study.

Adjuvant Arthroscopy Does Not Improve the Functional Outcome of Volar Locking Plate for Distal Radius Fractures: A Randomized Clinical Trial

To evaluate the outcomes of adding arthroscopy to osteosynthesis of distal radius fractures (DRF) with volar locking plate (VLP), by Patient-Rated Wrist Evaluation (PRWE) 1 year after surgery. In total, 186 functionally independent adult patients who met the inclusion criteria (DRF and a clinical decision for surgery with a VLP) were randomized to arthroscopic assistance or not. Primary outcome was PRWE questionnaire results 1 year after surgery. For the main variable, PRWE, we obtained the minimal clinically important difference based on a distribution-based method. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand and 12-Item Short Form Health Survey questionnaires, range of motion, strength, radiographic measures, and presence of joint step-offs by computed tomography. Data were collected preoperatively and at+1 and+4 weeks,+3 and+6 months, and+1 year after surgery. Complications were recorded throughout the study. In total, 180 patients (mean age: 59.0 ± 14.9 years; 76% women) were analyzed by modified intention to treat. A total of 82% of the fractures were intra-articular (AO type C). No significant difference between arthroscopic (AG) and control (CG) groups in median PRWE was found at+1 year (median AG: 5.0, median CG: 7.5, difference in medians 2.5; 95% confidence interval [CI] -2.0, 7.0, P= .328). The proportion of patients who exceeded the minimal clinically important difference of 12.81 points in the AG and CG was 86.4% vs 85.1%, P= .819, respectively. Percentage of associated injuries and step-offs reduction maneuvers was greater with arthroscopy (mean differences: 17.1 95% CI -0.1, 26.1, P < .001) and 17.4 (95% CI 5.0, 29.7, P= .007). The difference in percentage of residual joint step-offs at the postsurgical computed tomography in radioulnar, radioscaphoid, and radiolunate joints was not significant (P= .990, P= .538, and P= .063). Complications were similar between groups (16.9% vs 20.9%, P= .842). Adjuvant arthroscopy did not significantly improve PRWE score+1 year after surgery for DRF with VLP, although the statistical power of the study is below the initially estimated to detect the expected difference. Level I, randomized controlled trial.

Influence of surgical performance on clinical outcome after osteosynthesis of distal radius fracture

IntroductionClinical outcome after surgery depends on the surgeon's level of expertise or performance. The present study of minimally invasive plate osteosynthesis (MIPO) with anterior plate for distal radius fracture assessed whether clinical outcome correlated with surgeon performance. MethodsThe series included 30 distal radius fractures: 15 operated on by 4 level III surgeons (Group 1) and 15 by 4 level V surgeons (Group 2), utilizing the MIPO technique. The surgical performance of all 8 surgeons was assessed using the OSATS global rating scale. Clinical outcomes were assessed at 3 months’ follow-up using the modified Mayo score (MMS), in 4 grades: 0–64 (poor), 65–79 (moderate), 80–89 (good), and 90–100 (excellent). The QuickDASH score (QDASH) was also calculated, and complications were recorded. ResultsMedian MMS was better for level V (75 = fair result) than level III surgeons (62 = poor result). Median QDASH score likewise was better in group 2 (9.1) than group 1 (22.7). In group 1, there were 2 paresthesias in the median nerve territory, 1 type-1 complex regional pain syndrome, and 1 hypoesthesia in the scar area. Mean correlation between the 2 scores was –0.68. Group 1 patients were on average 7 years older. The number of patients, number of surgeons and distribution of OA A and C fractures were almost identical in the two groups. On MMS, the overall result of the two groups was moderate (70.5), which can be explained by short mean follow-up. DiscussionQuality of the clinical outcome on MMS and QDASH increased with surgical performance, with fewer complications. In the patients' interest, protocols for improving surgical performance should be implemented, for example, through deliberate practice.

Association of Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults

ImportanceRandomized clinical trials (RCTs) and meta-analyses have reported inconsistent conclusions regarding optimal distal radius fracture (DRF) treatment in older adults and are limited due to the inclusion of cohort studies with small sample sizes. A network meta-analysis (NMA) addresses these limitations by only synthesizing direct and indirect evidence from RCTs and may clarify optimal DRF treatment in older adults.ObjectiveTo examine DRF treatment results in optimal short-term and intermediate-term patient-reported outcomes.Data SourcesSearches of MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes in older adults between January 1, 2000, and January 1, 2022.Study SelectionRandomized clinical trials including patients with a mean age of 50 years or older that compared the following DRF treatments were eligible for inclusion: casting, open reduction and internal fixation with volar lock plating (ORIF), external fixation, percutaneous pinning, and nail fixation.Data Extraction and SynthesisTwo reviewers independently completed all data extraction. An NMA aggregated all direct and indirect evidence among DRF treatments. Treatments were ranked by surface under the cumulative ranking curve score. Data are reported as standard mean differences (SMDs) and 95% CIs.Main Outcomes and MeasuresThe primary outcome was short-term (≤3 months) and intermediate-term (&amp;amp;gt;3 months to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1-year complication rates.ResultsIn this NMA, 23 RCTs consisting of 3054 participants (2495 women [81.7%]) with a mean (SD) age of 66 (7.8) years were included. At 3 months, DASH scores were significantly lower for nail fixation (SMD, −18.28; 95% CI, −29.93 to −6.63) and ORIF (SMD, −9.28; 95% CI, −13.90 to −4.66) compared with casting. The PRWE scores were also significantly lower for ORIF (SMD, −9.55; 95% CI, −15.31 to −3.79) at 3 months. In the intermediate term, ORIF was associated with lowered DASH (SMD, −3.35; 95% CI, −5.90 to −0.80) and PRWE (SMD, −2.90; 95% CI, −4.86 to −0.94) scores. One-year complication rates were comparable among all treatments.Conclusions and RelevanceThe findings of this NMA suggest that ORIF may be associated with clinically significant improvements in short-term recovery compared with casting for multiple patient-reported outcomes measures with no increase in 1-year complication rates. Shared decision-making with patients may be useful to identify patient preferences regarding recovery to determine optimal treatment.

The Intraoperative Dorsal Tangential View and the Radial Groove View of the Distal Radius to Detect Dorsal Screw Protrusion in Volar Plating: Teaching Effect and Value in Clinical Practise

Abstract Background Dorsal screw tip protrusion (DSTP) with extensor tendon injury is a well-known complication of volar plating for distal radius fractures. The dorsal tangential view (DTV) and the radial groove view (RGV) have been recommended to detect DSTP. The value of these views depends on their quality and reproducibility. Aims It was the aim of this study to investigate the quality of these views before and after teaching of the involved surgeons. Methods All adult patients treated with volar plating for distal radius fractures between 10/2019 and 10/2020 were included. Prior to their first case in the study period, all involved surgeons were instructed in a standardized manner how to perform technically correct DTV and RGV. Patients from an earlier period served as controls. Image quality was rated independently by two investigators. Detection of DSTP based on fluoroscopy was documented and protruding screws were exchanged. The impact of teaching was assessed. Furthermore, reliability of DTV and RGV to detect DSTP was compared to postoperative ultrasound. Results A total of 124 patients were included in the study group, 125 patients served as controls. Interobserver agreement for the image quality was 97% for DTV and 98% for RGV. Image quality significantly improved with teaching (p&amp;lt;0.001). Correct images were observed in 81% vs. 58% for DTV and 81% vs. 53% for RGV. From a total of 571 evaluated screws intraoperative fluoroscopy identified 24 DSTP (4.2%) in 23 patients (18.5%). Postoperative ultrasound revealed 4 DSTP (0.8-1.2mm; 0.7%) in 4 patients (3.2%). Conclusions Teaching surgeons how to perform technically good DTV and RGV leads to a significant improvement of image quality. DTV and RGV are reliable tools to detect DSTP. However, despite correct views, some minor dorsal cortex penetrations may be missed. Thus, early further investigations are recommended in patients with extensor tendon irritation.

Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial

BackgroundThis study aimed to compare functional outcomes of a volar plate osteosynthesis for distal radius fractures (DRF) performed with either a standard volar approach (SVA), which required detachment of the pronator quadratus muscle, or a pronator-sparing approach (PqSA).Materials and methodsThis prospective randomized controlled study included 106 patients scheduled for volar plate osteosyntheses. Patients were allocated to either the SVA group (n = 53) or the PqSA group (n = 53). Patients were blinded to treatment until completion of the study. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcome parameters were the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Modified Mayo Wrist Score (MMWS). Follow-up examinations were performed at 8 weeks and 3, 6, and 12 months postoperatively.ResultsOverall, 91 patients were included in the final analysis: 48 in the SVA group and 43 in the PqSA group. The two cohorts were not significantly different in demographic characteristics, including age, sex, injuries on the dominant side, type of injury, and fracture classification. We found significant differences between groups at 6 months in the mean PRWE (SVA: 12.3 ± 10.4, PqSA: 18.9 ± 14.11 points) and in the mean DASH score (SVA: 12.3 ± 11.9, PqSA: 19.3 ± 16.7 points), which favoured the SVA. We found no significant differences between groups in the MMWS or in the PRWE and DASH scores at any other time points.ConclusionsThis randomized comparative clinical trial failed to demonstrate that a volar plate osteosynthesis performed with a PqSA could improve the outcome, compared to the SVA, in patients with DRF.Level of evidenceIITrial registration Comparison of Two Volar Plating Systems for Distal Radius Fractures, ClinicalTrials.gov (NCT03474445), registered 22 March 2018, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03474445?cond=radius&cntry=AT&draw=2&rank=1

Radius palmar plate removal without carpal tunnel release: Correlation between plate position and median nerve symptoms

We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93–16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. Level of EvidenceIV; Therapeutic.

Higher Soong grade predicts flexor tendon issues after volar plating of distal radius fractures – a retrospective cohort study

Background and purposeSoong classification is used to estimate volar locking plate prominence and evaluate the risk for flexor tendon ruptures after surgical treatment of distal radius fractures (DRFs). However, the scientific community has questioned the Soong classification due to lacking evidence. Therefore, this study aimed to evaluate the accuracy of Soong grading as a predictor for flexor tendon issues and plate removal.Patients and methodsWe performed a retrospective single-center review of adult distal radius fracture patients treated with a volar locking plate between 2009 and 2019. In total, 2779 patients were included in the study. The primary outcome was a flexor tendon issue (flexor tendon rupture, tendinitis, or flexor irritation), whereas plate removal was a secondary outcome. Using Soong grade 0 as a reference, we used univariable and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for flexor tendon issues and plate removal.ResultsIn total, 756 (27%) patients were graded as Soong 0, 1679 (60%) Soong 1, and 344 (12%) Soong 2, respectively. There were 32 (1.2%) patients with flexor tendon issues, of which 4 were flexor tendon ruptures, 8 tendinitises, and 20 flexor irritations. The adjusted OR for flexor tendon issues was 4.4 (CI 1.1–39.7) for Soong grade 1 and 9.7 (CI 2.2–91.1) for Soong grade 2. The plate was removed from 167 (6.0%) patients. Soong grade 1 had a univariable OR of 1.8 (CI 1.2–2.8) for plate removal, and Soong grade 2 had an OR of 3.5. (CI 2.1–5.8), respectively.ConclusionFlexor tendon ruptures are rare complications after the volar plating of DRFs. A higher Soong grade is a risk factor for flexor tendon issues and plate removal.Trial registrationThe trial was retrospectively registered.

Conservative management versus volar plating for dorsally displaced distal radius fractures in the elderly: A randomized control trial.

This randomized trial aims to compare the clinical, and radiological outcomes between plaster cast and volar plating for distal radius fractures (DRF) in the elderly at six months, and one-year. A randomized trial was performed at Jinnah Postgraduate Medical Centre between February 2015 and April 2020. The study included patients that were above 60 years but under 75 with an isolated, closed, unilateral, dorsally displaced DRF. Randomization into two groups (casting or plating) was based on a computer-generated algorithm stratified by age group and AO/OTA fracture type. The primary outcome was Patient Rated Wrist Evaluation score. Secondary clinical outcomes were active range of motion, grip strength, the Mayo's wrist score and the quick Disability Arm, Shoulder, Hands scale. Patient's satisfaction was evaluated with use of a SF-12 questionnaire and finally complications were recorded. This trial has shown that there is no significant difference in clinical outcomes of DRF at six and twelve months follow up when treated by cast immobilization or plating. Although, the radiological parameters and the number of complications were significantly higher in the immobilization group. The results of the trial have shown that plating and casting are equally effective in achieving satisfactory patient reported and clinical outcomes at intermediate and final follow-up restoring patient satisfaction.Trial registration: The trial is registered in the Chinese Clinical Trial Registry. The trial registration number is ChiCTR2000032843, and the URL is: http://www.chictr.org.cn/searchprojen.aspx.

Risk Factors of Flexor Tendon Rupture After ORIF of Distal Radius Fracture.

To analyze the risk factors associated with postoperative flexor tendon rupture, after a volar plate fixation of distal radius fractures. Retrospective observational case-control study. Tertiary Care University Hospital in the Republic of Korea (2009-2020). Sixteen referred patients were treated for flexor tendon rupture, following previously performed volar plating of distal radius fractures at other institutions. 16 patients were randomly selected from our database as controls, and were matched based on the Soong grade of the case group. Not applicable. Radial tilt and radial height were measured on anteroposterior radiographs. The volar tilt, tear drop angle, carpal translation, and Soong grade were measured in a lateral view. Quantitative measurements of the volar tilt, carpal translation, and tear drop angle were positively correlated with the flexor tendon rupture. The mean volar tilt and tear drop angle in the tendon rupture group were significantly smaller than those in the control group. The mean carpal translation in the tendon rupture group was significantly greater than that in the control group. This study demonstrated that volar tilt, carpal translation, and tear drop angle are significant risk factors for flexor tendon rupture, especially for plates placed at Soong grade 1 or 2. We suggest that the potential for tendon rupture because of incomplete reduction of the distal radius fracture along with implant prominence volar to the watershed line aggravates flexor tendon irritation at the distal edge of the plate because of distorted flexor tendon paths. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature.

Surgical techniques developed for distal radius fracture fixation have become increasingly advanced, including minimally invasive plate osteosynthesis (MIPO). This study aimed to introduce and evaluate the functional outcome of a novel MIPO technique that differs from previous reports. This study included 42 patients with distal radius fractures who underwent minimally invasive surgical plating of the distal radius. All patients were treated with closed reduction, fixation using K-wire, and subsequent insertion of a volar anatomical stable angle short plate on the distal radius. An arthroscopy-assisted evaluation and repair procedure were performed to correct intra-articular involvement, triangular fibrocartilage complex tears, and scapholunate injuries. Functional outcomes were assessed using a visual analog scale score; quick disabilities of the arm, shoulder, and hand score; and postoperative range of motion of flexion, extension, supination, and pronation at the 3-month follow-up, showing significant improvement in all parameters (all p ≤ 0.05). This study provides a simpler yet reliable method with reproducible and consistent results to treat distal radius fractures using minimally invasive plating with closed reduction and plate insertion, resulting in satisfactory clinical outcomes in all patients.

Outcome Of The Distal Radius Fractures Managed With Across Wrist External Fixator Vs Buttress Plates.

Distal radius fracture is one of the most common injuries presented to emergency department and can be presented in any age group. In young patients the most common cause is Road Traffic Accident (RTA), while old patient history of fall is the most common cause. Different surgical options are available to treat this injury. This study aims to compare the outcome of volar buttress plate vs across wrist external fixator for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2/C3 fracture of the distal radius. A retrospective comparative study between July 2020 to June 2021 at Ghurki Trust Teaching Hospital was done and a total of 50 patients who underwent surgical intervention for AO C2/C3 fracture of the distal Radius, were included. The follow-up period was 12 weeks. QuickDASH score was used to find out patient's functional outcomes. Functional outcome was analyzed between the two groups using Mann-Whitney U test, using SPSS version 21. There was no significant statistical difference between the functional outcome of patients with distal radius fracture treated with across wrist external fixator vs volar buttress plate, in term of QuickDASH score. Furthermore, age and gender also were having no effect on functional outcome in our population. Across wrist external fixator is a reasonable option for AO C2/C3 type fractures of the distal radius with comparable results with volar buttress plate. It is the procedure of choice in high volume tertiary care hospitals like Gurki Trust Teaching hospital as it saves time, have similar functional outcome score, no need to re-open for removal of implant, less chances of tendon rupture as compared to volar buttress plate for distal radius fracture.

Dorsal plating for distal radius fractures: A safe and effective technique for dorsally unstable fractures

Dorsal plating for distal radius fractures: A safe and effective technique for dorsally unstable fractures

Complications After Volar Locking Plate Fixation of Distal Radius Fractures: A Retrospective Study of 822 Patients

With the current routine use of volar locking plates as the preferred surgical treatment option for distal radius fractures, the purpose of this study was to investigate the incidence of postoperative complications following surgery and, second, investigate the correlation between demographic factors and the risk of complications. We retrospectively reviewed all patients who had been surgically treated for a distal radius fracture with open reduction and internal fixation using volar plating and screws during a 3-year period. Relevant demographic information and all postoperative complications of the 822 patients eligible for inclusion were recorded, with a mean follow-up time of 2.8 years. We identified an overall complication rate of 12.3% (101 of the 822 patients), with 4.8% defined as experiencing major complications and 7.5% defined as experiencing minor complications. The most frequent were complications that led to hardware removal, observed in 2.7% (n= 22) of the patients; wound-related problems that did not require surgical revision, observed in 2.2% (n= 18) of the patients; and carpal tunnel syndrome, observed in 1.9% (n= 16) of the patients. Binary logistic regression modeling showed no correlation between demographic factors and the risk of complications. In conclusion, a low overall complication rate of 12.3% was found. Further, 4.8% of the patients experienced a major complication and 7.5% of the patients experienced a minor complication following open reduction and internal fixation using volar plating of distal radius fractures. Age, sex, fracture type, and time from trauma to surgery were not found to be associated with an increased risk of postoperative complications. Prognostic IV.

Evaluation of Ulnar Setting of Volar Locking Plates for Distal Radius Fractures Using Modified Skyline View

Volar lunate facet fragments in distal radius fractures are located at the center of the load in the wrist joint and, therefore, should be properly supported by the distal ulnar setting of volar locking plates to obtain better postoperative outcomes. This study evaluated the usefulness of the modified skyline view (MSV) in intraoperative fluoroscopy for the ulnar setting of volar locking plates by comparing it with that of the anteroposterior view (APV). Sixty-five patients with distal radius fractures who underwent open reduction and plate fixation as well as follow-up intraoperative fluoroscopy and postoperative computed tomography (CT) at our institution between April 2019 and March 2022 were included. The distance between the ulnar edge of the plate and the distal radius (d-value) was measured retrospectively using intraoperative fluoroscopy (distance measured from MSV and distance measured from APV) or postoperative CT (distance measured using postoperative CT). The distance measured from MSV and that measured from APV were compared with those measured using CT as the true values. Each measurement was performed twice by 2 examiners at an interval of 1 month. The comparison scores were evaluated using the intraclass correlation coefficient. The distance measured from MSV showed a difference of 0.6 ± 0.5 mm from that measured using CT, which was significantly smaller than that measured from APV (1.2 ± 0.9 mm; P < .001). Neither postoperative volar subluxation nor dislocation of bone fragments was found during the study period. Both intraclass correlation coefficient (1,1) and intraclass correlation coefficient (2,1) reliabilities were substantial to almost perfect. Modified skyline view is an effective and versatile imaging method for estimating the ulnar setting of volar locking plates; it provides measurements more similar to those provided by postoperative CT compared with APV. The use of MSV may reduce postoperative complications, such as volar subluxation and dislocation of bone fragments, especially in cases with volar lunate facet fragments in which the ulnar setting of the plate is significant. Diagnostic III.