Radial Height Research Articles

A study of closed reduction and percutaneous pinning with plaster in distal end radius fracture in post menopausal women

Background: To evaluate radiological and functional outcome in fractures of the distal end radius treated by K-wire fixation in post menopausal women.Methods: Fifty patients with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary block or general anaesthesia. Anatomical restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 70% (n=35) of our patients had excellent to good outcome while as 20% (n=10) had fair outcome and 10% (n=5) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius

Background: Fractures of the distal radius remain the most common fractures approximately one-sixth of all fractures treated in emergency departments. There are three main peaks of fracture distribution: the first peak is in children ages 5 to 14, the second is in males under age 50 and the third peak is in females over the age of 40 years. Risk factors are – decreased bone mineral density, female gender, ethnicity, heredity & early menopause have all been shown to be risk factors for this injury. The outcome of these fractures is not uniformly good regardless the treatment instituted. A thorough understanding of the anatomy & biomechanics of the wrist is a prerequisite when treating these lesions. There is a strict relationship between the quality of anatomical reconstruction & the long-term functional outcome. No single treatment is the solution for every type of fracture in every kind of patient. Based on the functional anatomy, we analyze the actual treatment possibilities & try to develop strategies in the choice of treatment for different fracture types in different patient groups. Materials and Methods: 92 Patients with extra-articular distal radius fractures were studied retrospectively. 30 were treated with conservative management and 62 with surgical management. Out of 62 cases treated surgically, 11 were managed by Plate osteosynthesis, 27 with Ligamentotaxis with External fixator & 24 with K wire fixation using Kapandji method at Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, since July 2018 to November 2020. Results: The association of individuals anatomical parameters with the functional results was measured by Chi-square test of association and Odds ratio with the criteria of Stewart et al. taken as base line for comparison. This study showed a significant association of dorsal angulation < 10° and loss of radial inclination of < 9° with functional results, P < 0.001 also with loss of radial height < 6 mm, P < 0.001 (0.005). On reviewing literature only few articles were found determining values of individual radiological parameters for better functional outcome specially Smilovic et al. (2003) and few of them noted which parameters affect the function most but not determining the values for them. Conclusion: There was no significant difference in the functional outcome of conservative treatment in comparison to various surgical modalities namely plate osteosynthesis, ligamentotaxis and k wire reduction with Kapandji method in case of extra articular and partial articular fractures of distal radius. Therefore, we cannot generalize one treatment method for all fracture patterns and treatment should be individualized to a particular fracture. Keywords: Distal radius fracture, Radiological outcome, Functional outcome

Functional and Radiographic Outcomes for Distal Radius Fractures Treated with Volar-Locked Plates and Percutaneous K-Wires: A Comparative Study

Purpose to evaluate and to compare radiological and functional outcomes of the volar locking plate fixation using pronator-sparing approach and K-wire fixation of distal radius fractures. Materials and Methods. We retrospectively analyzed 41 patients with distal radius fractures (27 female and 14 male) treated in the period from 2016 to 2020 using minimally invasive osteosynthesis via pronator-sparing approach. The mean age was 51 years (31-74 years). The control group consists of 37 patients (19 female and 18 male, mean age 61 years (29-76 years)), who underwent minimally invasive percutaneous K-wire fixation of distal radius fractures during the same period of time. Comparative analysis of radiographic and functional outcomes in both groups of minimally invasive osteosynthesis of distal radius fractures was carried out in the period from 1 to 6 months after the surgery. Results. Primary union of distal radius fractures was confirmed in X-rays in all patients within 6 weeks after the surgery. There were no complications in patients treated by pronator-sparing volar locking plate fixation, whereas in K-wire group we had 6 patients with complications: 4 cases (11%) superficial infection around K-wires and 2 cases (5,4%) intraoperative damage of sensitive branch of radial nerve. There were statistically significant differences in radiographic results (volar tilt, radial inclination, and radial height) between two groups: they all were better in patients treated by pronator-sparing volar locking plate fixation during the whole follow-up period (р0,01). Minimally invasive volar locking plate fixation via pronator-sparing approach also provided significantly better grip strength and range of wrist motion and forearm rotation in the early 6-month postoperative period, compared with percutaneous K-wire fixation (р0,001). Conclusion. Our study demonstrates that both techniques of minimally invasive osteosynthesis of distal radius fractures are effective and relatively safe methods of surgical treatment, but volar plating via pronator-sparing approach leads to a better reconstruction of the distal radius and better functional outcomes compared to percutaneous K-wiring.

Radiographic Outcomes following K-Wire Augmentation of Dorsal Spanning Plate Fixation for Intra-Articular Fractures of the Distal Radius.

Background Restoration of articular surface alignment is critical in treating intra-articular distal radius fractures. Dorsal spanning plate fixation functions as an internal distraction mechanism and can be advantageous in the setting of highly comminuted fracture patterns, polytrauma patients, and patients with radiocarpal instability. The addition of K-wires to support articular surface reduction potentially augments fracture repair stability. Questions/Purposes We examined the radiographic outcomes and maintenance of reduction in patients with comminuted intra-articular distal radius fractures treated with K-wire fixation of articular fragments followed by dorsal spanning plate application. Patients and Methods We reviewed 35 consecutive patients with complex intra-articular distal radius fractures treated with dorsal spanning plate and K-wire fixation between April 2016 and October 2019. AO classification was recorded: B1 (3), B3 (2), C2 (2), C3 (28). A two-tailed paired t -test was used to compare findings immediately post-dorsal spanning plate surgery and at final follow-up after dorsal spanning plate removal. Results Mean patient age was 43.3 years (19-78 years). Mean follow-up was 7.8 months (SD 4.3 months) from surgery and 2.5 months from pin removal (SD 2.6 months). All patients achieved radiographic union. Radial height (mean interval change (MIC) 0.2 mm, SD 2.2, p = 0.63), articular step-off (MIC 0.1 mm, SD 0.6 mm, p = 0.88), and radial inclination (MIC -1.1 degrees, SD 3.7 degrees, p = 0.10) did not change from post-surgery to final follow-up. Ulnar variance (MIC -0.9 mm, SD 2.0 mm, p = 0.02) and volar tilt (MIC -1.5 degrees, SD 4.4 degrees, p = 0.05) were found to have decreased. Conclusion Dorsal spanning plate augmented with K-wire fixation for comminuted intra-articular distal radius fractures in polytrauma patients allows for immediate weightbearing and maintains articular surface alignment at radiographic union and may provide better articular restoration than treatment with dorsal spanning plate alone. Level of Evidence This is a Level IV , therapeutic study.

Are Radiographic Characteristics Associated With Outcome in Surgically Treated Distal Radius Fractures?

Evidence to date shows that distal radius fracture displacement measured on radiographs does not correlate with patient-reported outcomes. Quantitative 3-dimensional computed tomography (CT) (Q3DCT) potentially captures fracture displacement more accurately. We aimed to assess the independent association between radiographic, CT, and Q3DCT measures of residual displacement and change in disability, quality of life, range of motion (ROM), and grip strength 12 weeks and 1 year after volar plating of intra-articular distal radius fractures. We performed a secondary analysis of data from a prospective multicenter trial. Seventy-one patients underwent volar plating of their AO Foundation/Orthopaedic Trauma Association type B or C distal radius fracture and were available at 12 weeks; 67 (94%) were available at 1 year. We recorded demographics, postoperative periapical radiographs (radial height, ulnarward inclination, ulnar variance, gap, and step off), lateral radiographs (palmar tilt, scapholunate angle, teardrop angle, and anteroposterior distance), postoperative CT scans (gap [coronal, sagittal and axial]) and step off [sagittal and coronal]), and in 3-dimensional models (number of articular fragments, mean fragment articular surface area, 3-dimensional fragment displacement, and gap surface area). Radiographs and CT scans were obtained within 10 working days after fracture fixation. Outcome measures were change in Patient-Rated Wrist Evaluation (PRWE) scores, EuroQol Group 5-Dimension questionnaire (EQ5D) results, grip strength, and composite wrist ROM at 12 weeks and 1 year compared to preinjury level. At 1 year, greater recovery in PRWE scores was independently associated with older age. Greater recovery in composite ROM at 1 year was associated with injury to the dominant side and less step-off on posteroanterior radiographs. Less posteroanterior step-off was associated with a small improvement in composite wrist ROM at 1 year. This should be considered when counseling patients on the risks and benefits of surgical treatment when radiographic and CT measures of displacement fall within the range found in this study, and in older, low-demand patients. Prognostic II.

Numerical and experimental study of the embedded magnetic fluid seal with a small gap

To improve the pressure capability of the ordinary magnetic fluid (MF) seal (MFS) with a small gap, a device of the embedded MFS is designed according to the theory of embedded MFS. The magnetic field distribution in the seal gaps of the embedded MFS was studied by employing the finite-element method, and the theoretical pressure capability of the seal are calculated. A seal experimental platform was designed and built. The effects of MF injection volume, radial seal gap height, axial seal gap width, number of radial pole teeth (PT), number of axial PT, and the ratio of PT length to its width on the pressure capability of embedded MFS device was investigated, and compared to the experimental pressure capability of the ordinary MFS. The results show that the experimental and theoretical pressure capabilities of the embedded MFS are in good agreement. When the MF injection volume is 1.5 ml, the pressure capability has reached the maximum and tends to be stable. The pressure capability of the embedded MFS is better than that of the ordinary MFS. The pressure capability of the embedded MFS is not only related to the size of the seal gap and the number of PT but also related to the ratio of PT length to its width.

Changing to Removable Casts During the Coronavirus Pandemic-Has It Affected Outcomes for Distal Radius Fractures?

BOAST (British Orthopaedic Association Standards for Trauma & Orthopaedics) guidelines recommended that during the coronavirus pandemic most upper limb fractures should be treated conservatively, and removable casts should be used, where possible. As a result, our district general hospital started using a new soft combination (soft-combi) casting technique for conservative management of distal radius fractures (DRFs) in an attempt to reduce follow-up attendances.To assess if radiological outcomes of soft-combi casts are better or worse than previously used rigid casts for DRFs.Twenty DRFs treated with soft-combi casts were compared with 20 DRFs treated with the old rigid cast types. Radiological parameters were measured pre-manipulation, post-manipulation, at 2-week follow-up, and at final follow-up. Statistical analysis was performed to assess for significant differences seen at follow-up between the groups.The mean loss of volar angulation seen at 2-week follow-up was 4.9° for the rigid casts vs. 1.5° for the soft-combi casts (p = 0.158; 95% CI, − 8.17 to 1.38). The mean loss of radial height after 2 weeks was 0.2 mm vs 0.5 mm (p = 0.675; 95% CI, − 1.09 to 1.66), and the mean loss of radial inclination was 2.0° vs 1.0° (p = 0.349; 95% CI, − 2.96 to 1.07), respectively.The soft-combi casts appeared to be equally effective at maintaining the reduction of DRFs compared to their rigid counterparts, as no statistically significant difference was seen in our study. We can be reassured that continued use of these removable casts in the current climate is unlikely to have a detrimental effect on outcomes for DRFs.

1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

Abstract Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

Investigation of variable geometry orifice design for improving centrifugal compressor low-end performance and stable operating range

Active control of the inlet flow area in a centrifugal compressor is a method to improve compressor aerodynamic performance and stall margin. As a core part of the area control device, the variable geometry orifice is investigated and its two key design parameters are analyzed in detail, the setting angle of the orifice with respect to the shroud casing and the radial height of the orifice to the shroud casing from the orifice inner rim. This paper proposes a physics-based equation that describes the relationship of the two parameters with compressor mass flow rate and then validates the equation using numerical simulations. As far as the setting angle, the physics-based equation suggests not to be larger than 90°. The numerical results not only validate the physics-based equation but also show the most optimal angle of 78°. In terms of the orifice height, both the physics-based equation and the numerical simulations suggest an active height control of orifice in the compressor inlet duct.

Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases.

Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III–V.

To evaluate the functional and radiological outcome of fracture distal end radius treated with volar plating

The aim of this study is to assess the radiological and functional outcomes of open reduction and internal fixation with volar locking plates in the treatment of unstable intra-articular distal radius fractures. In this study functional evaluation was performed using the modified Gartland–Werley scoring system and for the radiological assessment, radial inclination, volar tilt and radial height was compared pre and post operatively.

Simulating tree growth response to climate change in structurally diverse oak and beech forests

This study aimed to simulate oak and beech forest growth under various scenarios of climate change and to evaluate how the forest response depends on site properties and particularly on stand characteristics using the individual process-based model HETEROFOR. First, this model was evaluated on a wide range of site conditions. We used data from 36 long-term forest monitoring plots to initialize, calibrate, and evaluate HETEROFOR. This evaluation showed that HETEROFOR predicts individual tree radial growth and height increment reasonably well under different growing conditions when evaluated on independent sites.In our simulations under constant CO2 concentration ([CO2]cst) for the 2071-2100 period, climate change induced a moderate net primary production (NPP) gain in continental and mountainous zones and no change in the oceanic zone. The NPP changes were negatively affected by air temperature during the vegetation period and by the annual rainfall decrease. To a lower extent, they were influenced by soil extractable water reserve and stand characteristics. These NPP changes were positively affected by longer vegetation periods and negatively by drought for beech and larger autotrophic respiration costs for oak. For both species, the NPP gain was much larger with rising CO2 concentration ([CO2]var) mainly due to the CO2 fertilisation effect. Even if the species composition and structure had a limited influence on the forest response to climate change, they explained a large part of the NPP variability (44% and 34% for [CO2]cst and [CO2]var, respectively) compared to the climate change scenario (5% and 29%) and the inter-annual climate variability (20% and 16%). This gives the forester the possibility to act on the productivity of broadleaved forests and prepare them for possible adverse effects of climate change by reinforcing their resilience.

A PROSPECTIVE STUDY OF A MODIFIED PIN-IN-PLASTER METHOD FOR THE TREATMENT OF FRACTURES OF THE DISTAL RADIUS

Introduction:- The motive of this study is to introduce a modied technique of 'pin in plaster.' that is a favourable treatment option for unstable fractures of the distal radius. This study was shown to narrated a modied technique using 'pin in plaster' that is a favorable treatment option for unstable fractures of the distal radius. A fracture of the distal radius is one of the most customary types of fracture, in the pediatric population fracture was 24% and up to 20% in the elderly, male-to-female ratio of one to four in older age groups. Methods:- 54 patients with fractures of the distal radius were followed for one year postoperatively. Patients were debarred if they had type B fractures according to AO classication, multiple injuries, or pathological fractures and were treated more than seven days after injury. Radiographic parameters, tilt and height including radial inclination, were measured pre-and postoperatively. Results:- The radial height was 10.2 mm at the sixth month postoperatively, and the average radial tilt was 10.6° of volar. Three patients of pin tract infection were recorded. There were no cases of pin loosening. Total 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. Conclusion:- Our modied technique is successfully restoring anatomic congruity and maintaining the reduction in fractures of the distal radius.

Greater radial tuberosity size is associated with distal biceps tendon rupture: a quantitative 3-D CT case\u2013control study

PurposeDuring pronation, the distal biceps tendon and radial tuberosity internally rotate into the radioulnar space, reducing the linear distance between the radius and ulna by approximately 50%. This leaves a small space for the distal biceps tendon to move in and could possibly cause mechanical impingement or rubbing of the distal biceps tendon. Hypertrophy of the radial tuberosity potentially increases the risk of mechanical impingement of the distal biceps tendon. The purpose of our study was to determine if radial tuberosity size is associated with rupturing of the distal biceps tendon.MethodsNine patients with a distal biceps tendon rupture who underwent CT were matched 1:2 to controls without distal biceps pathology. A quantitative 3-dimensional CT technique was used to calculate the following radial tuberosity characteristics: 1) volume in mm3, 2) surface area in mm2, 3) maximum height in mm and 4) location (distance in mm from the articular surface of the radial head).ResultsAnalysis of the 3-dimensional radial tuberosity CT-models showed larger radial tuberosity volume and maximum height in the distal biceps tendon rupture group compared to the control group. Mean radial tuberosity volume in the rupture-group was 705 mm3 (SD: 222 mm3) compared to 541 mm3 (SD: 184 mm3) in the control group (p = 0.033). Mean radial tuberosity maximum height in the rupture-group was 4.6 mm (SD: 0.9 mm) compared to 3.7 mm (SD: 1.1 mm) in the control group, respectively (p = 0.011). There was no statistically significant difference in radial tuberosity surface area (ns) and radial tuberosity location (ns).ConclusionRadial tuberosity volume and maximum height were significantly greater in patients with distal biceps tendon ruptures compared to matched controls without distal biceps tendon pathology. This supports the theory that hypertrophy of the radial tuberosity plays a role in developing distal biceps tendon pathology.Level of evidenceLevel III.

Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator?

Purpose:The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome.Methods:The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters.Results:At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (−15°, 25°), reduced radial inclination 2.3° (−6°, 12°), radial height 1.3 mm (−4 mm, 7 mm), and ulnar variance −0.5 mm (−6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found.Conclusions:We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013

Sliding rotational osteotomy for cases of dorsally angulated distal radius malunion: A technical note

The aim of this study was to present a novel pre-planned distal radius sliding rotational osteotomy that can address all deformities in dorsally angulated distal radius malunion through a volar approach using a locking plate. Four consecutive adult women with symptomatic dorsally angulated distal radius malunion were surgically treated with sliding rotational osteotomy. All the patients underwent preoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, a series of radiography, and a course of physiotherapy. The osteotomy was planned on 2 orthogonal radiographs, and the surgery was performed through a volar approach. A back slab was applied post-operatively for two weeks and changed to a removable splint for further four weeks. Gentle active movements out of splint were permitted at two weeks, and formal physiotherapy at six weeks post-operatively. Radiographs were taken immediately post-operatively, at three months, and with DASH scores at a mean final follow-up of 18 months. On radiographic evaluation, all the deformities were corrected within an acceptable range. The mean increase in radial inclination was 6.5 degrees. The mean gain in radial height was 2.95 mm. The mean improvement in ulnar variance was 4.25 mm. The mean change from dorsal to volar angulation was 23 degrees, and the mean improvement in the DASH score was 45.25 at a mean final follow-up of 16 months. All osteotomies achieved bony union within 3 months postoperatively. None of the patients required metalwork removal, and no complications were observed. Sliding rotational osteotomy appears to be a safe technique to correct deformity and improve function in patients with dorsally angulated, shortened, and radially deviated distal radius malunion.

Z-Corrective Osteotomy in Malunited Extra-Articular Fractures of Distal Radius

We sought to assess clinical, radiological, and functional outcomes following treatment of extra-articular malunions of the distal radius using a multiplanar z-corrective osteotomy. Fifteen patients with extra-articular distal radius malunions (13 dorsal and 2 volar) underwent z-corrective osteotomy and volar plate fixation without bone grafting. Correction and maintenance of each deformity was evaluated in terms of various radiographic indices (radial height; volar and radial tilt); osteotomy union; pain (visual analog scale); grip strength; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; and Mayo wrist scores. The mean follow-up was 16.4 months. The mean radial height was corrected from -1.3 mm to 4.9 mm. The mean ulnar variance improved from 4.3 mm to -0.4 mm. The sagittal radial tilt and radial inclination were restored from a mean of -17.9° (dorsal) to 3.3° (volar) and from 12.0° to 17.2°, respectively. The Disabilities of the Arm, Shoulder, and Hand and Mayo wrist scores improved from means of 36 and 56 preoperatively to 24.8 and 73.3, respectively, at 6 months and further to 20.6 and 77.6, respectively, at the last follow-up. There were no nonunions or tendon-related problems. The mean pain score decreased from 4.1 preoperatively to 1.0 at 6 months and 0.8 at the last follow-up. The mean grip strength improved from 5.6 kg preoperatively to 15.6 kg at 6 months and 19.7 kg at the last follow-up. There was a statistically significant improvement in range of motion at the wrist. The z-osteotomy provides correction of deformity in all 3 planes, along with restoration of radial height. It also maintains a broad area of bone contact between the 2 osteotomized bone fragments, facilitating bony union and eliminating the need for bone grafting. Therapeutic IV.

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Background: Optimization of the corrective osteotomy for the treatment of distal radius extra-articular ‎ ‎malunion is an ‎ongoing project‎‏. Objectives: In this study, ‏we aimed to evaluate the outcome of corrective osteotomy ‎with K-wire fixation in the treatment of patients with symptomatic distal radius extra-articular malunion.‎ Patients & Methods: Twenty-three patients with symptomatic distal radius extra-articular malunion, mean ‎age of ‎38.3±7.6‎‏ years‎, ‎and a mean follow‎-‎up of ‏‎34.4±11.3 months‎‏ were included‎. ‎Corrective osteotomy ‏was performed through a dorsal approach and using K‎-‎wire instead of the plate for the fixation ‏of the osteotomy site‎. ‎The outcome was assessed with radiographic measures including ‏ulnar ‎variance, radial tilt, radial inclination angle, radial height, and clinical measures including ‎wrist range of motion, the short form of Disabilities of the Arm, Shoulder, and ‎Hand (Quick-‎DASH), and the Modified Mayo Wrist Score (MMWS).‎ Results: Radiographic measures and wrist range of motion in all directions were significantly improved at the last follow-up. The mean final Quick-DASH score of the patients was 16.3±8. The mean final MMWS was 92.2±13.5. According to the MMWS, 9 (39.1%) patients had an excellent function, 13 (56.5%) patients had a good function, and one (4.4%) patient had a fair function. Radiographic union was observed in all wrists within an average period of 10.2±4 weeks. No postoperative complication was recorded. Conclusion: Since K-wire fixation is less expensive, requires smaller incision, and provides acceptable radiologic and clinical outcomes, it could be regarded as a good alternative for plate fixation in corrective osteotomy for distal radius extra-articular malunion.

Perte de hauteur radiale dans une fracture radiale distale extra-articulaire suite à la fixation par plaque antérieure verrouillée

BackgroundRadial height is an important prognostic factor in treating distal radius fracture. However, does further collapse of radial height in distal radius fractures after with volar locking plate fixation have a great impact on the prognosis? The present study aimed to elucidate radial height loss and determine the associated risk factors after open reduction and internal fixation with volar locking plate in patients with extra-articular distal radius fractures. HypothesisPatients with radial height collapse after fracture reduction and internal fixation with a volar locking plate may have poor outcomes. MethodsData of 87 patients (21 male) undergoing surgery for acute extra-articular distal radius fractures (AO: 23-A2 or 23-A3) between February 2014 and July 2016 were evaluated retrospectively. Patients were divided into two groups by radial height loss. Potential risk factors were tested by Pearson correlation coefficients. Stepwise multiple regression logistic analysis determined significant independent risk factors for extra-articular distal radius fractures. Clinical evaluation was performed by the same surgeon by determining wrist ROM. Grip strength was measured with a Jamar dynamometer and compared with non-affect wrist in percentage. In addition, all the patients were asked to grade modified Mayo wrist score and Visual Analogue Scale (VAS) score. These findings were recorded post-operative 1 year of follow up. ResultsMean radial height loss was 1.3±0.9mm. Age (ß=0.002, p=0.003), postoperative ulnar-positive deformity (ß=0.107, p<0.001), DEXA (ß=−0.015, p=0.008), and shortest diameter of distal fracture fragment in AP and lateral views (ß=−0.050, p=0.037; ß=−0.080, p=0.043) were significantly associated with radial height loss. As for the outcome of clinical prognosis, though radial height collapse group had poorer wrist range of motion, there was no statistical difference. Besides, there were no significant differences in grips strength and VAS score between these two groups. However, in regards of modified Mayo wrist score, the percentage of patients with poor outcomes is significant higher in radial height collapse group (p=0.039). Moreover, all patients with poor outcomes in radial height collapse groups were older than 65-year-old. DiscussionRadial height loss is noted in patients undergoing open reduction and internal fixation with volar locking plate for extra-articular distal radius fractures. Risk factors for radial height collapse include advanced age, poor bone quality, shortest distance between fracture site and articular surface and post-operative ulnar-positive deformity. Level of evidenceIV; non-comparative prospective study.

Analysis of Our Open Reduction and Internal Fixation of Distal Radius Fractures in Adults: Are We Over Operating?

Background Fractures of the distal radius are a common injury. The British Orthopaedic Association (BOA) and The British Society for Surgery of the Hand (BSSH) have released new guidelines outlining the management of these fractures, specifically identifying "thresholds for intervention," based on radiological parameters for management with open reduction and internal fixation (ORIF). Questions/Purposes Have our distal radius fractures (DRFs), previously managed with ORIF, met the new guidelines' thresholds for intervention, based on radiological parameters? Patients and Methods A retrospective assessment of DRFs treated with ORIF was performed between January 2017 and August 2018. Patients were categorized into three cohorts based on their age. The five radiological parameters of ulnar variance, dorsal tilt, radial inclination, radial height, and intra-articular step were measured on the initial plain radiograph, "pre-manipulation film," postplaster application radiograph, and "post-manipulation film." These were compared with the "thresholds for intervention" outlined in the BOA/BSSH guidelines. Results A total of 94 patients underwent an ORIF with a mean age of 56 years (range 17-86 years). As many as 75.74% of patients on the "pre-manipulation film" met the "threshold for intervention" on at least one radiological parameter, while 53.57% of patients on the "post-manipulation" met at least one "threshold for intervention." Dorsal tilt was the parameter that most often met the threshold in both films at 53.37% and 40.11%, respectively. Conclusion Within our trust, there is a tendency to over manage the distal radius fracture with ORIF, potentially resulting in unnecessary operations. Education surrounding the new guidelines will better serve our decision-making. Level of Evidence This is a level III study.