Unstable Distal Radial Fractures Research Articles

Headless screw fixation of unstable ulnar styloid base fractures after distal radial fractures fixation

Ulnar styloid fractures occur frequently concomitant with distal radial fractures. Although unstable distal radial fractures are mostly surgically treated, ulnar styloid fractures are often ignored. Unstable fractures at the base of the ulnar styloid may lead to persistent ulnar pain, due to distal radioulnar joint instability or ulnar styloid non-union.We retrospectively analyzed a single-surgeon cohort series of surgically treated distal radial fractures on how these concomitant ulnar styloid fractures were regarded: indications for surgery and surgical technique with headless screw fixation.119 surgically treated distal radial fractures were assessed. 51 (42.8%) of the surgically treated distal radial fractures had a distal ulnar fracture, and more specifically 23 (19.3%) had a base fracture of the ulnar styloid. 9 (7.6%) of the wrists had a base fracture of the ulnar styloid which was considered after distal radial fracture fixation as persistently unstable, during distal radioulnar joint ballottement translation test. This fracture subtype was immediately treated with headless screw fixation, resulting in all cases in bony union, with a mean active pronation of 85°, a mean active supination of 80° and a clinical stable distal radioulnar joint, with minimal ulnar pain after 6 weeks (mean Visual Analogue Scale 1). After at least 12 months, persistent pain did not occur and mean QuickDASH was 2.5.According to this single-surgeon cohort series, headless screw fixation provides a reliable treatment for unstable base fractures of the ulnar styloid after distal radial fixation.

Effectiveness of Distal Radial Locking Plate Fixation in Managing Unstable Distal Radial Fracture

Effectiveness of Distal Radial Locking Plate Fixation in Managing Unstable Distal Radial Fracture

Evaluation of Treatment of Unstable Distal Radial Fractures by External Fixator

Background: Distal radial fractures are very common in Orthopaedic practice but still there is no unanimity about its treatment. Objective: To evaluate the external fixator for the treatment of unstable distal radius fractures. Methods: This prospective observational study was carried out from January 2018 to December 2019 over a period of two years. Twenty-five consecutive patients of both sexes between the ages of 18 to 60 years with closed or open unstable distal radius fractures with or without intraarticular extension admitted in the Department of Orthopaedic Surgery, 250 Bedded General Hospital, Tangail & several private hospitals in Tangail & Dhaka city were selected. Patients with diabetes mellitus or chronic renal or hepatic disorder or extra-articular fractures or volar & dorsal shear injuries (Barton fractures) were excluded from this study. All the patients were evaluated thoroughly including distal neurovascular status and any associated injuries ruled out. Patients were operated as early as possible. But 4 cases were lost to follow up. Remaining 21 patients were followed up for at least 6 months and a maximum period of 12 months. Results: In this series mean age of the patient was 35.71±11.65 years and males (66.7%) were predominant than females (33.3%). In this series right side was involved in 13 patients (61.9%) and left side in 8 patients (38.1%). The mechanism of injury included road traffic accident 13 (61.9%), fall on slippery ground 7 (33.3%) and occupational accident 1 (4.8%). Six patients of this study (28.6%) had associated injury other than the local soft tissue injury. Most of the patients (66.7%) were operated on the day of admission, 2 patients (9.5%) were operated within 3 days and 5 patients (23.8%) were operated within 7 days. As per AO classification, majority (38.1%) injury was type C3 fracture followed by C1 (33.3%), C2 (14.3%), B1 (9.5%) and A3 (4.8%). According to functional outcome, satisfactory was 76.2% and according to anatomical outcome, satisfactory was 85.7%. Conclusion: According to this study finding satisfactory outcome was 76.2% (functional) and 85.7% (anatomical). J Shaheed Suhrawardy Med Coll 2021; 13(1): 20-25

Percutaneous Pinning Versus Volar Locking Plate Fixation in the Treatment of Intra_articular Distal Radius Fracture in Adults above 18 Years of Age

Background and objectives: Distal radius fractures account for more than 20% of all fractures seen in the emergency department, unstable distal radial fractures can be managed by several treatment options including cast immobilization, percutaneous pinning, plate fixation and external fixation, the aim of the study is to compare percutaneous pinning and volar locking plate in the treatment of distal radius fracture AO C1 subtype. Methods: Thirty patients were included and divided into 2 equal groups, group 1 underwent volar locking plate fixation and group 2 underwent percutaneous k wire fixation, the functional and radiological outcomes were assessed by DASH and Stewart’s score respectively and range of motion was measured. Results: Plate group has significantly higher mean flexion at 3 and 12 months than those of the pin group, DASH score at 3 and 6 months was significantly higher in pin group (28.43 and 10.59 respectively) than plate group (20.47 and 16.75 respectively) but no significant difference was showed between the pin and plate groups at 12 months (14.58 vs 13.23 respectively). When the difference between preoperative and 12 months radiographs was measured ulnar variance, radial inclination, and palmar tilt were significantly higher in the plating group, however, the Stewart’s score distribution between both groups showed no significant differences. Conclusions: While there was no functional outcome difference at one year of follow up between patients treated with either treatments modality, patients requiring faster recovery and return to function can be offered open reduction and volar locking plate fixation.

Simple surgical technique for minimizing the risk of extensor pollicis longus rupture following volar plate fixation of distal radial fracture: A case report.

Introduction and importanceExtensor pollicis longus (EPL) tendon injury is a major complication in distal radial fracture repair. The risk factors for EPL tendon injury are prominent dorsal screws, direct intraoperative damage through drilling, and/or dorsal roof fragments. Herein, we introduce a simple technique to minimize the risk of EPL tendon rupture after volar plate fixation of distal radial fracture.Case presentationThe patient was a 67-year-old woman with an intra-articular unstable distal radial fracture treated by volar locking plate fixation. Intraoperatively, we opened the third compartment after screw fixation. Because the screw had penetrated the floor of the third compartment, we moved the EPL tendon out of its groove and closed the third compartment by suturing the retinaculum. We confirmed that the EPL tendon was intact 7 years postoperatively, even though the screw was prominent in the third compartment.Clinical discussionAfter volar plate fixation of the distal radial fracture, we partially open the third compartment through an approximately 2-cm-long incision on the ulnar side of Lister's tubercle. If the screw is prominent in the third compartment, we completely open the third compartment, take the EPL tendon out of its groove, and close the compartment by suturing the retinaculum. Our method was proved useful because the EPL tendon has remained intact for 7 years with the screw protruding into the third compartment.ConclusionOur surgical technique is useful to prevent secondary EPL tendon rupture after distal radial plate fixation.

Evaluation of Functional Outcome of Unstable Distal Radial Fracture Treatment: A Comparison between Internal & External Fixations

Distal radial fracture is the most common fracture of upper extremity in all age group. In recent years, fixation with distal radial locking plate and external fixator both have become widely accepted modalities for treating unstable distal radial fracture. Purpose of this study was to evaluate the functional outcome of unstable distal radial fracture (AO/OTA 2.3B2 to C3) treated by internal and external fixations. Sample size was60 with (AO/ OTA 2.3-B2 to C3) fracture as per set criteria and was treated either by distal radial locking plate or by external fixator. Quick DASH Score was used for evaluation of functional outcome of surgery. Out of 60 patients, male (75%) were more than female (25%), maximum age incidence was found in 46-55 years age group (31.7%), right side involvement was 68.3% and left side was 31.7%. Over 66% incidence was due to RTA. Type of injury was 11.7% B2, 18.3% B3, 43.3% C1, 20.0% C2 and 6.7% C3. External fixation was 58.3% and internal fixation was 41.7%. Mean ± SD duration of operation was 39.14 ± 7.017 minutes in external fixation group and 92.80 ± 21.703 minutes in internal fixation group. Functional outcome was75.9% good and 17.2% excellent in external fixation group and 52.2% good and 34.8% excellent in fixation with distal radial locking plate group according to Quick DASH Score. Postoperative complication like soft tissue infection 34.3% and delayed union 25.7% and wrist stiffness 74.3% was in external fixation group and in internal fixation group, patients had suffered from soft tissue infection 32% and wrist stiffness 56%. No patient had non-union. Mean ± SD radiological union time in external fixation group was 16.53 ± 5.386 weeks and in internal fixation group was 16.67 ± 5.264 weeks. After 12 months of surgery both external fixation and locked volar plating provide good to excellent clinical outcomes.

The Effect of Ulnar Styloid Fractures on Patient-Reported Outcomes After Surgically Treated Distal Radial Fractures.

Background:Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF.Methods:Data from 2 randomized controlled trials on the treatment of unstable DRFs were pooled. The effect of a USF on the QuickDASH, EQ-5D, pain, and range of motion at 2 years was evaluated.Results:Two hundred and eighty-one patients were included; 177 (63%) had an associated, untreated USF. An unadjusted analysis demonstrated no significant difference in functional or patient-reported outcome measures (PROMs) at 2 years between patients with or without a concomitant USF. When controlling for confounding factors, the presence of a USF did not predict change in any of the PROMs from baseline to 2 years. A concomitant USF also did not predict change in grip strength or range of motion, except for a small effect on extension (−4.1°; 95% confidence interval, −7.5° to −0.8°; p = 0.02), which probably does not have clinical relevance.Conclusions:A USF in combination with a DRF does not affect PROMs, range of motion, or grip strength. We recommend that concomitant USFs be left untreated when treating a DRF with surgical fixation.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

The Management of Distal Radius Fracture for Adult Patients in Bangladesh

Background: Distal radius fractures are one of the most common fractures patients experience. Although there are a variety of treatments, there is a lack of standardization as it relates to treatment of such fractures. Objective: In this study our main goal is to evaluate the management of distal radius fracture for adult patients in Bangladesh. Method: This observational prospective study was carried out at Chittagong Medical College Hospital and private hospitals in Chittagong from May 2015 to November 2020. Where a total of 30 Patients with unstable distal radial fracture attending at the emergency and outpatient department of Chittagong Medical College Hospital and Private Hospitals in Chittagong were included in this study. Results: During the study, according to mechanism of injury 60% patients fall on out stretched hand followed by 33.3% injuries responsible from MVA and 6.7% cases were occupational. most of the injuries belong to type II Fernandez classification, 33%. Followed by 30% injury cases belong to type II Fernandez classification, 23.3% cases belong to type I Fernandez classification, 6.7% cases belong to type IV and V classification. 86.7% cases need physiotherapy for <6 weeks followed by 13.3% cases need physiotherapy for >6 weeks. Also, according to distribution of overall assessment of anatomical outcome 80%cases were satisfactory and 20% cases unsatisfactory. Conclusion: Distal radius fractures are a common orthopedic injury. Advanced nursing practice providers either directly or indirectly participate in the care of these patients. Also, management of distal radius fracture for adult patients with volar locking plating system results in satisfactory results.

Role of volar plating in unstable distal radial fractures in elderly patients in tertiary teaching hospital

<p><strong>Background: </strong>Aim of the study was to investigate the efficacy of volar locking plate fixation for unstable distal radical fractures DRFs in the elderly population (60 years old and older).</p><p><strong>Methods: </strong>An ethical committee approved the study protocol for research studies at NRI medical college<strong>.</strong> We included only unstable distal radial fractures in elderly patients between 60 to 70 years, and patients who consent to the study. We excluded patients with comorbid conditions and below 60 years and patients with vascular injuries. Results were evaluated by the DASH questionnaire and Gartland and Werley scores.</p><p><strong>Results: </strong>According to Gartland and Werley score, 30 patients (85.7%) had excellent and good results. According to the DASH score, 31 patients (88.5%) had excellent and good results, and four patients (11.4%) had fair results. The most commonly noted complications in our study were arthritis (2 cases 5.7%), extensor pollicis longus tendon irritation (1 case 2.9%), and Reflex sympathetic dystrophy (1 case 2.9 %).</p><p><strong>Conclusions: </strong>Locked compression plate in unstable distal radius fractures provides excellent results with an effective correction of distal radius anatomy. Early range of movements of joints leads to a good outcome and return to regular activity.</p><p><strong> </strong></p>

Functional Outcome of Distal Radial Fractures in Patients With a Mean Age of 75 Years at a Mean Follow-Up of 5.4 Years.

PurposeDistal radial fractures in the elderly are common and present in a wide spectrum of severity. Their management is varied. The aim of this retrospective case review is to evaluate the late functional outcome of surgically treated distal radial fractures in the elderly population.MethodsForty-two patients (36 female and six male) were surgically treated for an unstable distal radial fracture. The mean age of the patients was 75 years. Frykman classification was used to assess the severity of the injury. Surgical options used were reduction and K wires (19 patients) or open reduction and internal fixation (ORIF) using volar distal radial plate fixation (23 patients). At a mean follow-up of 5.4 years, a validated questionnaire (Patient Rated Wrist Evaluation-PRWE) of the functional ability was completed for each patient.ResultsThe outcome in both groups was satisfactory (PRWE 40-50) with no significant statistical difference, however, a better functional outcome (<40 PRWE) was achieved in the K wire group compared to the ORIF group. Factors such as post injury fear from fall, weakness of grip, wrist pain, and other comorbidities altered the predicted functional outcome score.ConclusionIn conclusion, surgically treated fractures in the elderly generally lead to good outcomes. However, confounding factors can contribute to unpredictable results despite good surgical reduction and fixation.

Nonoperative treatment compared with volar locking plate fixation for displaced and unstable distal radius fractures in patients sixty-five years of age and older – A prospective randomized trial

Recent trends have shown a decrease in nonoperative management for unstable distal radial fractures in elderly. The literatures available lack adequate information whether operative treatments are superior to nonoperative (cast) treatment. The purpose of this study was to compare the outcomes of two treatment methods that were used: (1) ORIF with volar locking plate and (2) closed reduction and plaster immobilization. 70 patients with a displaced and unstable distal radial fracture were randomized to ORIF with volar locking plate (n=35) or closed reduction and cast immobilization (n=35). Outcome was measured on the basis of the Patient-Rated Wrist Evaluation (PRWE) score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; the pain level; the range of wrist motion; the rate of complications; and radiographic measurements including dorsal radial tilt, radial inclination, and ulnar variance. Patients in the operative treatment group had lower DASH and PRWE scores, indicating better wrist function in early postoperative period (p

Percutaneous pinning for treating distal radial fractures in adults.

Background Fracture of the distal radius is a common clinical problem. A key method of surgical fixation is percutaneous pinning, involving the insertion of wires through the skin to stabilise the fracture. Objectives To evaluate the evidence from randomised controlled trials for the use of percutaneous pinning for fractures of the distal radius in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2006), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists of articles. No language restrictions were applied. Selection criteria Randomised or quasi-randomised controlled clinical trials involving adults with a fracture of the distal radius, which compared percutaneous pinning with conservative treatment, or different aspects of percutaneous pinning. Data collection and analysis Two authors independently assessed and extracted data from the included trials. Some pooling of data was undertaken for one comparison. Main results Thirteen trials, involving 940 generally older adults with dorsally displaced and potentially or evidently unstable distal radial fractures, were included. Methodological weaknesses among these trials included lack of allocation concealment and inadequate outcome assessment. Factors affecting the applicability of trial evidence included inconsistent fracture classification, variations in outcome assessment and incomplete reporting. Six heterogeneous trials compared percutaneous pinning with plaster cast immobilisation. Across-fracture pinning, used in five trials, was associated with improved anatomical outcome and generally minor complications. There was some indication of similar or improved function in the pinning group. One quasi-randomised trial found an excess of complications after Kapandji pinning. Three trials compared different methods of pinning. Two trials found a higher incidence of complications after Kapandji fixation compared with two methods of across-fracture fixation. The third trial provided inadequate evidence for modified Kapandji fixation versus Willenegger fixation. Two small trials comparing biodegradable pins versus metal pins found a significant excess of complications associated with biodegradable material. Two small trials compared plaster cast immobilisation for one week versus for six weeks after surgery. One trial found duration of immobilisation after trans-styloid fixation did not have a significant effect on outcome. More complications occurred in the early mobilisation group after Kapandji pinning in the second trial. Authors' conclusions Though there is some evidence to support its use, the precise role and methods of percutaneous pinning are not established. The higher rates of complications with Kapandji pinning and biodegradable materials casts some doubt on their general use.

Clinical and Radiological Results of Treating Unstable Distal Radial Fractures with a Domestically Developed Volar Locking Plate That Has the Characteristic of Double-Tiered Subchondral Support

Clinical and Radiological Results of Treating Unstable Distal Radial Fractures with a Domestically Developed Volar Locking Plate That Has the Characteristic of Double-Tiered Subchondral Support

Management of unstable distal radius fractures by ligamentotaxis with external fixation

Distal radial fractures accounts 16% in upper limb fractures. Not only management and restoration of articular compatibility is also a major task for successful recovery. External fixation, ligamentotaxis provides best functional and anatomical outcome for unstable distal radial fractures. This study was designed to assess the efficacy of ligamentotaxis with external fixation in the management of distal radius fractures. A total 32 cases with a chief complaint of unstable fractures distal radius between age group 3nd to 7th decades were considered. All fractures were fixed with external fixator with ligamentotaxis. Study outcome was evaluated by Modified of Gartland and Werley Demerit point system. 21.8% cases had excellent results, 40.6% cases had good results, 28.1% cases had moderate results and 9.3% cases had poor results when treated with ligamentotaxis with external fixation. Grip strength complication was seen in 2 cases (Table 4). No associated symptom was seen in 20 cases. Ligamentotaxis withexternal fixation is an effective method for unstable distal radius fractures management. It is minimally-invasive technique which reduces anatomical disabilities of distal radius fractures.

Biologic plating of unstable distal radial fractures

BackgroundVolar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction.MethodsThirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25–83 years), and the mean follow-up period was 47.5 months (range, 36–84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS).ResultsAll wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from − 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75–100).ConclusionOur experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.

External Fixation versus Volar Plate Fixation for Unstable Distal Radial Fractures - A 3-year Follow-up of a Randomized Controlled Trial

There is no financial information to disclose. To determine if volar locking plate (VLP) is superior to external fixation (EF) 3 years after surgery for unstable dorsally displaced distal radial fractures in patients 50-74 years of age after low energetic injury. During 2009-2013, 140 patients with unstable distal radial fractures were randomized to either VLP or EF with or without adjuvant pins. 118 patients (EF; 56, VLP; 62) were available for a 3 year follow up. Primary outcome was DASH. Secondary outcome variables were PRWE, EQ-5D, ROM, grip strength, radiological signs of arthrosis and complications to surgery. The intention to treat principle was used for all statistical calculations. There were no clinically or statistically significant differences regarding DASH, PRWE, EQ-5D, ROM and grip strength. The reoperation rate was 21% (13/62) in the VLP group compared to 13% (7/56) in the EF group. The arthrosis rate was 32% (19/59) in the VLP group compared to 21% (11/53) in the EF group. (Tables 58-1, 58-2) •The clinical result was equal after VLP compared to EF 3 years after surgery for dorsally displaced unstable distal radial fractures in patients 50-74 years of age after low energetic injury.•VLP caused more reoperations due to complications compared to EF.•The arhtrosis rate was higher after VLP compared to EF.Table 58-1DASH, PRWE, and EQ-5D in Patients Treated for Unstable Dorsally Displaced Distal Radial with External Fixation (EF) or Volar Locking Plate (VLP) Presented as Mean : Median (SD)(range)EF (n = 56)VLP (n = 62)P valueDASH7.0 : 2.5 (9.9) (0-52)5.4 : 2.5 (7.1) (0-40)0.724 (Mann-W)PRWE6.6 : 1.5 (12) (0-71)6.1 : 1.8 (9.2) (0-42)0.546 (Mann-W)EQ-5D0.92 : 1.0 (0.13) (0.35-1)0.92 : 1.0 (0.13) (0.41-1)0.860 (Mann-W) Open table in a new tab Table 58-2Secondary Surgery in Patients with Unstable Dorsally Displaced Distal Radial Fractures Treated with External Fixation (EF) or Volar Locking Plate (VLP)ComplicationEF (n = 56)VLP (n = 62)Fixation failure2 (1 also later plate extraction)2 (1 also later plate extraction)Plate extraction Tenosynovitis28 CRPS01 Other02Compartment syndrome01 (also later plate extraction)Carpal tunnel syndrome11 (also later plate extraction)Deep infection10Scar correction20Extensor tendon rupture01Total8∗One patient had 2 secondary surgeries at separate occasions – refixation due to fixation failure and later plate extraction16#Three patients had 2 secondary surgeries at separate occasions – 1 had refixation due to fixation failure and later plate extraction, 1 had fasciotomy due to compartment syndrome and later plate extraction, and 1 had carpal ligament release due to carpal tunnel syndrome and later plate extraction∗ One patient had 2 secondary surgeries at separate occasions – refixation due to fixation failure and later plate extraction# Three patients had 2 secondary surgeries at separate occasions – 1 had refixation due to fixation failure and later plate extraction, 1 had fasciotomy due to compartment syndrome and later plate extraction, and 1 had carpal ligament release due to carpal tunnel syndrome and later plate extraction Open table in a new tab

Evaluation of Results of Fixation of Unstable Distal Radial Fractures by Volar Locking Plating System

Distal radial fractures are most common fractures accounts 15% of whole skeletal injuries, as high as 40% to 49% are considered to be unstable that requires surgical fixation. The purpose of the study was to ascertain good functional hand by using volar locking plate &amp; screws, as with locking system, distal screws are locked to the plate, which stabilized the screws against lateral movement (toggle effect), thus providing a "single bone-plate-screws construct" which producing a scaffold in the mostly cancellous distal radial metaphysis, so preventing from collapse. This study was done from January 2007 to December 2008 at National Institute of Traumatology &amp; Orthopaedic Rehabilitation (NITOR). Total numbers of cases were 17. All patients were admitted in hospital &amp; most of them returned home within 4 days. Most patients were managed early within 1-10 days of injury. Most patients were Fernandez type 1, type 2, and type 3. Most patients were in the age group of 4th decade. All patients were followed up for a period of at least 3 months, mean follow up period was 6 months. Results showed that wrist pain, wrist stiffness, reduced grip strength were minimum with volar locking plate &amp; screws as there is minimal radial shortening, radial angulation, volar tilt &amp; ulnar variance and wrist flexion, wrist extension, ulnar deviation, supination, pronation were very good. So, the trauma surgeons can safely use this procedure.Faridpur Med. Coll. J. Jul 2016;11(2): 62-66

Volar Plate Fixation in Patients Older Than 70 Years with AO Type C Distal Radial Fractures: Clinical and Radiologic Outcomes.

Introduction Treatment of unstable distal radial fractures (DRFs) in elderly patients is controversial, and considering the increasing life expectancy, their appropriate treatment is of growing importance. Our aim was to analyze the clinical and radiologic outcomes in the elderly patients with AO type C DRF treated with volar locking plate (VLP). Materials and Methods Between 2007 and 2011, 572 DRFs were operated on in our hospital with open reduction and internal fixation with VLP. Of these, only 64 patients (66 DRFs) met the selection criteria (AO type C DRF, age > 70 years, minimum 12-month follow-up). Mean follow-up was 28 months. Outcome assessment included range of motion, grip strength, VAS pain, Mayo Clinic Score, and DASH score. Analysis of pre- and postoperative radiographs was performed. Complications were recorded. Statistical analysis was performed comparing the results with the contralateral side. Results Mean postoperative range of motion of the injured wrist compared with the control contralateral side was 86% for flexion ( p < 0.001), 92% for extension ( p < 0.001). The average DASH was 12. Mayo Clinic Wrist Score showed 43 excellent results, 15 good, 4 satisfactory, and 4 poor. Articular step-offs were reduced in 34 of 38 wrists. Five (7%) patients required plate removal. Conclusion The treatment of articular DRF (AO type C) with VLP in the elderly patients achieved greater than 90% of the wrist range of motion and grip strength with no residual pain in greater than 90% of the patients. Level of Evidence Therapeutic IV, case series.

Treatment of Distal Radial Fractures by Open Reduction and Internal Fixation with a Volar Locking Plate

The volar locking plate is a popular implant for surgical management of unstable distal radial fractures. We routinely utilize this system for all distal radial fractures except for those with entrapped intra-articular fragments and fractures with a displaced dorsomedial facet fracture (which is hard to capture with the volar approach alone). In this video, we describe in detail the necessary steps for successful placement of the volar locking plate, starting with preoperative planning and ending with expected outcomes. The approach that we utilize is through the flexor carpi radialis tendon sheath and avoids the radial artery. In the video, we describe 4 variations on the application of a volar locking plate: (1) the standard technique after appropriate reduction and provisional fixation with Kirschner wires, (2) regaining length through a shortened distal radial fracture, (3) using the volar plate to assist in the reduction and regain volar tilt, and (4) intraoperative management of coronal shift of the distal fragment. Complications reported for the volar locking plate have decreased with newer low-profile plate designs; however, they still include volar tendon irritation and/or rupture and median neuropathy. Postoperatively, we advise a brief 2-week period of immobilization for wound-healing, which is followed by a period during which a removable wrist splint is used and patients are instructed on the performance of a hand therapy regimen.

Intramedullary Nail Fixation for Displaced and Unstable Distal Radial Fractures in Patients Aged 65 Years or Older

Distal radius fractures in elderly patients are now commonly treated with a volar locking plate, but flexor pollicis longus dysfunction caused by stripping of the muscle and tendon irritation and rupture caused by prominence of the implant have been reported. Intramedullary implants can stabilize distal radius fractures while minimally affecting the flexor and extensor tendons and muscles around the site, but osteoporosis in elderly patients might affect the radiographic and functional results of distal radius fractures treated by intramedullary implants. We investigated the radiographic and functional results of intramedullary implants for distal radius fractures in patients ≥65 years of age. We reviewed medical records of 40 patients with extra-articular or simple intra-articular fractures with the sagittal fracture line treated by an intramedullary implant. All fractures achieved bony union, with an average radial inclination of 24.9 degrees, volar tilt of 9.2 degrees, and ulnar variance of 0.7 mm. We encountered one case of postoperative volar displacement of the distal fragment due to the small size of the intramedullary implant. The average range of motion was 69.8 and 59.9 degrees for dorsal and palmar wrist flexion, respectively. Average percentile grip strength of the uninjured side was 97%. The average Mayo modified wrist score at final follow-up was 91.9 points, with 20 patients graded as excellent, 16 as good, and 4 as fair. The findings of this study indicate that intramedullary implants for dorsally displaced extra-articular or simple intraarticular distal radius fractures may offer good radiological and functional outcomes without hardware irritation in elderly patients. Distal radius fractures with an osteoporotic, large medullary canal should be stabilized by implants of an appropriate size.