Unstable Distal Radius Fractures Research Articles

Trimed Fixation System for Displaced Fractures of the Distal Radius

To study the functional outcome of displaced distal radius fractures treated by open reduction and internal fixation with the use of fragment-specific fixation. Fifteen consecutive displaced distal radius fractures (5 extra-articular and 10 intra-articular) were treated using the Trimed distal radius fixation system (Trimed, Valencia, CA). Radiographic assessment and range of motion of the affected wrist were evaluated postoperatively. Functional outcomes were evaluated with use of the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. The mean follow-up was 11 months. The patients initiated controlled passive and active motion exercises during the first week. The mean score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 16 points. The mean return to work was 12 weeks. The functional outcome was 80% excellent or good by the Gartland and Werley scoring system for intra-articular fractures and 80% excellent for extra-articular fractures. Range of active motion in intra-articular fractures was measured 60 degrees wrist extension, 64 degrees flexion, 65 degrees pronation, and 70 degrees supination, and for extra-articular fractures, 75 degrees extension, 70 degrees flexion, 80 degrees pronation, and 75 degrees supination. There was failure of fixation with loss of the reduction that was achieved at the time of operation in one patient. Fragment-specific fixation of unstable distal radius fractures using the Trimed system appears to be effective. Anatomic reduction, earlier range of motion, and improved functional results can be achieved using low-profile implants.

Surgical treatment of unstable distal radius fractures with volar locking plates

BackgroundSurgical treatment of unstable distal radius fractures does not always yield a satisfactory outcome. The several surgical strategies available have problems associated with them. This study was undertaken to determine if volar locking plate fixation could be useful for treating unstable distal radius fractures. MethodsThis retrospective follow-up study assessed 24 fractures in 24 patients with unstable distal radius fractures surgically treated with one of three volar locking plate systems. According to the AO classification system, 7 patients had type A3 fractures, 5 patients had type C2 fractures, and the remaining 12 patients had type C3 fractures. Radiographic measurements included volar tilt, radial inclination, and ulnar variance. Clinical outcomes were evaluated by active range of motion of the wrist and forearm, grip strength, Saito’s wrist score, and the Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (JSSH version of the DASH). ResultsAt the time of final follow-up (5 months minimum) the mean volar tilt was 8.1°, radial inclination was 20°, and ulnar variance was 0.4mm. Mean wrist extension measured 61°, wrist flexion 55°, radial deviation 23°, ulnar deviation 35°, pronation 87°, and supination 87°. Grip strength recovered to a mean of 84% of the grip strength in the contralateral limb for patients who had injured their dominant hand and to a mean of 73% for patients who had injured their nondominant hand. Saito’s wrist score calculations revealed 20 excellent and 4 good results. The mean DASH disability/symptom score was 9.9 points, and the mean DASH work module score was 8.2 points. ConclusionsThe present study demonstrated that unstable distal radius fractures could be successfully treated with volar locking plate systems.

Results after operation of unstable distal radius fractures in the elderly. A comparison of three treatments

Die palmare winkelstabile Plattenosteosynthese wird immer haufiger zur operativen Versorgung von distalen Radiusfrakturen des Typ C eingesetzt. Ob sie dem Verfahren der nichtwinkelstabilen Platte oder dem des Fixateur externe bei komplexen geschlossenen Frakturen uberlegen ist, insbesondere im Bezug auf die Funktionalitat und die Patientenzufriedenheit, ist nicht geklart. Deshalb wurde diese retrospektive Match-Paar-Analyse (1994–2004), welche 45 Patienten im Alter von 50–70 Jahren einschliest, die wegen einer distalen Radiusfraktur (C1/C2) operiert wurden, ein. Postoperativ wurde eine klinische und radiologische Untersuchung, die Funktion, Schmerzhaftigkeit und Stellung des Gelenkes erfaste, durchgefuhrt. Der DASH-Bogen und der Martini-Score wurden verwendet. Insgesamt demonstrierte die winkelstabile palmare Plattenosteosynthese im Vergleich zu beiden anderen Verfahren signifikant bessere funktionelle und radiologische Ergebnisse. Das subjektive Empfinden der Patienten mit Plattenosteosynthese war besser als das der Patienten, die mit einem Fixateur externe versorgt wurden. Dies lies sich im DASH-Score mit 7 Punkten fur die winkelstabile Platte, 14 Punkten fur die nichtwinkelstabile Platte und 20 Punkten fur den Fixateur externe zeigen. Der Martini-Score, welcher auch radiologische Kriterien mit einbezieht, bestatigte diese Ergebnisse. Auch Komplikationen und Reoperationen wurden bei Versorgung mit einer Plattenosteosynthese im Vergleich zum Fixateur externe seltener beobachtet. So kam es beim Fixateur externe beispielsweise zur Entwicklung von M. Sudeck, Pininfektion, Fehlstellung und damit 2-mal zur Reoperation. Auffallend war, das ein Carpaltunnelsyndrom nur bei beiden Plattenosteosynthesen, nicht aber beim Fixateur externe beobachtet wurde. Dieser sollte deshalb bei Operation durch eine Platte gespalten werden. Unsere Daten zeigen, das die meisten C1/C2-Frakturen des distalen Radius erfolgversprechend durch die winkelstabile palmare Plattenosteosynthese versorgt werden konnen.Dieses Verfahren geht mit einer hohen Patientenzufriedenheit einher.

Multidirektionale winkelstabile Versorgung der instabilen distalen Radiusfraktur

Open reduction and internal fixation with plates is a valid treatment of displaced extra- and intra-articular distal radius fractures. This report presents our experience treating unstable distal radius fractures by using a multidirectional palmar fixed-angle plate system (Aptus(R) Radius 2.5 by Medartis). The subchondral support of the articular surface by fixed angle screws prevents secondary dislocation allowing early mobilisation. 61 patients with distal radius fractures were treated during 6/2003 and 10/2004 using this palmar fixed-angle plate fixation without bonegraft. Postoperative X-rays showed anatomical reduction in all cases. 55 patients could be evaluated postoperatively. The follow-up examination included the patient's history, physical and radiographic examination as well as the DASH questionnaire and the Krimmer's modified Cooney wrist score. The average follow-up time was 9.6 +/- 5.2 months. The mean age of the examined patients was 53.9 +/- 17.8 years. The fractures were classified according to AO. There were eleven A3, four B2 and five B3 fractures, ten C1, 16 C2 and nine C3 fractures. All fractures united without complications. Just two cases showed a loss of length. At follow-up the average palmar angulation was 8 degrees , ulnar inclination 21 degrees and ulnar variance + 0.2 mm. Wrist motion averaged a decrease for extension and flexion of 12 %, for ulnar and radial deviation of 9 % and for pronation and supination only of 2 % in comparison to the uninjured side. Grip strength reached an average of 85 % of the contralateral side. Patients regained good function as represented in a mean DASH score of 14 points and a Krimmer score of 82 points. The treatment of unstable distal radius fractures with this plate fixation provided stable internal fixation and allowed early function. Due to multidirectional angle fixation and two lines of cortical screws it is possible to achieve an optimal restoration. The fixation of the central articular surface is guaranteed by the distal line, the dorsal subchondral support by the proximal line.

Responsiveness of the Michigan Hand Outcomes Questionnaire and Physical Measurements in Outcome Studies of Distal Radius Fracture Treatment

Outcomes study of distal radius fracture (DRF) treatment has been hampered by an uncertainty regarding the most appropriate outcomes assessment tool to evaluate the effectiveness of treatment. This study aimed to measure the responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) and physical measurements to assess the value of these outcomes tools for DRF studies. Forty-seven patients prospectively completed the MHQ and physical testing at 3 months and 6 months (period 1) after open reduction and internal fixation of unstable DRFs. Thirty-seven patients prospectively completed the MHQ and physical testing at 6 months and 1 year after open reduction and internal fixation (period 2). Responsiveness to clinical change within each period was calculated with standardized response means (SRMs). In period 1, all domains of the MHQ except aesthetics significantly improved. The SRMs were large for the overall score and for the work domain. The SRMs were medium for the pain, function, and activities of daily living domains. In period 1, the grip strength, pinch strength, and active wrist range of motion measurements significantly improved and had large SRMs. In period 2, the grip- and pinch-strength tests significantly improved and the SRMs were medium, whereas the active wrist range of motion had a small SRM. Unlike other conditions such as carpal tunnel syndrome, for which the outcomes questionnaire is the most responsive measure, in DRF treatment both the MHQ and physical tests are responsive in measuring outcomes and should be reported for outcomes studies of DRFs. The MHQ and physical tests can be used for outcomes research related to DRF with the advantage of also being useful for assessing and comparing outcomes for other hand disorders.

Volar locking plate fixation of unstable distal radius fractures: A new ally against an old enemy

Volar locking plate fixation of unstable distal radius fractures: A new ally against an old enemy

A Biomechanic Comparison of an Internal Radiocarpal-Spanning 2.4-mm Locking Plate and External Fixation in a Model of Distal Radius Fractures

To compare the biomechanic stability of distal radius fracture fixation with a new internal radiocarpal-spanning 2.4-mm locking plate, which acts as an internal distal radius fixator, versus a standard distal radius external fixator. The number of locking screws necessary for adequate fracture fixation was also assessed. Ten cadaveric specimens were mounted in a loading fixture with cables attached to the 2 flexor and 3 extensor wrist tendons. A 1-cm osteotomy was created to simulate an unstable distal radius fracture. The radiocarpal-spanning locking plate was fixed to the radius and index metacarpal with 4 screws proximally and 4 distally. The specimen was incrementally loaded through the tendons. Motion at the fracture site was determined. Screws were sequentially removed from the construct, the specimen was again incrementally loaded, and fracture motion was measured. The fixation was then changed to an external fixator, and the loading tests were repeated. Fracture fixation with the radiocarpal-spanning 2.4-mm locking plate was significantly more stable with 4 screws proximally and 4 screws distally (4 x 4) and with the 3 x 3 configuration than with the external fixator in both flexion and extension. The 4 x 4 screw configuration was not significantly different from the 3 x 3 screw configuration. The 4 x 4 screw configuration was significantly more stable than the 2 x 2 and 1 x 1 screw configurations in both flexion and extension. All internal fixator configurations and the external fixator showed more fracture displacement at increasingly higher loads. Fracture fixation with the new internal radiocarpal-spanning 2.4-mm locking plate is more stable than with a standard distal radius external fixator. Only three 2.4-mm locking screws proximally and three 2.4-mm locking screws distally are required for adequate fixation of the locking spanning plate.

A Convenient Dynamic Wire Traction-fixation Method for Hand and Forearm Fractures

We report on a convenient intraoperative distraction technique, called the modified Dynamic Wire-framed Traction (mDWT) method, that assists in fracture reduction and/or is used as an external fixator in patients with unstable distal radius fractures and in other hand and forearm fractures. The mDWT device is easily assembled with wires at the time of surgery, and its configuration produces sufficient longitudinal distraction force that makes reduction easier and facilitates additional fixation procedures. Furthermore, the device can be converted into a simple unilateral external fixator that can be retained postoperatively. Our experience with 13 patients shows that the mDWT method is easy to apply and is a cost-effective technique when used as an intraoperative distraction device or as an external fixator.

Welche Vorteile bietet die volare Plattenosteosynthese gegenüber der Kirschner-Drahtstabilisierung bei distalen Radiusextensionsfrakturen des alten Menschen?

The purpose of this retrospective study was to compare the outcome of open reduction and internal fixation (ORIF) followed immediately by physiotherapy and of percutaneous K-wire-fixation and casting for unstable distal radius fractures in elderly patients, considering the results both in general, for all such fractures, and selectively for A3 and C2 fractures. Follow-up examinations were performed 26 (18-48) months after surgery in 43 patients (median age 67 (60-83) years) treated with K-wire fixation and 9 (5-17) months after surgery in 46 patients (median age 76 (60-90) years) treated with ORIF, and the outcome of each was recorded as Disabilities of the Arm, Shoulder and Hand (DASH), Gartland-Werley and Castaing scores; the radiological loss of correction was also assessed. Statistical analysis was performed first without reference to the specific type of fracture for the K-wire- and the total ORIF -groups, and then selectively for A3 and C2 -fractures only; in the second analysis the patients were divided into three groups: KD, ORIF with and ORIF without angular stability. The Garland-Werley and Castaing scores do not indicate any significant difference between the procedures specified. According to the Garland-Werley score 37 patients (86%) treated by K-wire fixation and 39 (85%) treated by ORIF achieved "excellent" and "good" results; according to the Castaing score there were 33 (77%) "good" results after K-wire fixation and 34 (74%) good results after ORIF. The radiological loss of correction (K-wire fixation/ORIF) as measured by the radial inclination (median 2/2.5 degrees), the palmar tilt (median 3/5 degrees) and the radial shortening (median 1/1 degrees mm) do not differ significantly. Suboptimal radiological results do not always correlate with results that are only "fair" or "poor". The non-fracture-specific DASH score suggests a higher degree of patient satisfaction after K-wire fixation (7 [0-87] points) than after ORIF (17 [0-82] points), which is not confirmed by fracture-specific evaluation. There is a significantly earlier return to the "activities of daily living" (4 as against 8 weeks) after ORIF. All the treatments compared are suitable for the treatment of A3 and C2 fractures. The important advantages of ORIF are the early functional physiotherapy without casting and without obligatory second surgery and the earlier return to "activities of daily living", which are all of decisive importance for older patients, who are the ones most frequently affected.

A Biomechanical Comparison of Two Volar Locked Plates in a Dorsally Unstable Distal Radius Fracture Model

This study compares the biomechanical stability of two volar locked plate systems for fixation of unstable, extra-articular distal radius fractures. In six matched pairs of fresh frozen cadaveric specimens, a simulated unstable, extra-articular distal radius fracture was created. The fractures were stabilized with one of two types of volar locked plates. Specimens were axially loaded at five different positions: central, volar, dorsal, radial, and ulnar. Initial (precyclic loading) stiffness of each locked plate system was calculated. Each specimen was then loaded for 5,000 cycles with an 80 N central load. Finally, specimens were axially loaded at the same five positions to calculate the postcyclic loading stiffness of each volar locked plate system. Main outcome measurements were precyclic loading stiffness, postcyclic loading stiffness, maintenance of stiffness after cyclic loading, and amount of fracture displacement between the two volar locked plate systems. There were no differences in maintenance of stiffness and fracture displacement following cyclical loading between the two volar plate systems. After cyclic loading, the distal volar radius (DVR) locked plate was significantly stiffer than the Synthes volar locked plate in volar loading only (p < 0.01). Materials properties and design differences between these systems did not provide enough biomechanical difference to support use of either implant over the other. With this in vitro model, both implants provided adequate stability to resist physiologic loads expected during therapy in the initial postoperative period.

Surgical treatment of distal radius fractures with an angle fixed bar palmar plating system: a single center study of 102 patients over a 2-year period

Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. This study reports a total number of 104 DRFs in 102 patients, operatively treated, over a 2-year period with a mean follow up time of 15.6 +/- 7.2 months The patient's average age was 59.9 +/- 18.0 years. The results were evaluated according to the scores of Gartland and Werley, Castaing and the disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire. Ninety-three patients were evaluated at final examination. Excellent and good results were achieved for 92 (98.9%) patients according to score of Gartland and Werley and for 86 (92.5%) patients regarding the scoring system of Castaing. The DASH outcome questionnaire averaged 8.0 +/- 13.7 points. This study shows, in a representative number of cases, that palmar plating of unstable fractures of the distal radius is a safe and effective treatment modality. Early surgical treatment results in optimal outcome regarding patient's quality of life.

2.4 Treatment of unstable distal radius fractures with a volar angle-stable plate (I.T.S. Plate). A prospective study

2.4 Treatment of unstable distal radius fractures with a volar angle-stable plate (I.T.S. Plate). A prospective study

Current Concepts in Volar Fixed-angle Fixation of Unstable Distal Radius Fractures

We present new developments in the volar treatment of unstable distal radius fractures in adults. New perspectives on the anatomy of the wrist, the watershed line on the volar radius and the usefulness of the pronator fossa are presented and these help to avoid flexor and extensor tendon disturbance when using a volar approach. Other new insights on the bony anatomy of the distal end of the radius are discussed, which are important in improving the quality of fracture fixation, including the benefits of constructing a precise fixed-angle scaffold underneath the articular surface in order to stabilize it. A volar fixed-angle plate must support the dorsal, central and volar aspects of the subchondral bone in order to stabilize the most complex fractures. Awareness of the anatomy of blood supply to the distal radius: the dorsal retinaculum that feeds the distal fragments and the blood supply to the diaphysis through branches of the anterior interosseous artery is necessary to maximize healing potential and avoid complications. Volar fixed-angle plates need to withstand very high forces during rehabilitation, the magnitude of these forces are up to five times the loads applied on the hand. Level V (expert opinion).

External Fixation Techniques for Distal Radius Fractures

Fractures of the distal radius are common injuries. Low-energy or high-energy mechanisms may be involved. Unstable distal radius fractures present a challenge to the treating orthopaedic surgeon. External fixation is a valuable instrument for fracture reduction and stabilization. Limited open incisions, early range of motion, and treatment of complex wounds are a few of the benefits of external fixation. Fixators may be spanning or nonbridging and may be used alone or in combination with other stabilization methods to obtain and maintain distal radius fracture reduction. Augmentation with percutaneous wires allows for optimal fracture stabilization with physiologic alignment of the wrist. Moderate distraction at the carpus does not induce postoperative stiffness. The distal radioulnar joint must be assessed and may need to be stabilized. Complications of external fixation are usually minor, but must be anticipated and treated early. Level V (expert opinion).

Volar locking compression plate fixation for osteoporotic distal radius fractures in the elderly patients

目的 探讨T形锁定加压钢板治疗老年桡骨远端骨质疏松性骨折的初期疗效.方法总结2003年6月～2005年5月T形锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折13例,男4例,女9例;年龄67～81岁,平均74岁.按AO分类标准:B2型2例,B3型3例,C1型2例,C2型5例,C3型1例,均为闭合性骨折.所有病例均采用掌侧入路,术中不显露背侧组织,骨缺损严重者置入人工骨(Osteoset).术后功能康复时间6～30周,平均12.3周.术后第1天开始被动活动腕关节,1周后主动活动,功能锻炼.结果13例全部获得随访,平均13.2个月(4～22个月).X线片显示骨折全部一期愈合,平均愈合时间为7周.所有病例均无感染、骨不连、钢板松动、腕管综合征、正中神经炎等并发症.按改良的Mcbride腕关节功能评价标准:优9例,良3例,可1例,优良率为92.3%.结论T形锁定加压钢板治疗老年骨质疏松引起的桡骨远端骨折,内固定牢靠,可以早期功能锻炼,减少了因长期固定而导致的骨量丢失,避免腕关节的僵硬程度,疗效佳。

Use of an External Fixation Combined with the Buttress-Maintain Pinning Method in Treating Comminuted Distal Radius Fractures in Osteoporotic Patients

It is difficult to keep the alignment of a distal radius fracture in patients with osteoporosis and prevent malunion. Therefore, we hoped to design better method to maintain alignment. Thirty-two patients over 65 years old with a displaced unstable distal radius fracture were treated by the external fixator combined with buttress-maintain pinning method and were compared with a group of 66 patients less than 60 years old treated by the same method. The radiologic results demonstrated that postoperative and final radial length and volar tilt were not statistically different between both groups. The functional result (excellent and good) in the elderly group was 87.5% and 89% to that of the control group. There was only one complication of pin tract infection in the elderly group. External fixation for unstable distal radius fracture combined with buttress-maintain pinning method can be used in the osteoporotic bone of older adults with results similar to those for young adults at 18 months follow-up.

Operative treatment for unstable distal radius fractures; The effects of approaches

Operative treatment for unstable distal radius fractures; The effects of approaches

Double-plating fixation for unstable distal radius fracture compromising the radiocarpal joint

Double-plating fixation for unstable distal radius fracture compromising the radiocarpal joint

Less invasive surgery for unstable distal radius fractures using small plates

Less invasive surgery for unstable distal radius fractures using small plates

Treatment of the Unstable Distal Radius Fracture with External Fixation and Bone Cement in Elderly Patients

Treatment of the Unstable Distal Radius Fracture with External Fixation and Bone Cement in Elderly Patients