Volar Plate Osteosynthesis Research Articles

Is Carpal Tunnel Release Necessary in High-Energy Distal Fractures of the Radius?

Purpose This study aimed to compare the clinical outcomes of patients who underwent volar plate osteosynthesis for high-energy distal radius fracture (DRFx) and carpal tunnel release (CTR) for acute or subacute carpal tunnel syndrome (CTS) with patients who did not undergo CTR. Methods This study is a retrospective evaluation of all high-energy DRFx treated with volar plate osteosynthesis in a regional hospital between January 2021 and January 2023. All adult patients (≥18 years) who underwent open reduction and internal fixation were included in the study after obtaining approval from the internal review board of our institution. Only patients who underwent plate osteosynthesis of the volar aspect through a modified Henry incision and patients who underwent CTR through a classic separate incision were included in the study. Clinical results includehand dynamometry, visual analog scale (VAS) scores, and physical examination findings of patients who underwent volar plate osteosynthesis because of high-energy DRFx and CTR due to CTS in the acute and subacute periods were retrospectively examined. Results Among the patients who underwent volar plate osteosynthesis because of high-energy DRFx, no statistically significant difference was detected between the hand grip strength and VAS scores of patients who underwent CTR because of acute CTS and subacute CTS at the sixth postoperative week (p>0.05). Conclusion Prophylactic CTR may be performed in the same session in selected cases, such as DRFx caused by a high-energy injury, to establish a scale for DRFx at a high risk of CTS and avoid delays in treatment. CTR for transient CTS detected in the subacute period during outpatient follow-up does not improve clinical outcomes.

The relationship between plate prominence and need for removal after volar plate osteosynthesis of distal radius fractures.

This study aimed to assess the incidence of plate-related complications and the need for plate removal after volar plate osteosynthesis of the distal radius in relation to Soong classification. All consecutive patients (age > 16years) in our level II trauma center treated with plate osteosynthesis for distal radius fractures from January 2017 until June 2019 were retrospectively evaluated. The main outcome measures were volar plate positioning according to Soong classification and incidence of plate removal. In addition, the incidence of tendon ruptures, reasons for volar plate removal, and improvement of complaints after removal were evaluated. The overall incidence of plate removal in the 336 included patients was 16.9% (n = 57). Removal incidence in Soong 2 plates (28.2%) was significantly higher compared to Soong 0 and 1 plates (8.0% and 14.4%, respectively), P = 0.003. Multivariable binary logistic regression analysis showed Soong grade 2 as an independent predictor for plate removal, OR 4.3 (95% CI 1.4-13.7, P = 0.013). Four cases of flexor and four cases of extensor tendon rupture were reported, all in Soong 2 grade plating. The main reasons for volar plate removal were pain (42%) and reduced functionality (12%). In cases where pain was the main reason for removal, 81% of patients reported a decrease in pain during follow-up after surgery. This study suggests an association between plate prominence graded by Soong and plate removal using a single plating system. Plate prominence should be reduced in volar plating whenever technically feasible.

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

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

Clinical, functional and radiological outcomes of volar locked plating of distal radius fracture: A prospective study

Background: The fracture of lower end radius is the most common fracture of the upper extremity encountered in practice and constitutes 10 to 20% of all the fractures and 75% of all forearm fractures. In spite of various new advances, closed reduction and cast immobilization has been the mainstay of treatment of these fractures, but malunion of fracture and subluxation /dislocation of distal radioulnar joint resulting in poor functional and cosmetic results is the usual outcome. Recently, the volar locked plate osteosynthesis is considered as the “gold standard” in treatment of ‘unstable’ distal radius fractures. The present study proposed to evaluate the role of volar locking plate fixation in the management of intra-articular and extra-articular volar fractures of distal end radius and to evaluate the clinical, functional and radiological outcomes.Aim and Objectives: To study the improvement in clinical, functional and radiological outcomes of volar locked plate fixation in a distal end radius fracture.Materials and Methods: A prospective study was undertaken in a Tertiary Hospital from September 2016 to September 2018, 30 patients (age >20 yrs) with volar fracture of lower end of radius i.e. AO types A 2.3, B 3.1, B 3.2, B 3.3 operated with volar locked plating. The patients were followed up at 2nd, 6th, 12th and 24th postoperative weeks. Radiological & clinical, functional outcomes were assessed by using Stewart score & PRWE (Patient–rated wrist evaluation questionnaire) score respectively. Data collected of these 30 patients were statistically analysed using ANOVA chi – square test.Results: Clinical and Functional outcome by Patient Rated Wrist Evaluation scoring system shows maximum no. of patients come in Good and Excellent grading i.e. 17(56.7%) and 8(26.7%) out of 30 patients, along with this 1(3.3%) Fair and 4(13.3%) Poor result. Radiological outcome by Stewart I scoring system is Maximum no. of cases shows Good and Excellent results i.e. 20(66.7%) and 6(20%) out of 30 patients. With this 1(3.3%) Fair and 3(10%) Poor result.Conclusion: Open reduction and internal fixation with volar locked plating has satisfactory functional and radiological outcome with minimal complications and thus it is an excellent modality to treat volar fractures of distal end radius.

Incidence of Complications following Volar Locking Plate Fixation of Distal Radius Fractures: An Analysis of 647 Cases.

This study assessed the risk and factors of complications after volar locking plate fixation of distal radius fractures. A single-institution retrospective review of patients undergoing volar locking plate fixation of distal radius fractures between May of 2000 and May of 2015 was undertaken. Demographic data, major complications, minor complications, and radiographic parameters were evaluated. Six hundred forty-seven distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean body mass index was 28.0, and 14.6 percent of patients had a body mass index greater than 35. Fractures were classified as Arbeitsgemeinschaft für Osteosynthesefragen class 23-C (67.2 percent), 23-A (26.6 percent), and 23-B (6.2 percent). The incidence of major and minor complications was 13.8 percent and 17.5 percent, respectively. The most common complication was transient paresthesia (9.7 percent). The incidence of tendon rupture or irritation was 0.5 percent or 2.5 percent, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2 percent at an average of 427.8 days after surgery. Major complications and minor complications were increased 2.2- and 1.9-fold, respectively, in patients with a body mass index greater than 35. Major complications were also increased 3.19 times in patients with residual intraarticular step-off. Hardware removal was 3.3 times more likely in patients with Soong grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes mellitus. Volar plate osteosynthesis of distal radius fractures is associated with an overall low complication rate. Patient factors, including diabetes mellitus and obesity, and intraoperative factors, including intraarticular fracture alignment and plate prominence, were associated with a higher rate of complications or revision surgery. Risk, III.

Management of Volar Barton fracture with volar plate osteosynthesis - Prospective study

Introduction- Distal radius reconstruction needs aggressive operative intervention is still a debate among researchers & orthopaedic surgeons. There is very little role of non operative management in geriatric unfit patients. Revolution of implants & techniques advocated the best clinical outcome. Material & methods- Prospective research study is conducted at G.S. medical college Hapur, in department of orthopaedics. 20 patients of volar Barton fractures between the age group of 20 to 50 years were included in the study and treated with volar locking plate. out come of study was evaluated by using the Gartland & Werly score modified by Sarmiento & patient rated wrist Evaluation (PRWE) score. Results- Mean palmar flexion was 74 degree, dorsi flexion was 84 degrees observed, average supination & pronation was 85 & 80 degrees respectively. Radial & ulnar deviations average 10 and 25 degrees observed. 85% of patient had loss of radial inclination less than 10 degrees. All the patient had less than 5 mm radial shortening. Loss of palmar tilt less than 6 degrees was observed. More than 90% of the patients had excellent to good outcome based on Gartland & Werley score. Conclusion- Volar plating reproducible & proven method of choice in majority of Volar Barton factures of radius irrespective of comminution & fragments separation. Keywords: Volar Barton fracture, volar plate, osteosynthesis

Comparison of volar and dorsal plate osteosynthesis for radial shaft fractures: an anatomical pilot study

BackgroundNo publication has yet described the interface between the radius and the plate in various positions. Neither clinical examination nor assessment of fracture radiographs provides information about the anatomy of the radius before injury. PurposeWe investigated radius anatomy to analyse dorsal and volar plate-to-bone fit for radial shaft fracture management. MethodsWe examined 20 specimens from human adult cadavers. An 8-hole 3.5-mm titanium locking plate was used at three different positions on the dorsal and the volar side of the bone. The space between the well-positioned plate and the radial shaft was attained for each hole of the plate. ResultsThe average space between the midshaft radial cortex and the plate holes for all positions was 0.69mm (range: 0.0mmto 2.38mm). The greatest mean distance between the plate and the radial cortex was measured at the volar mid-diaphyseal position of the plate with an average of 1.31mm. ConclusionThis incongruence between the radial cortex at the volar diaphysis and the plate should be considered when applying plates to this position of the radius. The results of this cadaver study indicate that radius plate osteosynthesis should preferably be done from the dorsal side.

Using self-drilling screws in volar plate osteosynthesis for distal radius fractures: a feasibility study

BackgroundSymptomatic extensor tendon irritation is a frequent complication in volar plate osteosynthesis of distal radius fractures. It is typically caused by dorsal screw protrusion and overdrilling of the dorsal cortex. The use of self-drilling locking screws (SDLS) could overcome both causes. The practical applicability of SDLS depends on two prerequisites: (1) the feasibility of preoperative distal screw length determination, and (2) sufficient primary biomechanical stability of SDLS compared to standard locking screws (SLS).MethodsWe first assessed the feasibility of preoperative screw length determination (1): Distal radius width, depth and distal screw lengths were measured in 38 human radii. Correlations between distal radius width and depth were assessed, a cluster analysis (Ward’s method and squared Euclidean distance) for distal radius width conducted, and intra-cluster screw lengths analyzed (ANOVA). The biomechanical performance of SDLS (2) was assessed by comparison to SLS in a distal radius fracture model (AO-23 A3). 75 % distal screw length was chosen for both groups to simulate a worst-case scenario. Uniaxial compression tests were conducted to measure stiffness, elastic limit, maximum force and residual tilt. Statistics comprised of independent sample t-tests and a Bonferroni correction (p < 0.0125).Results(1) Distal radius width and depth showed a high correlation (R2 = 0.79; p < 0.001). Three distal radius width clusters could be identified: small <34 mm; medium 34–36.9 mm; large >36.9 mm. ANOVA and Tukey post-hoc analysis revealed significantly different volar-dorsal depths (p < 0.05) for nearly all screws. (2) To assess biomechanical stability nine specimens were tested each; no significant differences were found between the SDLS and SLS groups.ConclusionsThis feasibility study demonstrates that (1) distal radius width can be used as a predictor for distal screw length and (2) that SDLS provides mechanical stability equivalent to SLS. These results highlight the feasibility of applying SDLS screws in volar plate osteosynthesis at least in extraarticular fractures.

Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment

Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.

Morphology of distal radius curvatures: a CT-based study on the Malaysian Malay population.

The purpose of this study was to examine the differing curves of the volar distal radius of healthy Malaysian Malays, so as to obtain detailed morphological information that will further the understanding of volar plate osteosynthesis in Malaysian Malays. Computed tomography with three-dimensional reconstruction was performed on the wrists of 16 healthy Malaysian Malay volunteers. Profile measurements were made using a software program. A novel parameter, the pronator quadratus curve angle, was explored and introduced in this study. Interclass correlation coefficients were calculated to assess the level of agreement between the data collected by the principal investigator and that collected by an independent radiologist. The mean ± standard deviation of the arc radii on the radial aspect was 17.50° ± 5.40°, while the median (interquartile range [IQR]) of the arc radii on the ulnar aspect was 25.27° (IQR 5.80°). The mean ± standard deviation of the curvature of the pronator quadratus line was 40.52° ± 2.48°. The arc radii on the radial aspect was significantly lower than the arc radii on the ulnar aspect (p = 0.001). Different radial and ulnar arcs were observed in 56.25% of the radii; the arc was deeper on the ulnar aspect in 93.75% of the radii. Based on the findings of this study, the likelihood of achieving anatomical reduction with uniformly curved, fixed-angle volar plates is questionable. Changes in the design of these implants may be needed to optimise their usage in the Malaysian Malay population.

The influence of distal screw length on the primary stability of volar plate osteosynthesis--a biomechanical study.

BackgroundExtensor tendon irritation is one of the most common complications following volar locking plate osteosynthesis (VLPO) for distal radius fractures. It is most likely caused by distal screws protruding the dorsal cortex. Shorter distal screws could avoid this, yet the influence of distal screw length on the primary stability in VLPO is unknown. The aim of this study was to compare 75 to 100 % distal screw lengths in VLPO.MethodsA biomechanical study was conducted on 11 paired fresh-frozen radii. HRpQCT scans were performed to assess bone mineral density (BMD) and bone mineral content (BMC). The specimens were randomized pair-wise into two groups: 100 % (group A) and 75 % (group B) unicortical distal screw lengths. A validated fracture model for extra-articular distal radius fractures (AO-23 A3) was used. Polyaxial volar locking plates were mounted, and distal screws was inserted using a drill guide block. For group A, the distal screw tips were intended to be flush or just short of the dorsal cortex. In group B, a target screw length of 75 % was calculated. The specimens were tested to failure using a displacement-controlled axial compression test. Primary biomechanical stability was assessed by stiffness, elastic limit, and maximum force as well as with residual tilt, which quantified plastic deformation.ResultsNine specimens were tested successfully. BMD and BMC did not differ between the two groups. The mean distal screw length of group A was 21.7 ± 2.6 mm (range: 16 to 26 mm), for group B 16.9 ± 1.9 mm (range: 12 to 20 mm). Distal screws in group B were on average 5.6 ± 0.9 mm (range: 3 to 7 mm) shorter than measured. No significant differences were found for stiffness (706 ± 103 N/mm vs. 660 ± 124 N/mm), elastic limit (177 ± 25 N vs. 167 ± 36 N), maximum force (493 ± 139 N vs. 471 ± 149 N), or residual tilt (7.3° ± 0.7° vs. 7.1° ± 1.3°).ConclusionThe 75 % distal screw length in VLPO provides similar primary stability to 100 % unicortical screw length. This study, for the first time, provides the biomechanical basis to choose distal screws significantly shorter then measured.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-015-0283-8) contains supplementary material, which is available to authorized users.

The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture

To determine the relative benefits of an extended flexor carpi radialis (FCR) (eFCR) approach with prophylactic carpal tunnel release at the time of volar plate osteosynthesis for distal radius fracture via a single incision into the traditional volar Henry (VH) approach. This was a prospective cohort comparison of preoperative and postoperative median nerve function of 27 patients (15 eFCR and 12 VH) with unilateral, isolated distal radius fractures requiring open reduction internal fixation without preoperative acute carpal tunnel syndrome. Patients were operated on via either the eFCR or VH approach. The validated Levine-Katz Carpal Tunnel Questionnaire (symptom and functional severity scores) was administered and Semmes-Weinstein monofilament and 2-point discrimination testing were conducted preoperatively and at 6 weeks and 3 months postoperatively. Grip and pinch strength were measured at 6 weeks and 3 months. The groups were comparable in terms of age, sex, and fracture type and displacement. Comparing across groups, there were no statistically significant differences in any outcome measured preoperatively or postoperatively. The eFCR and VH groups demonstrated significant improvement in functional severity scores, symptom severity, and grip strength. The symptom severity score improved to statistical significance at 6 weeks in the eFCR group and at 3 months in the VH group. In this small comparative study, the eFCR approach was found to be safe and efficacious. There was no increased surgical morbidity, which suggests that this technique can be used safely for all patients undergoing volar plating and not just in cases of concurrent carpal tunnel syndrome. It allows easier retraction of carpal tunnel contents; therefore, it is our preferred approach.

Intraoperative virtual implant planning for volar plate osteosynthesis of distal radius fractures

Digital planning of implants is in most cases conducted prior to surgery. The virtual implant planning system (VIPS) is an application developed for mobile C-arms, which assists the virtual planning of screws close to the joint line during surgery for treatment of distal radius fractures with volar plate osteosynthesis. The aim of this prospective randomized study was to acquire initial clinical experiences and to compare the VIPS method with the conventional technique. The study included 10 patients for primary testing and 30 patients with distal radius fractures of types A3, C1 and C2, divided in 2 groups. In the VIPS group, after placement of the plate and fracture reduction, a virtual 3D model of the plate was matched with the image of the plate from the fluoroscopic acquisition. Next, the length and position of the screws close to the joint line were planned on the virtual plate. The control group was treated with the same implant in the conventional way. Data were collected regarding screw replacement, fluoroscopy and operating room (OR) times. The VIPS group included six A3, one C1 and eight C2 fractures, while the control group consisted of six A3 and nine C2 fractures. Three screws were replaced in the VIPS group and two in the control group (p = 0.24). The mean intraoperative fluoroscopy time of the VIPS group amounted to 2.58 ± 1.38min, whereas it was 2.12 ± 0.73min in the control group (p = 0.26). The mean OR time in the VIPS group was 53.3 ± 34.5 minutes and 42.3 ± 8.8min (p = 0.23) in the control group. The VIPS enables a precise positioning of screws close to joint line in the treatment of distal radius fractures; however, for routine use, further development of the system is necessary.

The Dorsal Tangential X-Ray View to Determine Dorsal Screw Penetration During Volar Plating of Distal Radius Fractures

To evaluate whether the dorsal tangential view (DTV) allows for reliable and valid in vivo measurement of the distance between screw tips and the dorsal radial cortex (STCD) during volar plating of distal radius fractures. Subjects included 22 patients with displaced distal radius fractures who had volar plate osteosynthesis. We performed standardized DTV images intraoperatively. After surgery, we performed computed tomography (CT) scans with reconstructions parallel to the distal screws. Three independent observers blinded to the study protocol measured the STCD on the basis of the DTV images and CT reconstructions. We calculated inter- and intraobserver reliability and the correlation between STCD values measured with DTV images and CT scans. Eleven screws were changed intraoperatively. We observed no cases of postoperative screw perforations. Inter- and intraobserver reliability of STCD measurement was good when measured with DTV images and excellent when measured on the basis of CT reconstructions. Statistical analysis showed a good correlation between mean STCD values measured with DTV and CT. The DTV allowed in vivo evaluation of the dorsal radial cortex and enabled reliable assessment of the distance between the screw tip and the dorsal cortex. It may allow detection of dorsal screw perforation during volar plating of distal radial fractures.

The treatment of displaced intra-articular distal radius fractures in elderly patients.

From 2000 to 2012, the annual incidence of inpatient treatment for distal radius fracture in Germany rose from 65 to 86 per 100 000 persons. It is unclear whether open reduction and volar angle-stable plate osteosynthesis (ORIF), a currently advocated treatment, yields a better functional outcome or quality of life than closed reposition and casting. In the ORCHID multi-center trial, 185 patients aged 65 and older with an AO type C distal radial fracture were randomly assigned to ORIF or closed reposition and casting. Their health-related quality of life and hand/arm function were assessed 3 and 12 months afterward with the Short Form 36 (SF-36) questionnaire and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. The radiological findings, range of movement of the wrist, and EuroQol-5D (EQ-5D) scores were documented as well. Among the 149 patients in the intention-to-treat-analysis, there was no significant difference in SF-36 scores between the two treatment groups at one year (mean difference, 3.3 points in favor of ORIF; 95% confidence interval, -0.2 +6.8 points; p = 0.058). The DASH scores showed moderately strong, but clinically unimportant effects in favor of ORIF, and there was no difference in EQ-5D scores. ORIF led to better radiological results and wrist mobility at 3 months, with comparable results at 12 months. 37 of the patients initially allotted to nonsurgical treatment underwent secondary surgery due to significant loss of reduction. The findings with respect to mobility, functionality, and quality of life at 12 months provide marginal and inconsistent evidence for the superiority of volar angle-stable plate osteosynthesis over closed reduction and casting in the treatment of intra-articular distal radius fractures. Primary nonsurgical management is also effective in suitable patients.

Clinical study of the pronator quadratus muscle: anatomical features and feasibility of pronator-sparing surgery.

BackgroundNo clinical data for the relationship of pronator quadratus (PQ) muscle to distal radius had been reported. The aim of this study was to investigate the anatomical features of the PQ muscle related to plate osteosynthesis for distal radius fractures in clinical cases. The feasibility of PQ muscle sparing surgery was investigated as well.MethodsFifty two distal radius fractures (23-A2) were enclosed in this study. The whole width of the muscle and the distance from the distal edge of the muscle to the joint surface of the distal radius were measured. The distance from the fracture site of the radius to the joint surface was measured as well.ResultsThe average width of the pronator quadratus muscle was 37.6 mm. The average distance from the pronator quadratus muscle to the lunate fossa surface was 12.2 mm, and the average distance from the pronator quadratus muscle to the scaphoid fossa surface was 13.6 mm. The average distance from the lunate fossa of the distal radius to the fracture site was 12.2 mm (range, 7.3-17 mm), and the scaphoid fossa of the distal radius to the fracture site was 13.2 mm (range, 9.4-18.8 mm).ConclusionsThis PQ muscle sparing surgery is feasible and can be performed without difficulty. The data might provide a useful basis for the preservation of pronator quadratus muscle applied to a functionally reduced fracture regarding the potential efficacy of conventional volar plate osteosynthesis.

Influence of fracture type and surgeon experience on the emission of radiation in distal radius fractures

Ionising radiation is a potential risk for potentially exposed personnel. Only a few studies have examined the factors contributing to the emission of radiation in orthopaedic trauma procedures. We hypothesize that the experience of the surgeon and the fracture type influence the emission of radiation intraoperatively. In a retrospective analysis, we examined 100 consecutive distal radius fractures receiving a volar plate osteosynthesis. The following parameters were documented: demographic data, plate system, fracture type, duration of the surgical procedure and duration of the emission of radiation, the experience level of the surgeon and the first assisting surgeon. Of all included patients (74 female), 48 had a type A, 7 a type B and 45 a type C fracture. The duration of radiation was longer for type C fractures [1.04 min (min)] in comparison to type A fractures (0.88 min) (P = 0.8152). In the type C subgroup, the highest amount of radiation was required for type C3 fractures (1.6 min), which was significantly more in comparison to type A (P = 0.0460) and type C1 fractures (P = 0.0089). The intraoperative emission of radiation (P = 0.00141) and the procedure time (P = 0.0006) depended on the experience of the surgical team. The emission of radiation during this procedure depends on the fracture type and the experience of the surgical team. Operating theatre personnel should be aware of the higher emission rates during the treatment of type C fractures and in teaching hospitals with inexperienced team members.

Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures

The purpose of this study was to analyze the practicability and benefit of intraoperative C-arm computed tomography (CT) imaging in volar plate osteosynthesis of unstable distal radius fractures. During a 1 year period, intraoperative three dimensional (3D) imaging with the ARCADIS Orbic 3D was performed in addition to standard fluoroscopy in 51 cases. The volar angular stable plate oesteosyntheses were analyzed intraoperatively and, if necessary, improved immediately. The duration of the scan and radiation exposure dose were measured. On average, performance of the scan and analysis of the CT dataset took 6.7 minutes. In 31.3% of the surgeries a misplacement of screws was detected and correction was done immediately. C-arm CT imaging can easily be integrated in the normal course of surgery. As a complement to the standard 2D-fluoroscopy, the C-arm CT is a useful tool to evaluate the quality of osteosynthesis.

Betydningen av feilstilling etter dorsalt vinklet distal radiusfraktur

Distal radial fractures occur very frequently. Most are dorsally displaced (Colles' fracture). In contrast to previously, approximately a quarter of these patients now undergo surgery. This is more than the number that is reduced and immobilised in a plaster cast. Volar plate osteosynthesis is now the most common type of surgery. There is great uncertainty regarding indications for surgery. The article is based on own research, a search in PubMed and a review of reference lists to identify articles that compare radiological and clinical outcomes after Colles' fractures. A number of national orthopaedic associations have reviewed the literature in an attempt to draw up guidelines for indications for performing surgery on distal radial fractures, without being able to arrive at definite recommendations based on randomised studies. Our review of the literature indicates a very uncertain correlation between radiological displacement and the final clinical outcome. This applies particularly to elderly patients (over 55-65), where by far the majority of the studies do not find any such correlation. Complications and reoperation are common among patients who have undergone volar plate surgery. There is surprisingly little correlation between the radiological and clinical outcome after Colles' fractures. A practice where a large proportion of patients undergo surgery is probably not justified. Elderly patients will very seldom benefit from surgery in the longer term.

Isokinetic study of the impact of styloid fracture with a volar plate osteosynthesis on pronosupination strength

styloid; – group 2: patients without fracture of the ulnar styloid or just a tip fracture. A control group (Group 3) was composed of six healthy patients without history of trauma of the wrist. All the patients were tested bilaterally for isokinetic and isometric pronation and supination strength. Clinical outcomes such as grip strength, range of motion, Mayo Clinic Wrist score (MWS), DASH score and Lidstrom classification were evaluated by an independent observer and correlated with isokinetic results. Statistical analysis was performed with Kruskall-Wallis test and Wilcoxon test (P < 0.05). Results.– There were no significant differences in range of motion; grip strength; MWS and DASH scores and isometric strength of pronation and supination. Isokinetic evaluation showed a significant decrease of the supination strength between group 1 compared to group 2 and 3 at 458/s (P < 0.01). Discussion.– This study suggests that fracture of the base of the ulnar styloid has no effect on upper extremity specific questionnaires. However, a significant decrease in isokinetic supination force is expected. More specific health questionnaires may confirm the clinical effect of this loss of strength. Consequently, more aggressive treatment for the ulnar styloid may be proposed in case of fracture of the radius associated with ulna in young and active patients.