Volar Plate Research Articles

Management Options and Clinical Outcomes After Flexor Tendon Ruptures Following Volar Plating of Distal Radius Fractures.

The transition to volar locking plates for the treatment of distal radius fractures has improved patients' range of motion, reduced extensor tendon issues, and hastened return to activity compared to older fixation methods or nonoperative treatment. One drawback to volar plating is the potential for flexor tendon ruptures due to aberrant plate or screw placement. This study aims to describe the reconstruction options and patient outcomes after flexor tendon rupture due to volar plating. This is a single-institution, retrospective review of patients who presented with flexor tendon rupture from 2014 to 2023 after a distal radius fracture previously managed with a volar plate. Patient demographics, operative details, range of motion, complications, and patient-reported outcomes were collected. Ten patients presented with flexor tendon ruptures after volar plating for distal radius fractures from 2014 to 2023. The most common rupture was flexor pollicis longus (FPL) in 7 patients, followed by index finger flexor digitorum profundus (FDP) in 2 patients, and small and ring finger FDP rupture in 1 patient. Flexor pollicis longus (FPL) was reconstructed with a palmaris longus (PL) graft in 4 patients, ring finger flexor digitorum superficialis transfer in 2 patients, and repaired primarily in 1 patient. All patients with FPL ruptures regained functional thumb interphalangeal flexion except for 1 patient who reruptured 4 weeks after surgery. Flexor tendon ruptures can occur following volar plating of distal radius fractures, even years after fixation of the fracture. These are attritional ruptures and generally reconstructed with tendon grafting of transfer, providing functional flexion of the affected digit.

Dorsal Cortical Screw Penetration in Volar Distal Radius Plating: Comparison of 3 Fluoroscopic Views.

The skyline or dorsal tangential view (DTV) and the carpal shoot-through (CST) have been developed to enhance the intraoperative examination of the distal radius's dorsal cortex during open reduction and internal fixation with volar plates. This study aimed to assess the lateral view (LV), DTV, and CST's effectiveness in showcasing screws that penetrate the dorsal cortex. Eighty patients, comprised of 42 women and 38 men with an average age of 53 years, underwent volar locking plate fixation for displaced distal radius fractures. The procedures incorporated the use of intraoperative LV, DTV, and CST views. Every view was meticulously examined to record the presence of screws that breached the dorsal cortex of the fractured region. Only 2 screws were found to protrude the dorsal cortex in the LV, demonstrating 100% specificity and 18.8% sensitivity. On the DTV, 9 screws were detected with the same specificity but increased sensitivity (75%). On the CST, all 12 screws were identified, making for 100% specificity and sensitivity. Of 501 distal screws, 13 (2.54%) penetrated the dorsal cortex, with an average length of 1.34 mm (range, 0.5-2 mm). These screws were subsequently replaced with shorter screws in 12 of 80 patients. The findings show that the CST and DTV are more precise and accurate than LV in identifying dorsal screw protrusion during distal radius volar plating. To minimize the likelihood of subsequent complications, it is highly advisable to implement these views in all procedures.

Anatomy of Lister's Tubercle: Implications for Volar Locked Plating of the Distal Radius.

Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister's tubercle on the dorsal aspect of the radius. The anatomy and location of Lister's tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister's tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female. As measured in cadaveric arms, the mean Lister's tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister's tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister's tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister's tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister's tubercle. Knowledge of Lister's tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures. IV-Therapeutic.

Spring-Wire Technique as a Cost-Effective Alternative for Volar Rim Fragment Fixation in Distal Radius Fractures.

Introduction Volar rim fragment fixation is difficult to manage, as it is distal to the watershed line, rendering normal volar plates unable to securely capture it. This fragment must be precisely addressed as volar carpal subluxation is unavoidable when fixation is not efficient. The spring-wire technique maintains a stable fixation of this key fragment, which has been previously described in a small series. Materials and methods This is a prospective study of 20 patients who presented to El-Hadara University Hospital in Alexandria between the years 2020 and 2022, with complex distal radius fractures and small volar rim fragments, who were treated by open reduction and internal fixation using the spring-wire technique. The study was approved by the institutional review board of Alexandria Main University Hospital, and informed consent was taken from all patients in this study ensuring compliance with ethical standards. All patients underwent open reduction and internal fixation using the spring-wire technique. The procedure was performed by the same surgical team to ensure consistency. Postoperative radiographs were taken to assess reduction quality and fixation. Postoperative radiographic parameters, range of motion, grip strength and the El-Hadara wrist function scoring system were obtained after one year of follow-up, to evaluate results of fixation. Results All patients achieved a functional range of motion and grip strength and showed radiological union of the volar rim fragment with no volar carpal subluxation or escape of the volar rim fragment. The El-Hadara wrist function average score was 18.85±2.66, which represented a good overall result. No complications occurred during follow-up, and none of the patients required removal of the implant. Conclusion The spring-wire technique maintains a stable fixation of the volar rim fragment that cannot be held securely by volar plating alone. This method offersa low-profile implant that is readily available and simple to apply. Also, the fragment is stabilized by a dual effect by both the spring wire and the volar plate that act as a buttress to volar displacement.

A Comparison Between Volar Locking Plates and Percutaneous Pinning in the Treatment of Distal Radius Fractures: A Systematic Review

Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs. We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications. Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups. Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study's limitations. Therapy/Prevention, Etiology/Harm II.

Comparison of surgical and conservative therapy in older patients with distal radius fracture: a prospective randomized clinic al trial

IntroductionThe distal radius fracture is considered the most common fracture in humans. For fractures classified as Arbeitsgemeinschaft für Osteosynthese (AO) 23-C1 + C2, there is no consensus on treatment in older patients due to inconsistent study results. The aim of this study was to compare conservative and surgical treatment in relation to wrist function and satisfaction in patients older than 65 years.MethodsIn this prospective randomized clinical trial, patients aged older than 65 years who suffered an isolated AO-classified C1 or C2 distal radius fracture were randomized to surgical treatment using palmar plate osteosynthesis or conservative treatment. Patient-rated wrist evaluation (PRWE) score and disabilities of arm, shoulder, and hand (DASH) was assessed 3, 6 and 12 months post-interventionally. Satisfaction, range of motion (ROM) and pain scores were evaluated at 6 weeks and 3, 6 and 12 months post-interventionally.ResultsA total of 80 patients with a mean age of 77.3 years (± 6.1 years) in the conservative group and 72.5 years (± 5.3 years) in the surgery group were included. Both the PRWE score, and the DASH score showed a statistically significant difference between the two groups after 3 months, 6 months and 12 months (p < 0.001). Patients in the surgical cohort showed a statistically significant higher satisfaction at the 6-week, 6-month and 12-month follow-up (p < 0.001 6 weeks + 12 months; p = 0.004 6 months).ConclusionIn this prospective randomized study, surgical treatment proved to be superior to conservative treatment in terms of the primary outcome variable PRWE score. Satisfaction was significantly better in the surgical group.

Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases.

The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement. Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed. This study aims to present the outcomes of this technique applied to 44 patients with unstable and comminuted fractures of the scaphoid. The purpose of the study is to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. Between January 2021 and March 2023, a specific volar locking plate for the treatment of scaphoid fractures was used in 44 patients. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated. After plate removal, further improvement in range of motion was observed. The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.

Functional Outcome of Volar Barton Fracture of Distal End Radius Undergoing Plating

Background: Volar Barton fractures of the distal radius are complex intra-articular injuries that often require surgical intervention for optimal functional recovery. Volar plating is commonly used to achieve stable fixation and early mobilization.Objective: This study aimed to evaluate the functional outcomes and complications in patients with volar Barton fractures of the distal radius treated with volar plating.Methods: This prospective study was conducted from March 2023 to March 2024, including 60 patients aged 18-60 years with AO/ASIF type B3 volar Barton fractures. All patients underwent open reduction internal fixation (ORIF) using a volar locking plate through a modified Henry approach. Postoperative assessments were performed at six months using Gartland and Werley’s wrist score. Data analysis was conducted using SPSS 25, with one-way ANOVA applied to evaluate associations between variables, considering a p-value &lt; 0.05 as significant.Results: The average age was 34.43 ± 12.34 years. Excellent functional outcomes were achieved in 61.7% of patients, good in 30%, fair in 6.7%, and poor in 1.7%. Complications were minimal, with 95% of patients reporting none, 3.3% experiencing wound infections, and 1.7% reporting wrist stiffness.Conclusion: Volar plating for volar Barton fractures showed excellent to good functional outcomes in most patients, with minimal complications. Further studies with larger populations are recommended.

Prevention of screw penetration of the dorsal cortex in volar plating of distal end radius fracture by using dorsal tangential view

Background: The dorsal cortex penetration by a screw can leads to irritation and attritional extensor tendon injury in volar plating of distal end radius fracture. Our method in this study was to use dorsal tangential view (DTV) intraoperatively to detect screw protrusions in the dorsal cortex and replace these screws with screws of appropriate size. Methods: We have enrolled 60 patients from in patient department of orthopaedics in a rural tertiary care institute (Indian Institute of Medical Science and Research Warudi, Ta. Badnapur, Dist. Jalna, Maharashtra) having distal end radius fracture above 18 years of age planned for volar plating. DTV other than standard PA, lateral view was taken to evaluate the dorsal cortex penetration. Results: Seven patients required AP and lateral view while 14 patients needed DTV with 80% power (α=0.05, β=0.2). Conclusions: Our study concluded that additional DTV apart from standard AP and lateral view will detect the dorsal penetration of screws and can be changed intraoperatively. Thus, DTV is advised to minimise the iatrogenic extensor tendon injury by dorsal screw penetration which might be missed in lateral view.

Effect of Screw Length in Volar Plating for Intra-articular Distal Radius Fractures: A Biomechanical Study

PurposeThe purpose of this study was to compare the effect of varying screw lengths on load to failure and retention of the dorsal ulnar corner fragment after fixation of comminuted intra-articular distal radius fractures in a cadaveric model. MethodsTwenty-four fresh frozen cadaveric forearms were subjected to a standardized distal radius osteotomy to mimic an intra-articular fracture pattern. Dual X-ray absorptiometry scans were performed to ensure minimal variability in bone density. All fractures were fixed with a volar locking plate and distal locking screws. Three different lengths of distal locking screws were used in each group of eight specimens to simulate the clinical decision of different distal screw lengths. The screw lengths tested were bicortical, 100% of the width of the bone but unicortical, and 75% of the width of the bone and unicortical. All specimens were preconditioned with cyclic axial loading and then axially loaded using matching acrylic resin molds to clinical failure and fragment displacement as detected by a motion analysis system. Retention or loss of the dorsal ulnar corner fragment during loading was recorded as a binary variable. ResultsBetween the three groups, there were no statistically significant differences in precycling stiffness, postcycling stiffness, load at 2 mm displacement of the dorsal ulnar corner, or force at failure. The group with 75% length screws had a significantly higher loss of reduction of the dorsal ulnar corner (86%) compared with the other groups (0%). ConclusionsVarying screw lengths did not affect the stiffness or overall loads to failure of axially loaded specimens. However, the 75% length screws did not reliably secure the dorsal ulnar corner fragments. Although this did not significantly affect the overall load to failure of the construct, displacement of this fragment may have implications for rotation of the forearm through the distal radioulnar joint. Clinical relevanceSurgeons should consider the utilization of full-length unicortical locking screws to ensure adequate fixation of the dorsal ulnar corner. Type of study/level of evidenceBiomechanical study V.

Efficacy of Direct Versus Peripheral Adjuvant Dexamethasone on Duration and Rebound Pain in Regional Anesthesia for Outpatient Distal Radius Fracture Fixation: A Prospective Randomized Controlled Blinded Study.

Despite increasingly wider use, there remains controversy among anesthesiologists regarding preferred formulations and the role of steroid adjuvants in regional anesthesia. There is also uncertainty in the role of dexamethasone when administered directly versus peripherally. We hypothesize that directly mixing dexamethasone into the regional nerve block rather than peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy concerning duration and rebound pain, decreased postoperative pain scores, or opioid consumption within the short-term postoperative period. A prospective, randomized controlled blinded study was conducted for patients undergoing open reduction and internal fixation with a volar plate technique for distal radius fractures. Patients were randomized for their preoperative anesthesia. One group had ultrasound-guided supraclavicular block with ropivacaine with a direct mix of dexamethasone 4 mg (Direct group), while the other group had ultrasound-guided supraclavicular block with ropivacaine and peripheral intravenous dexamethasone 4 mg (Indirect group). Data was collected pre, intra, and postoperatively. Fifty patients consented and participated in the study, with 27 participants in the direct group and 23 participants in the indirect group. Compared to intravenous administration, directly administered dexamethasone demonstrated a significant difference in the average time for the block to fade, onset of motor and sensory recovery, and block resolution. Our findings prove that directly mixing dexamethasone compared to peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy with regards to duration and rebound pain, but do not prove that there will be a difference in decreased postoperative pain scores or opioid consumption within the 24-hour postoperative period. Prognosis Level I.

Functional Outcome of Intra-Articular Distal End Radius Fracture Treated Surgically by Volar Locking Plate: A Prospective Study

Background. Unstable distal end intra-articular fractures of the radius pose a greater risk of reduction loss, potentially resulting in malunion and poor functional outcomes. Therefore, the amount of reduction and the technique of fracture fixation play a crucial role in achieving improved functional outcomes and ensuring patient satisfaction.Material and methods. This is a study of prospectively enrolled 27 patients with displaced intra-articular distal end radius fractures treated surgically by volar locking plate through modified Henry’s approach in the department of orthopedics at a tertiary care center. Patients were post-operatively evaluated for functional outcome and complications. Results. Out of the 27 patients 26 came for regular follow up, ranging from 3 months to 18 months and one patient was lost to follow-up. The functional outcome was investigated with the Mayo wrist score. Excellent scores were noted in 34.6%, good in 53.8% and satisfactory in 11.5% of the patients. Conclusion. Irrespective of the direction and degree of displacement, the volar locking plate as a treatment for an intraarticular distal end radius fracture is a good option as it provides stable fixation, and good to excellent outcomes with less complications.

Application of improved carpal shoot through view in volar plate internal fixation of distal radius fractures

To explore the application of improved carpal shoot through view (ICSTV) method in the treatment of distal radius fractures with volar plate internal fixation. The clinical data of 67 patients with distal radius fractures who met the selection criteria between January 2020 and January 2023 was retrospectively analyzed. There were 30 males and 37 females with an average age of 53.6 years (range, 18-75 years). According to the AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 25 cases of type B and 42 cases of type C. The time from injury to operation ranged from 2 to 6 days, with an average of 3.8 days. During the operation, bilateral cortical drilling was performed, and the length of the implanted screw was 1-2 mm shorter than that measured by the depth ruler. Standard anteroposterior and lateral (AAL) fluoroscopy and ICSTV fluoroscopy were performed after volar anatomic locking plate fixation, respectively. If the dorsal cortex of the distal radius was detected to be penetrated, the short screw was replaced and ICSTV fluoroscopy was performed again until no screw was penetrated. The detection rate of dorsal cortical screw penetration was compared between AAL fluoroscopy and ICSTV fluoroscopy. Postoperative CT scan was performed to confirm the presence or absence of dorsal cortical screw penetration. Intraoperative AAL fluoroscopy found 5 screws penetrating the dorsal cortex in 4 patients (6.0%), and ICSTV fluoroscopy found 19 screws penetrating the dorsal cortex in 15 patients (22.4%) including the above 4 patients, with a significant difference in the detection rate between the two fluoroscopy methods [ OR=0.267 (0.084, 0.845), P=0.018]; 15 patients were replaced with short screws during operation. At the same time, ICSTV fluoroscopy detected 2 screws penetrating into the distal radioulnar joint in 2 cases (3.0%), which could not be found in AAL fluoroscopy, and the direction of the screws was adjusted and replaced. All patients were reexamined by wrist CT within 3 days after operation, and no dorsal cortical screw penetration or screw penetration into the distal radioulnar joint was found. All the 67 patients were followed up 6-18 months, with an average of 11.3 months. Extensor tendon irritation occurred in 2 patients at 3 months after operation, and no extensor tendon rupture occurred in all patients during follow-up. All fractures healed well, and the healing time was 8-13 weeks, with an average of 10.8 weeks. There was no complication such as internal fixation loosening or fracture displacement. The Gartland-Werley score at last follow-up ranged from 0 to 15, with an average of 5.6. ICSTV fluoroscopy can effectively detect occult dorsal cortical screw penetration of the distal radius that can not be revealed by AAL fluoroscopy.

Posttraumatic growth disturbances of the distal radius in childhood

Fractures of the distal radius in childhood are frequent but rarely lead to relevant growth disturbances. The experiences of apediatric trauma center over 15years are exemplarily presented and discussed. Osteotomies of the distal radius were selected and the clinical and radiological findings were recorded and analyzed. Posttraumatic growth disturbances were corrected in 10 cases with amedian age of 13 ½ years. In six cases an iatrogenic cause was also possible. In two cases callus distraction with secondary palmar plate osteosynthesis was used for consolidation. In eight cases primary ad hoc corrections were carried out using palmar plate osteosynthesis (six with iliac crest and two with allogeneic grafts). In five cases the distal ulnar growth plate was also addressed. During follow-up breakage of one plate was registered. After an average of 31months postoperatively, 9 children had full range of motion (ROM) and in 1 case there was an extension deficit of 10o. It is important to evaluate the cause of the mostly partially inhibiting growth disturbances to draw preventive conclusions. From a clinical perspective the visible deformity is given priority and the pain and functional limitations are less relevant. The indications for corrective surgery must include the age of the patient, remaining growth potential, size and localization of the growth plate bridge, the deformity and the individual wishes of patients and parents. In most cases afull correction is possible with palmar plate osteosynthesis and an iliac crest graft. External fixation and callus distraction is an alternative in cases where the correction is more extensive. The distal ulnar growth plate should be controlled concerning further growth potential before hardware removal.

Development of the Interosseous Muscles of the Human Hand: Morphological and Functional Aspects of the Terminal Insertion.

To date, there have been no studies conducted on the development of interosseous muscles (IO) in the human hand. This study aimed to investigate the development of these muscles in order to clarify their terminal insertions and their relationship with the metacarpophalangeal joints. Serial sections of 25 human specimens (9 embryos and 16 fetuses) between the 7th and 14th weeks of development, sourced from the Collection of the Department of Anatomy and Embryology at UCM Faculty of Medicine, were analyzed bilaterally using a conventional optical microscope. Our findings revealed that, during the 7th week of development, the metacarpophalangeal interzone mesenchyme extended into the extensor apparatus of the fingers. Furthermore, we observed that the joint capsule and the tendon of the IO derive from the articular interzone mesenchyme. By the end of the 7th week, corresponding to Carnegie stage 21, the myotendinous junction appeared, initiating cavitation of the metacarpophalangeal joint. During the fetal period, the terminal insertions of the IO were identified: both the dorsal interosseous (DI) and palmar interosseous (PI) muscles insert into the metacarpophalangeal joint capsule and establish a connection with the volar plate located at the base of the proximal phalanx and the extensor apparatus. Some muscle fibers also attach to the joint capsule at the level of the proximal synovial cul-de-sac. The functional implications of these findings are discussed within this work. This study provides the first detailed description of the development of the interosseous muscles in the human hand.

Assessment of Ulnar Carpal Translocation and Carpal Alignment After Volar Plate Fixation With Vascularized Bone Graft for Scaphoid Waist Fracture Nonunions

Multiple fixation methods with or without vascularized graft have been described to treat scaphoid nonunions. This study aimed to assess the incidence of carpal malalignment and the degree of ulnar carpal translocation after scaphoid volar plate fixation with pedicled vascularized bone graft in scaphoid waist nonunions with humpback deformity. A retrospective cohort study of individuals with recalcitrant scaphoid fracture nonunion treated with volar scaphoid plating and vascularized bone graft was analyzed. All patients had radiographs with the wrist at neutral with clinical follow-up of at least 3 months after surgery. Ulnar subluxation of the carpus was assessed by the change in lunate uncovering and carpal-radial distance before and after surgery. Seventeen patients were included for analysis. Average age was 26 years with an average follow-up interval of 11.0 months. After surgery, 16 patients (94.1%) had fracture union. Between preoperative and initial postoperative imaging, there was an increase in lunate uncovering (mean difference: 8.8%; 95% confidence interval, 4.6% to 13.1%) and carpal-radial distance (mean difference: 3.3% ulnar shift; 95% confidence interval, 1.1% to 5.4%). After surgery, there was minimal change in lunate uncovering and carpal-radial distance from immediately after surgery to final follow-up. Preoperative lunate uncovering was lower than normal values, suggesting an abnormal radial shift of the carpus with a collapsed scaphoid. Postoperative lunate uncovering was similar to normal values, reflecting an ulnar shift of the carpus after operative intervention. Therapeutic IV.

Numerical assessment of induced electric fields in a worker’s hand with commonly used metallic implants under exposure to low frequency magnetic fields

The European Union’s Workers’ Directive 2013/35/EU on the minimum health and safety requirements regarding the exposure of workers to electromagnetic fields specifies action levels (ALs) for external electric and magnetic fields, which should protect against induced tissue-internal electric field strength E i above the exposure limit values, the latter being defined in order to prevent tissue stimulation at low frequencies. However, although 2013/35/EU explicitly calls for the protection of ‘workers at particular risk’ (including workers with metallic implants), the AL specified in the Directive have been derived under the assumption that there are no metallic parts present inside the body. Therefore, in the present work, we analysed the situation of a worker’s hand and forearm bearing metallic implants (Herbert screw and volar radius plate) used for osteosynthesis after the most common bone fractures of the hand/forearm, exposed to low frequency magnetic fields. The uniform exposure of the whole hand and forearm as well as the exposure to a specific and widely used device, a deactivator for single-use labels of acousto-magnetic electronic article surveillance systems, were considered based on numerical computations using a high-resolution anatomical hand and forearm model. The results obtained indicated that the maximum induced electric field strength averaged in a volume of 2 mm × 2 mm × 2 mm cube was higher in the presence of the metallic implants by a factor of up to 4.2 for bone tissue and 2.3 for soft tissue compared with the case without an implant. Hence, it is obvious that the local induced electric field strengths may be substantially increased by the implants. The extent of this increase, however, is highly dependent on the implant’s position inside the body, the implant’s geometry, and the field distribution and orientation with respect to the anatomical structure and the implant.

Effectiveness of Delayed Surgical Treatment for Distal Radius Fractures With Loss of Reduction

This study investigated the effectiveness of volar plate surgery in patients with distal radius fractures (DRFs) initially treated nonsurgically but later experiencing reduction loss during follow-ups. Specifically, it assessed the impact of early surgery (E) (<3 weeks) versus delayed surgery (D) (3-6 weeks) on wrist function in surgically treated DRFs. This retrospective study included 131 patients who underwent surgery after loss of reduction. Among them, 42 patients had delayed surgery, whereas 89 received early surgical treatment. The mean follow-up duration was 18 months. The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand scores. Secondary outcomes included Short Form-12 physical component summary and mental component summary scores, postoperative range of motion, and radiological measurements such as radial length, radial inclination angle, and volar tilt angle. Fracture types were categorized using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification based on radiological images. All 131 DRFs achieved radiological union. Mean Disabilities of the Arm, Shoulder, and Hand scores were 8.0 (range, 0-78) and 10.8 (range, 0-73) for groups E and D, respectively, and the difference was not considered clinically relevant. Short Form-12 physical component summary scores (49.4 for E; 45.3 for D) and Short Form-12 mental component summary scores (52.3 for E; 53.5 for D) were similar in the two groups. Radiological measurements and range of motion were similar in the two groups. Complications, including carpal tunnel syndrome, superficial radial nerve neuropraxia, and complex regional pain syndrome, occurred in 12 (13.5%) E group patients and 9 (21.4%) D group patients. Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced DRF were similar. However, complication rates were higher in delayed surgery. Prognostic IV.

Bridge Versus Volar Plating Distal Radius Fractures in Patients With Concomitant Lower-Extremity Fractures

Our objective was to determine if patients with a distal radius fracture and concomitant lower-extremity fracture benefit from bridge plating when compared with volar plating. We conducted a retrospective cohort study evaluating distal radius fractures fixated by bridge or volar plating in orthopedic trauma patients with a concomitant lower-extremity fracture. Patients were prescribed a platform walker and followed for gait aid use and both upper and lower-extremity fracture-related outcomes. Differences in platform walker use, radiographic findings, and rates of complications for both distal radius and lower-extremity fractures were comparable between groups. Although more studies are needed, it appears that this cohort of patient's ability to mobilize using a gait aid is similar, regardless of the distal radius fracture fixation method. A concomitant lower-extremity fracture should not necessarily indicate bridge plating over volar plate fixation. Therapeutic Study IV.

Evaluation of anatomo-radiological outcomes of volar plating for volar displaced distal radius fractures

Background: The purpose of this study was to evaluate the anatomo-radiological outcomes of volar displaced distal radial fractures managed by volar plating. Methods: It was a retrospective analytical and monocentric study performed within 8 years from 01 January 2014 to 31 December 2022; at the orthopedic and traumatological department of the university hospital Idrissa Pouye in Dakar (Republic of Senegal). All the patients managed by volar plating for volar displaced distal radial fractures during the period of the study were included; those managed through another treatment option, lost and whose folders could not be explored were excluded. Clinically, the patients were evaluated at the last follow up thanks to the Green and O’Brien scale; radiologically, the comparison was done among the preoperative, postoperative and the last follow up standard lateral view and antero-posterior view of the wrist. Results: There were 37 patients (31 males and 6 females), the average age was 40 years old with a range from 18 to 66 years old. The minimum follow-up was 10 months. The clinical results showed at the last follow up an average functional Green and O’Brien scale of 80.2 with a range from 15 to 95. The postoperative radiological results showed the average radial frontal tilt of 21.3° with a range from 11° to 25°; the average radial sagittal tilt of 12.6° with a range from 10° to 15° and the average ulnar-radial index of 0mm with a range from -2 to +2. Three cases of radiocarpal arthrosis were found. Conclusions: The volar plating of volar displaced distal radial fractures constitutes the indication of choice in order to restore the normal anatomy of the wrist and its function.