Volar versus dorsal plating in the management of intra-articular distal radius fractures

PURPOSE: To compare the complications and functional and radiographic outcomes of volar and dorsal plating of intra-articular distal radius fractures. METHODS: This retrospective review included 34 patients found by searching a database of 350 patients treated for distal radius fractures. Inclusion criteria were (1) at least 1 year of follow-up data and (2) open reduction and internal fixation of a multifragmentary fragment intra-articular distal radius fracture with either a nonlocking volar or dorsal plate. Twenty patients were treated with a dorsal plate and 14 patients were treated with a volar nonlocking plate. Objective and subjective outcome parameters were compared between the 2 groups. Objective evaluations included wrist range of motion, grip strength, and preoperative and postoperative radiographic parameters (radial inclination, palmar tilt, ulnar variance, fracture pattern). Subjective evaluations were performed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score and the Gartland and Werley score. RESULTS: Volar plating resulted in a significantly better Gartland-Werley score compared with dorsal plating. There were no significant differences in the DASH score.Volar collapse was documented in 5 of the 20 patients in the dorsal plating group, which resulted in a mild loss of pronation compared with the volar plating group. No collapse occurred in the volar plating group. In addition the difference in the percentage of wrist range of motion compared with the contralateral wrist was not significant. Dorsal plating was associated with a ruptured extensor indicis tendon in 1 patient; secondary surgical procedures were required in 4 patients (tenolyses and radial styloidectomy). Volar plating was associated with median nerve neuropathy in 2 patients and intersection syndrome in one. CONCLUSIONS: Although both groups of patients had similar DASH scores the functional outcome in terms of Gartland and Werley scores was better in the volar plating group. In addition there was a higher rate of volar collapse and late complications in the dorsal plating group compared with the volar plating group. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.     

Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study

PURPOSE: Controversy exists surrounding the effectiveness and complications associated with dorsal plating for distal radius fractures. This study evaluated the functional outcome of dorsal plating for dorsally angulated distal radius fractures at a single institution. METHODS: Thirty patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. The functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. RESULTS: The median patient age at surgery was 59 years. The median follow-up period was 18 months. According to the AO classification system, there were 4 type A fractures, 5 type B fractures, and 21 type C fractures. The median preoperative dorsal angulation was 30 degrees, and the median postoperative angulation was -4 degrees volar. Sixteen patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points, and 28 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. One patient lost reduction, 1 patient needed a tenolysis of the extensor pollicis longus tendon, and 2 patients required the removal of a single metaphyseal screw. CONCLUSIONS: Results from this study show that patients can expect to have 80% of their range of motion and strength after dorsal plating for distal radius fractures. Moreover, 93% of the patients will have good to excellent functional outcomes. Complications from dorsal plating may be caused by the specific plate used, rather than by the technique itself, supporting a dorsal approach for dorsally angulated distal radius fractures.     

影响AO掌侧锁定加压接骨板治疗桡骨远端骨折疗效因素的随访研究

目的 通过分析AO掌侧锁定加压接骨板(locking compression plate LCP)治疗桡骨远端骨折的随访结果,探讨影响掌侧LCP治疗桡骨远端骨折疗效的因素.方法 对2004年7月-2007年10月,在我科采用AO掌侧LCP治疗的55例桡骨远端骨折患者进行随访.随访内容包括测量腕关节运动范围及握力,应用Gartland/Werley腕关节评分法和DASH上肢功能评定标准进行评分.结果 55例患者获得6～44个月的随访(平均17.3个月),骨折均愈合.疗效按Cartard/Werley腕关节评分:优32例,良10例,可12例,差1例,优良率76.4%;DASH上肢功能评定得分为[(9.3±13.8)分,x±s,下同].≤55岁组DASH评分为(9.2±15.6)分,Cartland/Wedey腕关节评分为(3.8 4±5.2);＞55岁组DASH评分为(9.4±11.2)分,Gartland/erley腕关节评分为(4.8±5.1);两组间差异无统计学意义(P＞0.05).单纯桡骨远端骨折组DASH评分为(4.9±6.4)分,Gaaland/Wedcy腕关节评分为(2.7±3.8);伴有尺侧损伤或严重局部软组织损伤组DASH评分为(14.1±18.0)分,Gartland/Werley腕关节评分为(5.9±6.0);两组间差异有统计学意义(P＜0.05).结论 AO掌侧LCP治疗桡骨远端骨折的固定效果好,配合适当的术后功能锻炼,可取得良好的疗效.采用AO掌侧IEP作内固定在≤55岁和＞55岁两个年龄组中腕关节功能恢复相近,而伴有尺侧损伤或严重局部软组织损伤者功能恢复较差.     

Trimed fixation system for displaced fractures of the distal radius

OBJECTIVE: To study the functional outcome of displaced distal radius fractures treated by open reduction and internal fixation with the use of fragment-specific fixation. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

Fragment-specific fracture fixation and double-column plating of unstable distal radial fractures using AO mini-fragment implants and Kirschner wires

OBJECTIVE: To evaluate the efficacy of AO mini-fragment implants and 1.25-mm Kirschner wires using fragment-specific fracture fixation and double-column plating for displaced or unstable distal radial fractures. METHODS: Design: prospective and consecutive. SETTING: level II trauma hospital. PARTICIPANTS: 28 people with 30 fractures and an average follow-up of 21.1 (range 12-41) months, treated with fragment-specific fracture fixation. Outcome measurements: anatomical assessment using anteroposterior and lateral radiographs, graded according to Sarmiento's modification of Lidstrom's scoring system. CLINICAL OUTCOME ASSESSMENT: DASH and Modified Gartland and Werley scores. RESULTS: There were 24 excellent and 6 good radiological results. Final mean grip strength was 83% of uninjured side, and mean wrist range of motion was 61 degrees dorsiflexion, 54 degrees palmar flexion, 85 degrees supination and 83 degrees pronation. Gartland and Werley's demerit point system revealed 13 (43%) excellent, 12 (40%) good, 5 (17%) fair and no poor results. The mean DASH score was 18, with a standard deviation of +/-18. CONCLUSION: This fixation method is a reliable and low-cost alternative with good clinical and anatomical results, particularly useful in open reduction and internal fixation of comminuted intra-articular distal radial fractures.     

Winkelstabile, volare Plattenosteosynthese komplexer artikulärer Frakturen am distalen Radius

Fractures of the distal radius represent one of the most common fractures and have high socioeconomic relevance. Using the volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 49 displaced intra-articular distal radius fractures with a new fixed-angle internal fixation device. According to the AO classification, there were 21 C1, 19 C2, and nine C3 fractures. A retrospective study was carried out to obtain the functional results after open reduction and plate osteosynthesis. Loss of correction between postoperative and follow-up radiography was 1 degrees in volar tilt and radial inclination. The radial shortening was 1 mm. Wrist motion at final follow-up examination had recovered to an average of 80% of that at the normal, contralateral site. Overall outcome according to the Gartland and Werley scales showed 35% excellent, 50% good, and 15% fair results. Using the Martini score, we obtained 85% excellent and good results. The DASH score represented high subjective satisfaction.     

Operative treatment of distal radial fractures with locking plate system-a prospective study

The aim of this study was to determine the results of operative treatment of distal radial fractures with a 2.4-mm locking plate system in a single tertiary teaching hospital. Seventy-five patients were recruited into the study between May 2004 and November 2006. There were 41 males and 34 females, with a mean age of 51. Seventy-five percent of patients had AO type C fractures. All patients were allowed free active mobilisation of the wrist joint immediately after surgery. They were followed up at two weeks, three months, six months, one year and two years. Assessments of pain, motion, grip strength, and standard radiographs were performed. The Gartland and Werley functional scores, the modified Green and O’Brien score, and the disabilities of the arm, shoulder and hand (DASH) scores were recorded. The radiographic results at the final follow-up showed a mean of 18° of radial inclination, 5° of volar tilt, 1.3-mm radial shortening, and no articular incongruity. Twenty-nine percent of patients showed grade 1 osteoarthritic changes and 6% had grade 2 changes in their final follow-up radiographs. An excellent or good result was obtained in 98% and 96% of patients according to the Gartland and Werley, and modified Green and O’Brien scores, respectively. The mean DASH score was 11.6, indicating a high level of patient satisfaction. Internal fixation of distal radial fractures with a 2.4-mm locking plate system provided a stable fixation with good clinical outcomes and patient satisfaction.     

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

Introduction 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.Methods 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.Results 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.Interpretation 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.     

掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折疗效的比较

目的 比较掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折的长期疗效.方法 对2005年9月-2007年11月间,采用切开复位掌侧锁定接骨板或普通接骨板内固定的45例随访资料完整的患者,进行两种疗法的比较.其中23例行锁定接骨板内固定,22例行普通接骨板内固定.按照AO分型:A型11例,B型11例,C型23例.随访内容包括:腕关节活动度(屈曲、背伸、尺偏、桡偏),前臂旋前、旋后活动范围,影像学资料(尺偏角、掌倾角、桡骨高度),应用DASH上肢功能评定标准和Gartland/Wertey腕关节评分法进行评分.结果 术后随访时间平均为18.8个月(12～36个月).腕关节活动度中,锁定板组背伸及两组的桡偏范围低于Gartland/Werley腕关节评分的基本范围.两组DASH值、腕关节活动度及前臂旋转范围,握力、捏力的恢复差异无统计学意义.Gartland/Werley腕关节评分普通接骨板治疗组优于锁定接骨板治疗组,差异有统计学意义.掌倾角均值两组都低于正常范围,尺偏角与桡骨高度均值在正常范围内,两组间差异无统计学意义.结论 掌侧锁定接骨板与普通接骨板在桡骨远端骨折治疗中具有相同疗效.     

背侧钢板辅助固定桡骨远端月骨窝背侧骨折块

目的：探讨背侧钢板辅助固定桡骨远端月骨窝背侧骨折块的临床疗效。方法：自2019年1月至2022年1月,采用背侧钢板辅助固定30例桡骨远端月骨窝背侧骨折块患者,其中男13例,女17例;年龄42~68(48.7±5.6)岁;骨折参照Doi分型:3块型24例,4块型6例。术中透视背侧钢板固定前后桡骨远端掌倾角度数,术后观察骨折愈合和腕关节功能恢复情况,术后12个月采用Gartland和Werley评分系统进行功能评价。结果：所有患者获得随访,时间12~13(11.3±0.9)个月。骨折全部愈合,时间4~5(4.7±0.8)个月。背侧钢板固定前、后桡骨远端掌倾角中位数(P25,P75)分别为5.30°(4.85°,6.03°)、12.45°(11.98°,13.43°),差异有统计学意义(P<0.01)。术后12个月Gartland和Werley评分(1.1±0.4)分,优27例,良3例。结论：背侧钢板辅助固定有利于月骨窝背侧骨折块的复位和掌倾角的恢复。