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Analysis of functional outcome for unstable distal radius fractures treated with closed reduction and percutaneous ‘K’ wire fixation with casting and closed reduction with casting: A comparative study

Analysis of functional outcome for unstable distal radius fractures treated with closed reduction and percutaneous ‘K’ wire fixation with casting and closed reduction with casting: A comparative study

This is to certify that Dr. SURYAWANSHI VIKRAM VILAS, post graduate student (2011 - 2014) in the Department of Orthopaedics and Traumatology, Govt. Stanley Medical College, Chennai has done this dissertation on ‘ ANALYSIS OF FUNCTIONAL OUTCOME FOR UNSTABLE DISTAL RADIUS FRACTURES TREATED WITH CLOSED REDUCTION AND PERCUTANEOUS ‘K’ WIRE FIXATION WITH CASTING AND CLOSED REDUCTION WITH CASTING : A COMPARATIVE STUDY ’ under my guidance and supervision in partial fulfillment of the regulation laid down by the Tamil Nadu Dr. M.G.R Medical University, Chennai for MS (Orthopaedics) degree examination to be held on April 2014.
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Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

This is to certify that this dissertation entitled “SHORTTERM COMPARATIVE STUDY OF EXTERNAL FIXATION VERSUS VOLAR LOCKING COMPRESSION PLATE IN THE TREATMENT OF UNSTABLE DISTAL RADIUS FRACTURES submitted by Dr. S.RAJASEKARAN appearing for Part II, M.S. Branch II - Orthopaedics degree examination in March 2010 is a bonafide record of work done by him under my direct guidance and supervision in partial fulfilment of regulations of The Tamil Nadu Dr. M.G.R. Medical University, Chennai.

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Original Article Efficacy of volar locking plate fixation for unstable distal radius fractures in elderly patients

Original Article Efficacy of volar locking plate fixation for unstable distal radius fractures in elderly patients

unstable DRFs who were treated by locking plate fixation via volar approach between February 2010 and February 2014. The inclu- sion criteria were: (1) a clinical diagnosis of unstable distal radius fractures according to the clinical features summarized by Cooney [16], including the pulverized cortex at the dor- sal (volar) side of distal radius and displace- ment of articular surface greater than 2 mm; palmar angle tilting to the dorsal side > 20; radial shortening > 5 mm; anterior-posterior displacement more than 1 cm; and instability after fracture reduction and fracture prone to re-displacement. (2) an age of > 75 years; (3) patients who were able to take care of them- selves before the injury. The indication for this surgery including types A3, B1, B3, C1 and C2 fractures on the basis of Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) [17], patients who were tolerant of anesthesia and surgery. Pati- ent with unwillingness to taken the surgery, or with poor cardiopulmonary function, or who had senile dementia and can’t actively cooper- ate with physiatrician for the postoperative functional exercises were all excluded. The demographic data consisting of age and gen- der and clinical data including AO/ASIF type, radiological measurements, waiting time before
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Role of ligamentotaxis in Unstable Distal Radius Fractures

Role of ligamentotaxis in Unstable Distal Radius Fractures

New developments in external fixator frames, combination and multiple modalities like combined internal and external fixation for highly unstable fractures, addition of bone grafting, biodegradable cementing and newer information on muscle – tendon physiology, wrist ligaments and 3 – dimensional motion studies will increase the understanding the surgical anatomy and accurate anatomic reduction of the fracture.

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Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

Patients and Methods: We reviewed 23 unstable distal end radius fractures that were treated at our institution with volar variable- angle locking plates. The mean age of the patients was 32.82 ± 11.81 years (range 19 to 62) and the mean duration of follow-up was 11.04 ± 2.47 months (range 6 to 15). All of the patients underwent open reduction and internal fixation with a variable-angle locking plate. Radiological parameters such as radial inclination, length, tilt, and ulnar variance were measured at six weeks and at the final follow-up. The functional evaluation was conducted by measuring the range of motion at the wrist joint as well as the grip strength. Gartland and Werley’s demerit scoring system was used to assess the final outcome.
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A Comparative Analysis of Surgical Management using External Fixation and Internal Fixation in Unstable Comminuted Fracture of Distal Radius.

A Comparative Analysis of Surgical Management using External Fixation and Internal Fixation in Unstable Comminuted Fracture of Distal Radius.

Of the patients employed in the study, 82% were males and 18% were females. In our study, sex of the patient is not statistically significant (p = 0.1021) in determining functional outcome of the patient. Previously zhuang cui et al 19 conducted meta-analysis of unstable distal radius fractures treated with Internal fixation versus External fixation. It included pooled data from ten randomized controlled trials included 738 patients, orthopedic journals. It discussed that a prospective study of patient’s age more than 35 years with colles fracture at six centers in the united kingdom for a period of one year reported that the overall incidence of this fractures is found to be more in females than in males. Therefore, although there may effect modification due to mean and proportion of women, we could not determine this from available data.
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Distal radius fractures with diaphyseal involvement: fixation with fixed angle volar plate

Distal radius fractures with diaphyseal involvement: fixation with fixed angle volar plate

Volar plate fixation has been recognized to be an effective and safe treatment in unstable distal radius fractures [1, 2]. Long volar plates are available in most surgical instrumen- tation boxes to manage distal radial fractures that extend to the diaphysis. The reasoning behind this treatment is that long volar plates can reduce the distal radius, stabilize the metadiaphyseal junction, and fix the diaphysis firmly, restoring the articular congruity and relationship, as well as the radial length and alignment. Wrist immobilization is limited to 3 or 4 weeks, allowing early functional recovery. We report the results of 21 cases treated with this technique using an extended Henry’s volar approach. M. Rampoldi ( & ) D. Palombi
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Benefits of Palmer T- Plate Osteosynthesis in Unstable Distal
Radius Fracture Management

Benefits of Palmer T- Plate Osteosynthesis in Unstable Distal Radius Fracture Management

Our study has been conducted in locally to assess the functional outcome of unstable distal radius fracture in adults treated with palmer T-plate Osteosynthesis. Palmer T- plate can be the choice of implant for fixation of unstable distal radius fractures. Use palmer T- plate provides the best mode of anatomical reduction and in addition to this their buttress modes reduces and stabilize vertical shear intra-articular fractures through an antiglide effect [11]. The purpose for conducting this study is to achieve a validated data by assessing the postoperative range of motion by the use of validated DASH score (Disability of Arm, Shoulder and Hand) and assessment of degree of flexion & extension at wrist post operatively. Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH & confirming its usefulness across the whole extremity [12,13]. A very strong correlation was noted between DASH & other scoring systems making it reliable in evaluating a subjective outcome. Range of flexion and extension which is most important function of wrist is evaluated.
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Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol

Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol

Therefore, we conceived this study based on the hy- pothesis that the use of locked volar plates in young patients with unstable distal radius fractures will pro- vide better results in terms of patient-reported func- tional outcomes. It is also anticipated that there will be a shorter time for returning to work, better radio- graphic parameters, and a lower rate of complications when compared to the external fixation method at the end of a one-year follow-up period. The objec- tives of the study are to determine which is the most effective method for treatment of young patients with unstable fractures of the distal radius: rigid internal fixation with a locked volar plate versus an external fixator combined with PKW. The primary outcomes that will be evaluated is patient-reported function via the “Disabilities of the Arm, Shoulder and Hand” (DASH) questionnaire [21] and pain [“Visual Analog Pain Scale” (VAPS) [22] and digital algometer]. The secondary out- comes that will be evaluated are as follows: radiographic parameters, objective functional evaluation (goniometry and dynamometry), and rates of complications and failures (intention-to-treat principle).
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A new classification and its value evaluation for intermediate column fractures of the distal radius

A new classification and its value evaluation for intermediate column fractures of the distal radius

approach, the reduction-fixation method, and outcome prediction. Currently, most authors select surgical treat- ment for displacement of more than 1~2 mm for intra-ar- ticular fractures of the distal radius [15 – 21]. Therefore, we regarded displaced ICF as unstable fracture for which sur- gical treatment was indicated, and non-obvious displaced ICF as stable fracture for which conservative treatment was indicated. Surgical approach must be selected accord- ing to the position of the fracture, a dorsal approach was used for the dorsal type, a volar approach was used for the volar type, the central group may use a dorsal or a volar approach, but the volar approach is superior to the dorsal approach as it may avoid injury to the tendons. The col- lapse type requires pry-poking reduction and fixation with screws or bone grafts to support the collapsed fractures, and the split type requires pressurized fixation as
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Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation

Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation

All patients were treated on an outpatient basis with reduction of fractures by manipulation with traction and counter-traction under anaesthesia by blockage of the brachial plexus or under general anaesthesia. Four previ- ously designated surgeons with proven familiarity with both surgical techniques took part in the study. The sur- gical instruments needed for application of both treat- ment techniques were always available in the surgical room used for each operation. The technique to be used for each patient was only revealed intraoperatively, after radiological verification of fracture reducibility. At that time, the opaque sealed envelope was opened by inde- pendent person to reveal the treatment technique to be used. None of the patients underwent any specific treat- ment for associated fractures of the ulnar styloid.
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Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

Those fractures amenable to open reduction and inter- nal fixation were posted for fixation in elective opera- tive list. Highly comminuted fractures not amenable to ORIF were stabilized by transarticular external fixator. Patients with closed reduction, cast, and percutanous pinning with cast were discharged on the same day. Any fracture showing displacement at one or two weeks of follow-up were considered unstable and managed as unstable type of fracture. Sixteen patients lost to the follow-up and were excluded from the study. Patients were followed in the outpatient department in 1, 3 and 6 weeks. Around 6 weeks period, cast, K-wires, or exter- nal fixator were removed and the patient was sent for physiotherapy. In those patients with internal fixation, range-of-motion exercises were started on the second postoperative day. Radiological union was considered when a minimum of 3 cortices showed trabeculae cross- ing at the fracture site. Mayo wrist scoring was done at final follow-up.
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Role of locking compression plate for Distal Radius Fractures in Postmenopausal Women

Role of locking compression plate for Distal Radius Fractures in Postmenopausal Women

Rohit Arora, et al.(2007): In Austria, 114 patients who had displaced, unstable fractures involving the distal radius were treated with ORIF using palmar LCP of 2.4mm size and followed up over a minimum time frame of 12 months. All the data based on the clinical and radiological findings were analyzed at the end of the research period and it was found that fixation with fixed angled plates allowed only a minimal loss of reduction and thereby provided stability to formerly unstable dorsally displaced fractures involving the distal radius (18) .
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Biologic plating of unstable distal radial fractures

Biologic plating of unstable distal radial fractures

Bridge plating through a PQ-sparing approach has been described in detail [10]. Once provisionally fixed, an image intensifier was used to archive the saved images of the contralateral wrist, which were used as reference guides to the restoration of radiologic parameters, including radial length and volar tilt, in the injured wrist. The tendon sheath was distally incised using a flexor carpi radialis (FCR) approach, allowing separate incisions for bridge plating, followed by exposure of the watershed line and distal margin of the PQ muscle and a proximal incision based on the length of the expected plate (Fig. 2). The plate was slid under the PQ muscle in a distal-to- proximal direction, and the optimal position of the plate on the distal radius was secured by inserting K-wires through the proximal and distal holes. After provisionally positioning the volar plate, radiologic parameters and con- formity of the volar plate were thoroughly assessed. The plate was fixed with two or three screws in the distal hole and with a temporary K-wire in the proximal hole, thereby maintaining plate alignment. After securing the distal sub- chondral row with two or three screws, intraoperative fluoroscopy was performed to ensure that the distal lock- ing screws were no more than 3–4 mm from the joint line and did not penetrate the joint surface. If the radial length was not restored, an additional screw was inserted prox- imally beyond the plate. Using a spreader, a distractive force was applied to restore radial length, comparing it with the saved image of the opposite wrist under the con- trol of an image intensifier (Fig. 3, spreader). After verify- ing all the radiologic parameters, the empty holes on the plate were fixed and the wounds were closed.
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Hybrid external fixation for neglected fractures of the distal radius: results after one year

Hybrid external fixation for neglected fractures of the distal radius: results after one year

The goal and methods of the study were approved by the ethical board of Poznan University of Medical Sciences in Poland and are in accordance with the Declaration of Hel- sinki. We report on the late outcomes of 14 cases of DRF treated with HEF. All sustained comminuted extrarticular fractures with significant displacement of the distal frag- ment, and gave informed consent to be enrolled to the current study. There were nine females aged 34–70 and five males aged 39–56 (Table 1). The use of HEF was always a sec- ondary choice, after failed attempts at conservative treatment. Fractures were classified according to the AO classification system [34]. All were considered unstable because of marked dorsal or volar comminution, angular deformity exceeding 20°, osteoporosis or redisplacement after previous satisfactory reduction. The operation was performed under general anesthesia or brachial plexus block (optional upon patient–anesthesiologist agreement) after 2– 5 weeks from injury (mean: 3).
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Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting -a long term followup study

Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting -a long term followup study

The management of complex distal radius fractures is controversial. The approach to these fractures range from cast immobilisation, external fixation, plating tech- niques including fragment specific fixation. The need for external fixation of these fractures to obtain accurate anatomic reduction has increased the interest in these devices. Late collapse of these fractures has been a sub- ject of debate for last decades. Bone grafting for large metaphyseal voids is well described entity to avoid col- lapse and morbidity. Open placement of pins has led to fewer complications including avoidance to injury to superficial radial nerve and less damage to tendons and soft tissues. Malunion and late deformity even after external fixation has been reported. Proper selection of patients for external fixation and timely bone grafting has resulted in best possible functional and cosmetic results. We present a long term followup of complex distal radius fractures treated by external fixation and
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Management of Intra Articular Fractures of Distal Radius with Volar Locking Compression Plate – Midterm Outcome Analysis

Management of Intra Articular Fractures of Distal Radius with Volar Locking Compression Plate – Midterm Outcome Analysis

especially for the unstable intra articular fractures has evolved over the past two decades from the century old cast immobilization through K wire and to the open reduction and internal fixation with plate osteosynthesis. The goals would be to maintain joint line congruity, joint stability, to achieve a near normal anatomical reduction and give a good functional range of movement to the patient post operatively.

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Mid-term functional outcome after the internal fixation of distal radius fractures

Mid-term functional outcome after the internal fixation of distal radius fractures

Many studies reviewing various methods of fixation look at radiographic parameters that affect outcome, however few if any have looked at surgeon grade or time to surgery as we have. In a large radiographic study, Mackenney et al. showed that age over 80 years; metaphyseal comminution and positive ulna variance were the main predictors of instability. This and poor radio-carpal alignment were shown to be associated with poor outcome [7]. However this study did not look at results after fixation with a volar locking plate, which has specific design applications for use in osteo- porotic unstable fracture patterns. We chose not to assess radiographic parameters such as residual intra- articular step, correction of normal distal radial anat- omy and presence of post traumatic osteoarthritis as we were interested purely in patient centered outcome and these radiographic features have consistently been Table 3 Time to Fracture Union with varying fracture type
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Percutanious Pinning And External Fixation In The Treatment Of Unstable Intraarticular Distal Radius FracturesAbhilekh Mishra, Sandeep Bhinde, Sameer Gupta

Percutanious Pinning And External Fixation In The Treatment Of Unstable Intraarticular Distal Radius FracturesAbhilekh Mishra, Sandeep Bhinde, Sameer Gupta

prospectively evaluated four options in the treatment of distal radius fractures that had lost their reduction after attempted closed treatment: (1) remanipulation and plaster, (2) open reduction and bone grafting, (3) closed reduction and application of external fixator (3) with mobilization at 3 weeks, and (4) without mobilization at 3 weeks. Despite improved radiographic appearance in the open reduction and bone grafting group, clinical outcomes were similar between groups at 1 year follow-up. 4

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Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

The use of an external fixator alone or in conjunction with percutaneous or limited internal fixation, for unstable fractures of the distal end of the radius has produced good or excellent results. We attribute to these good or excellent results to the early removal of the fixator that allows early range-of-motion exercises and to avoid complications commonly associated with the prolonged use of external fixators 18 . We believe that intra-articular (AO type-B/C) fractures of the distal part of the radius can be treated by closed reduction and external fixation. Our series demonstrates that this technique, supplemented by k-wires as needed, is a satisfactory treatment that can lead to a high rate of return to work and sports, a high level of patient satisfaction, and a low rate of complications.
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