Top PDF Closed reduction and percutaneous k-wire fixation for distal end radius fractures

Closed reduction and percutaneous k-wire fixation for distal end radius fractures

Closed reduction and percutaneous k-wire fixation for distal end radius fractures

Patients with fractures of distal end radius of either side or both sides, with or without ulnar styloid fracture, of age group 18 - 85 years, of either sex having closed fractures of up to 3 cm from distal articular surface of radius willing for treatment were enrolled for this prospective open randomized case control comparative study. Patients less than 18 years or more than 85 years, having compound fractures associated with vascular Department of Orthopaedics, GMC, Jammu, Jammu and Kashmir, India
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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 PERCUTANEOUSKWIRE 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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Original Article Comparison of open reduction volar locking plate fixation and closed reduction percutaneous K-wire fixation in the treatment of AO type C1 distal radius fractures

Original Article Comparison of open reduction volar locking plate fixation and closed reduction percutaneous K-wire fixation in the treatment of AO type C1 distal radius fractures

Abstract: Objective: We aimed to compare both functional and radiological outcomes of AO classification type C1 distal radial fractures managed using volar locking plates and percutaneous K-wire fixation. Materials and methods: In total, 15 patients were included in group 1, in which open reduction and internal fixation using volar locking plates were performed, whereas 15 patients were included in group 2, in which closed reduction and percutaneous K-wire fixation were utilized. In both groups, the functional outcomes were evaluated according to the Gartland-Werley scoring system. The Knirk and Jupiter scoring system was used to classify arthritic changes. Stewart’s radiological assessment criteria were used in angular assessments. Grip strength measurement was performed. Results: At the end of the follow-up, a significant difference was detected between the groups in volar tilt value (P<0.05) but not in radial inclination and radial length (P>0.05). Significant differences were detected in the Gartland-Werley score and the mean Knirk and Jupiter score between the two groups (P<0.05). No significant difference was found in the mean Stewart score between the groups (P>0.05). Conclusion: It was concluded that K-wire fixation seems insufficient in distal radius fractures of the complex intra-articular type.
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Comparative study of Closed Reduction and Cast, versus Percutaneous K Wire Fixation of Extra Articular Distal End Radius Fracture in a Tertiary Care Centre

Comparative study of Closed Reduction and Cast, versus Percutaneous K Wire Fixation of Extra Articular Distal End Radius Fracture in a Tertiary Care Centre

technique that provides added stability and better radiological outcome with respect to treatment of extra-articular distal radius fracture as compared to closed reduction and below elbow cast application, but the functional outcome between the two treat- ment modalities is not statistically significant. [18] Our findings were in contrast with Gupta et al. who, in his prospective, randomized study of 50 patients evaluated the efficacy of maintaining reduction and consequent functional end results of two treatment methods, ie, percutaneous crossed-pin fixation followed by plaster of Paris cast immobilization with the wrist in functional position versus conventional plaster of Paris cast immobilization. In his study 40% patients had good result and 20% had fair or poor result in cases of plaster cast application, whereas in patients who had K-wire fixation: 18% had good results and 4% had fair to poor results. He concluded that the anatomical and functional end results were significantly better with percutaneous crossed-pin fixation at final follow- up. [1]
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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

This study was conducted in Government Hospital for Bone and Joint Surgery, Postgraduate Department of Orthopaedics, Government Medical College, Srinagar Kashmir from September 2013 to august 2016. The study was approved by the College Research Ethics Committee. This prospective randomized observational study consisted 30 cases who underwent ligmentotaxis with external fixation. Patients included in the study were adults (Age 20 – 60), patient with intra articular fractures of distal end of radius (AO Type B/C), all closed and Grade I (Gustillo and Anderson) compound fractures and presenting within 72 hours of injury. Patients with Grade II and III open fracture distal radius, pathological fractures, rheumatoid arthritis, concomitant injuries of same limb, bilateral distal end radius fractures and neurovascular injuries were excluded. The specific radiographic criterion for considering closed reduction as acceptable was more than a 2- mm step-off of the distal articular surface of the radius, The fractures were assessed preoperatively by wrist radiographs (PA and
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A Comparative Study between Closed Reduction and Cast Application Versus Percutaneous K- Wire Fixation for Extra-Articular Fracture Distal end of Radius

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Introduction: In extra-articular distal radius fractures closed reduction and casting has been the mainstay of treatment, difficulty lies in predicting and maintaining the proper reduction at final union. Percutaneous K-wire stabilization is also a widely accepted treatment option, but there is no consensus on its outcome in comparison to closed reduction and casting. Aim: To evaluate the results of closed reduction and casting versus closed reduction with percutaneous K wire fixation and casting in the treatment of the distal radius extra-articular fracture with reference to the restoration of radial height, radial inclination, volar tilt of the distal articular surface and to assess the functional outcome of the same measured by the Gartland and Werley demerit scoring system.
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Evaluation of Functional results of distal end radius fractures managed by ligamentotaxis with or without percutaneous   K -wire augmentation

Evaluation of Functional results of distal end radius fractures managed by ligamentotaxis with or without percutaneous K -wire augmentation

. Symptomatic relief is achieved by immobilization with below elbow cast for 4 -6 weeks . in displaced and unstable intraarticular fractures, operative fixation is imperative in maintaining an acceptable reduction. Various methods for surgical management are available. For several decades, principle of ligamentotaxis is used for closed reduction and spanning external fixator for 4-6 weeks has been a well-established treatment of distal end radius fracture (11) . External fixator can be augmented by K- wires inserted by an array of techniques; across fracture site in crossed manner or using intrafocal Kampandji technique (12) to maintain reduction .The percutaneous pin fixation provides additional stability (13,14) .
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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

In Percutaneous pinning with K-wires wrist stiffness and reflex sympathetic dystrophy occur because of the palmar-flexed position of the wrist in which postoperative immobilization of the fracture is done. Prolonged immobilization of the wrist for greater than 3 weeks increases the magnitude of the problem. Hence we developed our protocol for the treatment of extra-articular distal radius fractures. Fracture reduction was achieved by longitudinal traction and direct pressure over the displaced fragment followed by percutaneous pinning. 12
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Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular  Fractures

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular Fractures

operatively by manual testing after completion of the surgery in all cases. We reduced radioulnar joint injury for 11 patients (45.8%) by using medial K-wire, and if the joint was still instable, the transfixing wire through DRUJ was retained for 6 weeks. The external fixator frames were removed after 6 to 8 weeks for all patients; however K-wires were not removed until complete consolidation of the fractures occurred. Wrist joint mobilization was allowed after removal of the ex- ternal fixator frame, regardless of the removal of the wire or its retention until 2 weeks. Group II: The patients of this group were treated by ORIF using distal volar radial locked plate. After reduction, K-wires were placed through the radial styloid provisionally, if required. An anterior locking plate was then positioned. All the plates were precontoured for anterior flare of the distal radius. The plate position was adjusted based on intra-operative fluoroscopy finding. The plate position was verified in both anteroposterior (AP) and lateral planes before the distal screws were placed. Among the cases where the distal fragment was se- verely comminuted, the plate was adjusted as far as possible, but not farther beyond the watershed line of the radius. Double plating was used in two cases, as the screw caused disfigurement of the dorsal articular surface, which necessi- tated buttressing from the dorsal surface (Figure 2). DRUJ was checked ma- nually after the surgery. After fixation of the distal radius, the distal end of the radius was grasped with the forearm in a neutral position, and the distal end of the ulna was grasped by the contra-lateral hand by moving distal ulna from the dorsal to the palmar direction. If there was a translation of 5 to 10 mm as com- pared with the uninjured wrist, it was considered as DRUJI. Transverse wire through the DRUJ was inserted in 12 patients (54.5%) who had significant DRUJI after plate fixation.
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Original Article Volar locking plate versus percutaneous fixation for the treatment of distal radial fractures: a meta-analysis of randomized controlled trials

Original Article Volar locking plate versus percutaneous fixation for the treatment of distal radial fractures: a meta-analysis of randomized controlled trials

the small size or incomplete evaluation of these RCTs makes the results inconsistent. Recently, a systematic review [9] regarding volar locking plates and K-wire/pin fixation in the manage- ment of distal radius fractures has been pub- lished. Regrettably, the systematic review was not based on RCTs, which only provided level 2 evidence. Another two meta-analyses [10, 11] were performed based on RCTs, however, meth- odological flaws in the process of data manage- ment, make the results imprecise. Thus, wheth- er surgical treatment of distal radial fractures with a volar locking plate improves clinical out- comes when compared with percutaneous Kirschner wires remains controversial.
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Comparative study on the analysis of functional outcome in distal radius articular fractures treated by closed
reduction through bridging external fixator augmented with K-wires and Volar-locking plating

Comparative study on the analysis of functional outcome in distal radius articular fractures treated by closed reduction through bridging external fixator augmented with K-wires and Volar-locking plating

The palmar ulnar cortex is richly embedded bone with the greatest trabecular density. The success of internal fixation techniques thrives on the fact that this superior quality thick bone, found in even the osteoporotic cadaver specimens. Distally, the radius attains a roughly trapezoidal shape. The radial styloid rotates palmarly 15 degrees off the axis of the radius. This makes it difficult to keep in reduced position from a dorsal approach. The lunate facet of the radius harbours the strongest bone. The line of force passes down the long finger axis, traversing through the capitolunate
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Demodex Folliculorum in Cutaneous Biopsy:  A Histological Surprise

Demodex Folliculorum in Cutaneous Biopsy: A Histological Surprise

Recently surgical management has been widely recommended and performed to prevent disability. Several studies have shown convincingly that functional outcome is good when the anatomy is restored by obtaining good reduction of fracture fragments maintaining the angulations of the articular surface of radius and radial length, and to minimize those related complications as well. This study evaluates the surgical and functional outcomes of intra- articular fractures of distal end radius in a comparative study between closed reduction using external fixation and distraction osteosynthesis to align fragments versus open reduction internal fixation (ORIF) with buttress plating.
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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

unilateral two bar/pin assembly (Stryker Howmedica Oste- onics, Kalamazoo, MI, USA) (Fig. 2). The procedure was performed under radiographic control with closed reduction after the implant was attached to both main bone fragments [35]. In principle, the fixator was removed after eight weeks. In the early postoperative period (two days), daily dress- ing changes at the implant–skin interface were performed and flexion–extension wrist motion was encouraged from the second postoperative day. Patients were dissuaded from rotational exercises. Routine clinical and radiographic evaluations were performed postoperatively on the second or third day (discharge from hospital), and then after 2, 8, and 14 weeks and one year. The anatomic end results were evaluated with the Lidstro¨m system, and functional results were evaluated using the Gartland-Werley system modified by Sarmiento [36, 37].
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FUNCTIONAL RESULTS OF COLLES' FRACTURE MANAGED BY PERCUTANEOUS CROSSED KIRSCHNER WIRES.Niaz Hussain*, Imran Javed, Muhammad Ali DOWNLOAD/VIEW

FUNCTIONAL RESULTS OF COLLES' FRACTURE MANAGED BY PERCUTANEOUS CROSSED KIRSCHNER WIRES.Niaz Hussain*, Imran Javed, Muhammad Ali DOWNLOAD/VIEW

Colles' fracture (distal radius) is a fracture which usually presents with posterior angulation of the wrist and hand [2] . The fracture is sometimes called "dinner fork" deformity due to typical shape the forearm bones. This fracture was described by Abraham Colles' in 1814. I it occurs within 2.5 cm of the articular surface and may extend into distal radioulnar and or radio carpal joints. Colles' fractures are very common in old age peoples mainly due to osteoporosis [3]. Female gender, early menopause and osteoporosis are the most common risk factors for these fractures [4]. Frykman introduced a comprehensive classification of Colles' fracturewhich is based mainly on involvement of articular surface of the radiocarpal and distal radioulnar joint [4]. All distal radial fractures with dorsal displacement are referred to as Colles' fracture regardless of the fracture configuration, comminution and age of the patient or mechanism of the injury [5]. There are different criteria to diagnose these types of fractures on x-rays like angulations and displacement for Colles' fracture occurs in more than 60% of cases [10]. There are many methods for managment of these types of fractures like, external fixation, cast imbolization, pin and plaster, functional braces, percutaneous pinning, and open reduction and internal fixation with pins, wires, screws or plates [11]. Percutaneous K-wires fixation provides effective anatomical fracture reduction [8].
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Closed reduction with pinning of metaphyseal fractures of thedistal  radius in children

Closed reduction with pinning of metaphyseal fractures of thedistal radius in children

report an incidence of up to 34% (Khosla et al., 2003; Malviya et al., 2007) and in one study redisplacement reached 48% (Van Leemput and De Ridder, 2009). To assess for redisplacement after conventional reduction and cast immobilization, patients have to be evaluated radiographically during the first 3 weeks after reduction. If redisplacement occurs and is accepted, a visible deformity can often be seen, which worries the parents and creates anxiety; if the deformity is not accepted, a further reduction needs to be performed, and the anxiety associated with this is even greater because of the need for general anesthesia and the financial costs involved (Van Leemput and De Ridder, 2009). The aim of the current study is to evaluate the efficacy and value of percutaneous Kirschner wire fixation with the application of a forearm cast in treating displaced distal forearm fractures in children, as a safe and effective method that can serve as an alternative to the conservative method of treating complete fractures of the distal radius.
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Distal radius fracture   outcome with volar locking compression plate

Distal radius fracture outcome with volar locking compression plate

Anatomic reduction, meticulous soft tissue handling , proper plate positioning, accurate screw trajectory and supervised operative rehabilitation in our study enabled mean recovery of ~ 82% in wrist range of motion & ~85% in grip ctional impairment at the final follow up when compared to the contra-lateral side. With the use of Gartland and Werely evaluation scale (Gartland and Werley, , we had 84% excellent, 14% good and 2% fair results. articular congruency is an important cause of post traumatic arthritis, which may not always correlate with the outcome scoring systems. Volar locked compression plate are very useful in achieving anatomical reduction, particularly in displaced unstable intra-articular Fitoussi and Chow, 1997; Adani et al.,
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Epidemiology of distal radius fracture in Akershus, Norway, in 2010–2011

Epidemiology of distal radius fracture in Akershus, Norway, in 2010–2011

Results: Overall, 1565 patients with an acute DRF presented to the institution in 2010 – 2011, of which 1134 (72%) were women. The overall annual incidence was 19.7 per 10,000 inhabitants 16 years or older. Women had an exponential increase in incidence after the age of 50, though the incidence for both genders peaked after the age of 80 years. There was an even distribution between extra- and intra-articular fractures. Falling while walking outside was the most common mechanism of injury. Of the 1565 registered, 418 (26.7%) patients underwent surgery, with a volar locking plate being the preferred surgical option in 77% of the cases.
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Closed reduction and percutaneous annulated screw fixation in the treatment of comminuted proximal humeral fractures

Closed reduction and percutaneous annulated screw fixation in the treatment of comminuted proximal humeral fractures

ated for their clinical outcomes, and the other 12 patients were excluded: 2 patients changed their address or phone number and could not be contacted, 3 declined partici- pation, 5 suffered closed reduction failure or the fracture had re-displaced and underwent ORIF treatment, and the remaining 2 patients suffered humeral head splitting frac- tures involving the articular surface, which were not suit- able for CRPF treatment. Open fracture injuries were not fit for this therapeutic technique, and were not brought into this study. The 26 participants’ general information and fracture types were recorded preoperatively (Table 1).
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Relationship between distal radius fracture malunion and arm related disability: A prospective population based cohort study with 1 year follow up

Relationship between distal radius fracture malunion and arm related disability: A prospective population based cohort study with 1 year follow up

linear regression analyses with the DASH score at one year as a dependent continuous variable and each of the variables dorsal tilt, ulnar variance and radial inclination at one year as independent continuous variable, adjust- ing for age, sex, fracture AO type, treatment method and the corresponding radiographic variable in the unin- jured wrist. Of the radiographic variables, dorsal tilt and ulnar variance were found to have statistically significant effect on the DASH score (Table 2), whereas radial inclination had no statistically significant effect (average change per unit -0.212; 95% CI -0.94-0.52, p = 0.564). The two significant radiographic variables were further analyzed as dichotomized categorical variables (dorsal tilt ≤10° or >10° and ulnar variance ≤0 mm or ≥1 mm). When judging malunion in clinical practice, cut-off values for radiographic variables are commonly employed and recommendations based on several bio- mechanical and clinical studies have suggested that a dorsal tilt exceeding 10° should not be accepted [4,17-19]. Recommendations regarding the degree of ulnar variance that may be considered acceptable are more diverse and range from a positive variance of 1 mm up to 6 mm [20,21]. We chose to consider ulnar variance of 1 mm or more as malunion because no evi- dence suggests that only greater incongruity of the distal radioulnar joint is important with regard to disability. These cut-off values were used to classify patients into three hypothesized malunion severity categories; no mal- union with both a dorsal tilt ≤ 10° and ulnar variance ≤ 0 mm, malunion involving either a dorsal tilt >10 degrees or an ulnar variance ≥1 mm, and combined
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Review Article The efficacy of volar locking plates and external fixation for patients with unstable distal radial fractures: a meta-analysis

Review Article The efficacy of volar locking plates and external fixation for patients with unstable distal radial fractures: a meta-analysis

VLP use may improve functional recovery early after surgery in patients with unstable distal radial fractures. However, VLP use and EF sh- owed comparable functional scores 12 mon- ths postoperatively. Nonetheless, the results need to be interpreted with caution due to Figure 5. Funnel plot comparing fusion rates for EF and VLP. The y-axis rep-

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