Top PDF Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

The goal of open reduction and plate fixation is to re- store articular congruity and axial alignment to prevent post-traumatic osteoarthritis. Additionally, open reduc- tion and plate fixation allows for early mobilisation and may theoretically lead to a more rapid recovery and bet- ter functional outcome [13, 14]. Especially in the young and working population, but also in the elderly patients, this could be an advantage. Moreover, redisplacement rates up to almost 60 % are encountered in patients treated with closed reduction and plaster immobilisation, especially in those with type C fractures [15–19]. How- ever, with nonsurgical treatment the standard risks for undergoing a surgical procedure and the risk of hard- ware removal, tendon rupture and neurovascular dam- age are avoided. Moreover, we know that especially patients over 65 years of age have a lower disutility for painful malunion [20]. Though, plaster immobilisation is not without risks either. Pressure neuropathy of the superficial radial nerve, Complex Regional Pain Syn- drome and stiffness of the wrist can occur.
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Operative Treatment of Intra Articular Distal Radius Fractures With versus Without Arthroscopy: study protocol for a randomised controlled trial

Operative Treatment of Intra Articular Distal Radius Fractures With versus Without Arthroscopy: study protocol for a randomised controlled trial

Although, no advantage of arthroscopically guided re- duction over conventional fluoroscopic-assisted reduc- tion in regard to functional and radiographic outcomes was found [17], to our knowledge no studies have been carried out to further examine the use of arthroscopy after ORIF to remove fracture haematoma and debris on functional outcomes. We hypothesise that, due to the removal of fracture haematoma and debris, functional outcomes will be better compared to the non- arthroscopically treated group. Therefore, the purpose of this randomised controlled trial (RCT) is to determine the difference in functional outcome, assessed with the Patient-Rated Wrist Evaluation (PRWE) score, after ORIF with and without an additional wrist arthroscopy in adult patients with displaced complete articular distal radius fractures. Furthermore, we aim to determine the differ- ence in functional outcomes with the Disability of the Arm, Shoulder and Hand (DASH) score, postoperative pain, range of motion (ROM), grip strength, complica- tions, and cost-effectiveness. Additionally, the quality of reduction, associated ligamentous injuries and cartilage damage will be assessed by arthroscopy.
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UK DRAFFT   A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

UK DRAFFT A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

The economic evaluation will estimate costs of both treat- ments, and if appropriate the incremental cost effective- ness of distal radial fractures treated by locking-plate fixation versus K-wire fixation for 1) patients under 50 years of age and 2) patients over 50 years of age. The primary outcome for the economic evaluation will be the Quality Adjusted Life Year gained. Health related quality of life will be estimated using the EuroQol (EQ-5D). This data will be collected at baseline (pre-injury and immedi- ate post-injury) 3, 6 and 12 months post operatively. Hos- pital based resource use will be extracted from patient records. Primary, community and social care service usage will be collected using a patient questionnaire, at 3, 6 and 12 months. Patients will also have the opportunity to detail out of pocket expenditure related to their treatment in the diary. Unit cost data will be obtained from national data- bases such as NHS reference costs, the BNF and PSSRU Costs of Health and Social Care. Where these are not available the unit cost will be estimated in consultation with the finance officer in the lead hospital department.
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Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial.

Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial.

In locking plate fixation, the locking plate is applied through an incision over the volar (palm) aspect of the wrist. The details of the surgical approach, the type of plate, and the number and configuration of screws were decided by the surgeon. The only stipulation was that the screws in the distal portion of the bone were “fixed angle”—that is, screwed into the plate—but this is the standard technique for the use of these plates. Some surgeons use a temporary plaster cast after the procedure, but the fixed angle stability provided by the locking plate is generally sufficient to allow early controlled range of movement exercises. The use or otherwise of a cast was again at the discretion of the surgeon.
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POWIFF  Prospective study of wrist internal fixation of fracture: A protocol for a single centre, superiority, randomised controlled trial to study the efficacy of the VRP (2 0) distal radius plate (Austofix) versus the VA LCP (Depuy Synthes) for distal r

POWIFF Prospective study of wrist internal fixation of fracture: A protocol for a single centre, superiority, randomised controlled trial to study the efficacy of the VRP (2 0) distal radius plate (Austofix) versus the VA LCP (Depuy Synthes) for distal radius fractures

Allocation of trial treatments will be provided through the local statistics department by a statistician who is not the trial statistician. Randomisation will be a 1:1 allocation using a computer generated randomisation schedule (using Stata Statistical Software: Release 14. College Station, TX: StataCorp LP) stratified by age and sex (four strata) using permuted blocks of size four. A seed was used as the random number generator to specify unique subject identifiers. The patient after being considered eligible for the study and consented by the orthopaedic trainee is stratified according to age and sex. The trainee then informs one of the coinvestigators who obtains the ran- domisation number from the previously generated sched- ule. The surgical team will be informed of the plate to be used, once randomised.
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UK DRAFFT : a randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

UK DRAFFT : a randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

Locking-plate fixation, in the distal radius and for other fractures, has been facilitated by recent advances in implant technology which allow the screws to be ‘ locked ’ into the plate. This produces a ‘ fixed-angle ’ bone-plate construct, (previously, plate-and-screw constructs relied on friction alone to maintain their position on the bone). Although originally designed for use in osteoporotic bone specifically, the theoretical advantages of the locking-plates may equally be applied to high-energy (often multi- fragmentary) fractures in younger patients. The technique has become increasingly popular in both the UK and across the developed world over the last five years. The procedure requires an incision over the volar (palm) side of the wrist. The plate and screws are then applied to the bone fragments under direct vision. This produces a rigid construct, [5] and therefore the patients can be permitted to mobilise their wrist more quickly, potentially reducing future stiffness. Since the plate and screws can remain inside the patient permanently, the risk of later collapse of the fracture is also smaller. However, this technique takes longer than a K-wire fixation and there is a risk of serious intra-operative complications such as injury to a nerve or blood vessel [5]. There is also a risk of flexor and/or exten- sor tendon irritation and rupture [6]. The locking-plate hardware itself is specialised and considerably more expensive.
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UK DRAFFT: A randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

UK DRAFFT: A randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

Of note, 430 patients with intra-articular fractures were excluded on the basis that the ‘ surgeon needed to open the fracture to achieve reduction of the joint surface ’ . Inevitably these fractures would be fixed with a plate, since the incision required to reduce the joint surface is essentially the same as that required for the insertion of the plate. There were 639 patients who fulfilled the eligibility criteria – some of whom did not wish to take part in the trial for the reasons described – so the majority of the patients who met the other eligibility criteria were considered by the surgeons to be eligible. Nonetheless, the number of patients excluded from the analysis on the basis of the ‘ surgeon needed to open the fracture to achieve reduction of the joint surface ’ eligibility criterion was perhaps greater than might have been expected given the proportion of complex intra-articular fractures, that is those who might be expected to fulfil this criteria, reported in the literature. Some surgeons may have taken a ‘ cautious ’ approach to the decision to include a patient in the trial, that is they excluded the patient if there was any doubt about their ability to subsequently reduce the joint surface without opening the joint. There was also some variability by trial centre in the number of patients excluded for this reason, but this was not unexpected and reflects variation in clinical practice and in particular the variation in surgeons ’ willingness to open the joint surface. To some degree, variation in the surgeons ’ preoperative assessment of their ability to reduce the fracture reflects such variation in clinical practice across the NHS.
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Open reduction and internal fixation versus casting for highly comminuted and intra articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi center trial

Open reduction and internal fixation versus casting for highly comminuted and intra articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi center trial

AE: adverse event; ANCOVA: analysis of covariance; AO: Arbeitsgemeinschaft Osteosynthese; BMI: Body-Mass-Index; CRC: closed reduction and casting; CRPS I: chronic regional pain syndrome type I; CRF: case report form; DASH score: disability of the arm, shoulder and hand score; DSMB: data safety monitoring board; GCP: good clinical practice; IQOLA: International Quality of Life Assessment; ITT: intention to treat; IRB: institutional review board; MCRD: minimally clinically relevant difference; MCID: minimum clinically important difference; NSAID: non-steroidal anti-inflammatory drug; ORCHID: open reduction and internal fixation versus casting for highly comminuted intra- articular fractures of the distal radius; PCS: physical component score; ORIF: open reduction and internal fixation; RCT: randomised controlled trial; ROM: range of motion; SAE: serious adverse event; SF-36: ShortForm 36 score; SF- 36-PCS: ShortForm 36 - Physical Component Score.
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Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius : randomised controlled trial

Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius : randomised controlled trial

All of the selected hospitals and the surgeons involved in the trial were familiar with both fixation techniques. Although the basic principles of Kirschner wire fixation and locking plate fixation are inherent in the design of the implants, there are several different implant systems and several different options for the positioning of wires and screws; the details of the surgery were left to the discretion of the surgeon to ensure that the results of the trial could be generalised to as wide a group of patients as possible. All patients underwent a routine preoperative assessment and had surgery under general anaesthetic. In Kirschner wire fixation, the wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct (anatomical) position. The size and number of wires, the insertion technique, and the configuration of wires were decided by the surgeon. A plaster cast was applied to supplement the wire fixation as per usual surgical practice.
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Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

The main focus in this study was the difference be- tween the two treatment groups in radiographic dis- placement. However, the difference between the groups in failure rate is also an important outcome to consider. Our findings showed that treatment failure occurred in 3/54 patients (6%) in the active group (i.e. mobilisation 10 days after reduction) versus no such failures in the controls (i.e. patients treated with plaster cast for 1 month). In 2/3 failures, the patients had to undergo surgery to restore an adequate position at the fracture site whilst in one patient, a good result was achieved simply by treating the patient with a new plaster cast for an additional 3 weeks. It should be noted that the frac- ture in the patient who felt fracture instability immedi- ately after early plaster cast removal was located slightly more proximal than the other fractures in the study, close to the transition between the metaphysis and the diaphysis. The anatomical location might have contrib- uted to the feeling of instability.
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Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

The most common type of fracture encountered was type 2A according to Ideberg classification described in Table 3. All patients presented to the casualty depart- ment were subjected to thorough clinical examination and evaluation of fracture and associated injuries. The standard evaluation for the affected shoulder included a 40-degree posterior oblique radiograph, a 60-degree anterior oblique (scapular Y) radiograph, and an axil- lary radiograph. All patients were advised a chest ra- diograph (antero-posterior view) and cervical spine ra- diograph (antero-posterior and lateral view). If the frac- ture was not clearly defined on these plain radiographs, 3D computed tomography was advised in almost all the patients before going for fracture fixation to know the amount of displacement. The average amount of displace- ment was 6.5 mm ranging from 3 to 8 mm. All displace- ments with intra-articular steps or gaps exceeding 2 mm or a glenoid-polar angle > 30 degrees were considered in- dications for surgery. In patients with preoperative pneu- mothorax treated with chest drain insertion, the drain was kept in situ until the operation was completed. The pa- tients were operated on once their conditions were sta- bilized. The duration between operation and admission ranged from 2 to 6 days (average of 3.5 days) surgical tech- nique:
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Becoming confident about confidence intervals

Becoming confident about confidence intervals

The simplest measure of variability is the range; the highest and lowest value for a variable. Table I and Figure 1 show raw data and the range for a fictional dataset, and graphically illustrate this using strip plots. The range is important but often fails to provide a complete description of variability if there are outliers (i.e. data points which are distant from other observations or lie outside expected or typical values).

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A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial

A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial

The treating surgeon or a member of the study staff will introduce and explain the trial to the patient and address any questions the patient might have. The patient will receive a written information form and a consent form. After receiving informed consent, eligible patients will be randomized. We will use a block randomization strategy with random blocksize and stratify for participat- ing country and age of the patients. Age groups will be 18-49 and ≥ 50 years old. Applicants will be allocated to either operative or nonoperative treatment using a web- based randomization program. This web-based pro- gram is secure and only members of the study staff have login credentials. It is not possible to blind surgeons and patients for the allocated treatment.
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Original Article Volar locking plate fixation versus Kirschner wire fixation in distal radius fractures: a meta-analysis

Original Article Volar locking plate fixation versus Kirschner wire fixation in distal radius fractures: a meta-analysis

Distal radius fracture is one of the most com- mon orthopedic injuries, which occurs in a pro- portion of approximate 25% [1]. It affects all age groups and is more common in older patients especially those with osteoporosis [2]. Therapeutic alternatives for distal radius frac- ture included surgical and non-surgical treat- ment. Non-surgical treatment is used if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic device. If this is not possible, surgical fixation is per- formed. External fixation (EF) with Kirschner (K)-wire has historically been used for distal radius fractures [3-5]. More recently, internal fixation (IF) with a volar locking plate is becom- ing popularity and trends to replace K-wire fixa- tion [6]. Favorers suggest that internal fixation with a volar locking plate results in a rapid fu- nctional recovery. However, the others favor K-wire because it is less expensive and has smaller surgical trauma with shorter operation
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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

Mean age in our study was 38.5 years with maximum patients in age group of 18-50 years (80%) which comparable with other studies (21) . Males predominated our study with 27 male patients and 13 female patients .The increased incidence of male sex in distal end radius can be attributed to an over whelming large proportion of male patients and high outdoor activities and the female population largely work indoors (21). Right hand was slightly more involved than left hand. RTA and fall from height was mode of trauma in 85% cases. Around 62.5 % of the study population had type III or type IV fracture according to Frykman’s classification. Similar results
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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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Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Fixation of the ulnar column was stressed for better function of the wrist and to avoid late distal radio ulnar instability 31,32 . Many studies revealed negative outcomes of distal radius fixation with untreated distal ulna fractures. Hence the classification of the distal ulna fractures came to vogue. Even separate classification for ulnar styloid fractures were proposed by Fernandez et al. The level of fracture has implications for management. The ulnar styloid fracture at the tip can be treated conservatively as only few ulnotriquetralfibres would be disrupted. The base of the styloid fractures with greater displacement along the line of the distal radius are to primarily fixed to achieve osteosynthesis to prevent later complications.
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Internal Fixation of Fractures of the Shaft of the Tibia and of the Distal Radius
in Adults

Internal Fixation of Fractures of the Shaft of the Tibia and of the Distal Radius in Adults

Amongst other things, the study recorded the median time to union and the number of days in hospital for both compound (open) and closed fractures. The details presented about the costing methodology are insufficient to allow detailed comments here. Although Shaw et al. 4 make a good attempt to describe the costing methodology, the figures are not presented in any depth. There would appear to be some confusion over the concept of fixed and variable costs given that the authors describe implants as fixed costs when they are clearly a variable component. Costs for first and second admissions have both been calculated at an average £120 per day (irrespective of whether the re-admission was for complications or for removal of implants). No sensitivities around these figures were presented in the paper. The results of the costing exercise were a cost per patient of £1,686 for the external fixator compared with £2,358 for nailing, and £2,022 and £3,412 for the two studies looking at plating. The results imply the relative cost-effectiveness of external fixation compared with the various forms of internal fixation. These results are dominated by the length of hospital stay costs and, as such, highlight the need for more precise attempts to model the marginal costs for hospital stays.
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Isolated fracture of the humeral trochlea: a case report and review of the literature

Isolated fracture of the humeral trochlea: a case report and review of the literature

Fracture of the trochlea is usually associated with elbow dislocation and capitellar or medial condylar fracture [12]. Isolated fracture of the humeral trochlea is very rare. This is explained by its position deep within the trochlear notch cavity and the absence of any muscular or ligamentous at- tachments at this level, which protects it against direct and indirect trauma [13]. Furthermore, the ulno-humeral joint is subjected to very light compressive and shear forces compared to those experienced by the radio- humeral joint, which explains the high frequency of capitellar fractures compared to trochlear fractures [14].
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External Fixation Versus Internal Fixation for Closed Unstable Intra Articular Fracture of the Distal Radius  Early Results from a Prospective Study

External Fixation Versus Internal Fixation for Closed Unstable Intra Articular Fracture of the Distal Radius Early Results from a Prospective Study

radiograph (anteroposterior and lateral) features such as dorsal angulation of more than 11 degrees, volar tilt of more than 11 degrees, radial shortening of more than 2 millimeters compared with the measurements on the uninjured side (radial length is defined as the distance between two lines perpendicular to the long axis of radius: one through the distal tip of the radial styloid process and one through the most distal aspect of the articular surface of the ulna), radial inclination of more than 21 degrees ; and/or group C fracture by AO classification. Exclusion criteria were a Smith or Barton fracture, fracture associated with an ipsilateral fracture of the scaphoid or other carpal fracture dislocation, more proximal traumatic injury of the upper extremeties (multiple fracture of the same limb), pathological fracture; and/or patients with osteoporosis and over 60 years old to avoid the problem of pin 5 .
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