Top PDF A Mechanical Device for the Reduction of Distal Radius Fracture

A Mechanical Device for the Reduction of Distal Radius Fracture

A Mechanical Device for the Reduction of Distal Radius Fracture

In the conventional method, more than two surgeons are required. Anaesthesia is provided to the patient prior to surgery. The patients hand is placed over a radiolucent table. Then traction is provided to the hand by a surgeon while another surgeon holds the radio-ulnar bones. Then ulnar deviation is done by one surgeon. Then one or two surgeons realigns the fractured bone to the original position by the reduction procedure. Then K-wires and fixators are inserted to the bone depending on the severity. These are guided by X-ray based imaging machines like C- arm or fluoroscopy. A C-arm is widely used to guide the K- wires. Then a palter of paris cast is made over the hand to heal.
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Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Procedural sedation and analgesia (PSA), defined as a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function, is com- monly utilized to reduce patient discomfort during man- ual reduction of displaced distal radius fracture in the emergency department outside the operating room [4, 5]. Pharmacologic options for PSA include a short- acting benzodiazepine, either alone or in combination with an opioid analgesic [6]. Evidence to support the use of other sedatives including etomidate and propofol for PSA is also emerging in the literature [7] However, PSA has its own risks and considerations for different levels of monitoring for cardiorespiratory function. Hematoma block (HB), defined as a procedure with local anesthetic injected directly into the fracture site, is a safe and effective alternative technique for pain control in assist- ance with manual reduction for distal radius fracture [8]. Its potential benefits include avoidance of PSA- associated risks, high cost-effectiveness, and time- sparing procedure. However, the highest level-evidence assessment relying on results from meta-analyses in 2002 cannot demonstrate the relative effectiveness of different methods of anesthesia including HB and PSA owing to lack of enough evidence from randomized trials [9].
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Original Article Is the preoperative closed reduction irreplaceable for distal radius fracture surgical treatment? - A retrospective clinical study

Original Article Is the preoperative closed reduction irreplaceable for distal radius fracture surgical treatment? - A retrospective clinical study

Abstract: Patients for all classifications of fresh distal radius fracture (DRF) routinely receive closed reduction com- bined with plaster immobilization at first. However, among these, some patients with serious communicated frac- tures asked for being treated surgically directly without prior closed reduction in clinical practice. Currently, the potential effect of preoperative closed reduction on therapeutic effects of surgical treatment has remained unclear. The purpose of the retrospective clinical study was to identify the potential effect of the preoperative closed re- duction on therapeutic effects of surgical treatment for fresh (DRF). 128 patients with DRF were divided into two groups, with 70 patients receiving closed reduction combined with plaster immobilization before operation, and the other 58 patients being treated only with plaster or brace immobilization for temporary external fixation. These two groups of DRF cases were compared in operative time, postoperative functional examination results (wrist pain, the range of wrist motion, grip strength and wrist function questionnaire) and radiograph examination results (dorsal radial tilt, radial inclination, radial shortening and articular step off) at different time points as well as the final radio- graph examination at 12 months. There were no differences in the demographic characteristics or fracture severity between groups. No significant difference was found between the two groups in the operation time and the rate of complications, but from the means, Closed reduction group (65±7.6) were shorter than the no closed reduction group (77±5.7). There was no significant difference between the two groups for the pain level, the mean ranges of motion, grip strength and DASH score at all time points. The two groups’ dorsal radial tilt, radial inclination, radial shortening and articular step off also had no significance at the time of the last follow-up. Preoperative closed re- duction and plaster immobilization techniques did not convey improvement of surgical results for the fresh fractures of the distal radius with volar palmar plates. But operation may cost the patients less time in the closed reduction and plaster immobilization group.
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Original Article Comparative study of the efficacy of open reduction and internal fixation versus closed reduction and external fixation in treating distal radius fracture

Original Article Comparative study of the efficacy of open reduction and internal fixation versus closed reduction and external fixation in treating distal radius fracture

A total of 77 patients with distal radius fracture, who were diagnosed in the orthopedics depart- ment of the Affiliated Zhongshan Hospital of Dalian University from January 2017 to Dece- mber 2018, were enrolled in this analysis. The- re were 33 males and 44 females, aged from 40 years old to 75 years old, with an average age of 64.0±8.9 years old. Among them, 40 patients were treated with open reduction and internal fixation with steel plates (observation group). In the observation group, there were 18 males and 22 females, with an average age of 62.9±8.5 years. The other 37 patients were treated by closed reduction and external fixa- tion (control group), including 15 males and 22 females, with an average age of 63.4±8.7 ye- ars. This study was approved by the Ethics Com- mittee of Affiliated Zhongshan Hospital of Da- lian University. All the patients signed an infor- med consent form.
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WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

Distal radius fracture is a common fracture associated with high-energy trauma in young adults or osteoporotic injury in the elderly [3, 4]. The use of a locking plate to treat such fractures has gained favor recently and helps maintain anatomical structure and facilitate earlier return to normal daily activities [5, 6]. However, plating for distal radius fractures usually requires more surgical time than that for minor hand surgeries as well as a bloodless surgi- cal field to achieve the anatomical reduction. Typically, a tourniquet is used to minimize blood loss, and because of the long duration of surgery and tourniquet-related pa- tient discomfort, open reduction and internal fixation (ORIF) has classically been performed under general anesthesia or brachial plexus block.
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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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Classification of distal radius fractures in children: good inter  and intraobserver reliability, which improves with clinical experience

Classification of distal radius fractures in children: good inter and intraobserver reliability, which improves with clinical experience

fractures differ from the buckle fracture as the cortex is disrupted on the tension side, but intact on the com- pression side of the fracture [19]. Complete fractures (adult type) have disruption of both cortices in one plane. Physeal injuries occur frequently during the prea- dolescent growth spurt, when there is a transient corti- cal porosity caused by the increase in calcium requirement and bone turn-over [22]. Fractures invol- ving the growth plate are often subdivided according to the classification of Salter and Harris [23]. The follow- up algorithm of these different categories varies, thus the classification will provide guidelines for management and prognosis. Buckle fractures are stable, and don ’ t need follow up, while the lateral angulation of greenstick fractures often change during the immobilization period [18,24,25]. Complete fractures are highly unstable, and will often need fixation with Kirschner pins [15,16]. Fractures involving the physis might lead to growth dis- turbances, although this is rare. The risk of growth dis- turbances increase, however, if the fracture is reduced more than 3 days after the fracture, or if repeat attempts of reduction is attempted [13].
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Prospective Study of Distal End Radius Fracture Volar Type Treated with Open Reduction Internal Fixation with Plating

Prospective Study of Distal End Radius Fracture Volar Type Treated with Open Reduction Internal Fixation with Plating

All the patients were selected on the basis of patients having distal end radius fracture with volar displace- ment without neurovascular injury. The exclusion cri- teria were age <20 years, pathological fractures and patients medically unfit for surgery. Surgery was indi- cated in cases where volar tilt was greater than 20°, dorsal tilt was greater than 10°, articular step-off was greater than 2 mm, radial shortening was greater than 5 mm, and radial inclination was less than 15° in conformity with the instability criteria proposed by David L. Nelson, of the International distal radius fracture study group. Fractures were classified according to the AO classifi- cation. Patients were discharged usually on the 3 rd day,
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Pathologic fracture of the distal radius in a 25 year old patient with a large unicameral bone cyst

Pathologic fracture of the distal radius in a 25 year old patient with a large unicameral bone cyst

Case presentation: A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications.
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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

Background: Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods: The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated.
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Assessment of a novel biomechanical fracture model for distal radius fractures

Assessment of a novel biomechanical fracture model for distal radius fractures

Overall, the above mentioned findings have implications for future biomechanical research, design of osteosynthe- sis devices and in vivo fracture treatment. Implementing this fracture model as the current gold standard fracture model will allow for better inter-study comparisons, inde- pendent of the loading protocol used. The new fracture model revealed greater displacement during axial loading than previously observed in biomechanical tests. This might have an impact on the material properties of novel osteosynthesis devices, as less displacement could result in fewer cases of secondary loss of reduction. Further research is needed to investigate the influence of the stiff- ness of osteosynthetic devices, secondary loss of reduction and screw cutting-through. Finally, the fact that the distal bone stock is significantly smaller than estimated in the old model underlines the need of polyaxial locking plates. As stated above, the screws inserted through the proximal screw row did fully engage in the bone stock for the gold standard fracture model but were only partially engaged in the smaller bone stock of the novel setup. Polyaxial locking systems are needed for adequate fracture reduc- tion and retention.
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Incidence and characteristics of distal radius fractures in a southern Swedish region

Incidence and characteristics of distal radius fractures in a southern Swedish region

Minimally displaced fractures of the distal radius are usu- ally treated non-operatively while displaced fractures are treated either with closed reduction and immobilization with cast, percutaneous pinning or external fixation or, especially when intraarticular, with open reduction and internal fixation. Recently, the use of internal fixation for displaced fractures, which is probably the most costly and technically demanding treatment method, has been widely increasing. Thus, estimating the incidence of frac- tures classified according to articular involvement and fracture displacement would be of importance in deter- mining costs and resource allocation for these injuries. Moreover, distal radius fractures may result in prolonged pain and functional impairment [11]. Complications such as persistent neuropathy of median, ulnar or radial nerve and fracture malunion have been reported in 1 out of 3 patients [12]. In this respect, fracture severity charac- teristics may be of importance. Previous Scandinavian studies of fracture incidence presented the proportions of fractures classified according to the methods of Older and Frykman [4,6,13,14]. The AO system (Arbeitsgemein- schaft fur Osteosyntesfrage) of fracture classification is
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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

now recommended because loss of reduction with subluxation of the carpus is so common in distal radius fracture [7]. Open reduction and internal fixation can be expected to provide better functional outcomes in the early post operative period so it could be considered as option of treatment for patients requiring a faster return to function after the injury [8]. The wide range of plating techniques exist for fracture fixation of distal radius, new implants designs and plating strategies have made certain treatment options more attractive. Now multiple options available to the treating surgeon for distal radius fracture fixation like palmer plating, dorsal plating, dual column plating and fragment specific fracture fixation with multiple implants available for each form of plating. Although many of these decisions remain controversial and are often based on surgeon preference, a few generalizations can be made. Volar displaced intra-articular fractures are best treated with a volar buttress plate [9]. Open reduction and internal fixation with palmer T-plate in intra-articular fractures of distal radius showed favorable outcomes [10].
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Pain and disability reported in the year following a distal radius fracture: A cohort study

Pain and disability reported in the year following a distal radius fracture: A cohort study

A cohort of 129 successive patients with a distal radius fracture who completed a baseline PRWE when attending hand clinic were entered into this study. Patients were excluded if they were unable to complete the PRWE due to mental incompetence or language barriers that could not be addressed using hospital or family translators (Availa- ble Cohort = 137 ; Excluded because baseline form not present = 8). The patients were treated by 7 different hand surgeons according to best treatment practices of a special- ized hand unit. The basic principles of fracture manage- ment of the Centre include initial reduction in emergency for displaced fractures, followed by re-examination in hand clinic. A treatment plan which provided for reduc- tion and fixation of the fracture was determined by indi- vidual physicians in consultation with patients and included a variety of options (see Table 1). An on-site hand therapy unit was available and patients were seen by therapists with treatment ranging from home programs to intensive therapy depending on the patient's needs. Patients from distant locations attended therapy in com- munity hospitals with supportive consultations provided by hand therapists, if required. Extra-articular, partial- articular and complete articular fractures were present. See Table 1 for descriptive information on patient and treat- ment characteristics.
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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

Various techniques and implants have been used for treating the distal radius fractures. From the days of cast application for all the cases the era changed to pinning and casting followed by external fixator application and indirect reduction of the fracture by the principle of ligamentotaxis. Later buttress plates of various shapes were used for internal fixation 24,28 . The next breakthrough was with the Locking plates which had better anchorage and stability even in the metaphyseal bone 28 . With advancement came the fracture specific smaller plates and anchorage pins 29 . The variable angled 2.4mm locking plates are the newer choice with maximum number of screws in the metaphyseal region in the desired direction of anchorage.
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Optimizing the Composition and Delivery of Assessment and Treatment Following Distal Radius Fracture

Optimizing the Composition and Delivery of Assessment and Treatment Following Distal Radius Fracture

This thesis only compared two superficial heat modalities to each other. Other heat modalities that are used by therapists clinically include paraffin wax baths and Fluidotherapy. Each modality has pros and cons, so further study looking in to the effects of these modalities for improving motion is needed. Establishing a hierarchy of the best method of heat depending on treatment goals would assist the clinical decision making process, and help therapists standardize treatment across centres. A reduction in the variability of treatments used by therapists may help to show that therapy is beneficial for treatment of a subset of the DRF population.
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Optimizing Physical Function Following Distal Radius Fracture

Optimizing Physical Function Following Distal Radius Fracture

Our findings of high reliability are in agreement with previous studies that use electrogoniometer for elbow pronation/supination 7 and healthy thumb ROMs measures 9 , and also for manual goniometry for wrist ROM measures. 5,6,7 The precision of measurement compared favorably with what has been reported for manual goniometry suggesting that some small advantages in precision may be obtained by the use of computerized goniometry. Potential reduction in error occur with the computerized goniometry relate to the use of the footswitch which may reduce error from movement of the goniometer arm from the tested position until when it is read since the footswitch collects the data at the time of placement. This data collection process also reduces errors numbers of the goniometer. Further, plastic goniometers may not be calibrated; and markers may vary; whereas computerized goniometers are calibrated for each use. Radial deviation ROM measure was the only measure that did not demonstrate high reliability. Possible reasons including difficulty in precise landmarking for this movement; and the relatively small ROM measures of the radial deviation must be considered. The SEM analysis identified that differences of 2˚to 4˚ could be considered as measurement error when the ROM measure was repeated by same rater and same instrument, while the measurement errors might be higher when the ROMs were measured by different raters or different instruments (3˚ to 5˚). Both of these estimates were within the 5˚ measurement error, which sometimes used as a rule of thumb in measuring joint motion 9,17 and so were not considered clinically meaningful.
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Evaluating Factors that Affect Hand Dexterity after Distal Radius Fracture

Evaluating Factors that Affect Hand Dexterity after Distal Radius Fracture

et al., 2012) showed that supination-pronation ROM predicts hand patient related disability after DRF. For the manipulation of small objects in 3-months age and ROM flexion-extension were significant predictors determining the 11% of the variability scores (Table 6). ROM flexion- extension physical impairment explained 3% of the total score indicating a small incremental contribution to small hand dexterity scores. This less predictable proportion could be justified by the fact that small dexterity probably is based more on the fingers motion than the wrist flexion-extension arc. The results at the 6-month follow-up identified 3 variables as significant predictors (grip strength, ROM flexion- extension and age) explaining 34% of the variation in large object dexterity scores (Table 7). For the small hand dexterity, significant predictors were: age, grip strength, sex and ROM ulnar-radius deviation determining 25.3% of the variation. Grip may contribute to small object dexterity as the finger flexors have to tightly hold an object for stability e.g for screwing a pin into a socket. The findings of our multiple regression analysis suggest that the restoration of grip and ROM should contribute to better hand dexterity. Additionally, this relationship could provide a more direct way for clinicians to improve the hand function. This suggests that dexterous movements require a combination of skills. The presence of variations in hand muscle strength after injury influences the capability to produce a higher quality movement. Previous studies (Martin et al., 2015) have showed that there is an association with increasing age and decreasing hand dexterity however, individuals practice greater hand dexterity in their daily tasks (Ralf Th Krampe, 2002) like musicians (R T Krampe & Ericsson, 1996) don’t display the same age-related reduction in hand dexterity .
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The Role of Postural Stability and Other Factors in Distal Radius Fracture

The Role of Postural Stability and Other Factors in Distal Radius Fracture

The platform has 8 levels of stability (Arnold & Schmitz, 1998). Stability level 8 is the most stable condition. For this study, the initial platform stability was set at 6 and the final platform stability was set at 2. Once the platform stability is set and the assessment is initiated the platform is released to the pre-set stability level. The participant is required to maintain the platform level. The deflection of the platform from zero points, in the anterior-posterior (APSI) and medial-lateral (MLSI) directions, are recorded, and the BBS device calculates the APSI, MLSI and OSI. Higher scores on the stability indexes indicate decreased postural stability. The BBS also measures the time spent in each concentric zone and quadrant. Each concentric circle (zones) represents the angular displacement of COM from the centre of the foot platform (Arnold & Schmitz, 1998). There are four zones namely: Zones A (0-5), Zone B (6-10), Zone C (11-15) and Zone D (16-20). A person with good postural stability spends the majority of time in Zone A. As postural stability decreases the angular displacement increases and the person spends more time in Zones B, C or D.
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Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

The inflatable bone tamp appears promising in treating depressed intra-articular fractures of the tibial plateau and distal radius. It appears safe, as no instances of joint pen- etration, over-reduction, or balloon breakage occurred. In these regions, the balloon appears superior to conventional methods of reducing comminuted intra-articular fracture depressions and equivalent when elevating broad, mini- mally displaced, fragments. It offers the advantage of being minimally invasive and leaving behind a void of known size and volume. Many isolated joint depression fractures now treated nonoperatively could thus undergo a simple, minimally invasive procedure that would restore articular congruency with minimal morbidity. Caution should be
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