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

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

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

fixation using the Stryker Matrix Volar Locking Plate (Stryker Leibinger GmbH & Co. Germany) between June 2004 and October 2007 treated in a single centre. Indications for surgery were displaced intra-articular fractures with post reduction articular step of > 2 mm; radial shortening of > 3 mm or > 15 degrees of saggital plane angulation (as measured from the anatomical volar tilted position)[2]. Additionally, fractures with fea- tures indicative of instability or poor outcome such as metaphyseal comminution and unsatisfactory radio-car- pal alignment were treated surgically [7]. Finally, patients who originally underwent non-operative treat- ment in plaster but whose fracture displayed one of the above stated parameters for surgery at follow up, and underwent subsequent volar plate fixation were included. Exclusion criteria were fractures treated with alternative instrumentation, fractures over 4 weeks old at the time of surgery, and non-trauma operations such as corrective osteotomies.
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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

Fractures of distal radius are most common fractures of the upper extremity forming about 17 % of all fractures. Distal radial fractures have a bimodal age distribution, consisting of a younger patients sustaining injury due to relatively high-energy trauma and an elderly patients sustaining low energy trauma. Around 50-70 % of the distal radius fractures are associated with distal ulna fractures following a rise in the high energy trauma in recent years. The treatment of distal radius fracture has seen a tremendous evolution from cast immobilization through Kirschner wire fixation to internal fixation with various plates. The significance of distal ulna fractures is often not appreciated and treated inadequately in comparison to its larger counterpart; the radius.
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Distal radius fracture   outcome with volar locking compression plate

Distal radius fracture outcome with volar locking compression plate

Being one of the most common skeletal injuries treated by Orthopaedic surgeons, Fractures of the distal radius constitute 17% of all the fractures evaluated in emergency room (Hagino Brown and Caesar, 2006). ency fracture in elderly patients associated with all of the risk factors for osteoporosis and has been linked to estrogen withdrawal and reduced bone mineral density in Mensforth and Latimer, 1989 O'Neill et al., A traumatic injury in younger males, where the injury is not as strongly related to gender, but related to high energy injuries (21% of all fractures) rather than to simple fall. As the consensus prevails, the vast majority of the distal radius articular injuries resulting in disruption of Lindau et al., 1997; The management of distal radius fractures has undergone an extraordinary evolution over the preceding Saffar, 1995). Open Reduction and Internal Fixation is an alternative but definitively valid treatment option for displaced intra-articular
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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

Abstract: Background: Although operative fixation with a volar locking plate is becoming increasingly popular for treatment of distal radius fractures, it is not clear whether it is superior to other conventional treatment methods such as percutaneous fixation with Kirschner wires. The present meta-analysis compared the effects of internal fixation with volar locking plates and percutaneous fixation for the treatment of distal radius fractures. Methods: A literature search was performed without language restrictions and all randomized controlled studies comparing the effects of volar locking plates and percutaneous fixation for the treatment of distal radial fractures were included. Data of function scores, range of motion, grip strength, radiographic results, and complications were pooled and analyzed with a standard meta-analytical method. Results: Seven studies in seven publications were included. Pooled data indicated that there were no significant differences in Patient-Related Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores between the two treatment methods postoperatively. Fixation with volar locking plates took significantly longer than percutaneous fixation. There was a significant differ- ence in supination and grip strength favoring volar locking plate fixation at 3 and 6 months but not at ≥12 months, postoperatively. The final complication rates were similar in the two treatment groups. Conclusion: In the manage- ment of distal radius fractures, volar locking plate and percutaneous fixation yielded similar outcomes, while the former had the advantage of supination and grip strength in the early stage postoperatively. Percutaneous fixation was quicker to perform than volar locking plate fixation.
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The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures

The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures

Thirty-nine patients with unilateral, intraarticular frac- tures of the distal radius were included. All patients gave informed consent and permission of the institu- tional ethical committee was obtained. Inclusion criteria were age over 50, fractures of AO-type C with a dorsal comminution zone and at least two instability criteria. Open fractures were excluded as well as additional osseoligamentous injuries of the extremity, such as car- pal injuries. Fractures were classified, using plain radio- graphs, into subgroups of C I - C III after the AO - System. Patients were randomized to either group I (20 patients), which received a dorsal implant only (Pi- Plate, Synthes Corporation), or group II (19 patients) which, additionally to the implant, received bone aug- mentation with granular beta-tricalcium phosphate (Chronos, Synthes Corporation). Surgery was carried out according to the techniques described previously. The defects in group II were filled with the granular phos- phate after internal fixation was completed. Granular material had been chosen due to the possibility to fill the defect after reposition. With the implant in place, the defect was filled with the granules, which were com- pressed into the dead space with a dasher. We had pre- viously found that method to be more effective than blocks or wedges which could often only be inade- quately fitted to the shape of the defect. To prevent accidental placement of granules into the joint, visual control of the joint and irrigation were done after com- pletion of augmentation procedure. Arthrotomy was car- ried out in all patients to estimate intraarticular steps
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External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

The advantages of open reduction and internal fixation include direct visualization and manipulation of the frac- ture fragments, stable rigid fixation, and the possibility of immediate postoperative motion. Fixed-angle plate designs minimize screw loosening in the distal fragments due to a ‘toggling effect’ and thus reduce the danger of secondary displacement. The subchondral placement of smooth pegs is useful to buttress small articular fragments and suc- cessfully control shortening and angular displacement, especially in osteoporotic bone [3]. Most fractures can be managed through a single volar access despite the presence of dorsal fragments, resulting in acceptable outcomes and good implant stability.
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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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Benefits of Palmer T- Plate Osteosynthesis in Unstable Distal
Radius Fracture Management

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

Distal radius fractures (DRF) occur more frequently than any other fracture. Various operating methods for distal radius fracture fixation have used by orthopedic surgeons, including K-wire fixation, external fixation and open reduction and internal fixation with different implants are well established and widely used [14]. External fixation with additional use of K-wires fixation to achieve stable fixation, may be associated with prolonged postoperative stiffness and pin tract infection and with loss of reduction. Dorsal plate Osteosynthesis may cause extensor tendons irritations and some time even rupture, so their removal is often necessary, in contrast volar plate can be left in place for most of cases [15- 17]. Several studies have conducted for the treatment unstable distal radius fracture and showed satisfactory results with each method but treatment of choice for such unstable fracture remain controversial. With the exception of a very recent study, not even randomized control trials could convincingly show better results for any of the procedures [16-19]. While dorsal plate used for treating unstable distal radius fracture, it requires exposure of the fragments, frequently spongioplasty, and usually removal of the implant later on. However, with the palmar approach for the reconstruction of the articular surface and restoration can easily be achieved with the T-plate.
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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.

In the surgical procedure, External fixation 2.94% patients had Excellent results, 70.59% had good results, 23.53% had fair results and 2.94% had poor results. In the Internal fixation group 5.88% patients had excellent results, 82.35% had good results, 11.76% had fair results and no one had poor results. Our study showed that method of fixation is statistically not significant (P = 0.3955) in determining the functional outcome of the patient, though the study has certain limitations such as non-randomized, non-blinding techniques used and less number of patients were employed. Similarly Margaliotet al 23 did a Meta – analysis of distal radius fractures treated with External fixation and Internal fixation. 46 articles were included in the study after careful serenity of Internal fixation and external fixation 917 patients were included in external fixation group and 603 were included in Internal fixation group. Outcomes were assessed using pooled grip strength, Range of motion, Radiographic assessment and physician related outcomes. The authors conclude that current literature does not recommend the superiority of one method over the other.
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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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Mid term results of a less invasive locking plate fixation method for proximal humeral fractures: a prospective observational study

Mid term results of a less invasive locking plate fixation method for proximal humeral fractures: a prospective observational study

First, there was a significant improvement in the Con- stant score between 6 months and 4.5 years after surgery (Fig. 3). This improvement may encourage patients to continue working on improving their shoulder function, even after an extended period of time. Röderer et al studied a group of 54 patients with a follow-up of 17 months, an average age of 70 years, and a mean Con- stant score (without normalization) of 66.8 points. These data are comparable to our results [9]. Additionally, Wu et al conducted a study with a minimum follow-up of 24 months using the locking proximal humerus plate (LPHP). Their data showed slightly better results in the functional outcome; however, their cohort was younger than ours (58.6 ± 11.0 vs. 67 ± 14 years; n = 28 vs. n = 140) [10]. Ockert et al showed that a good functional outcome is possible at mid-term follow-up (Constant score: 88.4, 95 % CI, 81.7-95.1). However, their patient group was younger than ours (median age 58.2 years), and our multivariate analysis showed that age had a major influence on the final outcome (Table 3). The comparability across studies is relatively low because dif- ferent implants and surgical approaches were used [11].
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Functional outcome of communited intra articular distal radius fractures managed by fragment specific fracture fixation: A Prospective study.

Functional outcome of communited intra articular distal radius fractures managed by fragment specific fracture fixation: A Prospective study.

This is to certify that this dissertation entitled ‘FUNCTIONAL OUTCOME OF COMMUNITED INTRA ARTICULAR DISTAL RADIUS FRACTURES MANAGED BY FRAGMENT SPECIFIC FRACTURE FIXATION’ is a record of bonafide research work done by Dr. M.NIRMAL, post graduate student under my guidance and supervision in fulfilment of regulations of The Tamilnadu Dr. M.G.R. Medical University for the award of M.S. Degree Branch - II (Orthopaedic Surgery) during the academic period from 2014 to 2017, in the Department of Orthopaedics, Govt. Kilpauk Medical College, Kilpauk, Chennai-600010
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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

In our study, routine evaluation of the DRUJ and transfixing wire was per- formed for the cases that required attention in both groups. Reduction of the joints with transfixing wires improved the outcome, as it reduces the complica- tions. DRUJ reduction is considered the cornerstone for the reduction of com- minuted distal radial fracture. Injury of the DRUJ has been classified into high energy or low energy trauma according to Fernandez and Jupiter [17] classifica- tion Fernandez and Jupiter based their classification on two main parameters; they considered soft tissue injury and DRUJ injury as the main factors which af- fect the outcomes of treatment for intra-articular fractures of distal radius.
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Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

From the structural and functional stand points the distal humerus is divided into separate medial and lateral components each containing an articular and non-articulating portion. Included in the non-articulating portion are the epicondyle which are the terminal points of the supracondylar ridges. The lateral epicondyle contains a roughened anterolateral surface from which the superficial forearm extensor muscles arise. The medial epicondyle is larger than the lateral counter part and serves as the origin of forearm flexor muscles.
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A study on functional outcome of adult Type C distal humeral fractures with bicolumnar fixation

A study on functional outcome of adult Type C distal humeral fractures with bicolumnar fixation

Patients injured limb was immobilized with POP slab initially. After treating for surgical and medical comorbidities all the patients were assessed for general or regional anaesthesia. Most of our patients were operated within 2 days with maximum period of 10 days in the elective operative list. The surgical delay was mainly to treat medical complications and head injury. The two open fracture were debrided and internally fixed on the 2 nd day of surgery. Prior to surgery, detailed instructions were given to each patient regarding the operative procedure and the possible complications associated with the surgical procedure and that the result of the procedure considerably depends on the patients own motivation to regain full function and the detailed written and informed consent was obtained.
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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

Methods: Both groups included 40 patients with an average follow-up of 12 months. The external fixation group comprised 20 patients and percutanious pinning comprised 20 patients. Average age at presentation was 34 years in the external fixation group and 30 years in the percutanious group. The male/female ratios were 12:8 among the external fixation group and 11:9 in percutanious group. The two groups were compared for clinical and functional outcomes measured by the disabilities of the arm, shoulder, and hand (DASH) score. Pain scores were similar. Radiographic measurements were also evaluated between groups.
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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

Since this analysis is from a societal perspective, direct health care costs, direct non- healthcare costs and indir- ect costs due to a distal radius fracture will be consid- ered. Direct health care costs include treatment, follow up visits to medical specialist, any additional visits to general practitioner or other health care professionals, prescribed medication, professional home care and treat- ment of possible complications (Table 1). Direct non- healthcare costs include travel expenses to and from the hospital, over-the-counter medication, care provided by family or paid help and assistive devices. Indirect costs originating from loss of production or hours of inactivity due to immobilisation, pain or decreased function of the wrist will be included as well. These will be estimated using the Friction-Cost method that limits productivity loss to the friction period. This friction period is the period to recruit and train a replacement for the sick employee [36–38]. The Human Capital Approach, which is based on the total expected loss of production for an individual worker [38], will also be used to estimate costs. Compared with the Friction-Cost method, the Hu- man Capital Approach will often overestimate costs from a societal perspective, especially in the long term [37, 39].
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Functional Outcome analysis of Open reduction and internal fixation of complex acetabular fractures.

Functional Outcome analysis of Open reduction and internal fixation of complex acetabular fractures.

8) Joel m. matta, m.d.t, los angeles, california, Fractures of the Acetabulum: Accuracy of Reduction and Clinical Results in Patients managed Operatively within Three weeks after the Injury, Journal of Bone and Joint Surgery1996;78:1632-45. 9) P. K. Sancheti, Atul Patil, A.K. Shyam, Kailash Patil , Milind Merchant, Outcome of Operatively Treated Anterior Column Fracture of the Acetabulum- A Short term Prospective Cohort study. Journal of Orthopaedics 2009;6(4)e7

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Functional outcome of medial distal tibial locking compression plate fixation in distal tibial fractures: A prospective study

Functional outcome of medial distal tibial locking compression plate fixation in distal tibial fractures: A prospective study

4. Interlocking nail used in comminuted diaphyseal fracture proved that open anatomical reduction of the fragment is not necessary and close treatment of the comminuted fragments with splinting by intramedullary nail produces abundant callus and solid healing. These four developments, Schuhli nut, point contact plate, fixed angled blade plate and locked intramedullary nail naturally lead to the development of internal fixator by locked head plate 23 .

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A Prospective study on Analysis of Functional Outcome of Internal Fixation of Fibula by Closed Tens Nailing in Addition to Tibia in Distal both Bone Leg Fractures

A Prospective study on Analysis of Functional Outcome of Internal Fixation of Fibula by Closed Tens Nailing in Addition to Tibia in Distal both Bone Leg Fractures

planes and one must be vigilant to not penetrate the posterior cortex. A special Herzog bend of 10 o in the proximal 50 mm is present in all AO IMIL tibia nails so as to ensure posterior cortex is not violated. Whether reamed or not, all tibia nails after insertion can cause considerable damage to the endosteal blood supply. The periosteal healing takes major part in fracture healing initially meanwhile the endosteal insult gets rectified in days to weeks. Before inserting the appropriate nail, reaming has to be done at least 2mm more than that of the diameter of the nail and nail should easily pass through the canal without and undue tightness or pressure.
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