Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius. Arch Orthop Trauma Surg
Department of Trauma and Reconstructive Surgery, Surgical Clinic University of Rostock, Schillingallee 35, 18055, Rostock, Germany. Archives of Orthopaedic and Trauma Surgery
(Impact Factor: 1.6).
02/2013; 133(5). DOI: 10.1007/s00402-013-1698-5
The aim of this study was to compare non-bridging external fixation to palmar angular stable plating with respect to radiological outcome, wrist function, and quality of life.
One hundred and two consecutive patients (mean age: 63 years) were enrolled in the study. Fifty-two patients were randomized for plate osteosynthesis (2.4 mm, Synthes), 50 patients received non-bridging external fixation (AO small fixator). Objective (range of motion, grip strength), patient rated outcomes (quality of life, pain), and radiological outcome were assessed 8 weeks, 6 months, and 1 year after surgery.
Loss of radial length of more than 3 mm was not detected in any group. Volar tilt was better restored by external fixation (7.2°) than by volar plating (0.1°). Wrist function was good in both groups. The external fixator was tolerated very well, and the quality of life assessment revealed comparable results in both groups. Osteoporosis was found in 54 % of patients and had no influence on radiological and functional outcome.
Non-bridging external fixation employing multiplanar K-wires is a suitable treatment option in intra- and extra-articular fractures of the distal radius even in osteoporotic bone.
Available from: Joerg G Prof Gruenert
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Palmar plate fixation of unstable distal radial fractures is quickly becoming the standard treatment for this common injury. The literature reporting complications consists mainly of isolated case reports or small case series.
Between February 2004 and December 2009 palmar plate fixation was performed in 665 cases. The overall complication rate was 11.3 % (75 complications). Revision surgery was necessary in 10 % (65 procedures).
The reasons for revision surgery were: postoperative median nerve compression (22 patients) and secondary dislocation (9 patients). An ulna shortening osteotomy for ulnar impingement syndrome was necessary in eight cases. Intraarticular screw placement occurred in three patients. There were two flexor pollicis longus, one finger flexor and three extensor pollicis longus tendon ruptures. Posttraumatic compartment syndrome of the forearm requiring fasciotomy occurred in four cases. There were three cases of infection. Nonoperative treatment was necessary in nine patients, who developed a complex regional pain syndrome. Hardware failure occurred in three cases. Hardware removal was performed in 232 (34 %) cases.
Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.
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The choice between volar locking plates (VLP) and external fixation (EF) for unstable distal radius fractures have not reached a consensus. The meta-analysis of randomized controlled trials was performed to compare VLP with EF to determine the dominant strategy.
Materials and methods:
Meta-analysis was performed with a systematic search of studies conducted by using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. The randomized controlled trials that compared VLP with EF was identified. Characteristics, functional outcomes, radiological results, and complications were manually extracted from all the selected studies.
Six studies encompassing 445 patients met the inclusion criteria. There was significant difference between two procedures in disabilities of the arm shoulder and hand scores at 3,6, and 12 mo, visual analogue scale at 6 mo, grip strength at 3 mo, supination at 3 and 6 mo, extension at 3 mo, ulnar variance at 12 mo, and reoperation rate at 12 mo, postoperatively. However, there was no significant difference between flexion, pronation, radial deviation, and ulnar deviation at all follow-up points postoperatively and overall complications at 12 mo, postoperatively.
EF had less reoperative rate due to complications, however, VLP had advantages in functional recovery in the early period after surgery, but two methods had similar functional recovery at 12 mo, postoperatively. Clinician should make the treatment decision with great caution for the patients who sustained unstable distal radial fractures.
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ABSTRACT: Objectives: To evaluate complications after distal radius fracture surgery. Design: Prospective registry study. Setting: Nationwide registry study. Patients: A total of 36,618 patients who underwent surgery because of a distal radius fracture during the period from January 1, 2001 to December 31, 2009 were followed from the date of operation until the occurrence of either reoperation, a new distal radius fracture, death, or December 31, 2010, whichever occurred first. Main Outcome Measurement: The occurrence of reoperations after different surgical methods is presented as proportions, incidence rates, and in a Kaplan–Meier survival analysis curve. Types and distributions of complications are presented for pinning, external fixation (EF), and plating, respectively. Results: The incidence of reoperation after fracture surgery using EF, pins, and plating was 100 [95% confidence interval (CI): 93–107], 140 (95% CI: 127–153), and 222 (95% CI: 207–237) per 10,000 person years, respectively. After stratified analysis adjusting for age and gender, the differences remained significant when comparing plating with EF (P = 0.001) and pinning (P = 0.01). Pinning and EF patients displayed an earlier onset of the complications when compared with plated patients. Conclusions: The incidence of reoperation was higher for patients treated with a plate than for patients treated with pins or EF. The timing of the reoperations differed in that pinning and EF patients displayed an earlier onset when compared with plated patients. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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