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Outcomes of distal radius fracture fixation with APTUS locking plates and variable angle locking screws

Authors:
164 Abstracts / Injury Extra 41 (2010) 131–166
doi:10.1016/j.injury.2010.07.492
2A.19
Outcomes of distal radius fracture fixation with APTUS locking
plates and variable angle locking screws
Talvinder Singh
a,
, Nikolas Jagodzinski
b
, Rory Norris
b
, Simon
Tan
a
, Vaikunthan Rajaratnam
a
, Johnathan Jones
b
, Dominic
Power
a
a
The Birmingham Hand Centre, Birmingham, United Kingdom
b
Peterborough District Hospital, Peterborough, United Kingdom
Purpose: Various methods have been described to treat unsta-
ble fractures of the distal radius. In recent times, there has been
a surge in the use of volar plating for distal radius fractures. Our
paper examines the clinical, functional and radiological outcomes
of distal radius fracture fixation with the APTUS locking plates and
variable angle locking screws.
Methods: We conducted a retrospective cohort study on 30
patients with distal radius fractures. The fractures were classified
according to the AO fracture classification system. Clinical assess-
ment was made using the DASH score. We measured range of
movement of the wrist joint and documented any post-operative
complication. Post-operative x-rays were obtained to assess frac-
ture union, restoration of anatomy and the presence osteoarthritic
changes. Post-operative patients were seen every 2 weeks.
Results: There were 10 males and 20 females who were treated.
The mean age was 41.1 years and the mean follow-up was 5.0
months. Mean post-operative dorsiflexion was 52.4
. Mean post-
operative volarflexion was 49.2. All fractures had united on final
follow-up. Congruent articular surfaces were achieved without
articular step-off. Reduction was maintained when union was
achieved. The mean DASH score was 26.9. Two patients developed
post-traumatic osteoarthritis. One patient had intra-articular screw
placement and subsequently developed post-operative carpal tun-
nel syndrome after the screw was removed. Six patients had
metalwork removed.
Conclusions: Volar distal radius locking plates haveexpandedthe
scope for internal fixation of distal radius fractures via the volar
approach. The new generation of variable angle locking systems
have the added benefits of more flexible implant positioning and
may allow enhanced intra-fragmentary reduction and fixation of
intra-articular fractures. Inadvertent placement of screws into the
DRUJ or radiocarpal joint is still a concern. We discuss early func-
tional and radiological outcomes of the APTUS plating system in
complex distal radius fractures.
doi:10.1016/j.injury.2010.07.493
2A.20
Functional outcome of proximal humerus fracture treated by
PHILOS plate
M. Al-Najjim
, A. Mustafa, S. Lipscombe, M. Waseem
Macclesfield District General Hospital, United Kingdom
Introduction: The aim of this study was to assess the intermedi-
ate functional out come and complications of the patient who had
undergone open reduction and internal fixation with PHILOS Plate
fixation following fracture of the proximal humerus. The locking
plates have extended the indication to osteoporotic and poor bone
quality.
Patients and methods: Retrospective data was collected from
January 2004 to May 2009 of patients who had sustained a prox-
imal humerus fracture and treated with PHILOS plating. Injuries
were classified according to the Neer system. Functional out come
was measured using DASH (disabilities of the arm, shoulder and
hand) and Oxford scoring system. Radiographic assessment for
osteonecrosis and implant failure was also completed.
Results: Forty-eight patients were identified. There were 19
male and 29 female. The mean age 55.3 years (range 20–89).
Fourteen patients had 4-part, twenty-five 3-part and nine 2-part
fractures. Patients were follow-up from 9 to 18 months mean
was (14 months). All fracture united in satisfactory position. Three
patients developed superficial wound infection, one patient devel-
oped radial nerve palsy which recovered spontaneously within
(6) months, one patient had broken distal screw, three patients
impingement syndrome, one patient had complex regional pain
syndrome, rotator cuff tear in two patients. There were no screw
perforations, implant failure, avascular necrosis or vascular injury.
Thirty-one patients returned the DASH and Oxford shoulder ques-
tionnaires. Four patients died, four patients have terminal diseases,
two patients have severe dementia and seven patients were lost in
follow-up. The mean post op Oxford score was 42.4 (range 13–48)
and the mean DASH score was 10.1 (0–54). Most of the patients had
returned back to their normal jobs and hobbies such as gardening,
swimming and bowling.
Conclusion: Internal fixation using PHILOS plate is a reliable
method of treating fracture of proximal humerus. It provides stable
fixation and allow early shoulder mobilisation. The functional out
come is satisfactory with minor complications.
doi:10.1016/j.injury.2010.07.494
... Our study had one case of screw malpostioning who remained asymptomatic through out the study period. This was also reported by Khatri et al in one patient who remained asymptomatic during follow up period [15] and T singh et al in one who subsequently developed postoperative carpal tunnel syndrome after the screw was removed [20] . Pace A et al. has advices the use of different articular wrist views to assess and avoid the risk of intraarticular screw penetration [21] . ...
... Pace A et al. has advices the use of different articular wrist views to assess and avoid the risk of intraarticular screw penetration [21] . 15 18 5 Fowler et al. 16 11 26 Marlow et al. 17 51 14 T.singh et al. 20 10 20 Present study 36 20 ...
... R Mehrzad et al. compared the complication rates between Variable angle and fixed angle distal radius plates and they noted 11 complications in the fixed angle group out of which 7 were hardware related while no hardware relaed complications were noted in variable angle group [26] . Screw malpositioning was also reported by Khatri et al (2015) in one patient who remained asymptomatic during follow up period 15 and by T singh et al. (2010) in one who subsequently developed post-operative carpal tunnel syndrome after the screw was removed [20] Pace A et al. advices the use of different articular wrist views to assess and avoid the risk of intra-articular screw penetration [21] . Our study had 2 cases of superficial infections managed by oral antibiotics for 10 days and regular change of dressings. ...
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