Background In severe comminuted metaphyseal distal radius fracture (DRF) of elderly patients, after maintaining only radiological parameters of the radius using long volar locking plates (VLPs), we inevitably eliminated a few volar cortical fragments of metaphysis. Here, we report the final radiological and clinical outcomes of our method. Methods: For the patients who were treated between 2014 and 2018, the demographic factors, the preoperative radiologic factors, area of the eliminated volar cortical fragment, and final radiologic parameter, were evaluated. Clinical outcomes and ranges of active motion were evaluated. Results: In total, 31 patients were included. The mean patient age was 77.3 years and the mean eliminated cortical area was 3.30 cm2. At the final follow-up, the mean volar tilt, radial inclination, articular step-off, and ulnar variance were 10.35°, 20.00°, 0.58 mm, and 0.71 mm, respectively. There were no definitive correlations between bone mineral density, fragment area, the largest cortical fragment diameter ratio and differences in final and immediate postoperative measurements of these radiological parameters, respectively. Visual analog scale and disabilities of the arm, shoulder, and hand (DASH) scores were satisfactory, and the mean arcs of flexion-extension and pronation-supination were 124.35° and 133.23°. Clinical outcomes were not significantly different according to the AO system category. Conclusions: For maintenance of radiological parameters of the radius, long VLPs are useful in older patients with DRFs who exhibit volar metaphyseal comminution, despite concurrent ulnar fractures. Inevitable elimination of irreducible free comminuted cortical fragments when filling the defect does not affect final radiological and clinical outcomes.
Level of evidence: Level IV, case series.
Purpose The management of distal radius fractures (DRFs) has evolved with the introduction of volar locking plate (VLP) fixation, offering stable fixation and better outcomes. Nevertheless, the impact of the surgeon’s experience on the complication rates in VLP fixation remains to be determined, particularly for less-experienced surgeons. This study compared the complication rates during the initial four years and subsequent two years of a hand surgeon’s practice of VLP fixation for DRFs.
Materials and Methods The data between March 2016 and December 2022 were analyzed retrospectively under the Institutional Review Board approval. A single surgeon performed all VLP fixation surgeries after finishing regular hand surgery training, with the first four years representing the less experienced phase (Group 1) and the following two years indicating the experienced phase (Group 2). The patients’ characteristics, operation-related factors, and postoperative complications, including tendon injuries, nerve-related complications, fixation and instrument-related issues, osteosynthesis-related problems, and infections, were compared. In addition, the authors compared the data with a large multicenter study conducted by experienced hand surgeons.
Results Three hundred and nineteen patients (321 wrists) were included. The mean age was 63.3 years, and 26.3% were male and 73.7% were female. The operation time was 53.7±14.5 minutes and 74.4±26.5 minutes in groups 1 and 2, respectively, which was statistically significantly shorter (p<0.001). The complication rates between the two groups were similar, except for the higher implant removal rates in Group 1. A comparison with a previous multicenter study revealed higher reduction losses and carpal tunnel syndrome in this study, but the overall complication rate was low.
Conclusion In DRF management, when the operating surgeon has completed an accredited training course, VLP fixation is a good treatment method that can be performed effectively even by less experienced surgeons with low complication rates.
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Author correction: “Does the operator's experience affect the occurrence of complications after distal radius fracture volar locking plate fixation? A comparative study of the first four years and thereafter” Kee-Bum Hong, Chi-Hoon Oh, Chae Kwang Lim, Sungwoo Lee, Soo-Hong Han, Jun-Ku Lee Journal of Musculoskeletal Trauma.2025; 38(1): 40. CrossRef
Purpose This study examined the demographic and radiological risk factors for later reduction loss of distal radius fractures treated conservatively.
Materials and Methods This study enrolled patients treated for distal radius fractures between January 2017 and December 2019. Seventy-eight patients were included in the analysis and divided into two groups. The patients who showed minimal reduction loss within an acceptable radiologic angle after initial manual reduction were classified as Group A. The patients who showed reduction loss out of an acceptable radiologic angle and finally malunited or converted to surgical treatments were classified as Group B. The patient’s age and bone marrow density were used as demographic data. The initial X-ray images were evaluated to determine the fracture type. Various radiological parameters were measured.
Results The 78-patient study cohort consisted of nine men and 69 women with a mean age of 67 years. Forty-eight cases were sorted into Group A, and 30 cases into Group B. On logistic regression analysis, the age of 80 or older was a risk factor for later fracture displacement among the demographic factors (p=0.037, odds ratio=4.937). Among the radiographic factors, the presence of distal ulnar fracture and dorsal cortical comminution were disclosed as risk factors of later displacement (p=0.049, 0.003, odds ratio=3.429, 7.196).
Conclusion When conservative management for distal radius fracture is decided in patients more than 80 years of age or accompanied by a distal ulnar fracture or with dorsal cortical comminution, the possibility of later displacement of the distal radius should be considered.
Fractures around the wrist are the third most common fracture among all pediatric fractures. Furthermore, distal radius fractures, a type of wrist fracture, are the most common fractures in children. Understanding pediatric fractures around the wrist is very important considering their prevalence. There is a specific belief that pediatric fractures can heal easily because of remodeling, but not all fractures can heal without proper treatment. Complications such as growth problems, nonunion can occur if the fracture is not treated properly. This paper reviewed recent articles about distal radius fractures, Galeazzi-equivalent fractures, and carpal bone fractures, including scaphoid fractures in children and adolescents. Successful treatment can be achieved without complications when an accurate diagnosis and proper non-surgical or surgical treatment are performed based on this article.
Purpose There are no standard surgical treatments for open distal radius fractures (DRFs), and the fracture fixator is chosen by the surgeon’s own experience. This study compared the outcomes of open reduction and volar locking plating (OR VLP) between closed and open AO-OTA type C3 DRFs.
Materials and Methods: Patient data were retrospectively collected between January 2010 and December 2018. Only patients aged >18 years with AO-OTA C3 DRFs were included. After further exclusion, the patients with DRFs were divided into two groups: 13 patients with open DRFs in Group 1 and 203 patients with closed DRFs in Group 2. Data on the patient characteristics and treatment-related factors were further investigated. For the radiological evaluation, the radial height, volar height, and volar titling were measured based on the final plain radiography, and the union time was measured. The wrist range of motion (ROM), pain visual analogue scale score, and modified Mayo wrist score for function were measured at the final outpatient follow-up. Finally, the complications associated with OR VLP fixa-tion were investigated.
Results: In the demographic comparison, the patients with open fractures were older (mean age, 62years) than those with closed fractures (mean age, 57 years), without a statistically significant differ-ence. The patients with open DRFs had longer antibiotic therapy and hospital stay durations. Although they presented a higher radial inclination, with statistical significance, the clinical implication was low with a mean difference of 3°. No significant differences were observed for the remaining radiological parameters, wrist ROM, and functional scores. An open DRF did not increase the complication rates,including deep infection.
Conclusion: Depending on the expertise of the operating surgeon, the primary OR VLP fixation in open intra-articular comminuted DRF did not increase the incidence of deep infections and yielded similar outcomes to a closed intra-articular comminuted DRF.
Purpose This study compared minimally invasive plate osteosynthesis (MIPO) using a single small skin incision and conventional open volar locking plate fixation (OP) for distal radius fracture to identify outcome difference. Materials and Methods Forty-three patients who underwent MIPO using a single small skin incision or OP for distal radius fractures were evaluated retrospectively. Of the patients, 21 were treated with MIPO using a single small skin incision and 22 with the OP method through the conventional volar approach. The postoperative radiographic results and clinical outcomes at the final follow-up in each group were compared. Results All patients achieved bone union in the MIPO and OP groups. No significant differences in the bone union time, alignment, range of motion, QuickDASH, or pain score were observed. On the other hand, the size of the incision was significant: 23 mm in the MIPO group and 55 mm in the OP group (p<0.001). Conclusion MIPO technique using a single small incision showed similar satisfactory radiographic and functional outcomes compared to conventional OP for distal radius fractures. The MIPO technique using a single small incision offered advantages, including cosmetic benefits and minimal soft tissue damage, is recommended, particularly in young women and high functional demand patients.
Most distal radius fractures are currently being treated with anterior plating using anatomical precontoured locking compression plates via the anterior approach. However, it is difficult to fix the volar articular marginal fragment because these anatomical plates should be placed proximally to the watershed line. There were just a few methods of fixation for this fragment on medical literature. Herein, we introduced a tension band wiring technique for fixation of a volar articular marginal fragment in the distal radius.
PURPOSE This study investigated the clinical and radiological outcomes of patients undergoing provisional fixation in conjunction with locking plate fixation. Miniplates were used as the reduction plates for the surgical treatment of severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. MATERIALS AND METHODS The radial length, radial inclination, volar tilt, and radial intra-articular step-off were measured preoperatively, postoperatively, and at one year after surgery in 12 patients (eight males, four females, mean age 55.4 years old). The patients underwent volar locking plate fixation with miniplate as a reduction plate for severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. Clinical evaluations were conducted using the modified Mayo wrist score (MMWS). RESULTS Bone union was achieved in all cases. The mean MMWS was 81.8 points, including two excellent, three good, and seven fair cases. Radiological improvements were observed in the average radial length (preoperative, 6.4 mm; postoperative, 11.8 mm), average radial inclination (10.2° to 22.4°), average volar tilt (−4.5° to 10.6°), and average radial intra-articular step-off (4.8–0.8 mm) (all, p<0.05). Radiographic measurements obtained immediately after surgery and at the final follow-up revealed insignificant decreases in radial length (0.6 mm), radial inclination (0.4°), and volar tilt (0.9°) (all, p>0.05). CONCLUSION Miniplate fixation can be an effective treatment option as a reduction plate for the treatment of distal radial fractures, which is challenging to reduce and maintain due to severely comminuted metadiaphysis fractures with the intra-articular fracture.
PURPOSE The purpose of this study was to evaluate the radiological and clinical results of plate fixation and external fixation with additional devices for treating distal radius fracture in AO type C subtypes, and propose a treatment method according to the subtypes. MATERIALS AND METHODS Two hundred and one AO type C distal radius fracture patients were retrospectively reviewed. Eighty-five patients in group 1 were treated with volar or dorsal plate, and 116 patients in group 2, were treated with external fixation with additional fixation devices. Clinical (range of mtion, Green and O'Brien's score) and radiological outcomes were evaluated. RESULTS At the 12-month follow-up, group 1 showed flexion of 64.4°, extension of 68.3°, ulnar deviation of 30.6°, radial deviation of 20.8°, supination of 76.1°, and pronation of 79.4° in average; group 2 showed flexion of 60.5°, extension of 66.9°, ulnar deviation of 25.5°, radial deviation of 18.6°, supination of 73.5°, and pronation of 75.0° in average. The mean Green and O'Brien score was 92.2 in group 1 and 88.6 in group 2. The radial height of group 1 and group 2 was 11.6/11.4 mm; radial inclination was 23.2°/22.5°; volar tilt was 11.6°/8.7°; and the ulnar displacement was 1.27/0.93 mm. CONCLUSION Judicious surgical techniques during device application and tips for postoperative management during external fixation can produce similar clinical results compared with internal fixation patients.
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Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study S.P.S Gill, Manish Raj, Santosh Singh, Ajay Rajpoot, Ankit Mittal, Nitin Yadav Journal of Orthopedics, Traumatology and Rehabilitation.2019; 11(1): 31. CrossRef
Distal radius fractures are a common upper extremity fracture and a considerable number of patients have a stable fracture. In the treatment of distal radius fractures, there is considerable disagreement regarding the need for a strict anatomical restoration with operation in elderly patients. Therefore, nonsurgical treatment is a still important treatment option in distal radius fractures. The radiological parameters of before or after manual reduction are important for deciding whether to perform operation or not. The radiological parameters include dorsal angulation of the articular surface, radial shortening, extent of dorsal comminution, intra-articular displacement, concomitant ulnar metaphyseal fracture, shear fracture, and fracture-dislocation of the distal radio-ulnar joint. In addition, clinical situations of patients, including age, activity level, underline disease, and recovery level, which the patients wish should be considered, comprehensively. For the duration of a splint or cast, three to four weeks are recommended in impacted or minimally displaced fractures and five to six weeks in displaced fractures. After reduction of the displaced fractures, patients should undergo a radiologicical examination every week to check the redisplacement or deformity of the fracture site until two or three weeks post trauma. Arm elevation is important for controlling fracture site swelling and finger exercises, including metacarpophalangeal joint motion, are needed to prevent hand stiffness. Active range of motion exercise of the wrist should be initiated immediately after removing the splint or cast.
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The Clinical Effect of Complex Korean Medical Admission Treatment in Patients with Fractures of Distal Radius by Traffic Accident: 2 Cases Series Report Gyu-cheol Choi, Ji-won Lee, Ji-Eun Bae, Dong-jin Kim, Jeong-su Hong, Da-hyun Kyung Journal of Korean Medicine Rehabilitation.2021; 31(1): 187. CrossRef
The Clinical Effect of Rehabilitation Protocol for Distal Radius Fracture in Korean Medicine: A Report of 3 Cases Won-Bae Ha, Ji-Hye Geum, Nak-Yong Koh, Jung-Han Lee Journal of Korean Medicine Rehabilitation.2018; 28(3): 97. CrossRef
PURPOSE This study examined the clinical outcomes of comminuted intraarticular distal radius fractures treated by an anatomical reduction using a brick-work technique. MATERIALS AND METHODS Seventeen patients with AO/OTA type 23-C3 distal radius fractures were enrolled in this study. An anatomical reduction of the articular surface was achieved using a brick-work technique through the dorsal approach and dorsal plates were used for fixation. The postoperative functional results were assessed with the range of motion of the wrist and the modified Mayo wrist score (MMWS). In addition, the radial length, radial inclination, volar tilt, and Lidstrom score were evaluated from the radiology results. The mean postoperative follow-up period was 13.6 months. RESULTS All patients showed bony union and the mean range of motion of the injured wrists was 94% (92% to 95%) of the uninjured side. The mean MMWS was 85.3, and the functional results were excellent in 12 patients, good in 4, and fair in one at the final follow-up. Based on the final radiographic measurements, the radial length, volar tilt, and radial inclination were 11.4 mm (10.0 to 13.5 mm), 6.6° (−1.8° to 9.2°), and 21.3° (20.1° to 25.7°), respectively. The radiologic results according to the Lidstrom score were excellent in 14 patients and good in three. CONCLUSION An anatomical reduction with the brick-work technique is relatively easy, results in a reproducible clinical outcome, and could be a safe and effective treatment option for severe comminuted intraarticular distal radius fractures that are not amenable to volar plate fixation.
PURPOSE This study was to assess the morphological changes of the pronator quadratus (PQ) muscle using an ultrasonography in the volar locking plate fixation group and in the percutaneous K-wire fixation group for distal radius fracture, and to evaluate the impact on clinical outcomes. MATERIALS AND METHODS Fifty-four patients who received surgical treatment for distal radius fracture were enrolled in this study. They were divided into two groups according to treatment modality: Group 1 included 34 patients who underwent internal fixation with volar locking plate and Group 2 included 20 patients with percutaneous K-wire fixation. Thickness of the PQ muscle was measured using an ultrasonography at the final follow-up. We evaluated the outcomes using the Mayo wrist score, wrist range of motion, and grip strength at the final follow-up. RESULTS Compared with the uninjured side, thickness of the PQ muscle showed 31.9% of mean atrophy in Group 1 and 11.4% in Group 2. The atrophy of PQ muscle was severe in Group 1 (p=0.01). However, there was no significant difference in the mean Mayo wrist score between the two groups (83.1±10.9 in Group 1 and 80.2±8.9 in Group 2, p=0.28), except a mild limitation of pronation in Group 1. CONCLUSION The healed PQ muscle from fracture itself after distal radius fracture revealed a morphological atrophy. Moreover, the volar locking plate resulted in greater atrophy of the PQ muscle, but there was no specific impact on clinical outcomes.
PURPOSE The spontaneous extensor pollicis longus (EPL) tendon rupture is a well-documented complication of non-displaced or minimally displaced distal radius fracture. Authors analyzed the radiographs of patients treated for closed EPL rupture after distal radius fracture. MATERIALS AND METHODS Twenty-eight patients (21 females, 7 males; average age of 58 years) with tendon transfer for spontaneous rupture of EPL after distal radius fracture were included. Wrist radiographs were taken at the first visit with EPL rupture. On the lateral view, posterior cortical displacement, distance from highest point in Lister's tubercle to fracture line, and height of the Lister's tubercle were measured. The distance from the lunate facet to the fracture line was measured on anteroposterior view. Radiologic change at the time of EPL rupture around the Lister's tubercle was evaluated by comparing it with the contra lateral wrist radiograph. Radial beak fracture pattern was also identified. RESULTS The interval between the injury and the spontaneous EPL rupture varied from 2 to 20 weeks, with an average of 6.7 weeks. There were 25 cases of non-displacement, 3 cases of mean 2.0 mm cortical displacement. The average distance from the lunate facet to the fracture line was 9.1 mm (3-12.1 mm), from the highest point in Lister's tubercle to the fracture line was 3.0 mm toward proximal radius (1.7-4.9 mm). The average height of the Lister's tubercle was 3.4 mm in the injured wrist and 3.1 mm in the opposite wrist. Radial beak fracture pattern was shown at 11 cases. CONCLUSION All cases presented no or minimal displaced fracture, and the fracture line was in the vicinity of the Lister's tubercle. Those kinds of fractures can highlight the possibility of spontaneous EPL rupture, depites its rarity.
PURPOSE We investigate the outcomes of treatment of patients with severe comminuted distal radius fractures with volar plate fixation using a pronator-preserving approach. MATERIALS AND METHODS Fourteen patients with severe comminution of the distal radius fractures for whom anatomical reduction of the fractures was deemed difficult to achieve with traditional approaches were enrolled. The gender ratio was 8 males to 6 females, and the average age of the patients was 64.9 years. According to the AO/OTA classification of fractures, 2 patients had 23-A3 fractures, 7 patients had 23-C2, and 5 patients had 23-C3. Radial length, radial inclination, and volar tilt were measured for radiologic evaluation. Modified Mayo wrist score (MMWS) was used for clinical outcome. RESULTS Bony union was achieved in all 14 patients without signs of complications. The average time-to-union was 4.3 months (3-6 months). The radiological findings at the final follow-up were as follows: the average radial inclination was 20.5degrees; the average volar tilt, 7.57degrees; and the average radial length, 11.8 mm. At the final follow-up, the results of the MMWS were 'Fair' in 1 patient, 'Good' in 4, and 'Excellent' in 9. CONCLUSION We propose that a pronator-preserving approach is an effective treatment for severe comminuted distal radius fracture.
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Use of Miniplate for Severe Comminuted Metadiaphyseal Fractures of the Distal Radius Jong-Ryoon Baek, Yong-Cheol Yoon, Seung Hyun Baek Journal of the Korean Fracture Society.2019; 32(4): 204. CrossRef
PURPOSE We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly. MATERIALS AND METHODS We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. RESULTS Using the MMWS, 13 cases were classified as 'good', 10 'fair', and 5 'normal'. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as 'good', 14 'fair', and 7 'normal'. CONCLUSION Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.
PURPOSE The purpose of this study is to evaluate outcome of variable-angle volar locking plate for treatment of distal radius fractures. MATERIALS AND METHODS We retrospectively analyzed the results in 45 cases treated by variable-angle volar locking plate. We evaluated the clinical results according to the Mayo wrist performance scoring system and radiographic results. RESULTS All cases had bony union. The mean Mayo wrist performance scoring system was 84.8. Between preoperative and immediate postoperative radiographic measurement, the mean radial length improved from 8.4 to 11.8 mm, radial inclination from 14.2degrees to 22.4degrees, volar tilt from -4.5degrees to 9.6degrees, and intraarticular step-off from 1.8 to 0.3 mm (p<0.05). Between immediate postoperative and latest follow-up radiographic measurements, the mean loss of radial length measured 0.8 mm, radial inclination 0.4degrees, and volar tilt 0.9degrees (p>0.05). All cases showed bone union with no evidence of malunion, nonunion, or metal failure. CONCLUSION Treatment of distal radius fractures using variable angle volar locking plate showed satisfactory outcomes. It is a good option to obtain stable fixation without significant loss of reduction.
PURPOSE This study evaluated the surgical outcomes of unstable distal clavicular fractures treated with a 2.4 mm volar distal radius locking plate. MATERIALS AND METHODS From August 2009 to August 2012, 16 patients with distal clavicle fractures underwent surgical treatment. Mean age was 36 years (18-62 years) and mean follow-up period was 12.9 months (6-32 months). Two cases were Neer type I, six cases IIa, three cases IIb, three cases III, and two cases V. For the radiologic assessment, union time and metal failure were evaluated, and coracoidiologic assessment, union time and metal failure were evaluatethe acromioclavicular joint. The clinical results were evaluated by range of motion, postoperative complication, and University of California at Los Angeles (UCLA) score. RESULTS Mean time to fracture union was 7.4 weeks (6-14 weeks) in all cases. No statistical difference in coracoid-clavicle distance was observed between immediate post-operation group and contra-lateral group (p=0.6), but an increase of 2.1 mm was observed in the last follow up group compared with the contra-lateral group (p<0.01). The UCLA scoring system showed excellent results in 15 cases and good results in one case. Acromial-clavicle instability occurred in one case so that metal removal and distal clavicle resection were performed. CONCLUSION A 2.4 mm volar distal radius locking plate can provide rigid fixation through several screw fixation in the short distal fragment and lead to satisfactory clinical outcomes in unstable distal clavicular fractures.
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Estudo retrospectivo da placa anterior superior como tratamento para fraturas instáveis da clavĂcula distal (tipo 2 de Neer) Syed Ibrahim, Jimmy Joseph Meleppuram Revista Brasileira de Ortopedia.2018; 53(3): 306. CrossRef
Retrospective study of superior anterior plate as a treatment for unstable (Neer type 2) distal clavicle fractures Syed Ibrahim, Jimmy Joseph Meleppuram Revista Brasileira de Ortopedia (English Edition).2018; 53(3): 306. CrossRef
PURPOSE The purpose of this study is to evaluate the incidence and characteristics of concomitant carpal bone fractures and ligament injuries and to analyze risk factors for carpal injuries in patients with distal radius fractures. MATERIALS AND METHODS A total of 362 patients with 379 distal radius fractures were reviewed retrospectively. Associated carpal bone fractures and ligament injuries were evaluated by plain radiographs and computed tomography at the time of initial trauma. Correlation between associated carpal injuries and various parameters was also analyzed. RESULTS Of 379 distal radius fractures, 39 cases (10.3%) had one or more carpal bone fracture and 40 cases (10.6%) had carpal ligament injuries. Overall, carpal injuries occurred in 59 cases (15.6%) distal radius fractures. Associated carpal ligament injuries showed correlation with young age and associated carpal bone fractures showed correlation with AO type B distal radius fractures. Carpal injuries including fracture and ligament injury showed correlation with male, high energy trauma, or associated injuries beyond wrist. CONCLUSION The incidence of concomitant carpal injuries in patients with distal radius fractures is relatively high. Concomitant carpal injuries were more common in young age, male, high energy trauma, AO type B distal radius fractures, or associated injuries beyond wrist.
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Korean Medicine Treatments for the Angular Deformity of Wrist Fracture with Disuse Osteopenia: A Case Report Myung Jin Oh Korean Journal of Acupuncture.2018; 35(4): 234. CrossRef
Comparison of Distal Radius Fractures with or without Scaphoid Fractures Jin Rok Oh, Dong Woo Lee, Jun Pyo Lee Journal of the Korean Society for Surgery of the Hand.2016; 21(1): 23. CrossRef
PURPOSE The purpose of this study is to evaluate the pronator quadrates muscle in patients who underwent internal fixation with a volar locking plate for unstable distal radius fractures. MATERIALS AND METHODS Forty patients who underwent internal fixation with a volar locking plate for unstable distal radius fracture were enrolled. We evaluated the clinical results according to the Mayo wrist score, the wrist range of motion, and the grip strength at the last follow-up. Using ultrasonography, muscle thickness of the pronator quadrates was compared between injured and uninjured arm. RESULTS Bone union was achieved in all cases. The mean Mayo wrist score was 82.79 points. The grip strength of the injured arm was decreased to 89.1% of the uninjured side. The decrease of pronation range of the injured wrist motions was significant (82.3degrees, p=0.004). There was significant atrophy of the pronator quadrates muscle on the injured side (injured side: 3.19 mm, uninjured side: 4.72 mm, p=0.001); and the decrement of muscle thickness in pronator quadrates showed an association with the Mayo wrist score (r=-0.35, p=0.042). CONCLUSION These results suggest that continuity of the muscle is maintained after use of the volar locking plating for unstable distal radius fractures with repair of pronator quadrates; however, there is atrophy of pronator quadrates muscle and limitation of pronation in the injured wrist.
PURPOSE To report the clinical results of opening wedge osteotomy graft in the volarly malunited distal radius. MATERIALS AND METHODS Ten patients with volarly malunited distal radius fractures treated by opening wedge osteotomy were included in this study. Grip power, range of motion of the wrist, radiographic parameter and Mayo wrist scores were retrospectively evaluated. RESULTS At the final follow-up, the rotation of the forearm, the range of motion of wrist, and the grip power were improved. The average radial inclination improved to 22.2degrees, the average volar tilting improved to 5.6degrees, and the average ulnar variance improved to 0.8 mm. The average Mayo wrist score was improved to 85.6. CONCLUSION Opening wedge osteotomy for volarly malunited distal radius was considered as one of the good treatments to restore anatomy of the distal radius and distal radioulnar joint and also to improve the function of the wrist joint.
PURPOSE The purpose of this study is to evaluate the clinical outcomes after removing the volar locking plate for distal radius fracture. MATERIALS AND METHODS We reviewed retrospectively the medical records of 34 patients, 36 cases after removing the plates among 150 patients, with 162 cases that underwent open reduction and internal fixation using the volar locking plate between January 2006 and May 2011. We performed preoperative and postoperative clinical assessments using the quick-disabilities of the arm, shoulder and hand (Q-DASH), the visual analog scale (VAS) score, and the range of motion on wrist, grip and pinch power. RESULTS The major reason for plate removal was the time to remove the plate according to the fracture union and the patient's demand without other specific complaints (28 cases). The mean preoperative VAS score was 1.78 and the mean postoperative VAS score 1.81 (p=0.64). The mean preoperative Q-DASH score was 30.02 and the mean postoperative Q-DASH score 38.46 (p<0.001). The mean preoperative grip and pinch power were 18.14 kg and 7.67 kg. The mean postoperative grip and pinch power were 15.27 kg and 6.94 kg (p=0.23). CONCLUSION The removal of the volar locking plate for distal radius fracture should be decided by considering the patient's clinical and socioeconomic conditions carefully.
As volar plate fixation of distal radius fracture becomes more common, reports of ruptured extensor pollicis longus tendon by a protruding distal screw tip are also increasing steadily. Authors have experienced a rare case of ruptured extensor pollicis longus tendon at the prominent proximal screw of fixed volar plate for distal radius fracture, and we report it herein with a review of the literature.
PURPOSE To determine the influence of osteoporosis on the results of percutaneous K-wire fixation for distal radius fractures. MATERIALS AND METHODS Between March 2007 and February 2011, Fifty seven patients who underwent fixative surgery with K-wires after closed reduction and those available for follow-up for at least 6 months were reviewed. They were divided into the two groups of T score -3 or more (group 1) and T score less than -3 (group 2). These groups were compared by the range of motion of the wrist and Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiologic evaluations consisting of radial length, radial inclination and volar tilt were compared. In group 1 with 34 cases, the average age was 65.4 years (50 to 78 years) and T score was -1.97 (-0.1 to -2.93). In group 2 with 23 cases, the average age was 74 years (54 to 89 years) and T score was -4.11 (-3.1 to -6.97). RESULTS There was no statistical difference between group 1 and group 2 in terms of range of motion, DASH score and radiologic evaluations. CONCLUSION In the case of no volar side cortical comminution, percutaneous K-wire fixation can be applied for the treatment of distal radius fracture with osteoporosis.
PURPOSE To compare the outcomes of distal radius fractures in a fixed-angle volar locking plate group and variable-angle volar locking plate group. MATERIALS AND METHODS Forty-one patients observed at least 6 months after surgery were included in this retrospective study. We used the range of motion, visual analogue scale score, Disabilities of the Arm, Shoulder and Hand Questionnaire score, and radiologic findings to measure the clinical results. RESULTS No differences in clinical results or radiologic results were noted between the fixed-angle volar locking plate group and variable-angle volar locking plate group. CONCLUSION We believe that it is important to minimize complications by using appropriate screws and plates according to the fracture type, though no differences in the surgical outcome were noted between the fixed-angle volar locking plate group and variable-angle volar locking plate group with distal radius fracture.
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Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference? Mohamed Abdel-Wahed, Ahmed Abdel-Zaher Khater, Mahmoud Ahmed El-Desouky International Orthopaedics.2022; 46(9): 2165. CrossRef
Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate Jae-Cheon Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung Journal of the Korean Fracture Society.2015; 28(1): 46. CrossRef
Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis Ki-Chan An, Gyu-Min Kong, Jang-Seok Choi, Hi-Chul Gwak, Joo-Yong Kim, Sung-Yub Jin Journal of the Korean Fracture Society.2013; 26(4): 248. CrossRef
PURPOSE To evaluate the clinical and radiologic results of the Kapandji procedure in AO classification type C distal radius fracture patients over 60 years old. MATERIALS AND METHODS Twenty-one type C distal radius fracture patients over the age of 60 years who were treated with the Kapandji procedure from June 2004 to June 2009 in our hospital and had a post-operative follow-up period of more than 1 year were enrolled. The volar tilt, radial inclination, and radial length were measured for the radiographic analysis using the modified Lidstrom scoring system about post-operative reduction loss in every follow-up radiogram. The clinical result was assessed with a visual analogue scale (VAS) and Korean Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) score at the last follow-up. RESULTS The mean radiologic loss of volar tilt was 1.1degrees and the mean loss of radial length was 2.6 mm and the mean radial inclination loss was 2.7degrees compared with the immediate post-operative period and last follow-up period. The average VAS and DASH scores were 1.4 and 15.9. CONCLUSION The radiologic results of closed reduction and percutaneous pinning using the Kapandji technique for distal radius AO type C fracture patients over 60 years of age was not satisfactory. Nevertheless, the clinical results were satisfactory.
Arm injuries occurring from high energy injuries such as falls or traffic accidents can be accompanied by wrist and elbow injuries. Monteggia fracture, Galeazzi fracture, and Essex-Lopresti fracture-dislocation are known some examples of such injuries. However, there are no reports on the dislocation of the elbow occurring from a distal radius fracture accompanied by scaphoid fracture, and there is nothing published about its prognosis. The authors report on the treatment and outcomes of a case of a 42-year-old male who had a distal radius and scaphoid fracture associated with posteromedial dislocation of the elbow on the same side of his arm along with a literature review.
PURPOSE To evaluate the cause and surgical outcome of extensor pollicis longus rupture after distal radius fractures. MATERIALS AND METHODS Nineteen cases in which the patients underwent surgical treatment for rupture of the extensor pollicis longus after distal radius fractures were followed for more than one year. Among the nineteen cases, fourteen extensor pollicis longus ruptures occurred after conservative treatment, four occurred after closed reduction with K-wire fixation, and one occurred after open reduction and internal fixation with a plate. All cases were treated by extensor indicis proprius transfer. RESULTS Extensor pollicis longus ruptures were caused by K-wire irritation in two, by a protruding screw tip in one, and by a callus in one. In the conservative treatment group, tendon ruptures were diagnosed at an average of 3.1 months (0.7~17). Tendon ruptures were detected in the surgical treatment group at an average of 12.8 months (1~48). All the patients showed favorable recovery of the extension capability of the thumb at the final follow-up. CONCLUSION The main cause of extensor pollicis longus rupture after distal radius fracture was ischemic damage. Therefore, during the surgery, the length and direction of screws and K-wires should be fixed carefully to avoid such damage. Distal radius fracture also requires careful observation of the extensor pollicis longus during follow-up. Furthermore, extensor indicis proprius transfer is considered to be an effective method for extensor pollicis longus rupture.
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Radiologic Analysis of Distal Radius Fracture Accompanying Spontaneous Extensor Pollicis Longus Rupture Jun-Ku Lee, In-Tae Hong, Young-Woo Kwon, Gyu-Chol Jang, Soo-Hong Han Journal of the Korean Fracture Society.2017; 30(2): 63. CrossRef
Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study D Williams, J Singh, N Heidari, M Ahmad, A Noorani, L Di Mascio The Annals of The Royal College of Surgeons of England.2016; 98(2): 138. CrossRef
Rupture of the Extensor Pollicis Longus Tendon at the Proximal Screw of Volar Plate Fixation for Distal Radius Fracture - A Case Report - Dong-Ju Shin, Seung-Oh Nam, Hun-Sik Cho Journal of the Korean Fracture Society.2013; 26(4): 338. CrossRef
There are few reported cases of flexor pollicis longus tendon (FPL) rupture complicating a closed distal radius fracture. We report a case of FPL tendon rupture complicating a closed distal radius fracture. A 24-year-old male presented with a severe right wrist pain. He had a closed distal radius fracture that was treated by closed manual reduction. Three days later, he complained forearm pain and limitation of thumb motion. The physical examination revealed loss of active interphalangeal joint flexion of thumb. He was taken to the operating room. Intraoperatively, the FPL was found to be discontinuous at the level of the radius fracture site. The FPL was repaired by a modified Kessler technique, and the fracture was repaired with a volar plate. Clinicians must be cautious in possibility of tendon injury complicating a closed distal radius fracture and assessing patients with distal radius fracture following closed reduction.
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Acute Rupture of Flexor Tendons as a Complication of Distal Radius Fracture Youn Moo Heo, Sang Bum Kim, Kwang Kyoun Kim, Doo Hyun Kim, Won Keun Park Journal of the Korean Orthopaedic Association.2015; 50(1): 60. CrossRef
PURPOSE To evaluate clinical and radiological results using 3.5 mm & 2.4 mm volar locking compression plate (LCP) in distal radius fractures. MATERIALS AND METHODS This study reviewed the results of 115 cases of distal radius fractures treated with 3.5 mm volar LCP (73 cases) & 2.4 mm volar LCP (42 cases) from September 2003 to June 2009. The radiographic results were evaluated by radiographic assessment, and the clinical results were evaluated by Knirk and Jupiter's criteria, Modified Mayo wrist scoring system and DASH score. RESULTS Radiological evaluation of the radial length, radial inclination, volar tilt and intraarticular step off were improved both 3.5 mm volar LCP and 2.4 mm volar LCP. Nine cases of arthritis occured in 3.5 mm volar LCP and 7 cases in 2.4 mm volar by using the Knirk and Jupiter's criteria. The mean score evaluated by Modified Mayo was 86.7 in 3.5 mm volar LCP and 84.8 in 2.4 mm volar LCP. DASH score was 11.2 point in 3.5 mm volar LCP, 10.9 point in 2.4 mm volar LCP. All cases showed bone union showing no evidence of malunion, nounion, nor metal failure. CONCLUSION Distal radius fractures treated with 3.5 mm volar LCP and 2.4 mm volar LCP show satisfying radiological and clinical outcome.
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Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate Jae-Cheon Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung Journal of the Korean Fracture Society.2015; 28(1): 46. CrossRef
Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis Ki-Chan An, Gyu-Min Kong, Jang-Seok Choi, Hi-Chul Gwak, Joo-Yong Kim, Sung-Yub Jin Journal of the Korean Fracture Society.2013; 26(4): 248. CrossRef
PURPOSE To evaluate outcomes 2.4 mm volar locking compression plate for treatment of unstable distal radius fractures. MATERIALS AND METHODS We retrospectively analyzed the results in 22 cases, which were treated by 2.4 mm volar locking compression plate. We evaluated the clinical results according to the Mayo wrist performance scoring system and radiographic results. RESULTS All cases had bony union. The mean Mayo wrist performance score was 85.23. Between preoperative and immediate postoperative radiographic measurements, the mean radial length was improved from 6.04 mm to 9.68 mm, radial inclination from 15.61degrees to 19.61degrees, volar tilt from -13.73degrees to 7.66degrees and intraarticular step-off from 0.79 mm to 0.33 mm (p<0.05). Between immediate postoperative and latest follow-up radiographic measurements, the mean loss of radial length measured 0.86 mm, radial inclination 0.41degrees, volar tilt 0.54degrees and intraarticular step-off 0.02 mm (p>0.05). Postoperative complication included that flexor pollicis longus and 2nd flexor digitorum profundus were ruptured in 1 case. CONCLUSION Treatment of unstable distal radius fractures using a 2.4 mm volar locking compression plate showed satisfactory outcomes. It is a good option to obtain stable fixation without significant loss of reduction.
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Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly Je Kang Hong, Chang Hyun Shin Journal of the Korean Fracture Society.2015; 28(1): 8. CrossRef