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Distal radius fractures (DRFs) are common injuries that represent 17% of all adult upper extremity fractures. Some fractures deemed appropriate for nonsurgical management following closed reduction and casting exhibit delayed secondary displacement (greater than two weeks from injury) and require late surgical intervention. This can lead to delayed rehabilitation and functional outcomes. This study aimed to determine which demographic and radiographic features can be used to predict delayed fracture displacement. This is a multicentre retrospective case-control study using radiographs extracted from our Analytics Data Integration, Measurement and Reporting (DIMR) database, using diagnostic and therapeutic codes. Skeletally mature patients aged 18 years of age or older with an isolated DRF treated with surgical intervention between two and four weeks from initial injury, with two or more follow-up visits prior to surgical intervention, were included. Exclusion criteria were patients with multiple injuries, surgical treatment with fewer than two clinical assessments prior to surgical treatment, or surgical treatment within two weeks of injury. The proportion of patients with delayed fracture displacement requiring surgical treatment will be reported as a percentage of all identified DRFs within the study period. A multivariable conditional logistic regression analysis was used to assess case-control comparisons, in order to determine the parameters that are mostly likely to predict delayed fracture displacement leading to surgical management. Intra- and inter-rater reliability for each radiographic parameter will also be calculated. A total of 84 age- and sex-matched pairs were identified (n=168) over a 5-year period, with 87% being female and a mean age of 48.9 (SD=14.5) years. Variables assessed in the model included pre-reduction and post-reduction radial height, radial inclination, radial tilt, volar cortical displacement, injury classification, intra-articular step or gap,
Essex-Lopresti injuries are often unrecognized acutely with resulting debilitating adverse effects. Persistent axial forearm instability may affect load transmission at both the elbow and wrist, resulting in significant pain. In the setting of both acute and chronic injuries metallic radial head arthroplasty has been advocated, however there is little information regarding their outcome. The purpose of this study was to assess the efficacy of a radial head arthroplasty to address both acute and chronic Essex-Lopresti type injuries. A retrospective review from 2006 to 2016 identified 11 Essex-Lopresti type injuries at a mean follow-up of 18 months. Five were diagnosed and treated acutely at a mean of 11 days (range, 8 to 19 days) from injury, while 6 were treated in a delayed fashion at a mean of 1.9 years (range, 2.7 months to 6.2 years) from injury with a mean 1.5 (range, 0 to 4) prior procedures. The cohort included 10 males with a mean age was 44.5 years (range, 28 to 71 years). A smooth stem, modular radial head arthroplasty was used in all cases. Outcomes included range of motion and radiographic findings such as
Ulnocarpal impaction (UCI) is a common cause of ulnar-sided wrist pain. UCI typically occurs in wrists with positive
Purpose: The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods: This prospective population-based cohort study included 143 patients above 18 years with acute distal radius fracture treated at one emergency hospital with either closed reduction and cast (55 patients) or with closed reduction and 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 (inquiring about disabilities before fracture) and at 6, 12 and 24 months after the fracture. The 12-month follow-up also included the SF-12 health status questionnaire as well as clinical and radiographic examination. The patients were classified according to the degree of malunion (defined as dorsal tilt >
10 degrees or
Distal radius fractures are among the most common fractures seen in the emergency department. Closed reduction can provide definitive management when acceptable radiographic parameters are met. Repeated attempts of closed reduction are often performed to improve the alignment and avoid operative management. However, multiple reduction attempts may worsen dorsal comminution and lead to eventual loss of reduction, resulting in no demonstrable benefit. We hypothesize that compared to one closed reduction attempt, repeated closed reduction of extra-articular, dorsally angulated, displaced distal radius fractures has a low success rate in the prevention of operative fixation and improvement of radiographic parameters. Initial and post reduction radiographs for all distal radius fractures managed at Vancouver General Hospital between 2015 and 2018 were reviewed. Inclusion criteria were based on the AO fracture classification and included types 23-A2.1, 23-A2.2 and 23-A3. Exclusion criteria included age less than 18, intra-articular involvement with more than two millimeters of displacement, volar or dorsal Barton fractures, fracture-dislocations, open fractures and volar angulation of the distal segment. Distal radius fractures that met study criteria and underwent two or more attempts of closed reduction were matched by age and gender with fractures that underwent one closed reduction. Radiographic parameters including radial height and inclination,
Distal radius fractures are among the most common fractures seen in the emergency department. Closed reduction can provide definitive management when acceptable radiographic parameters are met. Repeated attempts of closed reduction are often performed to improve the alignment and avoid operative management. However, multiple reduction attempts may worsen dorsal comminution and lead to eventual loss of reduction, resulting in no demonstrable benefit. We hypothesize that compared to one closed reduction attempt, repeated closed reduction of extra-articular, dorsally angulated, displaced distal radius fractures has a low success rate in the prevention of operative fixation and improvement of radiographic parameters. Initial and post reduction radiographs for all distal radius fractures managed at Vancouver General Hospital between 2015 and 2018 were reviewed. Inclusion criteria were based on the AO fracture classification and included types 23-A2.1, 23-A2.2 and 23-A3. Exclusion criteria included age less than 18, intra-articular involvement with more than two millimeters of displacement, volar or dorsal Barton fractures, fracture-dislocations, open fractures and volar angulation of the distal segment. Distal radius fractures that met study criteria and underwent two or more attempts of closed reduction were matched by age and gender with fractures that underwent one closed reduction. Radiographic parameters including radial height and inclination,
Ulnar shortening osteotomy (USO) is a procedure performed to alleviate ulnar sided wrist pain caused by ulnar impaction syndrome (UIS) and/or triangular fibrocartilage complex (TFCC) injury. Presently, non-union rates for ulnar shortening osteotomy is quoted to be 0–18% in the literature. However, there is a dearth of literature on the effect of site of osteotomy and plate placement on the rate of complications like a delayed union, symptomatic hardware and need for second surgery for hardware removal. In this study, we performed a multi-centered institutional review of ulnar shortening osteotomies performed, focusing on plate placement (volar vs. dorsal) and osteotomy site (distal vs. proximal) and determining if it plays a role in reducing complications. This study was a multi-centered retrospective chart review. All radiographs and charts for patients that have received USO for UIS or TFCC injury between 2013 and 2017 from hand and wrist fellowship-trained surgeons in Calgary, Alberta and Winnipeg, Manitoba were examined. Basic patient demographics including age, sex, past medical history, and smoking history were recorded. Postoperative complications such as delayed union, non-union, infection, chronic regional pain syndrome, hardware irritation requiring removal were evaluated with a two-year follow-up period. Osteotomy sites were analyzed based on the location in relation to the entire length of the ulna on forearm radiographs. Surgical techniques including volar vs. dorsal plating, oblique vs. transverse osteotomy cuts, and plate type were documented. Continuous variables of interest were summarized as mean or medians with standard deviation or inter-quartile range as appropriate. Differences in baseline characteristics were determined by t-test or one-way ANOVA for continuous variables and chi-square or Fischer exact test for dichotomous variables. All analyses were conducted using SPSS V24.0 (Chicago, IL, USA). All statistical tests were considered significant if p < 0.05. Between 2013–2017 there were 117 ulnar shortening osteotomies performed. The average age of patients was 46.2 ± 16.2, with 62.4% being female. The mean pre-operative
Purpose: We compare the accuracy and precision of patient-specific plastic guides versus computer-assisted navigation for distal radius osteotomy (DRO). We hypothesize that guides would provide similar accuracy and precision compared to computer-assisted surgery, and that they would be faster to use than navigated surgery. Method: We used CT scans, computer models, and planned corrections of radii from seven patients who had previously received computer-assisted DRO. The planned correction included the locations and directions of the screw holes for the fixation plate on the intact deformed radius. Using computer-assisted technique, the surgeon drills the holes for the fixation plate using computer navigation before performing the osteotomy; after cutting the radius, the plate is fixated to the distal radius, and the distal radius is distracted until the holes in the proximal radius align with the holes of the fixation plate. A patient-specific guide can be manufactured that fits on the intact deformed radius to guide the drilling of the screw holes. The guide is designed so that it mates exactly with the dorsal surface of the radius. Each guide was designed using custom software and manufactured in ABS plastic using a 3D printer. The surgeon places the guide on the radius and uses a metal drill sleeve in each guide hole to guide the drilling of the plate screw holes. We manufactured urethane plastic phantoms of the seven deformed radii. Our laboratory experiment had six surgeons each perform four computer-assisted and four patient-specific guide procedures on the phantom radii; the specimen and type of guidance were randomly chosen. The time from the start of the procedure to when the shaping of the distal radius was completed was recorded; we did not record the time required to cut and fixate the radius because this time does not depend on the type of guidance used. The plated phantoms were assessed for errors in
Introduction. The classical Colles fracture (extraarticular, dorsally angulated distal radius fracture) in patients with osteoporotic bone is becoming increasingly more frequent. There still appears to be no clear consensus on the most appropriate surgical management of these injuries. The purpose of this study is to appraise the use of percutaneous extra-focal pinning, in the management of the classical colles fracture. Methods. We retrospectively analysed 72 consecutive cases of Colles fractures treated with interfragmentary K-wire fixation, in female patients over sixty years of age, in two orthopaedic centres, under the care of twelve different orthopaedic surgeons. We correlated the radiographic distal radius measurements (ulnar variance, volar tilt, and radial inclination) at the pre-operative and intra-operative stages with the final radiographic outcome. Result. Mean dorsal angulation was 21° at time of presentation. Closed reduction significantly improved fracture position to a mean of 2.7° volar angulation (p<0.05). Mean angulation at time of k-wire removal was 1.6° dorsal, this was not significant in comparison to post reduction measurements (p< 0.05). Mean
Introduction. Acquired chronic radial head (RH) dislocations present a significant surgical challenge. Co-existing deformity, length discrepancy and RH dysplasia, in multiply operated patients often preclude acute correction. This study reports the clinical and radiological outcomes in children, treated with circular frames for gradual RH reduction. Materials and Methods. Patient cohort from a prospective database was reviewed to identity all circular frames for RH dislocations between 2000–2021. Patient demographics, clinical range and radiographic parameters were recorded. Results. From a cohort of 127 UL frames, 30 chronic RH dislocations (14 anterior, 16 posterior) were identified. Mean age at surgery was 10yrs (5–17). Six pathologies were reported (14 post-traumatic, 11 HME, 2 Nail-Patella, 1 Olliers, OI, Rickets). 70% had a congruent RH reduction at final follow-up. Three cases re-dislocated and 6 had some mild persistent incongruency. Average follow up duration was 4.1yrs (9mnths-11.5yrs). Mean radiographic correction achieved in coronal plane 9. o. , sagittal plane 7. o. and carrying angle 12. o. Mean ulna length gained was 7mm and final
Purpose: Fractures o the distal radius remain a problem difficult to resolve. A post-operative displacement is observed in about half the cases. The displacement is generally a secondary shortening with mis- or unrecognized metaphyseal comminution. In the United State, autologous bone graft is widely used, which, like bone substitutes also used in France, allows appropriate filling of the metaphyseal comminution which always remains open after pin withdrawal. We present a prospective series of 30 patients with a fracture of the distal radius treated by pin or plate fixation in combination with Norian to fill the substance loss subsequent to metaphyseal comminution. Material and methods: Thirty patients were treated between November 1998 and March 1999 for fracture of the distal radius with posterior displacement. The inclusion criterion was comminution >
2 according to the Laulan classification. All were treated by osteosynthesis with plate or pin fixation and insertion of Norian. There were 26 women and 4 men. Twenty-two patients had an articular fracture. Plate fixation was used in ten patients and pin fixation in 19. The fracture involved the dominant side in 21 cases. The fracture was closed in all cases. Norian was injected after osteosynthesis following the recommendations of the manufacturer (impaction of the cavity rims created by the comminution, no motion for 10 min after injection). All patients were reviewed at 1, 3 and 6 months and at last follow-up. The flexion-extension and pronation-supination amplitudes were measured, as was the muscle force. Results: All patients were reviewed with a minimum follow-up of at least 2 years. Mean age was 65 years (545–82). All fractures had consolidated. There were three defective calluses in patients aged over 80 years with osteoporosis; the clinical outcome was better than the radiological image. Three patients developed reflex dystrophy. Mean amplitudes were: flexion 43.6°, extension 52.3°, pronation 63°, supination 70°. The mean wrist force was 52 kpa. No complications related to Norian were observed. Two biopsies were made and showed, in one case at six months, early signs of osteointegration. The product disappeared progressively after 2 years but not in all patients. The immediate postoperative
To assess the efficacy of percutaneous K wiring in the treatment of distal radius fractures. A retrospective audit was performed of patients with distal radius fractures treated with the combination of manipulation under anaesthetic, K wiring and cast application at Auckland Hospital. Patients were identified by using the Orthopaedic Trauma Database. Charts were reviewed for patient demographics, preoperative delay and complications. X-rays were reviewed recording Frykman Grade and radial tilt, radial inclination and
Objective: To compare the functional results with the anatomical results of treatment for fractures of the distal end of radius in patients aged over 60 years. Methods: The results of treatment for fractures of the distal end of radius in 25 elderly patients were evaluated retrospectively. The average age of the patients was 70 years and the average follow-up period was 24 months. Twenty-one fractures were treated by percutaneous pinning, two were treated with plates, and two were treated conservatively. All patients were right-handed. The functional results were evaluated according to the sum of demerit points (Saito, 1983), and the following three parameters were used for evaluation of anatomical results: radial tilt,
The April 2015 Wrist &
Hand Roundup360 looks at: Non-operative hand fracture management; From the sublime to the ridiculous?; A novel approach to carpal tunnel decompression; Osteoporosis and functional scores in the distal radius;
The August 2014 Wrist &
Hand Roundup360 looks at: Trapeziectomy superior to arthrodesis;Tamoxifen beneficial in the short term; Semi-occlusive dressing “the bee’s knees” even with exposed bone; “Open” a relative concept in the hand and wrist; Editorial decisions pushing up standards of reporting;
To evaluate effectiveness and safety of acute ulnar lengthening osteotomy in Madelung's deformity associated with Hereditary Multiple Exostoses (HME). Seventeen ulnas in 13 patients had acute ulnar lengthening for HME associated forearm deformity. Defined radiographic parameters were compared pre- and post-operatively using student's t-test;
Purpose of the study: The purpose of this study was to evaluate and compare the functional and radiographic results of these two surgical techniques using a prospective study. Material and methods: This study involved two consecutive series of 70 patients with a posterior fracture of the distal radius. Mixed multiple pinning (MMP) consisted in the combination of two styloid pins and two infrafocal dorsal pins. The anterior plate was a locked ITS. The patients decided when it was appropriate to wear a brace postoperatively. Functional assessment used the range of motion, the Quick DASH score, and a self-evaluation of the number of days the brace was worn.
Introduction. The distal radius is the most frequently fractured bone in the forearm with an annual fracture incidence in the UK of about 9–37 in 10,000. Restoration of normal anatomy is an important factor that dictates the final functional outcome. A number of operative options are available, including Kirschner wiring, bridging or non-bridging external fixation and open reduction and internal fixation by means of dorsal, radial or volar plates. We designed this study to analyse the clinical and radiological outcome of distal radial fracture fixation using volar plating. Materials/Methods. Thirty-seven patients with distal radius fractures undergoing open reduction and internal fixation using volar plates were included. Tilt of the fractured distal radial fragment was recorded from the initial radiograph and classification of fractures was done using the Orthopaedic Trauma Association system. The QuickDASH questionnaire was used for evaluation of symptomatic and functional outcome six months to one year after surgery. The radiological outcome was assessed using measurements of radial inclination,
The aim of this study was to find out whether distal radius fractures treated by K wire fixation loose reduction after wire removal and analyze the variables may influence this. Patients who underwent K wire fixation for unstable fractures of distal radius over a period of 3 years were included in this retrospective study. Fractures were classified according to AO classification. Radiographs taken just prior to removal of K wires and radiographs taken at least 1 month after wire removal were analyzed to study three radiological parameters; Palmar or dorsal tilt, radial inclination and
