The study looked at early outcomes of 55 patients who underwent open reduction and internal fixation of distal radius fracture with a single variable angle volar locking plate (Variax, Stryker), by a single surgeon (GS), between May 2007 and December 2008. A retrospective review of notes and radiographs was performed. Twenty-nine women and 26 men were included. The mean age was 52 years. Mean follow up time was 3 months. The dominant wrist was involved in 38 patients. The mechanism of injury was of low energy in 38 patients and of high energy in 17 patients. All patients had comminuted fractures and 52 patients had intraarticular fractures. Seven patients underwent intraoperative carpal tunnel decompression. At latest follow up, active wrist motion averaged 37° extension, 40° flexion, 70° pronation, and 56° supination. Grip strength averaged 64% and pinch grip 77% of the contralateral wrist. Postoperative complications included one flexor pollicis longus rupture, one malunion and three patients with loosening of screws. There was a higher rate of complications seen in patients with high energy injuries. These early results suggest that volar plating with a variable angle plate is an effective treatment option, especially for complex intraarticular distal radius fractures. A medium term outcomes study of a larger number of patients is planned

Background. Distal radius fractures are common injuries but no clear consensus regarding optimal management of unstable fractures exists. Open reduction and internal fixation with volar plates is an increasingly popular but the associated complication rate can be 10%. Intramedullary nails are an alternative offering the potential advantages of reduced risk of tendon injury and intra-articular screw penetration. This article systematically reviews the published literature evaluating the biomechanics, outcomes and complications of intramedullary nails in the management of distal radius fractures. Methods. A systematic review of Medline and EMBASE databases was performed for studies reporting the biomechanics, functional outcome or complications following intramedullary nailing of distal radius fractures. Critical appraisal was performed with respect to validated quality assessment scales. Results. 16 studies were included for review. The biomechanical studies concluded that intramedullary nails had at least comparable strength to locking plates. The clinical studies reported that IM nailing was associated with comparable ROM, functional outcome and grip strength to alternative fixation techniques. However, the mean complication rate was 17.6% (range 0 to 50%) with the most common complication being neurapraxia of the superficial radial nerve in 9.5%. Conclusion. This systematic review of pooled data from published series has shown that IM nailing can give comparable clinical results to current treatment modalities in extra-articular and simple intra-articular distal radius fractures. However the evidence is insufficient to determine whether IM nailing has any clinically important advantage over well-established alternatives. The complication rate reported is higher than that in contemporary studies for volar plating and this raises concerns about the role of this technique particularly when comparative studies have failed to show any major advantage to its use. Further adequately powered RCTs comparing the technique to both volar plates and percutaneous wire fixation are required. Level of evidence. IIa – systematic review of cohort studies. Conflict of Interests. The authors confirm that they have no relevant financial disclosures or conflicts of interest. Ethical approval was not sought as this was a systematic review

Background. Volar locking plates have revolutionised the treatment for distal radius fractures. The DVR (Depuy) plate was one of the earliest locking plates which were used and they provided fixed angle fixation. Recently, newer volar locking plates, such as the Aptus (Medartis), have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. The aim of our study was to compare the outcomes of DVR and Aptus volar locking plates in the treatment of distal radial fractures. Methods. Details of patients who had undergone open reduction and internal fixation of distal radii from October 2007 to September 2010 were retrieved from theatre records. 60 patients who had undergone stabilisation of distal radius fractures with either DVR (n=30) or Aptus (n=30) plate were included in the study. Results. Mean age of patients undergoing fixation using DVR plate was 56.6 years (n=30) with 22 females and 8 males. Fractures in this group included 20 type 23-C, three type 23-B and seven type 23-A. The patients were followed up for an average of 5.5 months (2-16 months). 3 patients underwent revision of fixation due to malunion (n=1), non-union (n=1) and failure of fixation (n=1). Four patients had reduced movements even after intensive physiotherapy necessitating removal of plate. Mean age of patients undergoing Aptus volar locking plate fixation was 56.38 years (n=30) with 21 females and 9 males. There were 27 type 23-C, two type 23-B and one type 23-A fractures according to AO classification. The patients were followed up for an average of 4.1 months (2-11 months). 2 patients developed complex regional pain syndrome (CRPS) and 1 patient underwent removal of screws due to late penetration of screws into the joint. Conclusion. Complex and unstable fractures of the distal radius can be optimally managed with volar locking plates. Both systems are user friendly. Aptus plates provide an additional advantage of flexibility in implant positioning and enhanced intra-fragmentary fixation compared to the DVR plate. In our study Aptus plates had lower secondary surgical procedures compared to DVR plates

Distal radial fractures are amongst the most common trauma referrals, however controversy remains regarding their optimum management. We undertook a retrospective review of the management of distal radial fractures in our department. The prospectively maintained trauma database was used to identify patients admitted for operative management of a dorsally displaced distal radial fracture between June 2008 and June 2009. Only extra-articular or simple intra-articular fractures were included (AO classification A2/A3/C1/C2). Operation notes were reviewed to determine the method of fixation. Patients were contacted by post and asked to complete a functional outcome score - Disabilities of the Arm, Shoulder and Hand (DASH). A further 12 patients with similar fractures who had been managed conservatively were also asked to complete a DASH score to provide a comparison between operative and non-operative management. 98 patients were identified - 67 female, 31 male. Mean age was 51 years, range 15-85 years. All patients were at least 1 year post-op. 26 patients had manipulation under anaesthesia (MUA). 48 patients had MUA and K-wire fixation, which was supplemented with synthetic bone substitute in 16 cases. 3 patients had MUA and bone graft and 21 patients had open reduction and internal fixation (ORIF) with a volar plate. 34 correctly completed DASH scores were returned. A lower score equates to a better functional outcome. Mean DASH scores were: MUA 14.8; MUA+K-wire 13.1; ORIF 13.6; conservative 47.1. This data would indicate that patients with a significantly displaced distal radial fracture have a better functional outcome with operative management to improve the fracture alignment. However, all of the methods of fixation used resulted in similar functional outcomes at one year

Purpose. The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results to prior publications for both external fixation and internal fixation with volar locked plates. Methods. Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (MAT and MAI) from 5/30/2013 to 12/29/2015 were identified and included in the study. Retrospective chart and radiograph review was performed on nineteen patients, eleven male and eight female, with mean age of 47.83 years (22–82). No patients were excluded from the study. Results. All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49–129). Follow up radiographs showed average radial inclination of 20.5° (13.2°–25.5°), radial height of 10.7mm (7.5mm–14mm), ulnar variance of −0.3mm (−2.1mm–3.1mm), and volar tilt of 7.9° (−3°–15°). One patient had intra-articular step off >2mm. Conclusion. Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt. Type of Study/Level of Evidence. Therapeutic Retrospective Level IV

The management of displaced forearm diaphyseal fractures in adults is predominantly operative. Anatomical reduction is necessary to infer optimal motion and strength. The authors have observed an intraoperative technique where passive pronosupination is examined to assess quality of reduction as a surrogate marker for active movement. We aimed to assess the value of this technique, but intentionally malreducing a simulated diaphyseal fracture of a radius in a cadaveric model, and measuring the effect on pronosupination. A single cadaveric arm was prepared and pronation/supination was examined according to American Academy of Orthopaedic Surgeons guidance. A Henry approach was then performed and a transverse osteotomy achieved in the radial diaphysis. A volar locking plate was used to hold the radius in progressive amounts of translation and rotation, with pronosupaintion measured with a goniometer. The radius could be grossly malreduced with no effect on pronation and supination until the extremes of deformity. The forearm showed more tolerance with rotational malreduction than translation. Passive pronation was more sensitive for malreduction than supination. The use of passive pronosupination to assess quality of reduction is misleading