Purpose: The goal was to determine whether locking screws (LS) or smooth locking pegs (SP), optimize fixation of 4-part intraarticular distal radius fractures. The secondary goal was to determine which combinations of LS and SP influence construct stability.

Method: In anatomic radius models, 4-part intraarticular distal radius fractures were fixed using volar locking plates. For the first part, 16 specimens were randomized to receive either 2 LS or 2 SP in each of the 3 pairs of holes in the plate. For the second part, 30 specimens were randomized to receive any 4 combinations of LS and SP in each of the 3 pairs of holes. Axial loading to failure was applied.

Results: Constructs consisting of 4 SP within the lunate fragment were significantly weaker than constructs with 4 LS (mean 626.18 N vs. mean 980.76 N, p=0.01283). Constructs with SP in the ulnar positions of the lunate fragment were weaker than with LS in these positions (mean 736.73 N vs. 977.37 N respectively, p=0.00866). LS in the subchondral position of the lunate fragment were stronger than SP in these positions (mean 1226.99 N vs. 933.64 N, p= 0.00468) and any other combination (mean 1226.99 N vs. 941.97 N, p=0.0027).

Conclusion: The use of LS as opposed to SP for 4-part intraarticular distal radius fractures, particularly subchondral and in ulnar side of the lunate fragment, optimizes construct stability. This may have implications on postoperative rehabilitation protocols and may limit costs related to the use of volar locking plates.

A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups.

During the period of two years, patients who underwent indirect reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised.

The current standard recommendation for antibiotic therapy in the management of chronic osteomyelitis is intravenous treatment for six weeks. We have compared this regime with short-term intravenous therapy followed by oral dosage.

A total of 93 patients, with chronic osteomyelitis, underwent single-stage, aggressive surgical debridement and appropriate soft-tissue coverage. Culture-specific intravenous antibiotics were given for five to seven days, followed by oral therapy for six weeks. During surgery, the scar, including the sinus track, was excised en bloc. We used a high-speed, saline-cooled burr to remove necrotic bone, and osseous laser Doppler flowmetry to ensure that the remaining bone was viable. Infected nonunions (Cierny stage-IV osteomyelitis) were stabilised by internal fixation. In 38 patients management of dead space required antibiotic-impregnated polymethylmethacrylate beads, which were exchanged for an autogenous bone graft at six weeks. Free-tissue transfer often facilitated soft-tissue coverage. These 93 patients were compared with 22 consecutive patients treated previously who had the same surgical management, but received culture-specific intravenous antibiotics for six weeks.

Of the 93 patients, 80 healed without further intervention. Of the 31 Cierny-IV lesions, 27 healed without another operation, and four fractures required additional bone grafts. No more wound drainage was needed. Treatment was successful in 91% of patients, regardless of the organism involved. There was no difference in outcome in terms of these variables when the series were compared. We conclude that the long-term administration of intravenous antibiotics is not necessary to achieve a high rate of clinical resolution of wound drainage for adult patients with chronic osteomyelitis.

We sought to quantify agreement by different assessors of the AO classification for distal fractures of the radius. Thirty radiographs of acute distal radial fractures were evaluated by 36 assessors of varying clinical experience.

Our findings suggest that AO ‘type’ and the presence or absence of articular displacement are measured with high consistency when classification of distal radial fractures is undertaken by experienced observers. Assessors at all experience levels had difficulty agreeing on AO ‘group’ and especially AO ‘subgroup’. To categorise distal radial fractures according to joint displacement and AO type is simple and reproducible.

Our study examined only whether distal radial fractures could be consistently classified according to the AO system. Validation of the classification as a predictor of outcome will require a prospective clinical study.