Department of Orthopaedics,, Sir HN Reliance Hospital, Girgaon, Mumbai
|
|
- Herbert Hood
- 5 years ago
- Views:
Transcription
1 Orthopaedics Original Article International Journal of Clinical And Diagnostic Research ISSN Volume 5, Issue 6, Nov-Dec 2017 CONSERVATIVE VERSUS VOLAR PLATING FOR TREATMENT OF DISTAL END RADIUS FRACTURES- A PROSPECTIVE RANDOMIZED STUDY Vikas Jain 1*, Atul Patil 2, Siddharth Shah 3, Gaurav Sharma 4, Lokesh Naik 5 Abstract Introduction: Fractures of distal end radius continues to leave orthopaedic surgeons with dilemma with no proper consensus. The aim of the present study was to compare the radiological and functional outcome of these fractures using the conservative and operative modality (volar plating). Material and methods: A Prospective randomised study was conducted between May 2014 and May 2015 comprising of 60 patients. Group A (n=30) were treated with casting and Group B (n=30) were operated with volar plating. Results: As per Frykman s classification system, type 3 was the most common with 29 (48.3%) cases followed by type 1 with 18 (30%) cases. The average duration of surgery was 94±5.8 mins in patients with group B. The average radiological union was 9 ±2.3 weeks in group A and 8±3.6 weeks in group B patients. Parameters like range of movements, grip strength, radial inclination, volar tilt were better in operative group which were statistically significant (P<0.0001). Conclusion: Although it was a small study, yet it can be stated that plating gives a better functional and radiological outcome as compared to casting with fewer complication rates, early mobility and better anatomical reduction. Author Affiliations: 1, 4, 5 Department of Orthopaedics,, Sir HN Reliance Hospital, Girgaon, Mumbai 2 Department of Orthopaedics, Sushrusha Hospital, Mumbai, 3 Department of Orthopaedics, Nawale Hospital, Pune Keywords: Distal radius, Cast, Volar plating
2 *Corresponding Author: Dr Vikas Jain Department of Orthopaedics Sir HN Reliance Hospital, Girgaon, Mumbai. Mobile: INTRODUCTION Distal end of radius fractures are the commonest fractures occurring in upper extremity that account for 17% of all upper limb injuries [1]. The treatments of these fractures have been an issue of debate ever since its first encounter. Different modalities have been propped for the same namely closed reduction and cast application, Closed reduction with K wires, External fixation, Internal fixation with plating and also nailing. Conservative methods has always been the mainstay for treating these injuries since past many decades. However, complications like malreduction, collapse at the fracture site and stiffness has led to the development of new operative techniques [2.3].The decision for a specific modality is usually multifactorial depending upon patient s age, occupation, likelihood to return to work, fracture characteristics such as displacement, intraarticular extension, fracture communition and condition of the soft tissues [1,4-6]. These fractures are a result of high-velocity injuries in young adults whereas a trivial trauma can lead to these injuries in geriatric age group. With the lack of consensus for treating these injuries we decided to compare the functional and radiological outcome in fractures of distal end radius in geriatric age group. Material and Methods: A Prospective randomised study was conducted at a tertiary care hospital between May 2014 and May 2015 comprising of 60 patients presenting to the orthopaedic outpatient departments with distal end radius fractures. The inclusion criteria were patients with more than 60 years of age with closed intra and extra-articular distal end radius fractures, patients with low demanding profile. Patients with compound fractures, pathological fractures, polytrauma patients were excluded from the study. Once the patients met the inclusion criteria, a thorough clinical, radiological and haematological investigation was done for (Fig. 1). Frykman s
3 classification [7] was used to assess the fracture geometry and type. Primary treatment was given in the form of below elbow plaster slab. The selection of the treatment group was done on the basis of randomization using the closed envelope technique. The patient were asked to open the closed sealed opaque envelope just prior to the surgery following which, the final decision was taken. At the end of the study, there were 31 patients which were treated using the plaster technique (Group A), whereas 30 patients were operated using the variable angle volar plating of Zimmer (USA) (Group B). Well written informed consent was taken from all the patients. Ethical committee approval was obtained before the commencement of the study. Regular follow-up was done for ll the patients at 1,3,6,12 and 24 months respectively. Final outcome was calculated using the Lidstrom criteria [8] as excellent, good, fair and poor using the degree disability, deformity, grip strength, range of movements, activities of daily living and pain. Surgical Technique- Closed Reduction and Cast application- All the patients were operated under General anaesthesia. In supine position, first, the fragments were disimpacted using the traction-countertraction technique. Manual pressure was then applied to correct the dorsal tilt and displacement. The hand was then kept in ulnar deviation with the corrected volar tilt. Final reduction was then assessed in C-arm image intensifier in both the orthogonal planes. A below elbow plaster cast was then given with forearm in neutral position and hand in ulnar deviation (Fig. 2). The affected limb was kept in a sling for 1 week after which it was discarded. The cast was kept for a period of 6 weeks in total. A check x-ray was done just after the surgery top check for the displacement and then at 1 month and at the time of cast removal to assess the union. Open reduction and internal fixation with Volar plating- All the patients were operated using general anaesthesia and interscalene block. Three doses of intravenous third generation cephalosporin was administered (one just before the induction and two doses postoperatively at an interval of 12 hours). All the patients were operated under tourniquet coverage at a pressure of 250mm of Hg. A Trans-Flexor carpi radialis (FCR) volar approach [9] was used in all the cases. A vertical skin incision of 7-8cm was taken in all the cases starting from the distal palmar crease along the line of the FCR tendon. The tendon
4 sheath was incised and the FCR was mobilized ulnarly. The tendons of Flexor pollicis longus, flexor digitorum superficialis and the profundus tendons were retracted and mobilized towards the ulna. The pronatus quadratus was subperiosteally exposed in deep dissection and released carefully along the radial side. A cuff of the tendon was left to facilitate the later closure. Brachioradialis tendon was released only in case of difficult reduction. The fracture site was then exposed and temporary reduction was then attempted. A 3 or 4 hole plate was then applied in the buttress mode just proximal to the watershed line. Adequate reduction was obtained and checked in C-arm image intensifier in both the orthogonal planes (Fig. 3). Wound was then closed over layers and compression dressing was done. Similar standard pain control protocols was followed in all the patients. Mobilization in the form of finger and wrist movements were started after the check dressing on post-operative day 2. Patient was asked to use a sling post-operatively for a period of 1 week following which it was discarded. Suture removal was done after 2 weeks. Patients were asked to resume duties within 1 week of surgery and strenuous work was permitted after the radiological union was seen between 3-5 months. Results: The mean age of the patients was 63±3.4 years. There were 32 (53.33%) males and 28 (46.67%) females in the present study. 36 (60%) patients had left sided involvement while 24 (40%) patients had fracture on their right side. The commonest mechanism of injury was domestic fall comprising of 47 (78.3%) cases followed by road traffic accident and fall from height with 12 (20%) and 1 (1.67%) case respectively. As per the Frykman s classification system, type 3 was the most common comprising of 29 (48.3%) cases which was then followed by type 1 with 18 (30%) cases. The average duration of surgery was 94±5.8mins in patients with group B. The average radiological union was 9 ±2.3 weeks in group A and 8±3.6 weeks in group B patients. The mean range of movements and grip strength were as shown in Table 1. The comparison of radiological parameters amongst both the groups were as shown in Table 2. There was 6 (20%) case with loss of reduction in group A which later went in malunion. Two (6.66%) cases in group A and 1 (3.33%) case in group B had post-operative Sudeck s osteodystrophy which were treated conservatively. Two (6.66%) cases in group B had superficial infection
5 which responded well to oral antibiotics. Three (10%) cases in group A and 1 (3.33%) case in group B had carpal tunnel syndrome. One (3.33%) case from group A had preoperative median nerve symptoms while the others were treated conservatively. One (3.33%) case from group B underwent carpal tunnel surgery following which he was completely asymptomatic. (Table 3). The final outcome was calculated using the Lidstrom s criteria (Table 4). Table 1: Comparison of wrist range of movements and grip strength at 24 months followup Parameter Group A n=30 Group B n=30 P Value Palmar Flexion 79.53± ±2.98 < * Dorsal Flexion 83.04± ±2.42 < * Radial Deviation 65.87± ±3.74 < * Ulnar deviation 69.32± ±3.01 < * Pronation 33.01± ± Supination 42.01± ± Grip strength 74.14± ±6.34 < * *- statistically significant Table 2: Comparison of Radiological Parameters at 24 months Parameter Group A n=30 Group B n=30 P value Radial inclination 15.21± ±0.58 < * Volar tilt 5.14± ±1.23 < * Variance 0.31± ±0.24 < Radial length 7.14± ±0.35 < * *- statistically significant
6 Table 3: Complications Parameter Group A n=30 (%) Group B n=30 (%) Superficial infection 0 2 (6.66) Sudeck s osteodystrophy 2 (6.66) 1 (3.33) Carpal tunnel syndrome 3 (10) 1 (3.33) Malunion 6 (20) 0 Table 4: Final Outcome as per Lidstrom s criteria Grade Conservative Management Operative Management Satisfactory Excellent I 2 13 Good II Unsatisfactory Fair III 12 3 Poor IV 2 0
7 Fig 1: Pre-operative radiograph Discussion: Fig 2: After Cast application and Reduction Fig 3: Post-operative after Volar Plating Distal end radius fractures are the commonest fractures of upper limb with debatable treatment modalities. Whereas, the dictum followed among the orthopods is to undergo operative intervention in younger age groups, conservative treatment is usually reserved for the geriatric population. Various studies have stressed upon the linear co-relation of anatomical restoration with better functional outcome [10-12]. Once anatomical restoration has been achieved, methods like casting, external fixation, internal fixation should be used to maintain the same. Closed reduction and casting can help to achieve a three-point fixation required for proper union. Albeit, cast application alleviates the necessity for a surgical intervention, this method has limited rotational control and maintenance of length that is required for anatomical union to
8 Orthopaedics Original Article International Journal of Clinical And Diagnostic Research ISSN Volume 5, Issue 6, Nov-Dec 2017 occur [13]. There were 31 patients in Group A in the present study, off which there were 30 cases available till the last follow-up. One patient died at 3 months follow-up and thus was excluded from the study. Young et al [13] studied the functional and radiological outcomes in patients above 60 years of age treated with cast application. 22% of the patients had excellent outcome with only 3 patients with fair or poor results. Only 2 patients in their study had radiological signs of arthrosis which led to an unsatisfactory outcome. In the present study, there were 6 (20%) case in which there was loss of reduction after cast application. There were 80% cases with excellent and good results in the present study as per the Lidstrom s criteria. Zyluk et al 14 in their study stated that conservative treatment should be reserved only for undisplaced or minimally displaced fractures. We had similar findings as the rate of complications were more with the patients treated conservatively. In contrast, other studies have stated conservative treatment to be the safest options in most of the cases [15,16]. Operative modality has the benefit of better anatomical reduction, early mobilization and stable internal fixation with good functional stability leading to a better radiological and functional outcome [1]. Treatment of unstable distal end radius fractures with volar locking plates without additional bone graft can give good results [1,16-18]. However, many are of the opinion that the surgical modality is associated with higher morbidity and mortality especially amongst the geriatric age group with approximately 2% of the population with sustained complications within first 30 days of surgery [19,20]. Contradictory to this notion, the present study had better outcomes in patients who underwent volar plating in terms of range of movements, grip strength, radiological parameters which were statistically significant. Our findings were in consistent with that of Lutz et al [19], who prospectively studied 256 patients with distal end radius fractures from several databases and concluded that patients who underwent surgery had better functional and radiological outcome and better DASH scores. A recent meta-analysis [1] extensively compared 7 randomised control trials with 523 patients of distal end radius treated by conservative and operative modalities. They concluded that although, the patients treated with surgery had better radiological outcome, there were no statistically significant noted in terms of functional results and complication rates. Low sample size and less duration of follow-up were the limitations of the present study.
9 CONCLUSION The treatment for distal end radius fractures remains a challenge for every orthopaedic surgeon due to lack of consensus. However, it was our experience that the operative modality with volar locking plate had better radiological as well as functional outcome in elderly patients which are still inadequately treated. Conflict of Interest Statement- There is no conflict of interest. Informed consent was taken from the patient. REFERENCES: 1. Song J, Yu AX, Li ZH. Comparison of conservative and operative treatment of distal end radius fracture: a metaanalysis of randomized control trials. It J Clin Exp Med 2015;8(10): Ilyas AM, Jupiter JB. Distal radius fractures--classification of treatment and indications for surgery. Orthop Clin North Am. 2007;38(2): Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: current concepts. J Hand Surg Am. 2012; 37(8): Büyükkurt CD, Bülbül M, Ayanoğlu S, et al. The effects of osteoporosis on functional outcome in patients with distal radius fracture treated with plate osteosynthesis. Acta Orthop Traumatol Turc 2012;46: Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in lowdemand patients older than 60 years. J Hand Surg Am 2000;25: Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg [Am] 2006;88-A: Frykman G. Fracture of the distal radius including sequelae shoulderhand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand. 1967;Suppl 108:3. 8. Lidstorm A. Fractures of the distal end of the radius. A clinical and statistical study of end results. Acta Orthop Scand Suppl. 1959;41: Jupiter JB, Fernandez DL, Toh CL, et al. Operative treatment of volar intraarticular fractures of the distal end of the radius. J Bone Joint Surg [Am] 1996;78:
10 10. Haus BM, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults: reexamined as evidencebased and outcomes medicine [J]. J Bone Joint Surg Am 2009;91(12): Paksima N, Panchal A, Ponser MA, Green SM, Mehlman CT, Hiebert R. A Meta-analysis of the literature on distal radius fractures: review of 615 articles. Bull Hosp Jt Dis 2004;62(1-2): Vargaonkar G. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice. Chin J Traumatol. 2014;17(4): Fu YC, Chien SH, Huang PJ, et al. Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients. J Trauma 2006;60(2): Zyluk A, Puchalski P, Walazek I, Janowski P. A reasonable algorithm for treatment of distal radius fractures. Chir Narzadow. Ruchu Orthop Pol 2010;75(1): Trevisan C, Klumpp R, Nava V, Riccardi D, Recalcati W. Surgical versus conservative treatment of distal end radius fractures in elderly. Aging Clin Exp Res. 2013;25(1):S Ayong S, Traore A, Postlethwaite D, Barbier O. Functional evaluation of unstable distal radius fractures treated with an angle-stable volar T-plate. Acta Orthop Belg 2014;80(2): Sharma H, Khare GN, Singh S, Ramaswamy AG, Kumaraswamy V, Singh AK. Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment. J Orthop Sci 2014; 19: Marcheix PS, Dotzis A, Benkö PE, Siegler J, Arnaud JP, Charissoux JL. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixedangle plate. J Hand Surg Eur Vol 2010; 35: Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2014;39: Jiang JJ, Phillips CS, Levitz SP, Benson LS. Risk factors for
11 complications following open reduction internal fixation of distal radius fractures. J Hand Surg Am 2014;39:
COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF EXTERNAL AND INTERNAL FIXATION IN TREATMENT OF COMMINUTED DISTAL RADIUS FRACTURES
COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF EXTERNAL AND INTERNAL FIXATION IN TREATMENT OF COMMINUTED DISTAL RADIUS FRACTURES R. Sahaya Jose 1 1Assistant Professor, Department of Orthopaedics, Sree Mookambika
More informationORIGINAL ARTICLE TREATMENT DISTAL RADIUS FRACTURE WITH VOLAR BUTTRESS TECHNIQUE- A CLINICAL STUDY
TREATMENT DISTAL RADIUS FRACTURE WITH VOLAR BUTTRESS TECHNIQUE- A CLINICAL STUDY Neelanagowda V P Patil 1, Lingaraj 2, P S Kaladagi 3, Paramanda Hospeti 4, Nizamuddin 5. 1. Assistant professor, Department
More informationManagement of intra-articular fractures of distal end radius in adults
International Journal of Research in Orthopaedics Gawali SR et al. Int J Res Orthop. 2016 Dec;2(4):220-228 http://www.ijoro.org Original Research Article DOI: http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20163148
More informationJMSCR Vol 05 Issue 06 Page June 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i6.32 Functional & Radiological Outcome of the
More informationMINIMALLY INVASIVE PLATE OSTEOSYNTHESIS FOR DISTAL RADIUS FRACTURES: SURGICAL TECHNIQUE M. TOBE 1, K. MIZUTANI 1, Y. TSUBUKU 1, Y.
Riv Chir Mano - Vol. 43 (3) 2006 MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS FOR DISTAL RADIUS FRACTURES: SURGICAL TECHNIQUE M. TOBE 1, K. MIZUTANI 1, Y. TSUBUKU 1, Y. YANAGIHARA 2 1 Department of 2nd Orthopaedic
More informationEvaluation of volar locking plate fixation for management of intraarticular fractures of distal end of radius
International Journal of Research in Orthopaedics Pathak RS et al. Int J Res Orthop. 2018 Mar;4(2):193-197 http://www.ijoro.org Original Research Article DOI: http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20180400
More informationFactors Predicting Late Collapse of Distal Radius Fractures
http://dx.doi.org/10.5704/moj.1111.006 Factors Predicting Late Collapse of Distal Radius Fractures, MD Regional Hospital Durres, Orthopaedic Clinic, Durres, Albania ABSTRACT Background: Although fractures
More informationORIGINAL ARTICLE. possible. Accurate assessment of standard radiographs is essential for appropriate 3. management. And includes true posterior- 4
ORIGINAL ARTICLE Treatment of Colle's Fracture with Wrist Immobilization in Palmar flexed & Dorsiflexed Position Sohail Iqbal Shaikh, Abdul Basit, Javed Iqbal, Saba Sohail Shaikh, Imran Sohail Shaikh 26
More informationUniversity of Groningen. Fracture of the distal radius Oskam, Jacob
University of Groningen Fracture of the distal radius Oskam, Jacob IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationStudy of Evaluation of Lateral Surgical Approach for Diaphyseal Fractures of Distal 2/3rd of Radius at a Tertiary Care Teaching Centre
Original article : Study of Evaluation of Lateral Surgical Approach for Diaphyseal Fractures of Distal 2/3rd of Radius at a Tertiary Care Teaching Centre Chandra Prakash Singh Associate Professor, Department
More informationPrimary internal fixation of fractures of both bones forearm by intramedullary nailing
Original article 21 Primary internal fixation of fractures of both bones forearm by intramedullary nailing Nepal Medical College and Teaching Hospital, Kathmandu, Nepal Correspondenc to: Dr R P Singh,
More informationJMSCR Vol 05 Issue 04 Page April 2017
www.jmscr.igmpublication.org Impact Factor 5. Index Copernicus Value: 3.7 ISSN (e)-37-17x ISSN (p) 55-5 DOI: https://dx.doi.org/1.1535/jmscr/v5i.1 Functional Outcome after Surgical Stabilization of Fractures
More informationIndex. Note: Page numbers of article titles are in boldface type. Hand Clin 21 (2005)
Hand Clin 21 (2005) 501 505 Index Note: Page numbers of article titles are in boldface type. A Antibiotics, following distal radius fracture treatment, 295, 296 Arthritis, following malunion of distal
More informationDisclosures. Distal Radius Fractures 5/16/2017. Distal Radius Fractures: Complications & Limitations of the Volar Approach
Distal Radius Fractures: Complications & Limitations of the Volar Approach Frank R. Avilucea, MD Assistant Professor Department of Orthopaedic Surgery University of Cincinnati Medical Center Disclosures
More informationTechnique Guide. 2.4 mm Variable Angle LCP Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology.
Technique Guide 2.4 mm Variable Angle LCP Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology. Table of Contents Introduction 2.4 mm Variable Angle LCP
More informationComparison between Distractor Application on Both Radial & Ulnar Side and Radial Side Only for Fracture Distal Radius with Ulnar Styloid Fracture
Open Journal of Orthopedics, 2013, 3, 227-233 http://dx.doi.org/10.4236/ojo.2013.35043 Published Online September 2013 (http://www.scirp.org/journal/ojo) 227 Comparison between Distractor Application on
More informationMark VanDer Kaag 1, Ajmal Ikram 2. Hand Unit, Tygerberg Hospital University of Stellenbosch
A Prospective, Randomized Controlled Study To Determine The Radiological And Functional Outcomes Of IMN Fixation Of Distal Radius Fractures Using A Novel Device The Sonoma Wrx Distal Radius Nail Compared
More informationReview Article Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials
Int J Clin Exp Med 2015;8(10):17023-17035 www.ijcem.com /ISSN:1940-5901/IJCEM0009046 Review Article Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized
More informationDistal radius fracture Golden standard and breaking news
Distal radius fracture Golden standard and breaking news Copenhagen 2018 Yngvar Krukhaug MD,PhD Senior Consultant Orthopaedic Surgeon Associated Professor Orthopaedic Clinic Trauma Section Haukeland University
More informationQUICK REFERENCE GUIDE. The Pennig Dynamic Wrist Fixator. Part A: Trans-articular application
10 The Pennig Dynamic Wrist Fixator Part A: Trans-articular application B1 B2 B3 III IV TRANS-ARTICULAR APPLICATION The fractures that can be treated with this technique include AO type B and C fractures,
More informationFractures and dislocations around elbow in adult
Lec: 3 Fractures and dislocations around elbow in adult These include fractures of distal humerus, fracture of the capitulum, fracture of the radial head, fracture of the olecranon & dislocation of the
More informationAdditional Ulno-Radial Pinning for Prevention of Metaphyseal Collapse in Distal Radius Fracture: A Comparative Study
American Journal of Public Health Research, 2015, Vol. 3, No. 5A, 6-10 Available online at http://pubs.sciepub.com/ajphr/3/5a/3 Science and Education Publishing DOI:10.12691/ajphr-3-5A-3 Additional Ulno-Radial
More informationFractures of distal end of Radius: A study on fracture reduction and stable fixation
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 6 Ver. X (June. 2017), PP 27-31 www.iosrjournals.org Fractures of distal end of Radius: A study
More informationISSN (Online) ISSN (Print) Hospital, 7, Works Road, Chromepet, Chennai , Tamilnadu, India.
Scholars Academic Journal of Biosciences (SAJB) Sch. Acad. J. Biosci., 2016; 4(3B):237-243 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationCommon Limb Fractures. Mr Sheraz Malik MB BS MRCS Instructor Mr Paul Ofori-Atta Mb ChB FRCS President Motc Life UK April 2009
Common Limb Fractures Mr Sheraz Malik MB BS MRCS Instructor Mr Paul Ofori-Atta Mb ChB FRCS President Motc Life UK April 2009 Objectives To be able to describe all characteristics of a fracture Describe
More informationAcute Rupture of Flexor Tendons as a Complication of Distal Radius Fracture
60 pissn : 1226-2102, eissn : 2005-8918 Case Report J Korean Orthop Assoc 2015;50: 60-65 http://dx.doi.org/10.4055/jkoa.2015.50.1.60 www.jkoa.org Acute Rupture of Flexor Tendons as a Complication of Distal
More informationUniversity of Groningen. Fracture of the distal radius Oskam, Jacob
University of Groningen Fracture of the distal radius Oskam, Jacob IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationThe value of manipulation of displaced distal radius fractures in the emergency department
Acta Orthop. Belg., 2016, 82, 203-209 ORIGINAL STUDY The value of manipulation of displaced distal radius fractures in the emergency department Robert W. Jordan, Rahil Naeem, Saqiba Jadoon, Kuntrapaka
More informationResults of lateral pin fixation for the displaced supracondylar fracture of humerus in children
Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-1,13-17 Original Article Results of lateral pin fixation for the displaced supracondylar fracture of humerus in children H.K. Gupta 1, K.D.
More informationDisclosure. 85% Dorsal. 15% Volar. Distal Radius Fractures- Volar Plating for All. Skeletal Dynamics- Consultant
Distal Radius Fractures- Volar Plating for All Frontiers in Upper Extremity Surgery 2017 Francisco Rubio, M.D. Miami Hand and Upper Extremity Institute Miami, FL Disclosure Skeletal Dynamics- Consultant
More informationUZZAMAN KS 1, AWAL KA 2, ALAM MK 3
CLOSED REDUCTION AND PERCUTANEOUS KIRSCHNER WIRE FIXATION COMBINED WITH PLASTER CAST VERSUS CONVENTIONAL PLASTER CAST IMMOBILIZATION IN THE TREATMENT OF COLLES FRACTURE A PROSPECTIVE RANDOMIZED COMPARATIVE
More information6/5/2018. DISCLOSURES Hassan R. Mir, MD, MBA, FACS. Evolution of Distal Radius Fracture Treatment [Chung Hand Clinics 2012]
DISCLOSURES Hassan R. Mir, MD, MBA, FACS Paid Consultant for a Company or Supplier Smith & Nephew Zimmer Biomet Trice Medical Stock or Stock Options Core Orthopaedics OrthoGrid Systems Research Support
More informationEmile N. Brown, MD, and Scott D. Lifchez, MD
Flexor Pollicis Longus Tendon Rupture After Volar Plating of a Distal Radius Fracture: Pronator Quadratus Plate Coverage May Not Adequately Protect Tendons Emile N. Brown, MD, and Scott D. Lifchez, MD
More informationNon-comminuted extra-articular fractures of distal radius treated with Percutaneous pinning
Original article: Non-comminuted extra-articular fractures of distal radius treated with Percutaneous pinning Manikandan K, Khisankumar PN, Arunprasath.C Department of orthopedics, Kalitheerthalkuppam,
More informationComplications of Distal Radius Fractures. How to Treat a Distal Radius Fx 11/13/2017. Michael S. Bednar, M.D. Loyola University Chicago
Complications of Distal Radius Fractures Michael S. Bednar, M.D. Loyola University Chicago How to Treat a Distal Radius Fx Need to restore motion, begin with uninvolved parts Need to reduce an unreduced
More informationTreatment of unstable distal radius fractures with the volar locking plate
Upsala Journal of Medical Sciences. 2011; 116: 280 284 ORIGINAL ARTICLE Treatment of unstable distal radius fractures with the volar locking plate HANAE MINEGISHI 1, OSAMU DOHI 1, SOUKAN AN 2 & HIDETSUGU
More informationWINSTA-R. Distal Radius System
Distal Radius System Table of Contents Introduction WINSTA-R System 2 Indication 2 Surgical Technique Palmar Access for Radius Plate 3 Dorsal Access for Radius Plate 3 Positioning of the Radius Plate
More informationTreatment Approach To Cases Of Nonunion Intercondylar Fracture Humerus
The Journal of Maharashtra Orthopaedic Association June - 2006 Treatment Approach To Cases Of Nonunion Intercondylar Fracture Humerus Dr. Vikas Agashe Dr. Vivek Shetty Dr. Anurag Awasthy P. D. Hinduja
More informationAngle Stable Distal Radial Plate System WINSTA-R
Angle Stable Distal Radial Plate System WINSTA-R Priv.-Doz.Dr.med. Martin Walz Dr. med. Felix Menzinger Prof.Dr.med. Jürgen Rudigier www.marquardt-medizintechnik.de General The problem posed by metaphyseal
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 18 Orthopedic Trauma Key Points 2 18.1 Upper Extremity Injuries Clavicle Fractures Diagnose fractures from the history and by physical examination Treat with a
More informationSurgical Management of Distal end Radius Fractures by Various Methods: A Prospective Study
Original Article 1, 3 Assoc. Professor 2 Professor & HOD 4, 5 PG Students Department of Orthopedics MGM Hospital Kakatiya Medical College Warangal. Telangana State India. CORRESPONDENCE : Dr.Jhatosh.Venkateshwarlu,
More informationCASE REPORT. Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report
Nagoya J. Med. Sci. 79. 551 ~ 557, 2017 doi:10.18999/nagjms.79.4.551 CASE REPORT Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report Takaaki Shinohara 1
More information2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology.
Technique Guide 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology. Table of Contents Introduction 2.4
More informationA prospective study of surgical management of distal radius fracture in adult with plate fixation
2017; 3(3): 236-240 ISSN: 2395-1958 IJOS 2017; 3(3): 236-240 2017 IJOS www.orthopaper.com Received: 14-05-2017 Accepted: 15-06-2017 Dr. Jagadeesh Babu Somesula MS (Orthopaedics), Assistant RVM Institute
More informationOUTCOME OF MANAGEMENT OF CLOSED PROXIMAL TIBIA FRACTURES IN TERTIARY HOSPITAL OF SURAT Karan Mehta 1, Prashanth G 2, Shiblee Siddiqui 3
OUTCOME OF MANAGEMENT OF CLOSED PROXIMAL TIBIA FRACTURES IN TERTIARY HOSPITAL OF SURAT Karan Mehta 1, Prashanth G 2, Shiblee Siddiqui 3 HOW TO CITE THIS ARTICLE: Karan Mehta, Prashanth G. Shiblee Siddiqui,
More informationDistal radius fractures raises considerable interest and
Original Article Two peg spade plate for distal radius fractures A novel technique Sharad M Hardikar, Sreenivas Prakash, Madan S Hardikar, Rohit Kumar Abstract Background: The management of distal radius
More informationIS CASTING AN ACCEPTABLE TREATMENT APPROACH FOR A DISTAL RADIUS FRACTURE THAT HAS UNDERGONE A SATISFACTORY CLOSED REDUCTION?
Original Article FOR A DISTAL RADIUS FRACTURE THAT HAS UNDERGONE A SATISFACTORY CLOSED REDUCTION? Khalid Masood *, Muhammad Jamil **, Farooq Ibrahim Pasha*, Khalid Zulfiqar Quresshi **, Naveed Ishaq Malik
More informationA STUDY OF THE FUNCTIONAL OUTCOME OF LOW PROFILE DORSAL PLATING IN DISTAL END RADIUS FRACTURES
Original Article Orthopaedics A STUDY OF THE FUNCTIONAL OUTCOME OF LOW PROFILE DORSAL PLATING IN DISTAL END RADIUS FRACTURES Sunil H. Shetty 1, Amit B. Dhond 2, Manavdeep Singh 3, Atul Kharat 4, Abhimanyu
More informationjournal ORIGINAL RESEARCH
texas orthopaedic journal ORIGINAL RESEARCH Assessment of Volar Tilt Measurements with Variations in X-Ray Beam Centralization Along the Longitudinal Axis of the Radius Russell A. Wagner, MD; Will Junius,
More informationHand numbness and carpal tunnel syndrome after volar plating of distal radius fracture
HAND (2011) 6:34 38 DOI 10.1007/s11552-010-9283-7 ORIGINAL ARTICLE Hand and carpal tunnel syndrome after volar plating of distal radius fracture Angela Wing Hang Ho & S. T. Ho & S. C. Koo & K. H. Wong
More informationTherapeutic Effects of Volar Anatomical Plates Versus Locking Plates for Volar Barton s Fractures
n Feature Article Therapeutic Effects of Volar Anatomical Plates Versus Locking Plates for Volar Barton s Fractures Zhibing Tang, MD; Huilin Yang, MD, PhD; Kangwu Chen, MD; Genlin Wang, MD, PhD; Xiaoyu
More informationAcu-Loc Wrist Plating System. Surgical Technique
Acu-Loc Wrist Plating System Surgical Technique Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that
More informationAbd Ali Muhsin FICMS.
Comparative study between close reductions versus close reduction with K-Wire fixation in completely dorsally displaced distal radial metaphyseal fracture, in children and adolescent. Abd Ali Muhsin FICMS.
More informationCarpal rows injuries!
Carpal rows injuries! Michael Papaloïzos! Center for Hand Surgery and Therapy Geneva, Switzerland no conflict of interest to declare Fractures of carpal bones! The fractured scaphoid! Fracture-dislocations
More informationHand and wrist emergencies
Chapter1 Hand and wrist emergencies Carl A. Germann Distal radius and ulnar injuries PEARL: Fractures of the distal radius and ulna are the most common type of fractures in patients younger than 75 years.
More informationIntra articular distal radius fractures and volar plate fixation: a prospective study
International Journal of Research in Orthopaedics Kundu AK et al. Int J Res Orthop. 2017 May;3(3):589-594 http://www.ijoro.org Original Research Article DOI: http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20171907
More informationFunctional Outcome Of Intraarticular Distal Radius Fractures Managed By Volar Locking Compression Plate A Prospective Study
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 3 Ver.11 March. (2018), PP 29-34 www.iosrjournals.org Functional Outcome Of Intraarticular
More informationThe NBX Non-Bridging External Fixator A Non-Bridging External Fixator/Locking Plate capturing a series of.062mm K-wires and 3mm half-pins that are
The NBX Non-Bridging External Fixator A Non-Bridging External Fixator/Locking Plate capturing a series of.062mm K-wires and 3mm half-pins that are inserted in a multiplanar and multi-directional fashion
More informationConservative treatment of the distal radius fracture using thermoplastic splint: pilot study results
Conservative treatment of the distal radius fracture using thermoplastic splint: pilot study results Ammar Al Khudairy, Kieran M. Hirpara, Ian P. Kelly & John F. Quinlan European Journal of Orthopaedic
More informationFunctional Outcome in Distal Radius Fractures Treated with Locking Compression Plate
Functional Outcome in Distal Radius Fractures Treated with Locking Compression Plate Sanjay Agarwala*, Ganesh S Mohrir**, Shreyans D Gadiya*** Abstract Purpose: To determine outcome of patient on treatment
More informationVolar fixed-angle plating for distal radius fractures 刀圭会協立病院 津村敬
Volar fixed-angle plating for distal radius fractures 刀圭会協立病院 津村敬 Normal distal radius anatomy Radial styloid process EPL Volar lip Lister s s tubercle Radial styloid process Sigmoid notch palmar view
More informationPosteromedial approach to the distal humerus for fracture fixation
Acta Orthop. Belg., 2006, 72, 395-399 ORIGINAL STUDY Posteromedial approach to the distal humerus for fracture fixation Cédric LAPORTE, Maurice THIONGO, Dominique JEGOU From the General Hospital of Meaux,
More informationFractures of the distal end of the radius should be
FRACTURES OF THE DISTAL END OF THE RADIUS TREATED BY INTERNAL FIXATION AND EARLY FUNCTION A PRELIMINARY REPORT OF 20 CASES DANIEL A. RIKLI, PIETRO REGAZZONI From the University Hospital, Basel, Switzerland
More informationD-RAD SMART PACK Plating System. A series of case studies
D-RAD SMART PACK Plating System A series of case studies AO fracture classification: C3 Eben A. Carroll, MD Associate Professor Director Orthopaedic Trauma Service Director Orthopedic Trauma Fellowship
More informationLevels of the anatomical cuts of the upper extremity RADIUS AND ULNA right
11 CHAPTER 2 Levels of the anatomical cuts of the upper extremity AND right CUT 1 CUT 4 1 2 3 4 5 6 Isolated fixation of the radius is difficult at this level because of the anterolateral vessels and the
More informationTENS in paediatrics both bone forearm fractures
TENS in paediatrics both bone forearm fractures Dr.Ajit Singh, Associate Professor, Department of orthopedics, IMS, BHU, Varanasi. Abstract Context: Diaphyseal fractures of the radius and ulna are common
More informationComplications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate
Acta Orthop. Belg., 2005, 71, 672-677 ORIGINAL STUDY Complications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate Vikas KHANDUJA,
More informationClosed Proximal Phalangeal Fracture Management in Hand: An Outcome Analysis
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/577 Closed Proximal Phalangeal Fracture Management in Hand: An Outcome Analysis R Senthilkumar 1, E Kovarthini 2, Heber
More information5/9/2017. Distal Radius Fractures: What s New? What s New? Or Maybe New to you. Single Pak Sterile distal radius kits
Distal Radius Fractures: What s New? What s New? Or Maybe New to you. Single Pak Sterile distal radius kits Extension of FCR split to release tendon for retraction Pronator Quadratus elevation with BR
More informationComparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the Distal End Radius
SK Venkatesh Gupta, Pradeep Mandapalli Clinical study 10.5005/jp-journals-10017-1051 Comparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the
More informationA novel method of treating isolated unicondylar fracture of the head of the proximal phalanx: A case report
CASE REPORT 41 OPEN ACCESS A novel method of treating isolated unicondylar fracture of the head of the proximal phalanx: A case report Aysha Rajeev, John Harrison ABSTRACT Introduction: The phalangeal
More informationParesh Patil, Kiran Gaonkar, Adish Patil, Nishant Gaonkar, Ketan Gupta*, Nirav Patel, Himanshu Kulkarni
International Journal of Research in Medical Sciences Patil P et al. Int J Res Med Sci. 2015 Apr;3(4):883-890 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: 10.5455/2320-6012.ijrms20150412
More informationRedisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors
Original Article Clinics in Orthopedic Surgery 2015;7:377-382 http://dx.doi.org/10.4055/cios.2015.7.3.377 Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic
More informationDifferentiated approach to repair of displaced distal radial metaepiphyseal fractures. R.P. Matveev, S.V. Bragina, A.M. Shneiveis
s A group of authors, 2017 DOI 10.18019/1028-4427-2017-23-4-396-400 Differentiated approach to repair of displaced distal radial metaepiphyseal fractures R.P. Matveev, S.V. Bragina, A.M. Shneiveis FSBEI
More informationOrthopedics in Motion Tristan Hartzell, MD January 27, 2016
Orthopedics in Motion 2016 Tristan Hartzell, MD January 27, 2016 Humerus fractures Proximal Shaft Distal Objectives 1) Understand the anatomy 2) Epidemiology and mechanisms of injury 3) Types of fractures
More informationForearm and Wrist Regions Neumann Chapter 7
Forearm and Wrist Regions Neumann Chapter 7 REVIEW AND HIGHLIGHTS OF OSTEOLOGY & ARTHROLOGY Radius dorsal radial tubercle radial styloid process Ulna ulnar styloid process ulnar head Carpals Proximal Row
More informationSection: Orthopaedics. Original Article INTRODUCTION
DOI: 0.2276/aimdr.208.4.3.OR2 Original Article ISSN (O):239-2822; ISSN (P):239-284 A Comparative Study of Operative Management of Internal Fixation of Closed Tibial Plateau Fracture by Plates with Screws
More informationDo Radiographic parameters predict Functional Outcome in Distal end Radius Fracture?
Original Research Article Do Radiographic parameters predict Functional Outcome in Distal end Radius Fracture? Vikram Ashok Rajguru 1,*, Swarup-Masih Sohanlal Daniel 2, Amit Kale 3 1 Senior Resident, 2,3
More informationAcomparison of percutaneous and pin-and-plaster techniques in distal radius fracture
Original Research Medical Journal of the Islamic Republic of Iran.Vol. 22, No. 4, February, 2009. pp. 159-163 Acomparison of percutaneous and pin-and-plaster techniques in distal radius fracture Farshid
More informationFunctional Outcome of Displaced Extraarticular Distal Radius Fracture by Kapandji Intrafocal Fixation
Original Article Functional Outcome of Displaced Extraarticular Distal Radius Fracture by Kapandji Intrafocal Fixation RC Dirgha Raj*, Adhikari BR**, Sherchan B***, Khadka T**** *Associate professor, **
More informationJMSCR Volume 03 Issue 02 Page February 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Isolated Fracture of the Trapezium: A Case Report Authors Dr. Rajendraprasad. R. Butala 1, Dr. Mishil S. Parikh 2, Prof. Sunil H. Shetty
More informationClinical examination of the wrist, thumb and hand
Clinical examination of the wrist, thumb and hand 20 CHAPTER CONTENTS Referred pain 319 History 319 Inspection 320 Functional examination 320 The distal radioulnar joint.............. 320 The wrist.......................
More informationAcu-Loc 2 Wrist Plating System
Surgical Technique Acu-Loc 2 Wrist Plating System Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that
More informationBridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius
Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius A RANDOMISED, PROSPECTIVE TRIAL K. Egol, M. Walsh, N. Tejwani,
More informationVariAx TM Distal Radius Locking Plate System
Osteosynthesis VariAx TM Distal Radius Locking Plate System Operative Technique Anatomical & Universal Volar Plates Dorsal Plates Fragment Specific Plates Introduction -15 +15 The NEW VariAx Distal Radius
More informationSmall External Fixator Wrist Spanning Frame. For the treatment of wrist fractures.
Small External Fixator Wrist Spanning Frame. For the treatment of wrist fractures. Technique Guide Part of the Small External Fixation System Small External Fixator Wrist Spanning Frame When to use The
More informationClinical Study Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures
SAGE-Hindawi Access to Research Advances in Orthopedics Volume 2011, Article ID 565642, 4 pages doi:10.4061/2011/565642 Clinical Study Rate of Improvement following Volar Plate Open Reduction and Internal
More informationSurgical Technique. Wrist Plating System
Surgical Technique Wrist Plating System Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that improve
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/35777 holds various files of this Leiden University dissertation. Author: Wijffels, Mathieu Mathilde Eugene Title: The clinical and non-clinical aspects
More informationDistal Radius Plate Instrument and Implant Set. Discontinued December 2017 DSUS/TRM/0916/1063(1)
Distal Radius Plate Instrument and Implant Set Surgical Technique Discontinued December 2017 DSUS/TRM/0916/1063(1) The Distal Radius Plates Indications For fixation of fractures and osteotomies, including
More informationEvaluation of current treatment techniques for distal radius fractures amongst Belgian orthopaedic surgeons
Acta Orthop. Belg., 2015, 81, 321-326 ORIGINAL STUDY Evaluation of current treatment techniques for distal radius fractures amongst Belgian orthopaedic surgeons D.E.C van Schaik, C.K. Goorens, P. Wernaers,
More informationEvaluation of instability factors in distal radius fractures
Original Article Evaluation of instability factors in distal radius fractures Mohammad Ali Tahririan, Mohammad Javdan, Mohammad Hadi Nouraei, Mohammad Dehghani Department of Orthopedics, Kashani Hospital,
More informationDistal radius fractures
Distal radius fractures One of the most common fractures seen by orthopaedic surgeons Incidence 195.2/100,000 persons per year Significant financial burden Distal radius fractures Improved implants ORIF
More informationComparison of volar locking plate and external fixation with K wire augmentation in unstable distal radius fractures
Original Article Nepal Med Coll J 2015; 17(1-2): 67-72 Comparison of volar locking plate and external fixation with K wire augmentation in unstable distal radius fractures Pradhan RL, Sharma S, Pandey
More informationA Patient s Guide to Adult Distal Radius (Wrist) Fractures
A Patient s Guide to Adult Distal Radius (Wrist) Fractures Suite 11-13/14/15 Mount Elizabeth Medical Center 3 Mount Elizabeth Singapore, 228510 Phone: (65) 6738 2628 Fax: (65) 6738 2629 1 DISCLAIMER: The
More informationThe Kienböck disease and scaphoid fractures. Mariusz Bonczar
The Kienböck disease and scaphoid fractures Mariusz Bonczar The Kienböck disease and scaphoid fractures Mariusz Bonczar Kienböck disease personal experience My special interest for almost 25 years Thesis
More informationA prospective study of surgical management of distal end humerus fractures in adults
2016; 2(4): 223-229 ISSN: 2395-1958 IJOS 2016; 2(4): 223-229 2016 IJOS www.orthopaper.com Received: 06-08-2016 Accepted: 07-09-2016 Dayanand BB Associate Professor, Shri BM Patil Medical College Hospital
More informationUltrasound-guided reduction of distal radius fractures
American Journal of Emergency Medicine (2010) 28, 1002 1008 www.elsevier.com/locate/ajem Original Contribution Ultrasound-guided reduction of distal radius fractures Shiang-Hu Ang, Shu-Woan Lee, Kai-Yet
More informationMANAGEMENT OF INTRAARTICULAR FRACTURES OF ELBOW JOINT. By Dr B. Anudeep M. S. orthopaedics Final yr pg
MANAGEMENT OF INTRAARTICULAR FRACTURES OF ELBOW JOINT By Dr B. Anudeep M. S. orthopaedics Final yr pg INTRAARTICULAR FRACTURES Intercondyar fracture Elbow dislocation Capitellum # Trochlea # Radial head
More informationDistal Radius and Distal Ulna Plates System Self-Tapping Spherical Locking Screw Self-Tapping Conical Locking Screw Cortex Screw
DISTAL RADIUS AND ULNA LOCKING PLATE SYSTEM Surgical Technique Distal Radius and Distal Ulna Plates System Self-Tapping Spherical Locking Screw Self-Tapping Conical Locking Screw Cortex Screw Approved
More information