Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution

Background Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. Materials and methods Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. Results A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. Conclusions The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. Trial registration This study has been registered on the ClinicalTrials.gov.

Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

Corrective Intra-Articular Osteotomy Using a 3D-Printed Model and Induced Membrane Technique for AO/OTA C3 Distal Femur Fracture with Articular Malunion and Metaphyseal Nonunion

Comminuted distal femur fracture is a challenging injury, and care must be taken to reduce the articular fragment and acquire the sufficient stability for the metaphyseal comminution. We report the case of a AO/OTA C3-type distal femur fracture with articular malunion and metaphyseal nonunion. Articular malunion was treated with corrective osteotomy using a 3D-printed model for planning, and metaphyseal nonunion was treated with an induced membrane technique. Conclusion. Two major complications in the comminuted periarticular fracture can be addressed by an osteotomy and induced membrane technique. A 3D-printed model is a useful tool to evaluate the morphology of the malunited articular surface.

Is external fixation a better way than plaster to supplement K-wires in non-comminuted distal radius fractures?

BackgroundDistal radius fractures represent about one-sixth of all fractures. There is still no consensus on the treatment of this fracture. We have several issues to assess and address; one of them is the fixation method. We tried to compare the effectiveness of two methods of stabilisation of distal radial fracture. Comparison between the techniques of Kirschner wire (K-wire) fixation with plaster and K-wire fixation with external fixation (Ex-Fix) was undertaken to assess which treatment modality gives better results in patients with distal radius fracture Frykman VII and VIII with no metaphyseal comminution.MethodFifty-six patients were chosen randomly and then allocated to two different modalities of stabilisation randomly as well, they were followed up; three of them were lost to follow-up because of death and two moved away from the area. Fifty-one patients were randomised in two groups: 24 were treated with K-wire and spanning Ex-Fix supplementation and 27 were treated with K-wires and plaster. Patients were prospectively monitored following the operation with a minimum follow-up of 1 year. Measurement of range of motion was obtained after surgery. Visual Analogue Scale (VAS) scores for pain and satisfaction levels were also recorded.ResultsThere was statistically significant difference in favour of the Ex-Fix patient group for pain (VAS, Ex-Fix group: mean 14.9; plaster group: mean 28.1) and satisfaction (Ex-Fix group: mean 89.7;plaster group: mean 76.3). Although one would expect that range of motion would be reduced in the Ex-Fix group, there were no statistically significant differences found, with the exception of supination where results were in favour of the Ex-Fix group (mean 54.4; plaster group: mean 45.2).ConclusionIn our study, xternal fixator (Ex-Fix) supplementation of K-wiring favoured patients with distal radius fracture, even though there was no metaphyseal comminution, and therefore is suggested in contrast to plaster supplementation.

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

BACKGROUND: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes.METHODS: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications.RESULTS: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient).CONCLUSIONS: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.