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David Ring - One of the best experts on this subject based on the ideXlab platform.
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Combined dorsal and Volar Plate Fixation of complex fractures of the distal part of the radius.
The Journal of bone and joint surgery. American volume, 2020Co-Authors: David Ring, Karl Prommersberger, Jesse B JupiterAbstract:Fractures of the distal part of the radius that are associated with complex comminution of both the articular surface and the metaphysis (subgroup C3.2 according to the Comprehensive Classification of Fractures) are a challenge for surgeons using standard operative techniques. Twenty-five patients with subgroup-C3.2 fractures that had been treated with combined dorsal and Volar Plate Fixation were evaluated at an average of twenty-six months after the injury. Subsequent procedures included implant removal in twenty-one patients and reconstruction of a ruptured tendon in two patients. An average of 54 degrees of extension, 51 degrees of flexion, 79 degrees of pronation, and 74 degrees of supination were achieved. The grip strength in the involved limb was an average of 78% of that in the contralateral limb. The average radiographic measurements were 2 degrees of dorsal angulation, 21 degrees of ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular incongruity. Seven patients had radiographic signs of arthrosis during the follow-up period. A good or excellent functional result was achieved for twenty-four patients (96%) according to the rating system of Gartland and Werley and for ten patients (40%) according to the more stringent modified system of Green and O'Brien. Combined dorsal and Volar Plate Fixation of the distal part of the radius can achieve a stable, mobile wrist in patients with very complex fractures. The results are limited by the severity of the injury and may deteriorate with longer follow-up. A second operation for implant removal is common, and there is a small risk of tendon-related complications.
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Volar Tilt of the Lunate After Open Reduction Internal Fixation of a Distal Radius Fracture
Journal of Hand Surgery (European Volume), 2020Co-Authors: Daniel Bakker, David Ring, Joost T.p. Kortlever, Douglas Patterson, David Napoli, Neil G. Harness, Lee M. ReichelAbstract:The pathophysiology of carpal adaptations after fracture of the distal radius is incompletely understood. We report 5 patients who had normal carpal alignment on injury radiographs that developed marked Volar angulation of the lunate during recovery from Volar Plate Fixation of a fracture of the distal radius. There were no signs of alteration of the carpal ligaments. Two patients had similar Volar tilt on the contralateral side. The cause and optimal treatment of carpal malalignment after restoration distal radial alignment are unclear.
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What Factors are Associated with a Second Opioid Prescription after Treatment of Distal Radius Fractures with a Volar Locking Plate
Hand, 2015Co-Authors: Teun Teunis, Nicky Stoop, Christine J. Park, David RingAbstract:Purpose Knowledge of factors associated with patient’s requests for a second opioid prescription after Volar Plate Fixation of a fracture of the distal radius might inform better pain management protocols and encourage decreased and safer use of opioids. This study tested the primary null hypothesis that there is no difference in demographics, prior opioid prescriptions, injury characteristics, and psychological factors between patients that do and do not receive a second opioid prescription following treatment Volar locking Plate after distal radius fracture.
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a prospective randomized controlled trial comparing occupational therapy with independent exercises after Volar Plate Fixation of a fracture of the distal part of the radius
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: J S Souer, Geert A Buijze, David RingAbstract:Background: The effect of formal occupational therapy on recovery after open reduction and Volar Plate Fixation of a fracture of the distal part of the radius is uncertain. We hypothesized that there would be no difference in wrist function and arm-specific disability six months after open reduction and Volar Plate Fixation of a distal radial fracture between patients who receive formal occupational therapy and those with instructions for independent exercises. Methods: Ninety-four patients with an unstable distal radial fracture treated with open reduction and Volar locking Plate Fixation were enrolled in a prospective randomized controlled trial comparing exercises done under the supervision of an occupational therapist with surgeon-directed independent exercises. The primary study question addressed combined wrist flexion and extension six months after surgery Secondary study questions addressed wrist motion, grip strength, Gartland and Werley scores, Mayo wrist scores, and DASH (Disabilities of the Arm, Shoulder and Hand) scores at three months and six months after surgery. Results: There was a significant difference in the mean arc of wrist flexion and extension six months after surgery (118° versus 129°), favoring patients prescribed independent exercises. Three months after surgery, there was a significant difference in mean pinch strength (80% versus 90%), mean grip strength (66% versus 81%), and mean Gartland and Werley scores, favoring patients prescribed independent exercises. At six months, there was a significant difference in mean wrist extension (55° versus 62°), ulnar deviation (82% versus 93%), mean supination (84° versus 90°), mean grip strength (81% versus 92%), and mean Mayo score, favoring patients prescribed independent exercises. There were no differences in arm-specific disability (DASH score) at any time point. Conclusions: Prescription of formal occupational therapy does not improve the average motion or disability score after Volar locking Plate Fixation of a fracture of the distal part of the radius. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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fracture of the distal radius risk factors for complications after locked Volar Plate Fixation
Journal of Hand Surgery (European Volume), 2011Co-Authors: Maximillian Soong, Roderick Van Leerdam, Thierry G Guitton, Julia A Katarincic, David RingAbstract:Purpose To identify risk factors for complications after Volar locking Plate Fixation of distal radius fractures. Methods We assessed early postoperative complications in 594 patients with fracture of the distal radius repaired with a Volar locking Plate and a minimum 1-month evaluation in the medical record. Later complications were assessed among 321 patients as a subset of the original cohort with a minimum 6 months' evaluation. We compared patient demographics, fracture characteristics, and aspects of management between patients with and without complications in bivariate analysis. Multivariable logistic regression analysis was applied to identify the factors independently associated with complications. Results A total of 47 complications were documented in the medical record. Early complications occurred in 24 of 594, including 8 intra-articular screws and 7 patients with loss of Fixation. Late complications occurred in 23 of 321, including 14 patients diagnosed with tendon irritation (one rupture of the flexor pollicis longus tendon) and 5 patients who had subsequent surgery to address dysfunction of the distal radioulnar joint (malunion, synostosis, and arthrofibrosis). Of the 47 complications, 26 were attributed to the Plate, of which 9 were considered major (intra-articular screws and tendon rupture; 1.3% (8 out of 594) and less than 1% (1 out of 321) of the early and late groups, respectively). In the logistic regression models, fall from a height and an ipsilateral elbow injury were positive independent predictors of early complications, whereas high-volume surgeons and Plates other than the most commonly used Plate were positive independent predictors of later complications. Conclusions Volar locking Plate Fixation of distal radius fractures was associated with relatively few Plate-related complications in our institutions. Factors indicating higher energy or complexity predicted early complications. The most common late complication was tendon irritation, which is less discrete and perhaps variably diagnosed. Further study is warranted regarding Plate design and familiarity, which may help reduce complications. Type of study/level of evidence Prognostic IV.
Seth D Dodds - One of the best experts on this subject based on the ideXlab platform.
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lessons learned from Volar Plate Fixation of scaphoid fracture nonunions
Journal of Hand Surgery (European Volume), 2018Co-Authors: Seth D Dodds, John B Williams, Max Seiter, Clark J ChenAbstract:Treating scaphoid nonunions presents difficulties particularly when there is bone loss, significant humpback deformity or avascular necrosis. We describe a new type of Fixation with a Volar scaphoi...
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Volar Plate Fixation of recalcitrant scaphoid nonunions with Volar carpal artery vascularized bone graft
Techniques in Hand & Upper Extremity Surgery, 2014Co-Authors: Seth D Dodds, Joseph T Patterson, Andrea HalimAbstract:: Chronic scaphoid fracture nonunion continues to present a significant challenge to the treating orthopedic surgeon. Internal Fixation with threaded compression screws leads to high union rates, and is currently the gold standard, but there are certainly circumstances where a scaphoid screw does not provide the stability necessary for nonunion repair. Results using a Volar buttress Plate have been promising, but have not been described in conjunction with the use of vascularized bone graft. Vascularized bone grafts have been shown to be highly effective in achieving rapid and reproducible rates of union. We describe a novel combination of a vascularized Volar distal radius wedge autograft pedicled on the Volar carpal artery and Volar buttress plating for salvage treatment of chronic scaphoid nonunion.
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assessment of pronator quadratus repair integrity following Volar Plate Fixation for distal radius fractures a prospective clinical cohort study
Journal of Hand Surgery (European Volume), 2012Co-Authors: Carrie R Swigart, Mary Ann Badon, Victoria L Bruegel, Seth D DoddsAbstract:Purpose To assess prospectively the integrity of pronator quadratus (PQ) muscle repair following Volar Plate Fixation of distal radius fractures and to compare the clinical and radiographic outcomes of durable versus failed repairs in 24 subjects. In addition, by grading the degree of PQ injury, an attempt was made to correlate failure of repair with the PQ injury severity. Methods The extent of PQ injury was graded for each fracture. After fracture Fixation, the PQ muscle was repaired along its radial and distal borders. Radiopaque hemoclips were attached to each side of the PQ repair, 2 radially and 2 distally. The distance between these markers at time 0 versus x-rays taken at approximately 2 weeks, 6 weeks, and 3 months was recorded. Clip displacement of 1 cm or more compared to time 0 indicated repair failure. Results One of 24 repairs (4%) failed at 3 months. No statistical difference was noted between the type of PQ injury and wrist flexion/extension, pronation/supination, and grip strength. Conclusions Pronator quadratus repairs after Volar Plate fracture Fixation are generally durable. They withstand forces that occur at the distal radius during the healing process with a 4% failure rate. No correlation was shown between type of PQ injury and radiographic failure of the repair. Type of study/level of evidence Therapeutic II.
Namhoon Do - One of the best experts on this subject based on the ideXlab platform.
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Should an Ulnar Styloid Fracture Be Fixed Following Volar Plate Fixation of a Distal Radial Fracture
Chinese Journal of Orthopaedics, 2010Co-Authors: Namhoon DoAbstract:背景：尺骨茎突骨折常伴发于桡骨远端骨折。本研究的目的是确定桡骨远端骨折牢固内固定后伴发的尺骨茎突骨折对腕关节功能或远期下尺桡关节不稳定的发展是否有影响。方法：138例不稳定的桡骨远端骨折手术治疗病例纳入本研究。手术过程中伴发的尺骨茎突骨折未进行内固定。患者尺骨茎突骨折被分为未骨折组、非基底部骨折组和基底部骨折组，根据受伤时尺骨茎突骨折移位程度分为未骨折组、轻度移位组（≤2mm）和明显移位组（〉2mm）。术后评估包括握力和腕关节活动范围的测量；改良Mayo腕关节评分和臂、肩、手不稳定（DASH）评分系统，以及在平均术后19个月的测试下尺桡关节的不稳定。结果：138例中76例（55％）存在尺骨茎突骨折。47例（62％）为尺骨茎突非基底部骨折，29例（38％）为尺骨茎突基底部骨折。34例（45％）轻度移位，42例（55％）明显移位（〉2mm）。我们没有发现尺骨茎突骨折位置或移位程度与腕关节功能有显著相关性。2例腕关节（1．4％）出现下尺桡关节慢性不稳。结论：桡骨远端骨折稳定内固定后伴发的尺骨茎突骨折对腕关节功能或下尺桡关节的稳定性没有明显的不利影响。
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should an ulnar styloid fracture be fixed following Volar Plate Fixation of a distal radial fracture
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Namhoon DoAbstract:Background: Ulnar styloid fractures often occur in association with distal radial fractures. The purpose of this study was to determine whether an associated ulnar styloid fracture following stable Fixation of a distal radial fracture has any effect on wrist function or on the development of chronic distal radioulnar joint instability. Methods: One hundred and thirty-eight consecutive patients who underwent surgical treatment of an unstable distal radial fracture were included in this study. During surgery, none of the accompanying ulnar styloid fractures were internally fixed. Patients were divided into nonfracture, nonbase fracture, and base fracture groups, on the basis of the location of the ulnar styloid fracture, and into nonfracture, minimally displaced (≤2 mm), and considerably displaced (>2 mm) groups, according to the amount of ulnar styloid fracture displacement at the time of injury. Postoperative evaluation included measurement of grip strength and wrist range of motion; calculation of the modified Mayo wrist score and Disabilities of the Arm, Shoulder and Hand score; as well as testing for instability of the distal radioulnar joint at a mean of nineteen months postoperatively. Results: Ulnar styloid fractures were present in seventy-six (55%) of the 138 patients. Forty-seven (62%) involved the nonbase portion of the ulnar styloid and twenty-nine (38%) involved the base of the ulnar styloid. Thirty-four (45%) were minimally displaced, and forty-two (55%) were considerably (>2 mm) displaced. We did not find a significant relationship between wrist functional outcomes and ulnar styloid fracture level or the amount of displacement. Chronic instability of the distal radioulnar joint occurred in two wrists (1.4%). Conclusions: An accompanying ulnar styloid fracture in patients with stable Fixation of a distal radial fracture has no apparent adverse effect on wrist function or stability of the distal radioulnar joint. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
Prue P A Keith - One of the best experts on this subject based on the ideXlab platform.
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Flexor tendon injuries following Plate Fixation of distal radius fractures: a systematic review of the literature
Journal of Orthopaedics and Traumatology, 2013Co-Authors: Saeed Asadollahi, Prue P A KeithAbstract:Background Flexor tendon rupture is a rare but major complication associated with Volar Plate Fixation of distal radius fractures. Materials and methods We performed a systematic review to evaluate the demographics, clinical profile, treatment and outcome of flexor tendon rupture following Volar Plate Fixation of distal radius fracture. Electronic searches of the MEDLINE, EMBASE, and Cochrane databases for systematic reviews and conference proceedings were performed. Studies were included if they reported flexor tendon rupture (partial or complete) as a complication of distal radius fracture plating (all levels of evidence). Result Our search yielded 21 studies. There were 12 case reports and 9 clinical studies. A total of 47 cases were reported. There were 11 males and 23 females ( n = 16 studies). The mean age was 61 years old (range 30–85). The median interval between the surgery and flexor tendon rupture was 9 months (interquartile range, 6–26 months). Twenty-nine Plates were locking and 15 were nonlocking ( n = 20 studies). FPL was the most commonly ruptured tendon ( n = 27 cases, 57 %), with FDP to index finger being the second most common ( n = 7 cases, 15 %). Palmaris longus tendon graft and primary end-to-end repair were the most common surgical methods used in cases of FPL tendon rupture. Conclusion Flexor tendon rupture is a recognised complication of Volar plating of distal radius fracture. Positioning of the Plate proximal to the “watershed” line and early removal of the Plate in cases with Plate prominence or warning symptoms can reduce the risk of this complication.
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flexor tendon injuries following Plate Fixation of distal radius fractures a systematic review of the literature
Journal of Orthopaedics and Traumatology, 2013Co-Authors: Saeed Asadollahi, Prue P A KeithAbstract:Background Flexor tendon rupture is a rare but major complication associated with Volar Plate Fixation of distal radius fractures.
David S. Ruch - One of the best experts on this subject based on the ideXlab platform.
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distal radius fractures strategic alternatives to Volar Plate Fixation
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Christopher J Dy, Jesse B Jupiter, David S. Ruch, Scott W Wolfe, Philip E Blazar, Douglas P HanelAbstract:: Volar locking Plates have provided surgeons with enhanced capability to reliably repair both simple and complex fractures and avoid the hardware-related complications associated with dorsal plating. However, there have been an increasing number of published reports on the frequency and types of complications and failures associated with Volar locked plating of distal radius fractures. An informed, critical assessment of distal radius fracture characteristics will allow surgeons to select an individualized treatment strategy that maximizes the likelihood of a successful outcome. Knowledge of the anatomy, patterns, and characteristics of the diverse types of distal radius fractures and the complications and failures associated with Volar locked plating will be helpful to orthopaedic surgeons who treat patients with these injuries.
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Analysis of the complications of palmar plating versus external Fixation for fractures of the distal radius.
Journal of Hand Surgery (European Volume), 2011Co-Authors: Marc J. Richard, Daniel A. Wartinbee, Michael D. Miller, Fraser J. Leversedge, Jonathan Riboh, David S. RuchAbstract:Purpose To evaluate whether there was a difference in complication rates in our patients treated with external Fixation versus Volar plating of distal radius fractures. We also looked for a difference in radiographic results; in the clinical outcomes of flexion, extension, supination, pronation, and grip strength; and in scores on the visual analog scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Methods We reviewed 115 patients with comminuted intrarticular distal radius fractures. Of those patients, 59 were treated with external Fixation and 56 with Volar Plate Fixation. Postoperative radiographs, range of motion, and grip strength were measured; DASH and VAS pain questionnaires were administered; and complications were documented. Results The external Fixation group had a significantly higher overall complication rate. In the Volar Plate group, there were more tendon and median nerve complications, but this difference was not significant. Radiographically, the external fixator group demonstrated radial shortening of 0.7 mm, whereas the Volar Plate group demonstrated 0.3 mm of radial shortening during the postoperative period. There were no significant differences between the groups in the measurement of scapholunate angle or palmar tilt. The mean DASH score at final follow-up was 32 in the external Fixation group and 17 in the Volar Plate group, which was statistically significant. The final VAS scores were statistically different at 3.1 for the external Fixation group and 1.1 for the Volar Plate group. On physical examination, the Volar Plate group had significantly better arc of motion in pronation–supination and flexion–extension and better grip strength. Conclusions In the patients we studied, Volar Plate Fixation has an overall decreased incidence of complications and significantly better motion in flexion–extension and supination–pronation compared to external Fixation. Volar Plate Fixation also has less radial shortening than the external Fixation group, yet the absolute difference in magnitude of ulnar variance was only 1.4 mm, calling into question the clinical significance of this difference. Patients with Volar plating also have better pain and functional outcomes and better grip strength. Type of study/level of evidence Therapeutic III.
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Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius
Clinical Rhinology An International Journal, 2010Co-Authors: Marc J. Richard, Daniel A. Wartinbee, Michael D. Miller, Fraser J. Leversedge, Jonathan Riboh, David S. RuchAbstract:Background: Much attention has been given recently to the complication profile of Volar Plate Fixation of distal radial fractures. The purpose of this investigation was to compare complication rates among patients with distal radial fractures treated with Volar plating versus those treated with external Fixation. Methods: Two parallel series of patients with comminuted intra-articular distal radius fractures were reviewed. 59 patients were treated with external Fixation and 56 patients with Volar Plate Fixation. Postoperative radiographs, range of motion, grip strength, DASH scores, and VAS pain questionnaires were analyzed, and complications were described. Results: The external Fixation group had a significantly higher overall complication rate (p = 0.021) than the Volar Plate Fixation group. In the Volar Plate group, there were more tendon complications and median nerve pathology. Radial shortening was greater in the external Fixation group when compared to the Volar Plate Fixation group. DASH scores and VAS scores were significantly higher in the external Fixation group. Clinically, the patients in the Volar Plate Fixation group had significantly greater arcs of motion in pronation-supination (p < 0.0001) and flexion-extension (p = 0.002) with a trend towards better grip strength (p = 0.0062). Conclusions: Volar Plate Fixation for fractures of the distal radius provides an overall decreased incidence of complications, significantly less radial shortening, and significantly greater postoperative wrist motion when compared to external Fixation. Volar Plate Fixation is also associated with lower VAS scores when compared to external Fixation as well as DASH scores that approach statistical significance.
