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J. Carel Goslings - One of the best experts on this subject based on the ideXlab platform.
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Volar Plate Fixation in Adults with a Displaced Extra-Articular Distal Radial Fracture Is Cost-Effective.
The Journal of bone and joint surgery. American volume, 2020Co-Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, J. Carel Goslings, Jan Paul M. Frölke, S. Van Dieren, Niels W L SchepAbstract:Background To our knowledge, a health economic evaluation of Volar Plate fixation compared with plaster immobilization in patients with a displaced extra-articular distal radial fracture has not been previously conducted. Methods A cost-effectiveness analysis of a multicenter randomized controlled trial was performed. Ninety patients were randomly assigned to Volar Plate fixation or plaster immobilization. The use of resources per patient was documented prospectively for up to 12 months after randomization and included direct medical, direct non-medical, and indirect non-medical costs due to the distal radial fracture and the received treatment. Results The mean quality-adjusted life-years (QALYs) at 12 months were higher in patients treated with Volar Plate fixation (mean QALY difference, 0.16 [bias-corrected and accelerated 95% confidence interval (CI), 0.07 to 0.27]). (The 95% CIs throughout are bias-corrected and accelerated.) In addition, the mean total costs per patient were lower in patients treated with Volar Plate fixation (mean difference, -$299 [95% CI, -$1,880 to $1,024]). The difference in costs per QALY was -$1,838 (95% CI, -$12,604 to $9,787), in favor of Volar Plate fixation. In a subgroup analysis of patients who had paid employment, the difference in costs per QALY favored Volar Plate fixation by -$7,459 (95% CI, -$23,919 to $3,233). Conclusions In adults with a displaced extra-articular distal radial fracture, Volar Plate fixation is a cost-effective intervention, especially in patients who had paid employment. Besides its better functional results, Volar Plate fixation is less expensive and provides a better quality of life than plaster immobilization. Level of evidence Economic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Volar Plate fixation versus plaster immobilization in acceptably reduced extra articular distal radial fractures a multicenter randomized controlled trial
Journal of Bone and Joint Surgery American Volume, 2019Co-Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, Susan Van Dieren, J. Carel Goslings, Jan Paul M. Frölke, Niels W L SchepAbstract:BACKGROUND: There is no consensus as to whether displaced extra-articular distal radial fractures should be treated operatively or nonoperatively. We compared the outcomes of open reduction and Volar Plate fixation with closed reduction and plaster immobilization in adults with an acceptably reduced extra-articular distal radial fracture. METHODS: In this multicenter randomized controlled trial, patients 18 to 75 years old with an acceptably reduced extra-articular distal radial fracture were randomly assigned to open reduction and Volar Plate fixation or plaster immobilization. The primary outcome was function as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire after 12 months. Follow-up was conducted at 1, 3, and 6 weeks and at 3, 6, and 12 months. Analyses were performed according to the intention-to-treat principle. RESULTS: Ninety-two patients were randomized, 48 to open reduction and Volar Plate fixation and 44 to plaster immobilization; 1 patient in each group was excluded for withdrawing informed consent. At all follow-up time points, operatively treated patients had significantly better functional outcomes, as indicated by significantly lower DASH scores, than patients treated nonoperatively (all p values < 0.05). Twelve nonoperatively managed patients (28%) had fracture redisplacement within 6 weeks and underwent subsequent open reduction and internal fixation, and 6 patients (14%) had a symptomatic malunion treated with corrective osteotomy. CONCLUSIONS: Patients with an acceptably reduced extra-articular distal radial fracture treated with open reduction and Volar Plate fixation have better functional outcomes after 12 months compared with nonoperatively managed patients. Additionally, 42% of nonoperatively managed patients had a subsequent surgical procedure. Open reduction and Volar Plate fixation should be considered for patients who experience this common injury. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Repair of the pronator quadratus after Volar Plate fixation in distal radius fractures: a systematic review
Strategies in Trauma and Limb Reconstruction, 2017Co-Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, Niels W L Schep, J. Carel GoslingsAbstract:To position the Volar Plate on the distal radius fracture site, the pronator quadratus muscle needs to be detached from its distal and radial side and lifted for optimal exposure to the fracture site. Although the conventional approach involves repair of the pronator quadratus, controversy surrounds the merits of this repair. The purpose of this study was to compare the functional outcomes of patients with distal radius fractures treated with pronator quadratus repair after Volar Plate fixation versus no pronator quadratus repair. A systematic search was conducted in Medline, EMBASE and the Cochrane Central Register of Controlled Trials, on 23 July 2015. All studies comparing pronator quadratus repair with no pronator quadratus repair in adult patients undergoing Volar Plate fixation for distal radius fractures were included. The primary outcome was the Disability of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes included range of motion, grip strength, post-operative pain and complications. A total of 169 patients were included, of which 95 underwent pronator quadratus repair, while 74 patients underwent no pronator quadratus repair. At 12 months follow-up no statistically significant differences in DASH-scores and range of motion were observed between pronator quadratus repair and no repair. Moreover, post-operative pain and complication rates were similar between both groups. At 12 months of follow-up, we do not see any advantages of pronator quadratus repair after Volar Plate fixation in the distal radius. However, a definitive conclusion cannot be drawn from this systematic review due to a lack of available evidence.
Stephen A. Brennan - One of the best experts on this subject based on the ideXlab platform.
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Volar Plate versus k wire fixation of distal radius fractures
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Stephen A. Brennan, Christine Kiernan, Suzanne M. Beecher, Brian M. Devitt, Stephen R. Kearns, Rory T Oreilly, Michael E OsullivanAbstract:Abstract The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or Volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for Volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the Volar Plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a Volar Plate ( p p =0.28) (PRWE 17.56 vs. 16.31, p =0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.
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Volar Plate versus k-wire fixation of distal radius fractures.
Injury, 2015Co-Authors: Stephen A. Brennan, Christine Kiernan, Suzanne M. Beecher, Rory T. O’reilly, Brian M. Devitt, Stephen R. Kearns, Michael E. O'sullivanAbstract:The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or Volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for Volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the Volar Plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a Volar Plate (p
Aaron Daluiski - One of the best experts on this subject based on the ideXlab platform.
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Volar Plate position and flexor tendon rupture following distal radius fracture fixation
Journal of Hand Surgery (European Volume), 2013Co-Authors: Alison Kitay, Morgan M Swanstrom, Joseph J Schreiber, Michelle G Carlson, Joseph Nguyen, Andrew J Weiland, Aaron DaluiskiAbstract:Purpose To determine whether there were differences between Plate position in patients who had postoperative flexor tendon ruptures following Volar Plate fixation of distal radius fractures and those who did not. Methods Three blinded reviewers measured the Volar Plate prominence and position on the lateral radiographs of 8 patients treated for flexor tendon ruptures and 17 matched control patients without ruptures following distal radius fracture fixation. We graded Plate prominence using the Soong grading system, and we measured the distances between the Plate and both the Volar critical line and the Volar rim of the distal radius. Results A higher Soong grade was associated with flexor tendon rupture. Patients with ruptures had Plates that were more prominent Volarly and more distal than matched controls without ruptures. Plate prominence projecting greater than 2.0 mm Volar to the critical line had a sensitivity of 0.88, a specificity of 0.82, and positive and negative predictive values of 0.70 and 0.93, respectively, for tendon ruptures. Plate position distal to 3.0 mm from the Volar rim had a sensitivity of 0.88, a specificity of 0.94, and positive and negative predictive values of 0.88 and 0.94, respectively, for tendon ruptures. Conclusions We identified Plate positions associated with attritional flexor tendon rupture following distal radius fracture fixation with Volar Plates. To decrease rupture risk, we recommend considering elective hardware removal after union in symptomatic patients with Plate prominence greater than 2.0 mm Volar to the critical line or Plate position within 3.0 mm of the Volar rim. Type of study/level of evidence Therapeutic III.
Marjolein A. M. Mulders - One of the best experts on this subject based on the ideXlab platform.
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Volar Plate Fixation in Adults with a Displaced Extra-Articular Distal Radial Fracture Is Cost-Effective.
The Journal of bone and joint surgery. American volume, 2020Co-Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, J. Carel Goslings, Jan Paul M. Frölke, S. Van Dieren, Niels W L SchepAbstract:Background To our knowledge, a health economic evaluation of Volar Plate fixation compared with plaster immobilization in patients with a displaced extra-articular distal radial fracture has not been previously conducted. Methods A cost-effectiveness analysis of a multicenter randomized controlled trial was performed. Ninety patients were randomly assigned to Volar Plate fixation or plaster immobilization. The use of resources per patient was documented prospectively for up to 12 months after randomization and included direct medical, direct non-medical, and indirect non-medical costs due to the distal radial fracture and the received treatment. Results The mean quality-adjusted life-years (QALYs) at 12 months were higher in patients treated with Volar Plate fixation (mean QALY difference, 0.16 [bias-corrected and accelerated 95% confidence interval (CI), 0.07 to 0.27]). (The 95% CIs throughout are bias-corrected and accelerated.) In addition, the mean total costs per patient were lower in patients treated with Volar Plate fixation (mean difference, -$299 [95% CI, -$1,880 to $1,024]). The difference in costs per QALY was -$1,838 (95% CI, -$12,604 to $9,787), in favor of Volar Plate fixation. In a subgroup analysis of patients who had paid employment, the difference in costs per QALY favored Volar Plate fixation by -$7,459 (95% CI, -$23,919 to $3,233). Conclusions In adults with a displaced extra-articular distal radial fracture, Volar Plate fixation is a cost-effective intervention, especially in patients who had paid employment. Besides its better functional results, Volar Plate fixation is less expensive and provides a better quality of life than plaster immobilization. Level of evidence Economic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Volar Plate fixation versus plaster immobilization in acceptably reduced extra articular distal radial fractures a multicenter randomized controlled trial
Journal of Bone and Joint Surgery American Volume, 2019Co-Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, Susan Van Dieren, J. Carel Goslings, Jan Paul M. Frölke, Niels W L SchepAbstract:BACKGROUND: There is no consensus as to whether displaced extra-articular distal radial fractures should be treated operatively or nonoperatively. We compared the outcomes of open reduction and Volar Plate fixation with closed reduction and plaster immobilization in adults with an acceptably reduced extra-articular distal radial fracture. METHODS: In this multicenter randomized controlled trial, patients 18 to 75 years old with an acceptably reduced extra-articular distal radial fracture were randomly assigned to open reduction and Volar Plate fixation or plaster immobilization. The primary outcome was function as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire after 12 months. Follow-up was conducted at 1, 3, and 6 weeks and at 3, 6, and 12 months. Analyses were performed according to the intention-to-treat principle. RESULTS: Ninety-two patients were randomized, 48 to open reduction and Volar Plate fixation and 44 to plaster immobilization; 1 patient in each group was excluded for withdrawing informed consent. At all follow-up time points, operatively treated patients had significantly better functional outcomes, as indicated by significantly lower DASH scores, than patients treated nonoperatively (all p values < 0.05). Twelve nonoperatively managed patients (28%) had fracture redisplacement within 6 weeks and underwent subsequent open reduction and internal fixation, and 6 patients (14%) had a symptomatic malunion treated with corrective osteotomy. CONCLUSIONS: Patients with an acceptably reduced extra-articular distal radial fracture treated with open reduction and Volar Plate fixation have better functional outcomes after 12 months compared with nonoperatively managed patients. Additionally, 42% of nonoperatively managed patients had a subsequent surgical procedure. Open reduction and Volar Plate fixation should be considered for patients who experience this common injury. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Repair of the pronator quadratus after Volar Plate fixation in distal radius fractures: a systematic review
Strategies in Trauma and Limb Reconstruction, 2017Co-Authors: Marjolein A. M. Mulders, Monique M. J. Walenkamp, Niels W L Schep, J. Carel GoslingsAbstract:To position the Volar Plate on the distal radius fracture site, the pronator quadratus muscle needs to be detached from its distal and radial side and lifted for optimal exposure to the fracture site. Although the conventional approach involves repair of the pronator quadratus, controversy surrounds the merits of this repair. The purpose of this study was to compare the functional outcomes of patients with distal radius fractures treated with pronator quadratus repair after Volar Plate fixation versus no pronator quadratus repair. A systematic search was conducted in Medline, EMBASE and the Cochrane Central Register of Controlled Trials, on 23 July 2015. All studies comparing pronator quadratus repair with no pronator quadratus repair in adult patients undergoing Volar Plate fixation for distal radius fractures were included. The primary outcome was the Disability of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes included range of motion, grip strength, post-operative pain and complications. A total of 169 patients were included, of which 95 underwent pronator quadratus repair, while 74 patients underwent no pronator quadratus repair. At 12 months follow-up no statistically significant differences in DASH-scores and range of motion were observed between pronator quadratus repair and no repair. Moreover, post-operative pain and complication rates were similar between both groups. At 12 months of follow-up, we do not see any advantages of pronator quadratus repair after Volar Plate fixation in the distal radius. However, a definitive conclusion cannot be drawn from this systematic review due to a lack of available evidence.
Moheb S. Moneim - One of the best experts on this subject based on the ideXlab platform.
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two potential causes of epl rupture after distal radius Volar Plate fixation
Clinical Orthopaedics and Related Research, 2006Co-Authors: Eric C Benson, Alex Decarvalho, Elizabeth A Mikola, John M Veitch, Moheb S. MoneimAbstract:Rupture of the extensor pollicis longus tendon can occur after Volar Plate fixation of dorsally comminuted distal radius fractures. We attempted to identify the etiology of extensor pollicis longus tendon injury after Volar Plate fixation of the distal radius and potential solutions to this problem. After describing two case reports, we examine six cadaveric specimens and retrospectively review 10 selected patients to evaluate possible technique refinements to minimize damage to the extensor pollicis longus tendon during Volar plating of the distal radius. We identify specific screw holes in three commercially available Volar distal radius Plates that direct the drill bit or prominent screw tips into the third extensor compartment. In addition, after reduction and Plate fixation, bone fragments or dorsal gapping may predispose the extensor pollicis longus tendon to injury. We recommend either using shorter screw lengths or leaving the implicated Plate holes unfilled. In addition, we suggest consideration of an open assessment of the third extensor compartment, if indicated, as performed through a small dorsal incision ulnar to Lister's tubercle. Level of Evidence: Level III, Therapeutic Study. See the Guidelines for Authors for a complete description of levels of evidence.
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Two potential causes of EPL rupture after distal radius Volar Plate fixation.
Clinical orthopaedics and related research, 2006Co-Authors: Eric C Benson, Alex Decarvalho, Elizabeth A Mikola, John M Veitch, Moheb S. MoneimAbstract:Rupture of the extensor pollicis longus tendon can occur after Volar Plate fixation of dorsally comminuted distal radius fractures. We attempted to identify the etiology of extensor pollicis longus tendon injury after Volar Plate fixation of the distal radius and potential solutions to this problem. After describing two case reports, we examine six cadaveric specimens and retrospectively review 10 selected patients to evaluate possible technique refinements to minimize damage to the extensor pollicis longus tendon during Volar plating of the distal radius. We identify specific screw holes in three commercially available Volar distal radius Plates that direct the drill bit or prominent screw tips into the third extensor compartment. In addition, after reduction and Plate fixation, bone fragments or dorsal gapping may predispose the extensor pollicis longus tendon to injury. We recommend either using shorter screw lengths or leaving the implicated Plate holes unfilled. In addition, we suggest consideration of an open assessment of the third extensor compartment, if indicated, as performed through a small dorsal incision ulnar to Lister's tubercle.
