TITLE

Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates: A Multicenter Prospective Case Series

AUTHOR(S)
Jupiter, Jesse B.; Marent-Huber, M.
PUB. DATE
January 2009
SOURCE
Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p55
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: In the past decade, there has been a trend toward open reduction and internal fixation of unstable distal radial fractures. There are now more than thirty different implant designs specific for the fixation of distal radial fractures. A multicenter prospective study of a case series was conducted to determine the efficacy of the operative management of distal radial fractures stabilized with 2.4-mm locking plates. Methods: One hundred and fifty patients were entered into the study over a two-year period. The mean age of these patients was fifty-one years, and the cohort included eighty-eight women and sixty-two men. Eighty-six patients sustained a low-energy injury. Seventy-one percent of the fractures in the series were intra-articular and were Type C according to the Müller-AO Comprehensive Classification. The follow-up evaluations, which were conducted at six weeks, six months, one year, and two years, included assessments of pain, motion, grip strength, and standard radiographs. Gartland and Werley scores were recorded at six months and one and two years, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were recorded at one and two years. Results: One hundred and twenty-five patients (83%) had a complete follow-up at six months; 121(81%), at one year; and 117 (78%), at two years. Significant improvements in motion, grip strength, and patient satisfaction were observed between six months and one year, but further improvements were not seen at the two-year follow-up examination. The mean DASH score changed from a preinjury baseline of 2 points to 8 points at one year and 7 points at two years (p < 0.0001). The mean Gartland and Werley score improved significantly from 4 points at six months to 2 points at two years. Of the 102 intra-articular fractures examined in the immediate postoperative period, twenty had a step-off of ≤2 mm and seven had a step-off of >2 mm. Of the seventy-one intra-articular fractures seen at two years, sixty-one had no step-off, five had a step-off of ≤2 mm, and five had a step-off of >2 mm. Twenty-seven percent of the patients showed an increase of at least one grade in radiographic signs of arthritis at two years. There were twenty-eight complications, twenty of which were considered minor. Tendon inflammation occurred in nine patients. There were two tendon ruptures, one of which was due to a prominent dorsal screw tip placed through a volar plate and one of which was due to a prominent volar plate. Loss of reduction occurred in two patients, and screw loosening occurred in two patients. Conclusion: Internal fixation of displaced distal radial fractures with implants featuring locking screw fixation can result in good-to-excellent outcomes with a limited number of complications. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
36330039

 

Related Articles

  • Fractures of the Capitellum and Trochlea. Guitton, Thierry G.; Doornberg, Job N.; Raaymakers, Ernst L. F. B.; Ring, David; Kloen, Peter // Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p390 

    Background: Recent work has established that apparently isolated fractures of the capitellum are often more complex and involve the lateral epicondyle, trochlea, and posterior aspect of the distal part of the humerus. We assessed the experience with operative stabilization of fractures of the...

  • Fractures of the Lesser Tuberosity of the Humerus. Robinson, C. Michael; Teoh, Kar H.; Baker, Alex; Bell, Lawrence // Journal of Bone & Joint Surgery, American Volume;Mar2009, Vol. 91-A Issue 3, p512 

    Background: Fractures of the lesser tuberosity are rare injuries, and little is known of their epidemiology. Operative treatment is generally recommended for displaced fractures; however, the outcome of this method of treatment has not previously been studied. The aims of our study were to...

  • Subtalar Fusion After Displaced Intra-Articular Calcaneal Fractures: Does Initial Operative Treatment Matter? Radnay, Craig S.; Clare, Michael P.; Sanders, Roy W. // Journal of Bone & Joint Surgery, American Volume;Mar2009, Vol. 91-A Issue 3, p541 

    Background: Many patients with displaced intra-articular calcaneal fractures require subtalar arthrodesis for the treatment of posttraumatic arthritis. We hypothesized that patients who underwent initial operative treatment would have better functional outcomes as compared with those who...

  • Open Reduction and Internal Fixation of Capitellar Fractures with Headless Screws. Ruchelsman, David E.; Tejwani, Nirmal C.; Kwon, Young W.; Egol, Kenneth A. // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p38 

    BACKGROUND: The outcome of operatively treated capitellar fractures has not been reported frequently. The purpose of the present study was to evaluate the clinical, radiographic, and functional outcomes following open reduction and internal fixation of capitellar fractures that were treated with...

  • Volar Locked Plating Improved Wrist Range of Movement More Than External Fixation for Distal Radial Fracture. Egol, K.; Walsh, M.; Tejwani, N.; McLaurin, T.; Wynn, C.; Paksima, N.; Ring, David // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1280 

    The article reports on the results of research which was conducted in an effort to determine how bridging external fixation compared with locked volar plate and screw fixation in patients with displaced fracture of the distal part of the radius. Researchers conducted a randomized, unblinded...

  • Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. Eralp, Levent; Kocaoglu, Mehmet // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p181 

    BACKGROUND: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been...

  • Femoral Nerve Block for Diaphyseal and Distal Femoral Fractures in the Emergency Department. Mutty, Christopher E.; Jensen, Erik J.; Manka Jr., Michael A.; Anders, Mark J.; Bone, Lawrence B. // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p218 

    BACKGROUND: Diaphyseal and distal femoral fractures are painful injuries that are frequently seen in patients requiring a trauma work-up in the hospital emergency department prior to definitive management. The purpose of this study was to determine whether a femoral nerve block administered in...

  • Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate Reconstruction. Marco, Rex A. W.; Kushwaha, Vivek P. // Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p20 

    Background: The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the...

  • Open Reduction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures. Hall, Jeremy A.; Beuerlein, Murray J.; McKee, Michael D. // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p74 

    BACKGROUND: Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason,...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics