The volar rim of the distal radius is the only bony restraint to volar carpal subluxation. Higher loads across the volar rim require stable and rigid fixation to maintain reduction and allow healing while rehabilitation begins. Volar marginal fragments are not amenable to buttressing by fixed angle volar locking plates. Appropriate management of volar marginal fragments comprises two steps-recognition of their presence and rigid anatomical repair. The best opportunity for success in the presence of a volar marginal fragment is its adequate initial treatment. The purpose of this review is to reinforce the importance of a complete preoperative and intraoperative evaluation of distal radius fractures. Volar marginal fragments can easily be overlooked even following initial reduction and fixation. Understanding the relevant anatomy and loading parameters can facilitate intraoperative decisions on approach and fixation, which are integral to achieving optimal clinical outcomes.
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http://dx.doi.org/10.1055/s-0041-1732338 | DOI Listing |
BMC Musculoskelet Disord
November 2024
School of Medicine, China Medical University, Taichung, Taiwan.
Background: Arthrodesis serves as the traditional therapeutic approach for advanced distal interphalangeal joint (DIPJ) arthritis. However, the conventional technique may prove insufficient when the excision of pronounced volar and lateral spurs is required. To address this, we innovated the 'smile incision with reverse shotgun approach'.
View Article and Find Full Text PDFBMC Musculoskelet Disord
November 2024
Laboratory of Bioengineering, Department of Orthopedics and Anesthesiology, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Intra-articular fractures of the distal radius require anatomical reduction and stable fixation. When the fracture encompasses the articular facet of the bone, maintaining the reduction is challenging due to the fragment's size and high instability. While specific implants have been developed to fix this fragment, their effectives have been limited.
View Article and Find Full Text PDFPurpose: Distal radius fractures may include difficult-to-treat fractures of the volar ulnar corner, colloquially termed as the "critical corner." These fragments are problematic because they are often missed, and their fixation is difficult. We aimed to compare the distal extent of the exposure of the volar surface of the distal radius between the classic Henry approach and the extended flexor carpi radialis (EFCR) approach.
View Article and Find Full Text PDFJ Hand Surg Am
July 2024
Emory University, Department of Orthopedic Surgery, Atlanta, GA. Electronic address:
Purpose: Intramedullary (IM) screw fixation is gaining popularity in the treatment of metacarpal fractures. Despite its rapid adoption, there is a paucity of evidence regarding parameters to optimize effectiveness. This study aimed to quantify the relationship between stability, IM screw size, and canal fill using a cadaveric model.
View Article and Find Full Text PDFJ Hand Microsurg
March 2024
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Introduction: Mohs surgery and reconstruction has enabled tissue-preserving resection of cutaneous malignancies. The goal of our case series evaluation is to present reconstructive techniques and functional outcomes in patients undergoing digit-sparing treatment for primary melanoma.
Materials And Methods: A chart review was performed to identify consecutive patients undergoing Mohs surgery and reconstruction for melanoma of the digits.
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