Purpose: To determine if distraction bridge plate (DBP) fixation as the primary method of stabilization can effectively correct and maintain acceptable radiographic parameters in the treatment of comminuted, intra-articular distal radius fractures while allowing early load-bearing.
Methods: A retrospective review was performed of all consecutive intra-articular distal radius fractures that underwent DBP fixation with or without supplemental fixation methods (fragment-specific implants or K-wires). Patients treated with a volar locked plate in addition to DBP were excluded. Radiographic outcomes measures included volar tilt (°), radial height (mm), radial inclination (°), articular step-off (mm), lunate-lunate facet ratio (LLFR), and teardrop angle (°) measured on post-reduction, immediately post-operative, prior to and after DBP removal.
Results: Twenty-three comminuted, intra-articular distal radius fractures were treated with primary DBP fixation. Supplemental fixation was utilized in 10 fractures and included fragment-specific implants ( = 6) and/or K-wires ( = 5). Distraction bridge plates were removed after a mean of 13.6 weeks. At a mean radiographic follow-up of 11.4 weeks (range: 2-45 weeks) following DBP removal, all fractures had united with a mean volar tilt of 6.3° ± 5.8°, radial height of 11.3 ± 2.3 mm, radial inclination of 20.2° ± 4.5°, articular step-off of 0.6 mm ± 0.8, and LLFR of 1.05 ± 0.06. However, the teardrop angle could not be restored to a normal value with DBP fixation. Complications included 1 plate breakage and 1 peri-hardware radial shaft fracture.
Conclusion: Distraction bridge plate fixation is a reliable method to stabilize highly comminuted, intra-articular distal radius fractures in patients with a well-aligned volar rim fragment of the lunate facet.
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http://dx.doi.org/10.1007/s43465-022-00812-3 | DOI Listing |
Cureus
November 2024
Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Objective: This study aimed to evaluate the functional outcomes of three surgical management strategies for pilon fractures, including primary external fixation with delayed plating, external fixation with minimal internal fixation, and single-stage open reduction and internal fixation (ORIF) with plating.
Methods: This prospective cohort study included 34 patients with complex intra-articular fractures of the distal tibia (AO-OTA type 43-C) treated between June 2018 and December 2019. Patients were managed surgically based on the local skin condition and swelling, employing either primary-stage external fixation with delayed plating (Group A), external fixation with minimal internal fixation (Group B), or single-stage ORIF with plating (Group C).
BMC Musculoskelet Disord
December 2024
Orthopedics Department, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, China.
Purposes: The objective of this study was to investigate intra-articular distal radius fractures, aiming to provide a comprehensive analysis of fracture patterns and discuss the corresponding treatment strategies for each pattern.
Methods: 294 cases of intra-articular distal radius fractures lines were collected and clustered thorough K-means and hierarchical clustering algorithm. The demographic data of patients and the clinical treatment outcomes were recorded.
J Am Acad Orthop Surg
December 2024
From the Zucker School of Medicine at Hofstra/Northwell, New York Hand and Wrist Center of Lenox Hill, New York.
Surgical fixation of unstable distal radius fractures greatly depends on the characteristics of the fracture pattern. Intra-articular fractures of the distal radius often involve several key fragments that require adequate reduction and fixation. The volar lunate facet is just one of those fragments, making up the critical corner of the distal radius articular surface and serving as the keystone to both the radiocarpal and distal radioulnar joints.
View Article and Find Full Text PDFCureus
November 2024
Department of Orthopedics and Traumatology, Kunhitharuvai Memorial Charitable Trust (KMCT) Medical College, Manassery, IND.
Objectives: The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.
Methods: A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III.
Arthrosc Tech
November 2024
Department of Orthopedic Surgery, Hospital Clínico Universitario Valladolid, Valladolid, Spain.
The elbow is one of the most commonly dislocated joints. Although simple dislocations of the elbow usually resolve with conservative management, certain patients can experience residual chronic instability. Posterolateral rotational instability accounts for approximately 80% of elbow chronic instability cases.
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