Treatment of complex fractures of the distal radius: A prospective randomised comparison of external fixation ‘versus’ locked volar plating

Jeudy, J.; Steiger, Vincent; Boyer, Patrick; Cronier, P.; Bizot, Pascal; Massin, P.

doi:10.1016/j.injury.2011.05.021

Cited by 65 publications

(61 citation statements)

References 37 publications

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“…Although there are several papers that suggest that this is not essential for long-term functional outcome, it appears necessary to minimise the risk of rupture to the FPL tendon [6,7].…”

Section: Resultsmentioning

confidence: 99%

The Role of Fracture Reduction and Plate Position in the Aetiology of Flexor Pollicis Longus Tendon Rupture after Volar Plate Fixation of Distal Radius Fractures

Selvan

Machin

Perry

et al. 2015

Hand (New York, N,Y.)

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Background Flexor pollicis longus (FPL) rupture has been described as complication following volar plating for distal radius fractures. It has been hypothesised that this is due to plate prominence. The aim of the study was to investigate the relationship between sub-optimal plate position and fracture reduction on plate prominence. Methods Plate prominence was measured in two experimental models. In the first, the effect of plate position was investigated using 18 fresh frozen cadavers with prominence being measured using a micrometer. In the second study, the effect of fracture reduction on plate prominence was investigated using similar methodology with simulated mal-reductions on dry bone models. Results The results of the first study showed a significant increase in lift-off for three plates (DVR, Synthes Universal and Acu-Loc), if the plates were moved distally or proximally from the anatomical position. Similar increases in prominence were also seen with rotational mal-positions.The results of the second study showed a statistically significant effect on plate prominence for even a 5°mal-reduction (p=0.001) with worsening lift-off with increasing mal-reduction. These changes are significantly different from baseline and also significantly different to the lift-off recorded with mal-reductions 5°better and worse.Mal-reductions also necessitate more proximal placement of the plate to avoid screw penetration of the articular surface, and each 5°increment is significantly different from baseline. Conclusions The results show a statistically and clinically significant effect of both plate position and fracture reduction on plate prominence and support the theory that both contribute to the aetiology of post-operative FPL rupture.

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“…Although there are several papers that suggest that this is not essential for long-term functional outcome, it appears necessary to minimise the risk of rupture to the FPL tendon [6,7].…”

Section: Resultsmentioning

confidence: 99%

The Role of Fracture Reduction and Plate Position in the Aetiology of Flexor Pollicis Longus Tendon Rupture after Volar Plate Fixation of Distal Radius Fractures

Selvan

Machin

Perry

et al. 2015

Hand (New York, N,Y.)

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show abstract

“…One RCT was excluded from our analysis because of a duration of only 6 months after fixation (Jeudy et al 2012). …”

Section: Resultsmentioning

confidence: 99%

Comparison of internal and external fixation of distal radius fractures

Xie

Qin

et al. 2013

Acta Orthopaedica

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Background and purpose There is no consensus on the difference in effects of internal fixation (IF) and external fixation (EF) on outcomes for the treatment of distal radius fractures. We performed a meta-analysis of randomized clinical studies.Methods We searched the literature and included studies that compared the effects of IF and EF on the treatment of distal radius fractures. Statistically, we pooled patient data using standard meta-analytic methods. For the continuous variables, the weighted mean difference (WMD) was used. For dichotomous data, the relative risk (RR) was calculated.Results 10 studies were eligible for data extraction. The pooled data showed that compared with EF, IF led to statistically significantly better Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 12 months postoperatively, recovery of forearm supination at 3 months, and restoration of volar tilt and radial inclination. IF using volar locking plates resulted in better DASH scores than EF at 3 and 6 months, but the trend diminished over time; at 12 months postoperatively, the scores were not statistically significant. Compared with EF, IF led to fewer minor surgical complications.Interpretation For surgical treatment of distal radius fractures, IF yields better functional outcomes, forearm supination, restoration of anatomic volar tilt and radial inclination, and fewer minor complications. The patients who received IF using volar locking plates for the treatment of distal radius recovered more quickly than did patients who received EF.

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“…Furthermore, a loss of reduction may occur for a period up to 6 months after external fixation (20). ORIF using a plate has advantages for the restoration of anatomy, as it allows superior visualization, better mechanical stability, and a shortened immobilization period than cast immobilization or external fixation do (21222324). Our study confirms the increasing popularity of this surgical method.…”

Section: Discussionmentioning

confidence: 99%

National Surgical Trends for Distal Radius Fractures in Korea

Lee

Kim

et al. 2017

J Korean Med Sci

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The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ≥ 20 years with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30–100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.

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Treatment of complex fractures of the distal radius: A prospective randomised comparison of external fixation ‘versus’ locked volar plating

Cited by 65 publications

References 37 publications

The Role of Fracture Reduction and Plate Position in the Aetiology of Flexor Pollicis Longus Tendon Rupture after Volar Plate Fixation of Distal Radius Fractures

The Role of Fracture Reduction and Plate Position in the Aetiology of Flexor Pollicis Longus Tendon Rupture after Volar Plate Fixation of Distal Radius Fractures

Comparison of internal and external fixation of distal radius fractures

National Surgical Trends for Distal Radius Fractures in Korea

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