Implant removal following open reduction and internal fixation for distal radius fracture: A study based on the Diagnosis Procedure Combination database in Japan.

BACKGROUND: The rate of implant removal and the factors influencing its indication in patients with distal radius fracture (DRF) in Japan are unclear. METHODS: We retrospectively evaluated the incidence rate of implant removal in a large cohort of DRF patients obtained from the Diagnosis Procedure Combination database in Japan between April 2014 and March 2019. Patient- and hospital-related factors possibly affecting removal rate, including age, sex, annual number of open reduction and internal fixation (ORIF) for DRF procedures per hospital, number of hospital beds, advanced or general care hospital, and hospital location were analyzed as well. Hospital location was classified into three types based on population and population density as 1) large city, 2) local city, and 3) sparse area. RESULTS: Implant removal was performed in 3242 (26.3%) of 12,328 DRF patients receiving ORIF. According to multivariate analysis, the significant factors related to a decreased probability of removal were older patients, male, large annual number of ORIF for DRF procedures per hospital, large number of hospital beds, advanced care hospital, and hospital in large city. CONCLUSIONS: This study clarified the current implant removal rate and trends following ORIF for DRF in Japan. Both patient- and hospital-related factors significantly impacted the decision for implant removal.

Radiographic Change in Articular Reduction After Volar Locking Plating for Intra-Articular Distal Radius Fractures.

PURPOSE: To examine the stability of the articular reduction 12 weeks after intra-articular distal radius fracture (DRF) fixation with a volar locking plate (VLP). METHODS: We prospectively assessed for losses in articular reduction, including gap and step, during the 12 weeks following surgery for intra-articular DRF treated with a VLP in 68 wrists. The mean patient age was 62 years (range, 16-88 years). Frontal and lateral digital tomosynthesis, a recently developed form of digital tomography, was employed to measure articular gap and step in the lunate and scaphoid fossa of the radius. The average time between surgery and imaging was 1.2 days (range, 0-2 days) for the first evaluation and 87.0 days (range, 74-105 days) for the second examination. RESULTS: The mean gap and step were similar at the first and second examinations: 0.4 mm (SD, 0.8) and 0.3 mm (SD, 0.6) and 0.3 mm (SD, 0.7) and 0.3 mm (SD, 0.5), respectively. CONCLUSIONS: There was no change in the alignment of the fragments in cases treated with VLP. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Venous perfusion assist system has no additional effect compared to simple elevation on post-operative edema in patients with distal radial fracture treated with volar locking plate fixation: A randomized controlled trial.

BACKGROUND: While limb elevation and other methods for reducing hand edema are commonly used in clinical practice, alternative methods, such as compression and venous perfusion assist system (VPAS), have emerged. This study compared the efficacy of VPAS to limb elevation in decreasing hand edema after surgery for distal radial fracture (DRF) treated by a volar locking plate (VLP). METHODS: A randomized controlled trial was conducted in 102 patients to compare VPAS and elevation methods for edema reduction following VLP fixation for DRF. Changes in edema were measured using the tape measure method along with other parameters on the next day and at one, three, six, and 12 weeks postoperatively. RESULTS: There were no significant differences in edema reduction or other factors between the VPAS and elevation groups at any measurement point. CONCLUSIONS: VPAS appears to confer no measurable advantage over management with elevation for edema reduction after VLP fixation of DRF. TRIALS REGISTRY: This study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000015640).

Prospective Evaluation of Median Nerve Dysfunctions in Patients with a Distal Radius Fracture Treated with Volar Locking Plating.

Background: The aim of this study was to identify the risk factors for median nerve dysfunctions after volar locking plate (VLP) fixation for distal radius fracture (DRF). Methods: We prospectively assessed the incidence of median nerve symptoms (MNS) such as numbness, pain, paresthesia, or hypesthesia in the area innervated by the median nerve and evaluated post-operative nerve conduction (NC) in 91 hands of 121 patients after VLP fixation for DRF. Multivariate logistic regression analysis was conducted to identify factors independently associated with MNS and abnormal NC in the injured wrist. Results: There were 18 cases (20%) of MNS on the injured side, 9 hands (10%) of both MNS and abnormal NC, 11 hands (12%) with only abnormal NC, and 9 hands with only MNS. Sensitivity, specificity, and diagnostic accuracy of abnormal NC for diagnosing MNS were 50%, 86%, and 78%, respectively. Four cases did not respond to conservative treatment and received carpal tunnel release concomitantly with plate removal. Logistic regression examination revealed that volar placement of the plate and short stature were significant independent predictors of MNS, while patient age was the sole independent predictor of abnormal NC. Conclusions: Our study demonstrated that plate prominence, short stature, and age were significant independent risk factors for median nerve dysfunctions after VLP fixation for DRF.

Attrition of the Extensor Tendon of the Index Finger Following an Avulsion Fracture of the Third Metacarpal.

We report an avulsion fracture at the base of the third metacarpal involving the extensor carpi radialis brevis insertion and a resulting complication of attritional rupture of the extensor indicis proprius tendon and the extensor digitorum communis to the index finger, in a 67-year-old man.