Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series.

INTRODUCTION: Since the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. OBJECTIVE: The present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. MATERIAL AND METHODS: The series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. RESULTS: At a mean 7 months' follow-up, mean scar length was 17mm (range, 10-40mm), pain 1.13/10 (0-8), Quick-DASH 13.28 (0-86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0-91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DISCUSSION: The minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. LEVEL OF EVIDENCE: III; single-centre retrospective study.

Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning.

The purpose of this study was to develop a technique allowing a faster return to previous activities after surgical treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal. It consisted of an anterograde and retrograde centromedullary double pinning connected. Our series included 40 patients of average age 25 years including 2 women. In 20 cases (group I), an anterograde centromedullary pinning with a 1.6- or 2-mm pin was performed followed by a 6-week orthosis and then 2-week self-education. In 20 cases (group II), an anterograde and retrograde centromedullary double pinning was performed using 2 1.5-mm pins connected by a connector (MétaHUS®, Arex™). A first pin was introduced into the canal antegrade, then the second retrograde. The 2 externalized pins were connected, and self-rehabilitation was encouraged. Mean tourniquet time was 14.75 min (group I) and 15.8 min (group II), respectively. At the last follow-up, the average pain was 0.35/10 and 0.2/10, the Quick DASH 0.68/100 and 0.57/100, the strength of the hand 94.65% and 94.35%, the active flexion MCP 98.5% and 99%, respectively. MCP active extension was 98.5% and 98.75%; the sick leave was 8.4 and 6.3 weeks. All fractures healed without recovery with 3 complications: 2 infections on pins, in each group, 1 CRPS1 (group I). Our results seem to show that the technique of anterograde and retrograde centromedullary double pinning connected in the treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal gives results at least as good as the reference technique with a non-negligible socioeconomic advantage, a less time off work.

Minimally invasive internal fixation for extra-articular distal radius fracture: Comparison between volar plate and intramedullary nail.

INTRODUCTION: There are numerous internal fixation techniques for distal radius fracture, using pins, plates or nails. Some authors have developed minimally invasive procedures. The aim of the present study was to compare two minimally invasive internal fixation techniques for unstable extra-articular distal radius fracture in women over 50 years of age: volar plate (minimally invasive plate osteosynthesis: MIPO), and intramedullary nail. HYPOTHESES: The main study hypothesis was that the incision scar left by minimally invasive internal fixation is smaller using MIPO than an intramedullary nail. The secondary hypotheses were that the two techniques do not differ in terms of pain, functional score, strength, range of motion and radiologic indices. MATERIAL AND METHOD: The series comprised nineteen A2.2 and one A2.1 fractures in 20 female patients with a mean age of 72 years. The first 10 (group 1) received minimally invasive internal fixation of the distal radius by MIPO, and the other 10 (group 2) by intramedullary nail locked onto the distal radius epiphysis and diaphysis. RESULTS: The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail (mean, 14.3mm vs. 32.8mm). Some of the secondary hypotheses were also confirmed: there were no differences between the two techniques in terms of pain at 6 months, QuickDASH, PRWE (Patient-Reported Wrist Evaluation), range of motion or ulnar variance; two were not confirmed: pain at 6 weeks was less with intramedullary nails, and palmar slope was better with MIPO. DISCUSSION AND CONCLUSION: The main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail. In conclusion, the present findings showed that internal fixation of unstable extra-articular fracture in over 50-year-olds gave better clinical results at 6 weeks using an intramedullary nail, while MIPO required smaller incision. LEVEL OF EVIDENCE: III, retrospective study.

Minimally Invasive Plate Osteosynthesis for Extra-articular Distal Radius Fracture in Postmenopausal Women: Longitudinal versus Transverse Incision.

Background This work aimed to compare two mini-invasive palmar approaches (longitudinal and transverse) to osteosynthesize fractures of the distal radius. The main hypothesis was that the longitudinal technique gave smaller incisions. The secondary hypothesis was that the longitudinal technique would be better for the recovery of pain, functional scores, strength, and mobility. Materials and Methods The series included 30 extra-articular distal radius fractures in 30 patients (average age: 74 years) fixed with volar locking plate using a mini-invasive technique. Fifteen of these patients had a single longitudinal surgical approach (Group I), and 15 had a transverse approach that was completed with a longitudinal incision for the proximal screws (Group II). Results The combined average incision size was 14.73 mm in Group I and 19.8 mm in Group II. After 6 months, the pain was on average 1.4/10 (Group I) and 0.46/10 (Group II), the quick Disability of the Arm, Shoulder, and Hand was 13.63/100 (Group I) and 2.8/100 (Group II), Patient-Related Wrist Evaluation was 11.8/100 (Group I) and 5.97/100 (Group II), grip strength was 81.06% (Group I) and 72.13% (Group II), flexion was 88.13% (Group I) and 75% (Group II), extension was 86% (Group I) and 64.6% (Group II), ulnar inclination was 89% (Group I) and 78.67% (Group II), radial inclination was 89.73% (Group I) and 79.93% (Group II), pronation was 96.67% (Group I) and 81.46% (Group II), and supination was 91.93% (Group I) and 79.87% (Group II). Clinical Relevance The longitudinal technique gave smaller incisions than the transverse technique. Among the secondary hypotheses, all the variables were better with the longitudinal technique, except the pain, although without any significant difference.

Correction to: Distal radius fluoroscopic skyline view: extension-supination versus flexion-supination.

The original version of this article unfortunately contained a mistake and has been corrected. First and last names of the author were interchanged. The correct author name is given below.

Distal radius fluoroscopic skyline view: extension-supination versus flexion-supination.

The aim of our study was to compare the vertical fluoroscopic view of the wrist in extension and supination (ES) to the view in flexion and supination (FS) and determine which of the two views allowed the best visualization of four selected anatomical landmarks SDLR (radial styloid, dorsal radius cortex, Lister's tubercle and distal radioulnar joint). Our case series included 50 patients who had suffered a distal radius fracture and undergone an open reduction and internal fixation procedure with a volar locking plate. For each case, two fluoroscopic views were taken: ES (wrist extension and supination) (group I) and FS (wrist flexion and supination) (group II). Ten observers had to recognize the SDLR anatomical landmarks on 100 fluoroscopic skyline views (time 1) and 15 days later (time 2). The rate of recognition of the four anatomical landmarks was 78% in group I and 66% in group II (p < 0.001). The concordance rate of recognition of the four anatomical landmarks was mediocre (κ = 0.411). In conclusion, the vertical fluoroscopic skyline view in wrist extension and supination seems to be the most adequate view to assess the quality of the fracture reduction, the distal radioulnar joint and the length of the screws in open reduction and internal fixation of distal radius fractures with volar locking plates.

Treatment of tendinous mallet fingers using a Stack splint versus a dorsal glued splint.

The goal of this study was to compare the results of a Stack splint compared to a dorsal glued splint in the treatment of tendinous mallet fingers. Our series included 100 patients, aged 47 years in average, among which 40 are women, with a 9-week follow-up. The first 50 patients (group I) were treated with a dorsal glued splint, and the 50 following patients (group II) were treated with a Stack splint. The average lack of active extension of the distal phalanx was 3.1° in group I and 1.74° in group II. The average pain was rated 0.22/10 in group I and 0.26/10 in group II. There were seven cases of nail dystrophies, 18 cases of macerations and five cases of swan neck deformities in group I. There were six cases of macerations and four cases of swan neck deformities in group II. The dorsal nail-glued splint gives comparable results to the Stack splint with the added advantage of leaving the fingertip free.

Surgical technique: about a new total and isoelastic wrist implant (Prosthelast®).

This study describes a new total wrist implant (Prosthelast®) designed to reduce the risk of distal migration of the carpal component. The Prosthelast® implant consists in a one-block radial implant replacing the metaphysis and the articular surface fixed to a radial elastic centromedullar wire and a carpal component in titanium with an articular condylar surface in polyethylene. We operated on five patients (three male patients and two female patients) and followed them up for 12 months on average. Two of the patients presented with rheumatoid arthritis of the wrist, and an ulnar osteotomy (Darrach procedure) was carried out at the same time of the arthroplasty. All clinical variables improved postoperatively (Quick DASH score, pain score, range of motion) except from wrist flexion which was reduced. No patients underwent revision surgery. Two patients presented with a periprosthetic radiolucent loosening around the radial component, but no implant migration was observed. Overall, the preliminary results of our case series show that the new Prosthelast® implant presents comparable short-term results to those described in the literature. We will follow up the patients to verify that long-term results are as satisfactory as the short-term results.

Results of the treatment of first carpometacarpal joint osteoarthritis: trapeziectomy alone versus trapeziectomy associated with suspensionplasty.

BACKGROUNDS: The goal of this study was to compare trapeziectomy alone to trapeziectomy associated with a technique of suspensionplasty using the abductor pollicis longus with a minimum of 6 years of follow-up in the treatment of osteoarthritis of the first carpometacarpal joint. METHODS: Our series included 46 trapeziectomies in 35 patients, aged 69 years in average, among which 27 were women. In 27 cases group I, a trapeziectomy alone was performed, and in 19 cases group II, a trapeziectomy associated with an abductor pollicis longus suspensionplasty was performed. RESULTS: At the last follow-up, the difference between pre- and postoperative Quick DASH was - 36.104 in average in group I and - 38.877 in average in group II p = 0.7717. The difference between pre- and postoperative pain was - 3.926 in average in group I and - 4.368 in average in group II p = 0.35. The difference of pre- and postoperative thumb opposition was 0.630 in group I and 0.421 in group II p = 0.3033. The average difference of pre- and postoperative key pinch was 0.389 in group I and 0.842 in group II p = 0.3303. No complication was reported. CONCLUSIONS: Our results suggest that it is unnecessary to perform a ligamentoplasty when a trapeziectomy is indicated.

Correction to: The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures.

With regards to Juan José Hidalgo Diaz, fifth author. The author's name is incorrectly listed on Pub-Med. The first and last name has been mixed up.Correct first name is: JJ (on PubMed: JJH.).Correct last name is: Hidalgo Diaz (on PubMed: Diaz).On SpringerLink the name is listed correctly, but on PubMed he is listed as Diaz JJH.

Teaching of distal radius shortening osteotomy: three-dimensional procedural simulator versus bone procedural simulator.

In order to facilitate the learning of distal radius shortening osteotomy by junior surgeons, the main assumption was that using a three-dimensional procedural simulator was better than a bone procedural simulator. After viewing a video, ten junior surgeons performed a distal radius shortening osteotomy: five with a bone procedural simulator (Group 1) and five with a three-dimensional procedural simulator (Group 2). All subsequently performed the same surgery on fresh cadaveric bones. The duration of the procedure, shortening of the radius, and the level of osteotomy were significantly better in Group 2. The three-dimensional procedural simulator seems to teach distal radius osteotomy better than a bone model and could be useful in teaching and learning bone surgery of the wrist.

Conservative treatment of distal fractures after the age of 65: a review of literature.

The goal of this study was to evaluate the role of conservative treatment of distal radius fractures in the elderly since 2000. Our series included 22 articles, of which 3 reviews, 2 meta-analyses, 6 descriptive series of conservative treatment, 10 series comparing surgical and conservative treatments and 1 series comparing different types of conservative treatments. The reduction was performed by closed reduction in 7 cases and by traction in 3 cases. A short-arm cast was used in 8 cases and a long-arm cast in 4 cases for an average length of 6 weeks. The indications of conservative treatment were varied: AO type A fractures in 2 cases, type C fractures in 1 case, types A and C in 8 cases and types A, B and C in 3 cases. No article reported any significant difference between surgical and conservative treatments in terms of DASH or PRWE, whereas strength was sometimes improved when surgical treatment was used. Radiological results were always better after surgical treatment. The rate of complications varied greatly, greater, equally or lower compared to conservative treatment depending on the series. All in all, there is no consensus to assert that a conservative treatment is more justified than a surgical treatment to treat distal radius fractures after the age of 65. Most authors consider that the long-term clinical outcome is identical and that the radiological result is better after surgical treatment. The fact that the fixation of a distal radius fracture by a volar locking plate after 65 years speeds up the recovery remains to be proven.

The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures.

The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used. It offers the advantage of preserving ligamentotaxis which facilitates the reduction, and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intraarticular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.

Long Volar Plating for Metadiaphyseal Fractures of Distal Radius: Study Comparing Minimally Invasive Plate Osteosynthesis versus Conventional Approach.

Background Minimally invasive plate osteosynthesis (MIPO) has been used in wrist surgery for several years. The purpose of this retrospective study was to compare clinical and radiologic outcomes of MIPO technique with those of a conventional approach in the treatment of metadiaphyseal distal radius fracture by long volar plating. Materials and Methods Our series consisted of 32 fractures in 31 patients, mean age 63.9 years, including 16 men and 15 women. MIPO technique was used in 15 wrists (group 1) and conventional approach (> 60 mm of skin incision) in 17 wrists (group 2). In group 1, a long volar plate was inserted under pronator quadratus through a 15- to 30-mm distal incision then fixed to the epiphysis of the distal radius. Then, through a 15- to 30-mm proximal incision, the plate was fixed to the diaphysis of the radius, thus reducing the fracture. Results In group 1, mean distal incision size was 23.5 and 16.9 mm for proximal one. Mean total scar size (sum of both distal and proximal incisions) was 40.0 mm in group 1 and 84.1 mm in group 2. Mean tourniquet time was 58.4 minutes in group 1 and 68.9 minutes in group 2. At latest follow-up, no significant difference was noted in both the groups concerning pain, quick-DASH score, grip strength, ROM, and radiologic data. One extensor pollicis longus rupture treated by tendon transfer was done in group 1. Conclusion The MIPO technique for metadiaphyseal fractures of the distal radius by long volar plating has cosmetic and economic advantages compared with the conventional approach. Conversion to conventional approach is possible at any time in case of technical difficulties. Level of Evidence III.

Carpal scaphoid non-union treatment: a retrospective trial comparing simple retrograde percutaneous screw fixation versus percutaneous screw fixation plus pulsed electromagnetic fields (Physiostim®).

BACKGROUND: The purpose of this retrospective comparative study was to assess whether a complementary treatment by pulsed electromagnetic field could increase the bone-healing rate of scaphoid non-union without SNAC (scaphoid non-union advanced collapse) treated by retrograde percutaneous screw fixation. CASE DESCRIPTION: Eighteen patients with scaphoid non-union were included in this retrospective study. The group 1 was made of nine cases (seven stage IIA and two stage IIB) of scaphoid non-union treated by retrograde percutaneous screw fixation and pulsed electromagnetic fields (Physiostim®). The group 2 was made of nine cases (six stage IIA and three stage IIB) treated by simple retrograde percutaneous screw fixation. RESULTS: With a 10-month follow-up in group 1 and a 9.5-month follow-up in group 2, there were three cases of non-union in group 1 and two cases in group 2. Regarding the type of non-union, there was one case among the stage IIB and four cases among the stage IIA. CLINICAL RELEVANCE: The results of the study did not show any interest in the use of pulsed electromagnetic field for the treatment of carpal scaphoid non-union. They should be dropped. LEVEL OF EVIDENCE: III.

Erratum: Distal Radius Isoelastic Resurfacing Prosthesis: A Preliminary Report.

[This corrects the article DOI: 10.1055/s-0035-1556855.].

Review of Acute Traumatic Closed Mallet Finger Injuries in Adults.

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

Hyperparathyroidism-related extensor tenosynovitis at the wrist: a general review of the literature.

Extensor tenosynovitis often occurs accompanying with rheumatoid arthritis, gout, trauma, mycobacterium and dialysis-related amyloidosis. However, there is no recognition of extensor tenosynovitis accompanying with hyperparathyroidism. The purpose of this general review was to describe the clinical condition and to report the results of surgical intervention in the extensor tenosynovitis at the wrist related to hyperparathyroidism. Hyperparathyroidism is thought to be a rare disease in adult. Although renal symptoms are the commonest symptom, musculoskeletal complaints also occur in hyperparathyroidism. From our general review, hyperparathyroidism deserves consideration in the differential diagnosis of extensor tenosynovitis at the wrist.