Ultrasonography of the median nerve before removal of anterior locking plates from the distal radius.

Both forearms of 36 patients who had been treated with an anterior locking plate using the trans-flexor carpi radialis approach for unilateral distal radial fractures were investigated by ultrasonography from the distal end of the radius to 5 cm proximally before plate removal. After fixation of the anterior locking plate, the median nerve was significantly more radially located to the flexor carpi radialis tendon than on the healthy side and showed hypertrophy and flattening at the distal end of the radius. In six cases, the median nerve on the plate side lay radial to the flexor carpi radialis tendon. The median nerve after plate fixation may lie more radially than its original position. Confirming the radial deviation of the median nerve by ultrasonography before removal of the anterior locking plate is useful to prevent the complication of median nerve injury.Level of evidence: IV.

Impact of Possible Sarcopenia and Nutritional Status on Postoperative Quick Disabilities of the Arm, Shoulder, and Hand Score in Geriatric Women With Distal Radius Fracture.

PURPOSE: Distal radius fracture (DRF), sarcopenia, and malnutrition have been reported to be interrelated. However, there are few reports on the effects of sarcopenia and malnutrition on DRF patients' postoperative outcomes. This study examined the healthy-side grip strength and preoperative blood tests to determine the presence of possible sarcopenia (PS) and malnutrition in geriatric women with DRF and their impact on postoperative functional outcomes. METHODS: Fifty-five woman older than 60 years treated with volar-locking plate fixation for low-energy DRF from standing-level falls were retrospectively studied. Based on the criteria of The Asian Working Group for Sarcopenia 2019, patients with a healthy-side grip strength <18 kg were defined as PS. Nutritional assessment was performed using Onodera's Prognostic Nutritional Index (PNI) before surgery, with a value <50 defined as malnutrition. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for functional assessment at 1 year after surgery. Patients were divided into two groups according to PS, and patient demographic data and postoperative outcomes were compared. Multiple regression analysis was performed to estimate the regression coefficient and 95% confidence intervals for 1-year QuickDASH after surgery with adjustment for age, PS, and malnutrition. RESULTS: Possible sarcopenia was present in 10 patients (18.2%), and malnutrition in 24 patients (43.6%). Possible sarcopenia patients were older, had lower PNI, serum albumin, and both sides grip strength, and worse QuickDASH compared with non-PS patients. In multiple regression analysis, age, PS, and malnutrition were significant predictors of QuickDASH (standardized coefficient ß, 0.35, 0.34, and 0.24; 95% confidence interval, 0.22-1.02, 3.52-16.49, and 0.50-10.78). CONCLUSIONS: Possible sarcopenia with a healthy-side grip strength <18 kg and malnutrition with a PNI <50 were associated with worse 1-year QuickDASH after surgery in women DRF patients over 60 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic Ⅳ.

Surgical Treatment of Distal Radius Fractures Complicated by Concomitant Flexor Carpi Radialis Brevis: A Case Series and Surgical Techniques.

Introduction: The flexor carpi radialis brevis (FCRB) is a rare anatomical variation, with a reported prevalence ranging from 0.9% to 8.7%. Our previous report showed three cases of FCRB in distal radius fracture (DRF) and found that hypoplastic pronator quadratus (PQ) adjacent to the FCRB muscle made it difficult to cover a volar locking plate (VLP). As we subsequently experienced additional six FCRBs, we report on new findings and surgical tips. Case Report: VLP fixation was performed on DRF with FCRB in nine limbs of eight patients. The prevalence was 2.9% (9 of 310 limbs). Of the seven patients that underwent unilateral surgery, six were muscle type and one was tendon type. One patient who underwent bilateral surgery had a muscle type on the left and a tendon type on the right. In three muscle types, as the FCRB muscle belly was widely attached to the radial side of the radius and the radial side of the PQ was hypoplastic, postoperative covering of the plate by repair of the PQ was impossible. Then, in two of those cases, the PQ and FCRB were sutured and the plate was covered. FCRB muscle could be retracted to the radial side in all cases. One patient with a tendon type had a ruptured tendon, which was left unrepaired. All patients had no postoperative problems. Conclusion: In the muscle-type FCRB, the muscle should be retracted to the radial side for VLP fixation. The muscle belly might occupy the radial side of the radius, and the PQ might be hypoplastic and unrepairable. However, the plate can be covered by suturing the PQ and FCRB.

Relationship Between Malunion and Short-Term Outcomes of Nonsurgical Treatment of Distal Radius Fractures in the Elderly: Differences Between Early- and Late-Geriatric Patients.

PURPOSE: Previous studies have suggested little association between radiographic malalignment and long-term functional outcomes of nonsurgical treatment of distal radius fractures in geriatric patients. However, no report has stratified the elderly by age and focused on short-term outcomes. The purpose of this study was to determine how the relationship between malunion and patient outcomes differs between early- and late-geriatric patients in the short and long terms after injury, thereby informing explanations and decision-making on treatment options for geriatric patients with distal radius fractures. METHODS: One hundred patients treated nonsurgically for distal radius fractures were evaluated retrospectively; 52 were defined as early-geriatric patients (aged 60-72 years) and 48 as late-geriatric (aged >77 years). Malunion (dorsal tilt > 10°, ulnar variance > 3 mm, or intra-articular displacement or step-off > 2 mm), range of motion, and grip strength were investigated at 3 months. Multiple regression analysis was performed for each age group using Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores at 3 months as the dependent variable. QuickDASH scores over 1 year after injury were analyzed in the same way. RESULTS: The early-geriatric patients included 33 acceptable unions and 19 malunions. The late-geriatric patients included 12 acceptable unions and 26 malunions. The significant predictors of QuickDASH scores at 3 months were malunion for the early-geriatric group and grip strength for the late-geriatric group (standardized coefficient ß, 0.31 and -0.49, respectively). No factor significantly predicted the QuickDASH scores after at least 1 year in either group. CONCLUSIONS: Malunion was associated with worse QuickDASH scores at 3 months after injury in the early-geriatric patients but not in the late-geriatric patients and did not predict the QuickDASH scores at 1 year after injury in either age group. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Factors Affecting Functional Recovery After Volar Locking Plate Fixation for Distal Radius Fractures.

BACKGROUND: There is still no certainty about factors delaying functional recovery after surgery, although volar locking plate (VLP) fixation is the mainstay of treatment for distal radius fractures (DRFs), and several good postoperative recoveries have been reported. The purpose of this study was to investigate factors affecting functional recovery after VLP fixation for DRF. METHODS: The subjects included 104 patients (84 females, 20 males, mean age: 63.2 ± 13.8 years) treated with VLP fixation for DRF, who could be followed for 1 year. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and range of motion of the wrist joint were measured at 3, 6, and 12 months postoperatively, and the primary outcome was the QuickDASH score. A multiple regression analysis adjusted for age and sex was used to analyze factors affecting functional recovery at 12 months. RESULTS: A multiple regression analysis showed that the factors that significantly influenced the QuickDASH score at 1 year postoperatively were the grip strength ratio to the uninjured side, dominancy of the injured hand, and postoperative ulnar variance, in descending order of involvement. Trauma energy, history of diabetes, fracture type, complications, and range of motion were not included in the model. CONCLUSIONS: Smaller grip strength, dominant-hand injury, and larger postoperative ulnar variance significantly worsened the QuickDASH score at 1 year postoperatively. In order to achieve satisfactory functional recovery at 1 year after surgery, we confirmed that it is important to surgically achieve smaller postoperative ulnar variance and increase grip strength.

The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores in 961 Japanese volunteers.

INTRODUCTION: Patient-reported outcomes recently have been used to assess treatment outcomes. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) is a particularly convenient and useful tools. However, data on the normative values of Japanese population are lacking, so the present study was conducted to gather this information. METHODS: We assessed 1098 volunteers over 18 years of age (363 men and 735 women, average 50 years old) who had not received upper limb treatment in a medical facility. These participants included our institution's staff, their family members, and the participants in the group meetings held by institution's staff. Their occupations were also examined. We divided occupations into nonmanual and manual labor. These factors of the participants were then analyzed to clarify which (if any) influenced the QuickDASH. RESULTS: Valid answers were obtained from 961 subjects (87.5%). The median score was 2 (mean: 4.8) in the overall population, 0 (mean: 2.6) in men, and 2.5 (mean: 6.0) in women. The scores increased with age and were higher in women than in men. There were no significant differences by manual labor. Female sex and older age were identified as factors that influenced the QuickDASH score in the multiple regression analysis. There were high correlations among QuickDASH, work and sports/music scores. CONCLUSIONS: The present study provided QuickDASH scores for Japanese volunteers who had not received upper limb treatment in a medical facility. The scores were associated with older age and female sex. This study helps us to know the degree of potential upper limb impairment in the general population, and will help in populational strategies as primary and secondary preventive medicine for upper limb-related diseases.

Relationship Between Hand Dominance and Treatment Outcomes for Distal Radius Fractures in the Elderly in the Short-Term.

Purpose: Many studies have found no notable long-term differences in functional outcomes between operative and conservative treatments for distal radius fractures (DRFs) in elderly patients. However, those studies have not considered hand dominance. The current study compared outcomes between both treatments in a dominant wrist-injured group (dominant group) and nondominant wrist-injured group (nondominant group). Methods: A total of 101 patients aged 65 years and older who experienced displaced DRF requiring reduction and who were managed for over 3 months with either operative or conservative treatment were examined. The dominant group included 46 subjects (operative, n = 26; conservative, n = 20), and the nondominant group included 55 subjects (operative, n = 28; conservative, n = 27). All operative treatments were performed with volar locking plate fixation, and all conservative treatments were immobilized with a sugar-tong orthosis or forearm cast. Functional outcomes and radiographic assessments were compared 3 months after treatment. The primary outcome measure was the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; secondary outcomes were grip strength, range of motion, and Mayo wrist score. We also examined QuickDASH scores after at least 1 year. Results: The QuickDASH score showed no significant differences between treatments by dominance at 3 months or more than a year. In the dominant group, operative treatment resulted in significant 7-kg greater grip strength at 3 months, whereas the nondominant group showed no significant differences in functional outcomes between treatments. Conclusions: Although QuickDASH scores were similar at 3 months and 1 year between treatments regardless of hand dominance, surgery for dominant-side DRF resulted in better grip strength than conservative treatment at 3 months. Clinical relevance: This study will help clarify potential outcomes differences between operative and conservative DRF treatment in patients aged over age 65 years.

Volar Locking Plate Fixation of Distal Radius Fracture with a Flexor Carpi Radialis Brevis and a Hypoplastic Pronator Quadratus.

INTRODUCTION: Recently, distal radius fracture (DRF) has been treated with internal fixation using volar locking plates and several reports describing patients with a flexor carpi radialis brevis (FCRB) appeared. However, no studies have so far investigated the location of the FCRB relative to the volar locking plate. CASE REPORT: We herein report three cases of DRF with an FCRB. Two patients had a bilateral FCRB, and an FCRB was detected in 5 of 174 limbs (2.9%). In all cases, the FCRB had a muscle belly and was retracted to the radial side and volar plate fixation was performed without difficulty. The pronator quadratus (PQ) under the FCRB was thin. In one case, the PQ was hypoplastic and restoration was impossible. The distance from the plate to the FCRB and that from the plate to the flexor pollicis longus (FPL) tendon were examined postoperatively using ultrasound. In the case in which the PQ could not be restored, the FPL tendon was located close to the plate and the FCRB was in contact with the plate. CONCLUSION: As volar locking plate fixation of a DRF with an FCRB and a hypoplastic PQ may cause the restoration of the PQ impossible, the operation should be performed more carefully and follow-up is necessary to avoid post-operative FPL tendon injury and FCRB tendinopathy due to friction with the plate.