Radiological results of surgical management of fracture of the distal radius treated with volar locking plates.

OBJECTIVES: Distal radius fracture (DRF) is the most common upper extremity fracture. The incidence of complications after surgical treatment still remains high. The objective of our study was to assess functional and radiological results of DRF treated with volar locking plate. METHODS: We conducted a retrospective study including DRF treated by open reduction and internal fixation with a volar locking plate during a period of 8 years (2010-2018). Data were collected from clinical records and included patient demographics, fracture characteristics, radiological parameters (radial inclination, palmar tilt, ulnar variance, articular step-off), range of motion (ROM), complications and reinterventions. RESULTS: A total of 170 patients (63.5% female) met the inclusion criteria with a mean age of 55.9 years [24.1-83.7; 13.76]. High energy injuries were more frequent in younger patients (25.56% vs 3.95%; p < 0.0001). AO classification was: 2R3A: 23.5%, 2R3B: 24.1% and 2R3C: 52.4%. Time until surgery was 8.5 days, longer in extraarticular fractures (AO-2R3A: 12.22 days, AO-2R3B: 7.97 days, AO-2R3C: 7.04 days, p = 0.018). Younger patients had better radial inclination (excellent in 85.1% vs 59.21%, p = 0.001) and radial shortening (excellent in 100% vs 88.15%, p = 0.001). ROM was: flexion 63° [0-90°; 19.73], extension 57.67° [5-90°; 21.61], pronation 78.94° [40-90°] and supination 81.76° [38-90°; 8.87]. We found a weak correlation between ROM in flexion-extension and radial shortening (r = 0.218; p = 0.001) and articular step-off (r = -0.269; p = 0.002). We had 39 complications (21.18% of patients). 10.6% of patients needed a re-operation, being the most frequent hardware removal (6.5%) and tendinous disruptions repairs (2.4%). Reintervention rate was higher in younger patients (14.9% vs 5.3%; p = 0.042), complete articular fractures (AO-2R3A: 2.5%; AO-2R3B: 7.3%; AO-2R3C: 15.7%; p = 0.037) and high energy injuries (8.4% vs 22.2%; p = 0.044). Patients undergoing reintervention had a decreased flexion-extension (94.44° vs 123.83°, p = 0.007). CONCLUSION: Radial shortening and articular step-off seem the most important predictors for postoperative range of motion. Worse radiological outcomes are observed in complete articular fractures and those affecting elder population. Although radiological and functional results are good or excellent in most of cases, the incidence of complications and need for reintervention still remains noticeable. Re-operations were more frequent in younger patients, complete articular fractures and high energy injuries, and it worsened functional outcomes.

Resultados a largo plazo de la reparación por doble incisión de las roturas distales del bíceps braquial. Cómo evitar las complicaciones / Long term results of double-incision repair of distal brachial biceps ruptures. How to prevent complications

Objetivo: Revisar los resultados de la reinserción de la rotura distal del músculo bíceps braquial con la vía de doble incisión. Material y metodología: Con un seguimiento de cinco años valoramos once pacientes intervenidos mediante la técnica modificada de doble incisión de Morrey, utilizando arpones para su reinserción y una movilización precoz del codo. Todos eran varones, fumadores y trabajadores de esfuerzo, con una edad media de 51 años. En 8 casos la rotura fue tendinosa y en 3 se observaron desinserciones óseas. Analizamos los resultados midiendo la movilidad flexo-extensora del codo y prono-supinadora con goniómetro y la fuerza supinadora con un dinamómetro. Se analizaron radiografías de codo, se realizó el cuestionario DASH, el grado de satisfacción personal y el dolor. Resultados: No hemos visto ninguna complicación postoperatoria inmediata ni tardía. Los resultados fueron excelentes en el 94% de los casos y buenos en el 6%, no apareciendo ninguna rerrotura. Conclusión: una intervención precoz y una técnica meticulosa puede conseguir un resultado excelente en la reparación de la rotura distal del bíceps braquial (AU)

Objective: To review the results of reinsertion of distal rupture of the brachial biceps muscle with the doubleincision technique. Material and Methods: With a follow-up of five years, we assessed eleven patients operated on by the modified Morrey double-incision technique using harpoons for reinsertion and early mobilization of the elbow. All were male, smokers, and heavy exertion workers, with a mean age of 51 years. In 8 patients, rupture was of the tendon and 3 showed bone detachments. We analyzed the results measuring elbow flexion-extension and pronation-supination mobility with a goniometer and supination strength with a dynamometer. Elbow X-rays were analyzed, the DASH questionnaire was performed, and degree of personal satisfaction and pain were measured. Results: We did not observe any immediate or late postoperative complication. The results were excellent in 94% patients and good in 6%, and no rerupture occurred. Conclusion: Early intervention and meticulous technique can achieve an excellent result in repair of distal brachial biceps rupture (AU)