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1.
Bone Joint J ; 102-B(7): 874-880, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600133

RESUMO

AIMS: The aim of this study was to investigate whether intraoperative 3D fluoroscopic imaging outperforms dorsal tangential views in the detection of dorsal cortex screw penetration after volar plating of an intra-articular distal radial fracture, as identified on postoperative CT imaging. METHODS: A total of 165 prospectively enrolled patients who underwent volar plating for an intra-articular distal radial fracture were retrospectively evaluated to study three intraoperative imaging protocols: 1) standard 2D fluoroscopic imaging with anteroposterior (AP) and elevated lateral images (n = 55); 2) 2D fluoroscopic imaging with AP, lateral, and dorsal tangential views images (n = 50); and 3) 3D fluoroscopy (n = 60). Multiplanar reconstructions of postoperative CT scans served as the reference standard. RESULTS: In order to detect dorsal screw penetration, the sensitivity of dorsal tangential views was 39% with a negative predictive value (NPV) of 91% and an accuracy of 91%; compared with a sensitivity of 25% for 3D fluoroscopy with a NPV of 93% and an accuracy of 93%. On the postoperative CT scans, we found penetrating screws in: 1) 40% of patients in the 2D fluoroscopy group; 2) in 32% of those in the 2D fluoroscopy group with AP, lateral, and dorsal tangential views; and 3) in 25% of patients in the 3D fluoroscopy group. In all three groups, the second compartment was prone to penetration, while the postoperative incidence decreased when more advanced imaging was used. There were no penetrating screws in the third compartment (extensor pollicis longus groove) in the 3D fluoroscopy groups, and one in the dorsal tangential views group. CONCLUSION: Advanced intraoperative imaging helps to identify screws which have penetrated the dorsal compartments of the wrist. However, based on diagnostic performance characteristics, one cannot conclude that 3D fluoroscopy outperforms dorsal tangential views when used for this purpose. Dorsal tangential views are sufficiently accurate to detect dorsal screw penetration, and arguably more efficacious than 3D fluoroscopy. Cite this article: Bone Joint J 2020;102-B(7):874-880.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(29): e21250, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702907

RESUMO

BACKGROUND: Given this lack of conclusive outcome data, there are currently no clear guidelines to direct the treatment of displaced distal radius fractures in the elderly. This retrospective clinical trial was performed to compare the outcomes of two methods that were used for the treatment of displaced and unstable distal radial fractures in patients 65 years of age or older: METHODS:: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. Between January 2017 and May 2018, a total of 184 patients who presented to Huzhou Traditional Chinese Medicine Hospital with distal radius fractures were extracted from the hospital database and evaluated for eligibility. This retrospective cohort study was approved by the institutional review board in our hospital. Outcome measures included Patient-Related Wrist Evaluation score, patient satisfaction, complications, and radiographic outcomes. SPSS software package (version 21.0; SPSS Inc, Chicago, IL) was used for all statistical analyses. RESULTS: The hypothesis was that the two groups would achieve similar functional scores and complications in distal radial fractures. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5689).


Assuntos
Fraturas do Rádio/terapia , Idoso , Moldes Cirúrgicos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Imobilização/métodos , Masculino , Redução Aberta/métodos , Fraturas do Rádio/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(29): e21343, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702933

RESUMO

RATIONALE: Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture. PATIENT CONCERNS: A 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist. DIAGNOSIS: Radiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea. INTERVENTIONS: The patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ. OUTCOMES: At 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist. LESSONS: Malunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.


Assuntos
Luxações Articulares/etiologia , Fraturas do Rádio/complicações , Articulação do Punho , Idoso , Fraturas Mal-Unidas/complicações , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Instabilidade Articular/etiologia , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Recidiva , Tomografia Computadorizada por Raios X , Ulna/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
5.
Bone Joint J ; 102-B(6): 744-748, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475231

RESUMO

AIMS: The aim of this study was to compare patient-reported outcome measures (PROMs) and the Single Assessment Numerical Evaluation (SANE) score in patients treated with a volar locking plate for a distal radial fracture. METHODS: This study was a retrospective review of a prospective database of 155 patients who underwent internal fixation with a volar locking plate for a distal radial fracture between August 2014 and April 2017. Data which were collected included postoperative PROMs (Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE)), and SANE scores at one month (n = 153), two months (n = 155), three months (n = 144), six months (n = 128), and one year (n = 73) after operation. Patients with incomplete data were excluded from this study. Correlation and agreement between PROMs and SANE scores were evaluated. Subgroup analyses were carried out to identify correlations according to variables such as age, the length of follow-up, and subcategories of the PRWE score. RESULTS: The Pearson correlation coefficient (r) between PROMs and SANE scores was -0.76 (p < 0.001) for DASH and -0.72 (p < 0.001) for PRWE, respectively. Limits of agreement between PROMs and '100-SANE' scores were met for at least 93% of the data points. In subgroup analysis, there were significant negative correlations between PROMs and SANE scores for all age groups and for follow-up of more than six months. The correlation coefficient between PRWE subcategories and SANE score was -0.67 (p < 0.001) for PRWE pain score and -0.69 (p < 0.001) for PRWE function score, respectively. CONCLUSION: We found a significant correlation between postoperative SANE and PROMs in patients treated with a volar locking plate for a distal radial fracture. The SANE score is thus a reliable indicator of outcome for patients who undergo surgical treatment for a radial fracture. Cite this article: Bone Joint J 2020;102-B(6):744-748.


Assuntos
Placas Ósseas , Autoavaliação Diagnóstica , Fixação Interna de Fraturas/instrumentação , Medidas de Resultados Relatados pelo Paciente , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
6.
J Zoo Wildl Med ; 51(2): 398-406, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549571

RESUMO

Three captive macropods comprising three different species sustained unilateral antebrachial fractures. All fractures were assumed to be trauma related, although the specific circumstances surrounding each case was unknown. Each fracture was surgically repaired with type Ia (unilateral, monoplanar) external skeletal fixators, which were all removed approximately 3 mo postoperatively. Although each animal experienced at least one complication, all animals showed adequate bridging and remodeling at the fracture sites and had good-to-excellent return to normal function after fixator removal. This case series is the first to describe the successful repair of antebrachial fractures using external skeletal fixation in captive macropods and details some of the complications that can occur with postoperative management of captive animals.


Assuntos
Fixação de Fratura/veterinária , Fraturas Fechadas/veterinária , Fraturas Cominutivas/veterinária , Macropodidae , Fraturas do Rádio/veterinária , Fraturas da Ulna/veterinária , Animais , Fraturas Fechadas/cirurgia , Fraturas Cominutivas/cirurgia , Masculino , Fraturas do Rádio/cirurgia , Resultado do Tratamento , Fraturas da Ulna/cirurgia
7.
Clin Sports Med ; 39(3): 623-636, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446579

RESUMO

The elbow joint consists of the humeroulnar, humeroradial, and proximal radioulnar joints. Elbow stability is maintained by a combination of static and dynamic constraints. Elbow fractures are challenging to treat because the articular surfaces must be restored perfectly and associated soft tissue injuries must be recognized and appropriately managed. Most elbow fractures are best treated operatively with restoration of normal bony anatomy and rigid internal fixation and repair and/or reconstruction of the collateral ligaments. Advanced imaging, improved understanding of the complex anatomy of the elbow joint, and improved fixation techniques have contributed to improved elbow fracture outcomes.


Assuntos
Articulação do Cotovelo/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Redução Aberta , Placas Ósseas , Ligamentos Colaterais/lesões , Ligamentos Colaterais/cirurgia , Articulação do Cotovelo/anatomia & histologia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Olécrano/lesões , Olécrano/cirurgia , Redução Aberta/instrumentação , Redução Aberta/métodos , Osteotomia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/cirurgia
8.
PLoS One ; 15(5): e0232684, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433648

RESUMO

INTRODUCTION: One out of every 5 elderly patients will suffer a distal radius fracture and these injuries are often related to poor bone health. Several surgical subspecialties have demonstrated that pre-injury activity level can impact patient outcomes. To determine the importance of physical activity, we examined the relationship between pre-injury activity and patient-reported and functional outcomes among fracture patients. METHODS: This is a retrospective analysis of prospectively collected data from participants enrolled in the Wrist and Radius Injury Surgical Trial (WRIST) from April 10, 2012 to December 31, 2016. This study included 304 adults, 60 years or older with isolated unstable distal radius fractures; 187 were randomized to one of three surgical treatments and 117 opted for casting. Participants opting for surgery were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Participants who chose not to have surgery were treated with casting. All participants were stratified prior to analysis into highly and less-active groups based on pre-injury Rapid Assessment of Physical Activity Scores. RESULTS: 280 patients had 12-month assessments of outcomes. Highly active participants scored 8 and 5 points greater on the Michigan Hand Questionnaire at 6 weeks and 3 months respectively, p<0.05. Highly active participants demonstrated greater grip strength at the 3-month (p = 0.017) and 6-month (p = 0.007) time-points. Highly active participants treated with volar locking plate scored 10+ points greater on the Michigan Hand Questionnaire compared to the less-active group at the 6-week (p = 0.032), 3-month (p = 0.009) and 12-month (0.004) time points, with an effect size larger than 0.50, suggesting pre-injury level of activity had a significant clinical impact. CONCLUSIONS: Higher levels of pre-injury activity are predictive of patient-reported and functional outcomes following distal radius fracture. Because of the greater PROs, the early mobility and lower risk of hardware infection reported in the literature, volar plating is preferable to other treatments for highly active patients who request and meet indications for surgery. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01589692.


Assuntos
Fraturas do Rádio/cirurgia , Fatores Etários , Idoso , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fraturas do Rádio/diagnóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
9.
Can J Surg ; 63(3): E261-E271, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32436686

RESUMO

Background: For the management of distal radius fractures, surgical decision-making depends on radiographic measurements of indicators including radial inclination (RI), ulnar variance (UV) and radial tilt (RT). Evaluation of the inter- and intrarater reliability of surgeons' measurements of these criteria has been limited. Methods: Twelve physicians were invited to participate in this study. Anonymously, they measured RI, UV and RT on 30 digitally stored radiographs of distal radius fractures on 3 occasions, each at least 1 week apart, using online measuring tools. After taking the third set of measurements, the participants were given a tutorial by the senior author (G.J.) on a single technique to measure all 3 indicators. The participants then took 3 more sets of measurements using only the technique they had been taught. Intraclass correlation coefficients (ICCs) were used to evaluate interrater reliability each week. Multiple logistic regression was used to calculate the effect of the tutorial, controlling for week of study along with reader (participant) and patient variance. Results: The ICCs indicated that the participants' measurement precision improved promptly after the tutorial, and this improvement was sustained through subsequent readings. The odds of an "accurate" measurement (within 2° of the senior author's measurements for RI, 1 mm for UV and 4° for RT) was 1.7 times higher for RI, 2.7 times higher for UV and 2.3 times higher for RT after the tutorial; all of these results were statistically significant. Conclusion: Surgeons ought to be familiar with a method to reproducibly measure the indicators used in the published guidelines for surgical intervention. The tutorial on a single standardized technique for online measurement of RI, UV and RT in distal radius fractures improved measurement precision.


Assuntos
Tomada de Decisão Clínica , Educação de Pós-Graduação em Medicina/métodos , Fixação de Fratura/educação , Ortopedia/educação , Radiografia/métodos , Fraturas do Rádio/diagnóstico , Rádio (Anatomia)/diagnóstico por imagem , Adulto , Feminino , Fixação de Fratura/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/lesões , Fraturas do Rádio/cirurgia , Reprodutibilidade dos Testes
10.
Plast Reconstr Surg ; 146(3): 581-588, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32459734

RESUMO

BACKGROUND: The authors sought to determine the reliability of the Soong classification, which relates the position of the implant to the watershed line of the distal radius, for predicting flexor tendinopathy in distal radius fractures treated with volar plate fixation. METHODS: Medical records were reviewed, including demographics, fracture and operative characteristics, tendon-related complications, and radiographic outcomes. Six hundred fifty-nine distal radius fractures were reviewed with a mean duration of clinical follow-up of 12.9 ± 0.7 months. RESULTS: The incidence of isolated flexor tendinopathy and tendon rupture was 0.9 and 0.3 percent, respectively. The Soong classification failed to independently predict flexor tendon rupture or tendinopathy. Fractures classified as inadequately reduced were significantly associated with Soong grade 0 or grade 2, whereas adequately reduced fractures were significantly associated with Soong grade 1. CONCLUSION: The Soong classification is not the sole predictor of flexor tendinopathy and may be viewed as a reflection of the overall appropriateness of fracture reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/complicações , Tendinopatia/etiologia , Traumatismos dos Tendões/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tendinopatia/epidemiologia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Adulto Jovem
11.
Zhongguo Gu Shang ; 33(4): 367-70, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351093

RESUMO

OBJECTIVE: To explore the clinical effect of the treatment of Fernandez type Ⅲ fracture of the distal radius with hyperextension traction prying, volar reduction, bone grafting and internal fixation. METHODS: From February 2017 to March 2018, 11 cases of Fernandez type Ⅲ fracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation, including 6 males and 5 females, aged 55 to 67 years. Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression, collapse. According to Fernandez, all of them were type Ⅲ. After operation, the reduction of articular surface and fracture healing were evaluated. VAS score and Cooney wrist score were used to evaluate the curative effect. RESULTS: All the patients were followed up for 12 to 14 months. All the fractures healed. Cooney wrist score scale was used to evaluate the curative effect, 9 cases were excellent, 1 case was good and 1 case was fair. CONCLUSION: In the operation of Fernandez type Ⅲ fracture of the distal radius, hyperextension traction was used to enlarge the angle, and through the volar fracture end prying reduction and internal fixation with bone graft, the collapsed articular surface could be effectively reduced and fixed. The early functional exercise after the operation had satisfactory clinical effect.


Assuntos
Fraturas do Rádio/cirurgia , Punho , Idoso , Placas Ósseas , Transplante Ósseo , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia) , Amplitude de Movimento Articular , Tração , Resultado do Tratamento
12.
PLoS One ; 15(4): e0230862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236117

RESUMO

INTRODUCTION: The way strength recovers after reduction of pediatric fractures of the upper extremity has not previously been the specific scope of research. This is remarkable, since strength measurements are often used as an outcome measure in studies on trauma of the upper extremity. The aim of this study was to evaluate how strength recovers after sustainment of fractures of the forearm, wrist or hand treated by closed or open reduction in children and adolescents in the first 6 months after trauma. How much strength is lost at 6 weeks, 3 months and 6 months after trauma, and is this loss significant? Are there differences in the pattern of recovery between children who underwent a different treatment? And finally, which of the following factors are associated with an increase in the ratio between affected grip strength and expected strength: type of fracture, cast immobilization, occurrence of complications, and degree of pain? DESIGN: Prospective observational study. PARTICIPANTS: Children and adolescents aged 4-18 years with a reduced fracture of the forearm, wrist or hand. METHODS: Grip strength, key grip and three-jaw chuck grip were measured twice in each hand 6 weeks, 3 months and 6 months after trauma. Details on fracture type and location, treatment received, cast immobilization and complications were obtained. Hand-dominance and pain were verbally confirmed. RESULTS: Loss of strength was more prominent and prolonged the more invasive the treatment, hence most extensive in the group receiving open reduction with internal fixation (ORIF), intermediate in the group receiving closed reduction with percutaneous pinning (CRIF), and least extensive in the group undergoing closed reduction without internal fixation (CR). Besides time passed, gender and age were of significant influence on strength, although there was no difference in pattern of recovery over time between children who received a different treatment. In the period of 6 weeks to 3 months after trauma, female gender, type of fracture sustained and occurrence of an unwanted event were associated with an increased ratio between affected and expected grip strength. For the later phase of recovery, between 3 and 6 months, this was only true for the occurrence of an unwanted event.


Assuntos
Traumatismos do Antebraço/reabilitação , Força da Mão , Recuperação de Função Fisiológica/fisiologia , Adolescente , Criança , Pré-Escolar , Redução Fechada , Feminino , Antebraço , Traumatismos do Antebraço/cirurgia , Fixação Interna de Fraturas , Mãos , Humanos , Masculino , Redução Aberta , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Punho
13.
Ann R Coll Surg Engl ; 102(5): 348-354, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233845

RESUMO

INTRODUCTION: Predicting when fracture incidence will rise assists in healthcare planning and delivery of preventative strategies. The aim of this study was to investigate the relationship between temperature and the incidence of hip and wrist fractures. METHODS: Data for adults presenting to our unit with a hip or wrist fracture over a seven and eight-year period respectively were analysed. Incidence rates were calculated and compared with meteorological records. A Poisson regression model was used to quantify the relationship between temperature and fracture rate. RESULTS: During the respective study periods, 8,380 patients presented with wrist fractures and 5,279 patients were admitted with hip fractures. All women (≥50 years: p<0.001; <50 years: p<0.001) and men aged ≥50 years (p=0.046) demonstrated an increased wrist fracture rate with reduced temperature. Men aged <50 years also had an increased wrist fracture rate with increased temperature (p<0.001).The hip fracture rate was highest in women aged ≥50 years but was not associated with temperature (p=0.22). In men aged ≥50 years, there was a significant relationship between reduced temperature and increased fracture rate (p<0.001). CONCLUSIONS: Fragility fracture of the wrist is associated with temperature. Compared with an average summer, an additional 840 procedures are performed for wrist fractures during an average winter in our trust with an additional 798 bed days taken up at a cost of £3.2 million. The winter increase seen in male hip fracture incidence requires approximately 888 surgical procedures, with 18,026 bed days, and costs £7.1 million. Hip fracture incidence in older women is not related to temperature.


Assuntos
Temperatura Baixa/efeitos adversos , Fraturas do Quadril/epidemiologia , Temperatura Alta/efeitos adversos , Fraturas por Osteoporose/epidemiologia , Fraturas do Rádio/epidemiologia , Traumatismos do Punho/epidemiologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Fatores de Risco , Estações do Ano , Fatores Sexuais , Traumatismos do Punho/cirurgia , Adulto Jovem
14.
Orthop Clin North Am ; 51(2): 235-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138861

RESUMO

To determine if orthopedic surgeons are more efficient than nonsurgical providers at care of operative injuries in walk-in clinics, patients in a walk-in clinic for evaluation of acute injury who subsequently had surgical treatment of isolated distal radial fracture were compared based on whether the initial visit was with a surgical or nonsurgical provider. Initial evaluation in a walk-in orthopedic clinic setting versus a conventional hand surgeon's clinic was associated with longer delay between initial evaluation and surgical treatment, but this difference may not be significant. Evaluation by a nonsurgical provider was not associated with increased duration to definitive treatment.


Assuntos
Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/terapia , Tempo para o Tratamento , Adulto Jovem
15.
Plast Reconstr Surg ; 145(4): 969-976, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221216

RESUMO

BACKGROUND: This study assessed the risk and factors of complications after volar locking plate fixation of distal radius fractures. METHODS: A single-institution retrospective review of patients undergoing volar locking plate fixation of distal radius fractures between May of 2000 and May of 2015 was undertaken. Demographic data, major complications, minor complications, and radiographic parameters were evaluated. RESULTS: Six hundred forty-seven distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean body mass index was 28.0, and 14.6 percent of patients had a body mass index greater than 35. Fractures were classified as Arbeitsgemeinschaft für Osteosynthesefragen class 23-C (67.2 percent), 23-A (26.6 percent), and 23-B (6.2 percent). The incidence of major and minor complications was 13.8 percent and 17.5 percent, respectively. The most common complication was transient paresthesia (9.7 percent). The incidence of tendon rupture or irritation was 0.5 percent or 2.5 percent, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2 percent at an average of 427.8 days after surgery. Major complications and minor complications were increased 2.2- and 1.9-fold, respectively, in patients with a body mass index greater than 35. Major complications were also increased 3.19 times in patients with residual intraarticular step-off. Hardware removal was 3.3 times more likely in patients with Soong grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes mellitus. CONCLUSIONS: Volar plate osteosynthesis of distal radius fractures is associated with an overall low complication rate. Patient factors, including diabetes mellitus and obesity, and intraoperative factors, including intraarticular fracture alignment and plate prominence, were associated with a higher rate of complications or revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura Espontânea/etiologia , Tendinopatia/etiologia , Fatores de Tempo , Adulto Jovem
16.
Clin Sports Med ; 39(2): 299-311, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115086

RESUMO

Although the technical details of distal radius fracture fixation in athletes are largely similar to the general population, the issues surrounding the injury, desire to return to sport, and rehabilitation require specialized attention. Athletes are generally healthy, with a drive to recover and must balance the risk of long-term consequences of returning to play too early with the potential loss of scholarship, salary, or opportunities for advancement. Outcomes after nonoperative and operative treatment of distal radius fractures are generally excellent in athletes and return to the same level of sport occurs in most patients.


Assuntos
Traumatismos em Atletas/terapia , Fraturas do Rádio/terapia , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Rádio (Anatomia)/anatomia & histologia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Volta ao Esporte
17.
Clin Orthop Surg ; 12(1): 22-28, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32117534

RESUMO

Background: We hypothesized that volar locking pate fixation using a minimum number of screws-four in the distal row and two in the shaft of the plate-will provide sufficient stability for unstable extra-articular fractures of the distal radius. We aimed to compare the biomechanical properties of different numbers and locations of screws in volar locking plate fixation and describe the clinical and radiological outcome of plate fixation using a minimum number of screws for distal radius fractures. Methods: We divided 48 artificial radius fracture bones into four groups (group A-D) based on the number and location of screws used for fixation with volar locking plates. The artificial bone models were subjected to axial compression and volar bending load with a force of 250 N and 80 N, respectively, for 1,000 cycles at a frequency of 1 Hz. We also retrospectively reviewed 42 patients with unstable, extra-articular, distal radius fractures who were treated with volar locking plate fixation using a minimum number of screws. Results: Group A (seven distal screws and three proximal screws) had the highest mean stiffness: 303.7 N/mm under axial compression and 61.1 N/mm under volar bending. Compared with group A, group D (four screws in the distal part and two screws in the shaft) showed significantly lower stiffness; therefore, group D was considered inferior in terms of stability. However, in the fatigue test, neither deformation of the metal plate nor detachment or breakage of the metal screws was observed in all groups. In the clinical study, all fractures united without displacement and satisfactory clinical outcome was obtained. Conclusions: In the dorsally comminuted, extra-articular, nonosteoporotic distal radius fractures, the minimum number of screws-four in the distal row and two in the shaft-in volar locking plate fixation can provide sufficient stability. Further biomechanical studies involving osteoporotic bone will be necessary to confirm the results because volar plate fixation is most commonly used in patients with osteoporosis.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Clin Orthop Surg ; 12(1): 130-134, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32117549

RESUMO

Distal ulnar fractures are commonly accompanied by distal radial fractures, and several treatment options such as plate osteosynthesis and pinning with Kirschner's wires are used. In this study, we present a technique using headless compression screws to achieve bony union of distal ulnar fractures. From November 2016 to November 2018, we treated 11 patients with distal ulnar fractures combined with distal radial fractures with headless compression screws (DePuy Synthes). Patients were instructed to maintain a short-arm splint for less than two weeks after the treatment. The mean time to bony union was 6.5 weeks, mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14.6 points, and mean visual analog scale score was 1.09 points. Full range of motion was possible in all directions after surgery and no specific complications were observed. The suggested technique allows minimal incision and minimally invasive intramedullary fixation and can promote bony union in a simple way without specific complications.


Assuntos
Parafusos Ósseos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Idoso de 80 Anos ou mais , Feminino , Fixação Intramedular de Fraturas/métodos , Humanos , Pessoa de Meia-Idade
19.
Arch Orthop Trauma Surg ; 140(5): 697-705, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193673

RESUMO

Indications for surgical treatment of distal radius fractures (DRF) remain controversial in the literature, especially in elderly patients. Complication rates after operatively treated DRF are low and well documented. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. If conservative treatment fails then salvage procedures are necessary. This review summarizes the therapeutic options available to treat degenerative osteoarthritis after malunited distal radius fractures, regardless of the initial operative or conservative treatment.


Assuntos
Fraturas Mal-Unidas/cirurgia , Dor/etiologia , Fraturas do Rádio/cirurgia , Terapia de Salvação/métodos , Articulação do Punho/cirurgia , Fraturas Mal-Unidas/complicações , Fraturas Mal-Unidas/fisiopatologia , Humanos , Dor/cirurgia , Fraturas do Rádio/complicações , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Reoperação , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
20.
Arch Orthop Trauma Surg ; 140(5): 665-673, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32193674

RESUMO

In the recent years, treatment of distal radius fractures (DRF) has advanced considerably. Surgical fixation with palmar angular stable plate has gained popularity, due to a reported lower complication rate when compared to dorsal fixation. The type of trauma or injury, surgical procedure and impaired bone quality are all contributors to complications in DRF. The main aim of this review is to summarize the most common complications and possible therapeutic solutions. In addition, strategies for minimizing these complications will be discussed.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias , Fraturas do Rádio/cirurgia , Humanos
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