To assess the results of threaded pin fixation and volar plate fixation of extra-articular distal radius fractures. Methods: A retrospective case comparison study of patients undergoing operative fixation of distal radius fracture and postoperative therapy at 1 hand clinic was performed. Clinical variables included implant type along with the assessment of the volar tilt; radial height; postoperative wrist flexion, extension, pronation, and supination; key pinch; and grip strength. The duration of postoperative hand therapy was recorded. An independent Student t test was used to compare the 2 groups. Results: Forty-three patients were identified (21 threaded pin and 22 volar plate). The mean ages were 46 years and 54 years for the threaded pin and the volar plate groups, respectively. Preoperative and postoperative radiographic parameters were similar for both the groups. No loss of reduction was observed. There were no statistically significant differences for postoperative range of motion or pinch and grip strength at the time of discharge from therapy. The threaded pin group had a mean duration of 65 days of therapy, and the volar plate group had a mean duration of 132 days of therapy. Conclusions: Both groups achieved equivalent range of motion and functional recovery; however, the threaded pin group required significantly less therapy than the volar plate group. At the time of discharge from therapy, radiographic and clinical outcomes were similar for both types of implants, but the patients treated with a threaded pin required significantly less therapy and were discharged from therapy an average of 67 days sooner than the patients undergoing volar plate fixation. Type of study/level of evidence: Therapeutic IV.

Background The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique. Methods This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3. Range of motion and strength measurements were documented throughout the postoperative period, noting the time until return to athletic competition. These results were compared with historical values using other forms of fixation Results Nineteen athletes, average age of 35 years, were treated with threaded pin technique with early rehabilitation; all had complete healing and maintained alignment based on radiographic evaluation. The average time span between surgery and release to competition was 8 weeks, with all but 1 patient returning to sport within 12 weeks of injury. Average postoperative flexion measured 58°, extension was 57°, pronation was 81°, and supination was 74°. JAMAR grip strength in position 3 measured 25.22 kg, which equated to 73% of the uninjured side’s grip strength at the time of release to play. Conclusions Surgical fixation using a purpose-designed threaded pin is a useful alternative to volar plating for isolated radial styloid and extra-articular distal radius fractures in athletes. The purpose-designed threaded pin may afford athletes rapid recovery during the early postoperative period, preserving strength and dexterity and minimizing time lost before return to play.

Background: Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases. Purpose: To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures. Results: Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy. Conclusion: There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.