Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius

Axelrod, Terry S.; McMurtry, Robert Y.

doi:10.1016/s0363-5023(09)91097-8

Cited by 239 publications

(113 citation statements)

References 18 publications

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“…In our series, the articular congruity improved significantly following surgery in all patients, and after 3-7 years most patients had no arthrosis. These findings support the contention that restoration of accurate articular congruency prevents posttraumatic wrist arthrosis (Axelrod andMcMurtry 1990, Hastings andLeibovic 1993).…”

Section: Discussionsupporting

confidence: 78%

“…In our series, all patients with severe injuries and all with a palmar approach had the carpal tunnels opened. Other reports routinely recommend carpal tunnel release in all operative cases (Axelrod and McMurtry 1990) which, together with the operative prevention of malunion, may reduce the number of entrapments of the median nerve (Aro et al 1988, Hove 1995.…”

Section: Discussionmentioning

confidence: 99%

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Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3-7 years

Hove

Nilsen

Furnes

et al. 1997

Acta Orthopaedica Scandinavica

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3-7 years

Hove

Nilsen

Furnes

et al. 1997

Acta Orthopaedica Scandinavica

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“…Many authors have reported excellent outcomes following IF with volar plating for unstable DRFs. [7][8][9] However, some authors have reported association of complications, such as tendon rupture, hardware malposition, and loss of fixation. 10,11 In addition, IF with volar plating requires longer duration of operation and high treatment costs.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study

et al. 2017

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Background: Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An attempt was made to analyze patients treated with Ex-Fix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Ex-fix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications.Methods: A prospective trial was undertaken at our hospital with 35 patients,all aged >20 yrs with closed distal radius fracture and divided into two groups: group I (Ex-fix with or without percutaneous k-wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year, 6 months average.Results: Group I consumed significant less operative time, fluoroscopic exposure, reduced hospital stay, quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with Ex-Fix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &1 case of pin tract infection with ex-fix application was observed. Conclusions: Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext-fixation can be considered as a primary treatment modality in the extra-articular fractures in young or even intra-articular fractures in the elderly.

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“…The close proximity between plate and tendons, however, meant that extensor tendon irritation and rupture were common; hence, although it inferred improved fixation, it had unacceptable tendon complications. [1][2][3][4] Improvements in plate design, in the form of locking plates, have allowed mechanical stability of the fracture to be achieved with plates on the volar surface of the radius, which has better tendon relationships. This mechanical advantage stability, even in osteoporotic bone, allows early active mobilisation and has resulted in a marked increase in the use of volar fixation of distal radius fractures.…”

mentioning

confidence: 99%

Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

Perry

Machin

Casaletto

et al. 2011

annals

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Ann R Coll Surg Engl 2011; 93: 57-60 57 Distal radius fractures are one of the most common fractures presenting to orthopaedic surgeons. Traditionally, such fractures have largely been treated by closed reduction and immobilisation in plaster, yet improvements in orthopaedic technology have changed the management of distal radius fractures. The use of volar plates for managing distal radius fracture is now almost universal to orthopaedic surgeons engaged in adult trauma care.The conventional means of internal fixation of dorsally displaced distal radius fractures was by dorsal plating to create a mechanically stable, dorsal buttress effect. The close proximity between plate and tendons, however, meant that extensor tendon irritation and rupture were common; hence, although it inferred improved fixation, it had unacceptable tendon complications.1-4 Improvements in plate design, in the form of locking plates, have allowed mechanical stability of the fracture to be achieved with plates on the volar surface of the radius, which has better tendon relationships. This mechanical advantage stability, even in osteoporotic bone, allows early active mobilisation and has resulted in a marked increase in the use of volar fixation of distal radius fractures. 5,6 Despite the improved tendon relationships, extensor tendon complications remain. Most commonly affected is the tendon of the extensor pollicis longus (EPL), owing to its confinement within the EPL groove. The cause of tendon irritation and rupture is thought to be due to attrition either by prominent screws or perforating the dorsal surface intraoperatively with a drill. 7-13We sought to investigate if it were possible to identify screw hole positions, within three of the most commonly used locking plates in the UK, through which a long screw may pose a risk of injury to the EPL tendon in the EPL groove. This knowledge combined with the understanding that the use of all screw holes is not always necessary to achieve fracture stability may reduce the risk of EPL tendon irritation and rupture. Subjects and MethodsEighteen preserved cadaveric forearms were examined. Each arm was from a different individual and had been preserved by freezing and was completely thawed before use. Cadavers were examined both visually and radiographical- (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific 'high-risk' holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of 'high-risk' holes and appropriate minor alterations in surgical ...

show abstract

Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius

Cited by 239 publications

References 18 publications

Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3-7 years

Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3-7 years

Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study

Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

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