Restoration of the volar cortex: Predicting instability after manipulation of distal radial fractures

Phillips, Alistair R.; Al-Shawi, A.

doi:10.1016/j.injury.2014.09.007

Cited by 11 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are also challenges with treating the fractured joint in cases of substantial cartilage loss and extended metaphyseal/subchondral bony defects [19]. The importance of the dorsal medial fragment is that it helps to restore volar cortical alignment and thus increases the stability after manipulation of distal radial fractures [20]. Reducing and securing the small and comminuted dorsal medial fragments, especially around the articular area, are beneficial for restoring good functionality to the wrist.…”

Section: Discussionmentioning

confidence: 99%

Melone’s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping

Zhang

Wang

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background: There is no consensus in the literature about the ideal classification of the distal radius fracture for the clinical practice. The traditional Melone classification system divides the distal radius into four basic components, the shaft, radial styloid, dorsal medial fragment, and volar medial fragment. The aim of this study was to identify fracture lines in comminuted distal radius fractures using three-dimensional mapping of computed tomography (CT) images to test the hypothesis that fracture fragments can be divided according to the Melone classification. Methods: Fifty-nine consecutive OTA/AO 23C3 fractures presented at the hospital between January 2018 and October 2019 were retrospectively reviewed. The fracture lines were characterized in the axial, sagittal, and coronal CT planes. After reducing the fractures in a three-dimensional (3D) model, the fracture lines were plotted from the CT images and were then superimposed on one another and oriented to fit a standard template. The area of articular surfaces was measured and compared to quantify the differences between the radial bone fragments. Results: Thirty-five cases (59.3%) in this study fit the Melone classification and 24 cases (40.7%) did not. On the radiocarpal surface, there was a greater concentration of fracture lines in the dorsal area of the radius than in the volar area. On the distal radioulnar joint (DRUJ), the fracture lines were focused around two specific concentrated regions. For the articular surface area, the mean area of the radial styloid, volar medial fragment, and dorsal medial fragment was 141.13 ± 90.16 mm 2 , 147.79 ± 75.94 mm 2 , and 79.05 ± 70.73 mm 2 , respectively. There was a significant difference in articular surface area for the Melone fragments (P = 0.002). Conclusions: The Melone classification system is not suitable for characterizing all C3 fractures. The findings of this study confirm that the dorsal medial fragments are relatively comminuted and small. Extra care should be given to these small fragments when reducing the fracture.

show abstract

Section: Discussionmentioning

confidence: 99%

Melone’s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping

Zhang

Wang

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…Accordingly, for patients treated conservatively, we found that lateral radiographic images during reduction can be used to predict subsequent parameter changes. Phillips et al reported that the restoration or maintenance of volar cortical alignment during the manipulation of distal radial fractures offers patients the best chance of avoiding the need for further surgery [8]. In addition, he noted that this factor should be taken into account in the decisionmaking process for these fractures [12].…”

Section: Discussionmentioning

confidence: 99%

“…In 2010, Court-Brown reported that the percentage of distal radius fractures treated conservatively in the United States was 70% [7], indicating that conservative treatment is still the first-line treatment used by orthopedic surgeons. Furthermore, it was reported that the restoration or maintenance of volar cortical alignment during the manipulation of distal radial fractures offers patients the best chance of avoiding the need for further surgery [8].…”

Section: Introductionmentioning

confidence: 99%

Radiographic Measurements as a Predictor of Correction Loss in Conservative Treatment of Colles’ Fracture

Zenke

Furukawa

Furukawa³

et al. 2019

J UOEH

View full text Add to dashboard Cite

Dorsal displaced distal radius fracture (Colles' fracture) is very common and could occur from fragility in middle-aged and elderly people. Many Colles' fractures are still treated conservatively in clinics without hospitalization. Internal fixation using a palmar locking plate has been the standard treatment, but some complications have been reported. The aim of this study was to analyze changes in radiographic parameters over time in patients with conservatively treated Colles' fractures, and to establish whether the type of fracture influenced these changes. Prospective data collected included patient characteristics and radiological findings. The study was conducted at two private clinics and included 60 patients (13 men and 47 women; mean age, 72.5 years old; range, 55 to 96 years old) with a Colles' fracture (types of injury: intramedullary [n = 15], anatomical [n = 39], extramedullary [n = 2], and unknown [n = 4]) who were treated conservatively with manipulation and cast immobilization. Conservative, nonsurgical treatment with manipulation was performed first, then, cast immobilization continued for 4 weeks. Loss of correction between the time of reduction and the final observation was defined by the following radiographic measurements: palmar tilt, radial inclination, and ulnar variance. The average final follow up period was 4.6 months (1.5-12 months). Immediately after reduction, 11 intramedullary fractures, 42 anatomical fractures and 7 extramedullary fractures were confirmed. Correction loss according to ulnar variance was significantly greater (P = 0.012) during the final observation for patients with an intramedullary injury at reduction than that for patients with extramedullary and anatomical injuries at reduction. We found that the correction loss for ulnar variance from immediately after reduction until the final observation was significantly greater in the intramedullary group, suggesting that an alternative to conservative treatment may be beneficial for patients with intramedullary fractures.

show abstract

“…8 Increasing age, presence of osteoporosis and dorsal comminution leads to increased fracture instability. 11,12 After plaster cast application not all parameters are retained equally. Loss of radial height is most difficult displacement to retain, volar tilt is retained to some extent and radial angle has intermediate position between loss of radial height and volar tilt.…”

Section: Discussionmentioning

confidence: 99%

Cast immobilization in fracture distal radius with wrist in dorsiflexion

2019

View full text Add to dashboard Cite

Background: The purpose of this study was to evaluate the anatomical and functional outcome of cast immobilization in fracture distal radius with wrist in dorsiflexion. Study design selected was prospective cohort study.Methods: The study group comprised 60 patients, with a mean follow-up of 3 month. Patients were evaluated for radial height, radial inclination and volar tilt according to Lindstrom criteria. Functional outcome were assessed with PRWE score.Results: Mean loss of radial height was 4.11 mm. Mean loss of radial inclination was 6.85 degree and mean loss of volar tilt was 7.06 degree at the end of 3 month follow up. As per Lindstrom criteria 88% were excellent to fair and 93% were excellent to fair functional outcome as per PRWE score.Conclusions: Cast immobilization in fracture distal radius with wrist in dorsiflexion produces better anatomical and functional outcome.

show abstract

Restoration of the volar cortex: Predicting instability after manipulation of distal radial fractures

Cited by 11 publications

References 23 publications

Melone’s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping

Melone’s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping

Radiographic Measurements as a Predictor of Correction Loss in Conservative Treatment of Colles’ Fracture

Cast immobilization in fracture distal radius with wrist in dorsiflexion

Contact Info

Product

Resources

About