Radiological Evaluation of Volar Cortical Angle in the Anatolian Population / Evaluación Radiológica del Ángulo Cortical Volar en la Población Anatoliana

SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

A STUDY OF OUTCOMES OF DISTAL END RADIUS FRACTURES MANAGED BY EXTERNAL FIXATOR

BACKGROUND: Fractures of the distal radius continue to be the most common skeletalinjuries treated by the orthopedic surgeon. Unstable fractures of the distal part of the radiushave shown an inherent tendency towards loss of reduction after non-operative treatment.External skeletal fixation has been popular for the treatment of displaced, unstable fracturesof the distal part of the radius because it combines a minimally invasive procedure withreduction by ligamentotaxis.METHOD: A retrospective study of 70 patients of fracture of distal end radius treated withexternal fixator came to OPD at tertiary care hospital during the study period of 2 years fromJuly 2020 to June 2022, were included in the study after obtaining permission frominstitutional review board.RESULT: All 70 patients were assessed in the form of the functional and radiologicaloutcome based on Subjective evaluation by Modified Demerit Point System of Gartland andWerley (Functional) and Lidstorm and Frykman Criteria modified by Sarmiento(Anatomical). We obtained “excellent” results in 47.15%; “good” in 35.72% cases; “fair” in14.28% and “poor” in 2.85% cases with a mean G & W score of 6.35.CONCLUSION: Finding of this study shows that external fixator is an easy, cost effective,reliable and most suitable treatment in treating intraarticular and unstable extraarticular distalend radial fractures by the principle of ligamentotaxis.

Treatment of Distal End Radius Fractures - By Various Modalities

Introduction: Fractures of the distal end radius represent approximately 16% of all fractures treated by orthopedic surgeons.Our study is intended to find both conceptual and practical guidance for precision treatment with an expectant favorable result.Materials and Methods: Atotal of 50 patients of distal end radius fractures were treated with cast immobilization, percutaneouspinning, external fixation, and volar locking plate fixation. Fernandez classification was used. Functional outcomes wereassessed using Demerit Point System of Gartland and Werley (modified). The anatomical evaluation was done by Lindstromcriteria (modified).Results: Functional outcomes depend on patient’s age, fracture anatomy, displacement, reducibility, stability, and articularincongruity of fractures. They are related more to the anatomical reduction than to the method of immobilization. Volar lockingplate is a safe and effective treatment for unstable and metaphyseal comminuted fractures.Conclusion: According to Fernandez classification, Type I fractures were the most common. The volar locking compressionplate fixation gives excellent functional and anatomical results than other modalities of treatment. Hence, we recommend volarlocking plate fixation is the best modality of treatment among others.

A Comparative Study of Operative Management of Intraarticular Fracture Distal end of Radius (External Fixator Versus ORIF with Buttress Plating)

Background: Intraarticular fracture distal end of the radius isone of the most common fracture of upper extremities. Here israndomised comparative study of the most effective treatmentmodality to deal with such fracture by external fixator vsbuttress plating.Method: Patients were randomly allocated into two groups of30 each (group A and group B). Patients treated with externalfixator was put in group A while those treated with buttressplating was kept in group B. At the end of 8 months of follow-upfinal assessment was done for fracture union and patients wereassessed for pain, wrist range of motion (ROM), grip strengthand activity and scored according to the Modified Green OBrien Scoring System. The mean duration of treatment and theoutcome were comparable.Results: In group A (external fixator) only 7 patients hadexcellent and 18 had good results while patient in group B(ORIF with plating) 14 patients had excellent and 11 had goodresult.Conclusion: We found that plating predominantly providesmore excellent results as long as the radiological parametersare met and fixation achieved as early as possible along withvigorous physiotherapy.Level of Evidence: Level II randomised comparative series.

An Analysis of Different Modalities of Surgical Management of Giant Cell Tumor of Distal Radius

The distal end of the radius is one of the common sites of involvement in giant cell tumors (GCTs) with increased chance of recurrence. The objective of the present analysis was to study the modalities of management of the different types of distal end radius GCTs so as to reduce the recurrence rates and retain adequate function. Methods: A prospective study of 24 patients of GCT of distal end of radius treated by various procedures in our institute and followed upto 24 months to analyse complications and functional outcome based on The Musculo Skeletal Tumour Society Score. Results: In our series of 24 patients of GCT distal radius, 7 cases treated with curettage and bone graft 4cases were presented with recurrence, 1 with stiffness, and 2 with superficial infection. Out of14 cases treated with Wide Resection and reconstruction with nonvascularized proximal fibula 4 cases appeared with recurrence,2 showed non-union and 1 delayed union , 3 with wrist deformity,7with stiffness, 4 with carpal subluxation & 2 with donor site morbidity. In 3 patients treated with centralisation of ulna 2 case presented recurrence. Conclusion: A careful clinical and radiological assessment of distal radius GCT and judicious treatment plan is the key for successful outcome.

Functional Outcome in Fractures of the Lower End Radius in Elderly Patients Treated by Static External Fixator

Background: Fractures of the distal end radius represent the most common upper extremity fracture in elderly. The treatment problem includes not only achieving union in right anatomical position but also good functional results as far as joint mobility is concerned. Many types of external fixation devices are described to achieve reduction and fixation of the fragments without loss of position and acceptable functional results. The ligamentotaxis is the basic principle used by external fixation. The aim of the study was to assess the functional outcome in fractures of the lower end radius in elderly patients treated by static external fixator (Modified JESS). Materials and Methods: A total of 52 wrists in 51 patients (24 males and 27 females), aged more than 50 years with intra-articular distal end radius fracture were treated with Modified Joshi’s External Stabilization System from 2003 to 2016. The patients were followed up at 2 weeks, 3 weeks, between 6 and 8 weeks, 6 months, 1 year and at 2 years after the surgery. The assessment of pain, range of motion, grip strength and activity were assessed at 6th month, one year and two years follow- up and scored according to Green and O’Brien scoring system. Results: Result was excellent in 42 (80.76%), good in 6 (11.54%) and poor in 4 (7.69%) at 2 years post operatively. Conclusion: Ligamentotaxis using external fixator has been the traditional mode of treating unstable distal radius fractures and is still used by many as the preferred technique due to its acceptable results, easy application and cost-effective.

Prospective study of treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji’s method of intrafocal pinning anatomically and functionally.

Background: Distal radius fractures account for 17% of all fractures in adults. The fracture of the lower end of radius crushes the mechanical foundation of man’s most elegant tool, the hand. No other fracture has a greater potential to devastate hand function. Extra-articular fractures (type A in the AO classification) require avoidance of malunion with angulation and shortening. Malalignment results in limitation of movement, changes in load distribution, midcarpal instability and an increased risk of osteoarthritis of the radiocarpal joint. Aims and objectives: Treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji’s method of intrafocal pinning anatomically and functionally. Methods: Total 50 cases were included in the study. First 25 cases were treated by Kapandji’s method and next 25 cases were treated by cross K wire fixation and all cases were given below elbow cast after internal fixation. Patients were followed up at regular intervals and Anatomical and functional outcomes were evaluated in all the patients. Results: In our study anatomical end results were satisfactory in 96% and unsatisfactory in 4% of the subjects treated with cross K wire fixation and 72% and 28% in cases treated by Kapandji’s method whereas Functional end results were excellent in 28% cases, good in 68% cases, fair in 4% case and poor in 0% cases treated with cross k wire fixation and 12%, 60%, 24% and 4% in cases treated by Kapandji’s method. Conclusion: Cross K wire method proved to be better than Kapandji’s method of intrafocal K wire fixation both functionally and anatomically.