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.

Clinical application of special fluoroscopy method in the treatment of distal radius fractures with volar locking plate / 中国骨伤

OBJECTIVE@#The relationship between the distal screws and the wrist articular surface was assessed by the additional lateral oblique fluoroscopic view during the operation, and the dorsal tangential view of the wrist was used to observe whether the distal screw penetrated the dorsal cortex, so as to evaluate the clinical efficacy of the volar locking plate in the treatment of distal radius fractures.@*METHODS@#From January 2020 to June 2021, 45 cases of fresh distal radius fractures were treated using the volar Henry's approach, including 20 males and 25 females, aged from 32 to 75 years old with an average of (52.4±8.1) years old. During the operation, they were divided into 2 groups according to the different intraoperative fluoroscopic views:the control group of 20 cases, treated with standard anteroposterior and lateral fluoroscopic view;25 cases in the observation group, additional lateral oblique fluoroscopic view and dorsal tangential view of the wrist were taken. The wrist joint function score and postoperative complications were evaluated at 6 weeks, 3 and 6 months after operation between two groups.@*RESULTS@#All 45 patients were followed up and the duration ranged from 6 to 14 months, with an average of (10.8±1.7) months, all patients achieved bone union and the incision healed well. The incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). In terms of Gartland-Werley score of wrist joint function, the score of wrist function in the observation group was (4.58±1.31) at 6 weeks, (2.98±0.63) at 3 months and (1.95±0.65) at 6 months post-operatively, which were better than those in the control group (6.32±1.96) at 6 weeks, (3.63±0.76) at 3 months and (2.43±0.73) at 6 months. The difference was statistically significant (P<0.05). In the observation group, 7/25 cases(28%) were found to have screw penetration during the operation by additional lateral oblique and dorsal tangential radiograph fluoroscopic views of wrist.@*CONCLUSION@#The addition of lateral oblique and dorsal tangential during the operation could improve the accuracy of distal screw placement, reduce postoperative complications, and achieve early functional exercise.

Stabilization of dorsal intra-articular fragment in distal radius fracture after volar locking plate fixation / 中华创伤骨科杂志

Objective:To explore the risk factors that may affect the stabilization of dorsal intra-articular fragment in distal radius fracture after volar internal fixation.Methods:A retrospective analysis was performed of the patients with distal radius fracture who had been treated by volar internal fixation at Department of Traumatic Orthopedics, Tongji Hospital Affiliated to Tongji University from July 2016 to July 2020. After 3D reconstruction of their preoperative CT scans by software Mimics 20.0, 66 patients with a dorsal intra-articular fragment were screened out. They were 31 males and 35 females, aged from 23 to 78 years (average, 53.4 years). By the AO classification, there were 17 case of type C1, 22 cases of type C2, and 27 cases of type C3. The displacement of dorsal intra-articular fragment was judged by X-ray observation on postoperative day 2 and X-ray follow-up at the outpatient department. The 13 patients with displacement of dorsal intra-articular fragment>2 mm were assigned into a displacement group while the other 53 ones into a displacement-free group. The 2 groups were compared in terms of preoperative general data and anatomical data of the dorsal intra-articular fragment (total preoperative displacement, radius-ulnar length, dorsal-volar length, aspect ratio, proximal-distal length and volume) to analyze the correlations between them and displacement.Results:There was no significant difference in preoperative general data (age, gender, affected side, cause of injury or AO classification) between the 2 groups, showing comparability between groups ( P>0.05). All patients were followed up for 6 to 24 months (mean, 14 months) after surgery. There were no postoperative complications like neurovascular lesion or infection. None of the patients in the displacement group underwent revision surgery, and the fractures healed successfully during the postoperative follow-up. The total preoperative displacement in the displacement group was(10.0±1.3) mm, significantly larger than that in the displacement-free group [(7.8±1.5) mm]; the radius-ulnar length in the displacement group was (8.2±1.3) mm, significantly shorter than that in the displacement-free group [(10.8±2.3) mm]; the aspect ratio of the fragment in the displacement group was 1.2±0.2, significantly lower than that in the displacement-free group (1.4±0.2); the fragment volume in the displacement group was (690.5± 201.4) mm 3, significantly smaller than that in the displacement-free group [(995.8±295.0) mm 3]. There were significant differences in the above items between the 2 groups ( P<0.05). Conclusion:The total preoperative displacement, radius-ulnar length, aspect ratio and volume of a dorsal intra-articular fragment are important factors which may affect the displacement of the dorsal fragment after volar internal fixation.

The Relation between the Radial Collapse and the Number of Metaphyseal Screws for Distal Radius Fractures

@#Introduction: The purpose of this study is the evaluation of radial collapse, based on the number of screws used in the metaphyseal region and by distal dorsal distance (DDD) and lunate facet distance (LFD) measurement. Materials and methods: Between 2015 and 2019, 60 patients who were being treated with volar locking plates due to isolated distal radius fracture were evaluated. Control radiographs were taken on the first day and at 3rd-, 6th- and 12th-month follow-ups. Distal dorsal cortex distance and lunate facet distance were measured in the lateral radiographs. The number of screws used in the metaphyseal region was also evaluated. According to the number of screws, the amount of collapse was analysed based on both the LFD and the DDD. Results: The mean age of patients was 43.5±12.7 years. Thirty-three of the patients included in the study were male and 27 were female, and the minimum follow-up period was one year. According to the mean number of screws, groups were defined as up to 6 screws or 7 screws and above. There was a statistically significant difference between the groups in terms of DDD collapse at the 6th-month and 12th-month follow-ups (p<0.005). It was observed that the radial collapse and decrease in DDD and LFD were lower in plates with seven screws and above. Conclusion: Decreases in either DDD or LFD, or radial collapse were observed less in patients who had seven or more metaphyseal screws inserted. These findings might be useful for surgeons treating distal radius fractures to reduce radial collapse.

Estudio comparativo entre fijador externo versus placa volar de estabilidad angular en las fracturas de radio distal / External fixator versus angular stability volar plates in distal radius fractures. A comparative study

Las fracturas del radio distal están entre las patologías más comunes en el área de la emergencia, actualmente los tratamientos más utilizados son la fijación con alambres de Kirschner y fijador externo (AKFE), o la osteosíntesis con placas volares de estabilidad angular (PVEA), realizamos un estudio comparativo de los resultados a corto plazo entre ambos métodos. Se realizó un estudio transversal, retrospectivo y descriptivo desde el 2005 al 2019, donde se revisaron las historias de los pacientes con fracturas de radio distal tratados con AKFE o PVEA, evaluando el alta después de la medición de la amplitud de movimiento articular funcional. Se incluyeron 68 pacientes, 47(69,11%) pacientes tratados con PVEA y 21(30,88%) con AKFE, la edad promedio fue de 53,07 años, la causa más común fue la caída de su altura en 60,29% casos, el alta médica por mejoría se realizó a las 15,95 semanas para AKFE y a las 9,86 semanas para PVEA (<0.05). La osteosíntesis con PVEA evidenció un menor tiempo de recuperación de la amplitud de movimiento articular con respecto a los pacientes tratados con AKFE(AU)

Fractures of the distal radius are among the most common pathologies in the emergency area, currently the treatment more frequently used are fixation with Kirschner wires and external fixator (KWEF), or osteosynthesis with angular stability volar plates (FAVP), we carried out a comparative study of the short-term results between both methods. This is a cross-sectional, retrospective and descriptive study from 2005 to 2019, where the histories of patients with distal radius fractures treated with KWEF or FAVP revised, evaluated, evaluating at discharge after functional joint range of motion was measured.68 patients were evaluated, 47 patients treated with FAVP and 21 with KWEF, average age of 53.07 years, the most common cause was the fall from his height with 60.29%, the medical discharge was made at 15,95 weeks for KWEF and 9,86 weeks for FAVP; with a t student<0.05 between them. Osteosynthesis with FAVP evidenced a shorter recovery time for joint range of motion compared to patients treated with KWEF(AU)

Value of ultrasonography in diagnosis of closed volar plate injury of proximal interphalangeal joint / 中华超声影像学杂志

Objective:To evaluate the role of high frequency ultrasonography in diagnosis of closed volar plate injury of proximal interphalangeal joint.Methods:From May 2015 to may 2021, 41 patients with acute closed volar plate injury confirmed by Department of Hand and Foot Surgery of the Provincial Hospital Affiliated to Shandong First Medical University were examined by high frequency ultrasonography. The sonographic features were analyzed and classified.Results:High frequency ultrasonography could not only clearly show the thickness, shape and echo of volar plate, but also the degree of injury and avulsion fracture of volar plate, according to which the closed volar plate injury could be divided into three types: A, B and C. Type A(13 cases): Avulsion fracture of the middle phalangeal base was found with volar plate rupture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and avulsion fracture was found at the distal end of the volar plate. Type B(11 cases): Complete rupture of the volar plate attachment of the middle phalangeal base was found without avulsion fracture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and the end of the volar plate contracted and thickened. Type C(17 cases): Tear of the volar plate was found, the sonogram showed enlarging volar plates, heterogeneous internal echo, and liquid dark area was visible in some cases. The average thickness of the three types of closed volar plate injury of the proximal interphalangeal joint measured by ultrasound was (0.33±0.05)cm, and the average thickness of the volar plate at the same position of the corresponding finger on the opposite side was (0.22±0.03)cm. There was significant difference between the two groups ( t=7.864, P=0.006). Conclusions:High frequency ultrasonography is the preferred imaging examination method for the diagnosis of closed volar plate injury in proximal interphalangeal joint, which has an important guiding significance for the selection of clinical treatment.

A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures / 中华创伤杂志(英文版)

PURPOSE@#Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.@*METHODS@#A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score.@*RESULTS@#Patients in volar plate group had superior PRWE score and DASH score at each stage of follow-up. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group.@*CONCLUSION@#Fixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.

Functional Outcome of Unstable Distal Radius Fracture with Dorsally Displaced Radial rim Treated with Volar Variable Angle Locking Compression Plate

Introduction: Distal radius is one of the common fracture sites of the human skeleton. Dorsally displaced distal radius fractures(DRFs) are the most common type of DRF.Materials and Methods: Two matched cohorts of 20 matched patients, one with a displaced dorsal rim fracture >2 mm (Group1), and the other without a dorsal rim fracture (Group 2) were analyzed in this study with volar variable angle locking compressionplate fixation for dorsally unstable DRFs.Results: No significant difference was found between the two groups in overall wrist function or wrist pain. The mean displacementof dorsal rims in Group 1 was 3.0 mm and the mean diameter of the retained articular portion of the dorsal articular wall was2.0 mm. No significant difference was found between the two groups in terms of any radiographic parameters or the arthriticgrading of radiocarpal joints.Conclusion: These results suggest that a displaced dorsal rim fracture does not adversely affect the outcomes after the volarvariable angle locking compression plate fixation of a dorsally displaced DRF, indicating that an additional dorsal approach isunnecessary for reducing a displaced dorsal rim fracture

The Functional Outcome Volar Barton Fracture Treated by Open Reduction and Internal Fixation with T Plate – A Prospective Study

Introduction: Barton's fracture is fracture-dislocation ofradiocarpal joint with the intra-articular fracture involvingthe volar or dorsal lip. These injuries are inherently unstabledemanding open reduction and internal fixation. We presentour experience with buttress plate fixation for volar Barton’sfracture with Ellis T-plate. Aims: To evaluate the functionaloutcome and complications in volar Barton’s fracture treatedby open reduction and internal fixation with T plate.Material and methods: This case series study wasconducted between January 2012 and November 2012 atDepartment of Orthopaedics, Government Medical CollegeThiruvananthapuram. The patients in the age group 18 -75years who were treated by ORIF for volar Barton fractureswere included in the study. During follow up, subjective andobjective assessments were done and the patient’s functionalstatus was evaluated with modified clinical scoring system ofGreen and O’Brien. The 32 patients involved were followedup for eleven months. The descriptive data were analysedusing ‘SPSS’ and conclusions were made based on it.Results: Wrist functions as assessed by Green and O’Brienscore showed 84.4% patients with excellent to good results.Five patients had either fair or poor outcome. None of thesevariables were found to have any significant effect on the finaloutcome.Conclusions: Ellis T plate is a simple and cheap implantwhich provides effective volar distal buttressing in treatmentof volar Barton fractures. Our study shows encouragingresults with good functional results. Also, there is a relativelyshort learning curve and the implant is cost effective.

Research and development of fluoroscopy for the detection of dorsal screw penetration in the fixation of distal radius fracture with volar locking plate / 中国组织工程研究

BACKGROUND: Although the Incidence of irritation, abrasion and rupture of the extensor tendon at the dorsal carpal side of the distal radius caused by internal fixation with volar locking plate is not high, these complications seriously affect the quality of life of the patients. OBJECTIVE: To summarize the latest progress of intraoperative fluoroscopy in the treatment of distal radius fracture with volar locking plate. METHODS: Using the English key words "volar locking plate, distal radius fracture, radiological method", the authors retrieved PubMed for 160 relevant studies published from 2000 to 2019. Using the Chinese key words "fluoroscopy, distal radius fracture, volar plate", the authors searched Wanfang database for 7 relevant studies published from 2000 to 2019. This paper reviewed the literature of intraoperative fluoroscopy in the treatment of distal radius fracture with volar locking plate. RESULTS AND CONCLUSION: (1) There are various methods of intraoperative fluoroscopy during volar locking plate fixation for distal radius fracture, such as standard anteroposterior view, lateral view, carpal canal method, skyline, dorsal tangent view and radial groove view. (2) The above common methods still have some limitations in detecting the problem of posterior screw penetration in volar locking plate fixation. The complications such as irritation, abrasion and rupture of the extensor tendon of the dorsal wrist still occur, and the problems brought by the secondary and multiple operations to the patients' life and economy should also be paid attention to. (3) More appropriate intraoperative detection methods should be found, in order to reduce the incidence of complications caused by the internal fixation of the posterior screw with the locking plate on the palmar side.

Effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults / 中国修复重建外科杂志

Objective: To investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults. Methods: The clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation. Results: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group ( P0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups ( χ2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) ( χ2=9.325, P=0.002). Conclusion: It is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.

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.

Comparison of Functional and Radiological Outcome of Joshi’s External Stabilization System Versus Volar Locking Compression Plate in Unstable Distal End Radius Fractures: A Short-term Prospective Study

Purpose: The purpose of this study was to compare the short-term functional and radiological outcome between Joshi’s externalstabilization systems (JESSs) with volar locking compression plate (LCP) in treatment of unstable distal end radius fractures.Materials and Methods: A prospective study was conducted which included a total of 50 patients between the age group of20–60 years with fresh closed unstable distal end radius fractures and was randomized into two groups of 25 patients eachand their outcomes were compared.Results: The average period of follow-up was 2 years after which range of motion of the two groups was compared and clinicaland radiological evaluation was done. The functional result according to modified Gartland and Werley scoring was excellent in8%, good in 40%, fair in 48%, and poor in 4% in JESS group while it was excellent in 8%, good in 84%, fair in 4%, and poor in4% in volar LCP group. According to Stewart scoring system, the result was excellent in 8%, good in 40%, fair in 48% cases,and poor in 4% cases in JESS group while it was excellent-good in 88%, fair in 8%, and poor in 4% in the LCP group.Conclusions: The mean time to union was 5.71 months in volar LCP group and 3.75 months in JESS group. The functional andanatomical evaluation of both the groups showed that fixation by volar LCP group had better result in comparison to externalfixation by JESS with accurate maintenance of articular margin. Better functional results can be expected in the early postoperative period in association with open reduction and internal fixation, and this form of treatment should be considered forpatients requiring a faster return to function after the injury, but in the long run, this is comparable with JESS fixation.

Do we really need to repair the pronator quadratus after distal radius plating? / 中华创伤杂志(英文版)

Purpose:@#Fractures of distal radius are one of the common orthopaedic injuries. Placing the plate on volar surface requires release of underlying pronator quadratus (PQ) muscle. No consensus is present in the literature about the repair or not of the PQ. The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.@*Methods:@#Retrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated. Demographic data, operative notes and physical therapy records were retrieved. Patients were divided into group A where PQ repair was done and group B where no repair was done. Functional data such as range of motion (ROM), grip strength, visual analogue scale (VAS) score and disabilities of arm, shoulder and hand (DASH) score at 4 weeks, 3 months, 6 months and finial follow-up were retrieved.@*Results:@#Totally 63 patients (n = 29 in group A and n = 34 in group B) with the mean age of 51.64 years were examined. Patients were followed up for a mean of 35.2 months (range 27.2-47.1 months) in group A and 38.6 months (range 28.6-51.0 months) in group B. Though functional outcome of the affected limb was not significantly different between two groups after 3 months, PQ repair did affect the recovery at an early stage. Repair group had significantly better ROM (p = 0.0383) and VAS score at 4 weeks (p = 0.017) while grip strength (p = 0.014) was significantly better at 3 months.@*Conclusions:@#Repair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.

Repair of digital volar complex soft tissue defect with heterodigital antegrade digital artery island flap innervated by digital nerve / 中国修复重建外科杂志

Objective: To investigate the effectiveness of heterodigital antegrade digital artery island flap innervated by proper digital nerve and the dorsal branch of proper digital nerve for repairing digital volar complex soft tissue defects. Methods: Between May 2014 and January 2018, 27 patients with digital volar complex soft tissue defects were treated. There were 17 males and 10 females with an average age of 37 years (range, 18-60 years). The causes included electric saw injury in 8 cases, twisted injury in 12 cases, and heavy pound injury in 7 case. There were 9 thumbs, 5 index fingers, 6 middle fingers, 3 ring fingers, and 4 little fingers. The interval between injury and admission ranged from 1 to 4 hours (mean, 2.5 hours). The defect size ranged from 2.2 cm×1.4 cm to 3.8 cm×2.3 cm. The mean length of unilateral proper digital nerve defect was 2.9 cm (range, 2-4 cm). All defects were repaired with heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve. The proper digital nerve and the dorsal branch of the proper digital nerve in the flap were anastomosed with the proper digital nerve stumps in the wound. The flap size ranged from 2.4 cm×1.6 cm to 4.1 cm×2.6 cm. A segment of dorsal branch of the proper digital nerve was intercalated into the defect of the proper digital nerve in donor site. And the defect of donor site was repaired with the full-thickness skin graft. Results: All flaps and skin grafts survived, and the wounds healed by first intention. All patients were followed up 12-24 months (mean, 17 months). The appearance, color, and texture of the flaps were similar to the surrounding tissue. There was no pain and double sensibility in any flap. At last follow-up, the static two-point discrimination of the flaps ranged from 4 to 8 mm (mean, 5.3 mm). And the two-point discrimination of digital pulps of recipient and donor fingers ranged from 4 to 10 mm with the average of 6.2 mm and 6.0 mm, respectively. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 18 cases and good in 9 cases. No scar contracture was observed in donor site. Conclusion: The heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve provides a safe and simple technique with minimal donor site cost and satisfactory effectiveness, which could be an ideal option for repairing digital volar defect, especially for the defect complicated with digital nerve defect.

Combination Effects of Self-Volar Gliding Using a Strap and Wrist Distraction on Pain and Wrist Extension Range of Motion in Subjects with Dorsal Wrist Pain

PURPOSE: This study examined the effects of self-volar gliding combined with a strap and wrist distraction on pain and the active and passive wrist extension range of motion (ROM) in subjects with dorsal wrist pain during partial weight bearing of the hand.METHODS: Thirty subjects (14 males and 16 females) with dorsal wrist pain during partial weight bearing through the hand participated in this study. The two different self-volar gliding techniques were performed for each group. Self-volar gliding using a strap (SVGS) and SVGS and wrist distraction (SVGSD) were performed five times for one week for each group. The active and passive ROM of wrist extension and the peak pressure pushed by the hand at pain (PPHP) were measured. An independent t-test was used to compare the improvements of these elements between the two different self-volar gliding techniques. The level of statistical significance was at α=0.05.RESULTS: The active and passive ROM of wrist extension and PPHP were greater in both self-volar gliding groups after the one week intervention. On the other hand, these parameters were greater in the SVGSD group than in the SVGS group (p<0.05)CONCLUSION: SVGSD is recommended to improve the active and passive ROM of wrist extension and PPHP in subjects with dorsal wrist pain during partial weight bearing of the hand.

Plating the radial shaft on the lateral surface: An outcome study / 中华创伤杂志(英文版)

PURPOSE@#Plate fixation is the gold standard for the treatment of displaced forearm shaft fractures in adults. Conventionally radial shaft fractures will be plated either on the volar surface or on the dorsal surface depending on which approach has been chosen. The lateral surface of the radius provides an even and uniformly curved area for placing a plate. It has the advantage of restoring and easy assessing the radial bow after surgery. We designed a prospective study to observe the outcome of lateral plating of radius shaft fractures.@*METHODS@#Nineteen patients were included in this study performed in Government Medical College, Jammu, India. Among them, 13 had fractures of both the forearm bones and 6 had isolated radial shaft fracture. Three patients had Galeazzi fracture dislocation. Fixation was done within 36 h of injury in all using 3.5 mm limited contact dynamic compression plate or locking compression plate applied to the lateral surface of the radius. Ulna was fixed in routine manner.@*RESULTS@#Union was achieved in 18 out of 19 patients, after a mean time of 17.44 weeks. According to Anderson et al.'s criteria, 12 patients had excellent results, 5 had satisfactory and 1 had unsatisfactory result. There was one failure (nonunion).@*CONCLUSION@#The outcomes including rate of union were comparable to those in the existing literature. Plating the radial shaft on the lateral surface is a viable alternative to volar or dorsal plating of the radius. Larger studies with randomized data are needed to assess whether it has any superiority over other existing techniques.

Operative strategy and clinical results of complex four part distal radius fractures by combined palmar and dorsal internal fixation / 中华外科杂志

Objective@#To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results.@*Methods@#From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months.@*Results@#Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively.@*Conclusion@#Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.

Treatment of acute volar plate avulsion fracture of proximal interphalangeal joint with double thread compression suture fixation / 中华骨科杂志

Objective To investigate the treatment and surgical results of acute volar plate avulsion fracture of proximal interphalangeal joint.Methods From August 2013 to June 2016,data of 15 cases of acute volar plate avulsion fracture of proximal interphalangeal joint were retrospectively analyzed.There were 8 males and 7 females aged 18-43 years old with an average of 28.6 years old.There were 4 cases of index finger,6 cases of middle finger,2 cases of ring finger and 3 cases of little finger.Eight injuries resulted from falls,four from finger breaking and three from crushing.The time from injury to operation was 5-9 days,with an average of 6.7 days.The acute volar plate avulsion fracture of proximal interphalangeal joint were treated by double thread compression suture fixation,and Kirschner wires were used to obliquely fix the interphalangeal joint.After the operation,the fore arm was fixed by plaster for 3-4 weeks.After the removal of the plaster,the flexion and extension function of the distal interphalangeal joint and the metacarpophalangeal joint was performed under the guidance of the rehabilitation instructor in a state of no weight.The finger was evaluated by X-ray every 2 weeks until the fracture healing.After 5-8 weeks,the Kirschner wire was removed when the fracture line disappeared,and the active flexion and extension of the proximal interphalangeal joint was guided by the rehabilitation instructor.Resuts In this group of 15 patients,all the incisions healed at the first stage.There was no surgical complications such as skin necrosis,and needle path infection and no abnormal finger feeling or blood circulation disorder.All patients were followed up for 8-32 months (mean,21.7 months).8 months after operation,the DASH score was 1.5 to 7.0 points with an average of 4.6 points.At the latest follow-up,there was no pain,swelling and joint contracture in the proximal interphalangeal joints.The dorsal extension of joints were stable,and the degree of active joint activity was:90°±7° of the metacarpophalangeal joint,80°±6° of the proximal interphalangeal joint,78°±7° of the distal interphalangeal joint,and 248°±22° of total active activity.According to TAM system assessment criteria:there was excellent in 12 cases,good in 2 cases,fair in 1 case,and excellent rate was 93.3％(14/15).Conclusion Double thread compression suture fixation for the treatment of acute volar plate avulsion fracture of proximal interphalangeal joints could reduce the damage to the accessory structure of the joint,and reach adequate exposure in the operationfor fixing the bone block firmly.After operation,good fracture healing and good finger function could be achieved,so the double thread compression suture fixation is an effective surgical method.

Analysis on clinical effect of volar side locking compression titanium plate and external fixation trestle for treating unstable type C distal radius fracture / 重庆医学

Objective To comparatively analyze the clinical effects of volar locking compression titanium plate and external fixation trestle for treating unstable type C distal radius fracture.Methods The clinical data of 78 patients with unstable type C distal radius fracture treated in this hospital from March 2014 to February 2016 were analyzed retrospectively.The patients were di-vided into the volar locking plate group and external fixattio trestle group according to different treatment methods,39 cases in each group.The clinical efficacies of different treatment methods were observed.Results The postoperative bleeding volume,operation time,hospitalization time and fracture healing time in the external fixation group were less than those in the volar locking plate frac-ture group(P<0.05).The palmar tilt angle,ulnar inclination angle and radial height on postoperative 3 d,6 weeks and 24 mopnths in the volar locking plate group were significantly better than those in the external fixation group(P<0.05).The last follow-up showed that the palmar flexion degree,dorsiflexion degree,VAS score and Gartland-Werley score had no statistical difference be-tween the two groups(P>0.05).The incidence rates of postoperative incision infection,carpal tunnel syndrome and thumb extensor tendon rupture had no statistical differences between the two groups(P>0.05).Conclusion The two kinds of treatment method all have better clinical curative effect.The external fixation trestle treatment has the advantages of shorter operation time and shorter hospitalization time,while the volar locking compression titanium plate can reset the fractures under direct vision,is significantly su-perior to the external fixation trestle treatment in the aspects of recovery of palmar tilt angle,ulnar inclination angle and radial height,and is more suitable for the patients with unstable type C distal radius fracture..