Comparative study between volar locked plates versus closed reduction with percutaneous pinning in management of unstable extra-articular distal radius fractures.

BACKGROUND: Unstable extra articular fractures of distal radius need operative treatment, either by manipulation and closed pinning by K-wires, or by locked types of plates that give good anatomical restoration. OBJECTIVE: To compare the volar locked plate versus manipulation and percutaneous pinning method of fixations for unstable extra articular fractures of distal radius. METHODS: A prospective comparative study was conducted on 26 patients with mean age of 48.42±10.7 years having closed, unilateral, unstable extra articular distal radius fracture according to the one or more of the following criteria; (dorsal displacement ≥20 degrees, metaphyseal dorsal comminution, age ≥60 years , ulnar fracture, initial displacement ≥ 1cm, radial shortening ≥ 5 mm). Patients were divided in two treatment groups, thirteen were fixed with k-wires and thirteen with volar locked plate. The follow up visit was scheduled after 3 months after surgery to assess the union and functional outcomes using Modified Mayo score and Quick DASH score at 3 months postoperatively and then up to 6th months to assess clinical outcomes and complications for each case. RESULTS: No significant difference in time of union was observed in both groups, but better functional outcome was seen in the locked plate group compared to the K-wire group. The total infection rate, was 4(30.76 %) patients for wire group and one (7.70%) patient for plate group, mal-union was seen in 4(30.70%) patients in wire group and one (7.70%) patient in the plate group, tendonitis was encountered in one (7.70%) patient in wire group and 3(23.08%) patients in the plate group. Painful hardware was noted in one (7.70%) patient in the wire group and 2(15.40%) patients in the plate group. Re-operation was required in 2(15.40%) patients in wire group and one (7.70 %) patients in the plate group. CONCLUSIONS: In distal radius extra articular unstable fracture, volar locked plate provides a superior functional outcome, less complications compared to closed percutaneous k-wires pinning.

Osteochondroma : the local effects and the management.

Osteochondroma is a common benign bone tumour, presenting as a single or multiple lesions, pedunculated or sessile type, mainly in 1st-2nd decades and mostly in males. The presented case series, studied the local effect of (osteochondroma) at the end of long bones with best line of treatment (RQ). Eighteen patients with osteochondromas, with an age range of 9- 45 years, mean age 19.6 ± 11.147 years, were seen from October 2016 to November 2018. There were 8 cases with painful lesion due to (mechanical interaction) or (pressure on near by neurovascular bundle), or from (inflamed bursa). Four cases were asymptomatic, 3 cases had Growth disturbances of the fellow bone, 3 cases presented with neurological symptoms and one case had vascular complications. Osteochondromas may present with different types of local effects on its surrounding tissues. Surgical excision is the best line of treatment.