What to Expect? Use of Supplemental Fixation With a Concomitant Dorsal Spanning Plate for Complex Intraarticular Distal Radius Fractures.

BACKGROUND: The dorsal spanning plate (DSP) is a versatile implant suitable for bridging severely comminuted intraarticular distal radius fractures [AO (Arbeitsgemeinschaft für Osteosynthesefragen) 23-C.1-C.3]. It may be used alone or with supplemental fixation such as a volar locking plate (VLP) or fragment-specific fixation (FSF). Outcomes following DSP fixation with additional implants have not been specifically evaluated. METHODS: We retrospectively reviewed consecutive patients who underwent internal fixation of a distal radius fracture by a single surgeon from 2017 to 2021. Patients were grouped according to implants used: DSP only, DSP + FSF, and DSP + VLP. Preoperative variables, treatment times, and wrist range of motion (ROM) were assessed. Functional wrist ROM was defined as minimum 80° combined flexion and extension. RESULTS: One hundred fifty-two patients underwent surgery for wrist fracture, 33 of them were treated with a DSP: 8 DSP only, 6 DSP + VLP, and 19 DSP + FSF. Falls from height greater than 10 ft accounted for 52% of injuries, most of which were treated with a DSP + FSF. Treatment times and ROM were similar between subgroups. Wrist ROM did not improve significantly beyond 4 weeks following DSP removal. Overall, DSP patients recovered a mean wrist ROM of 85° (range 0°-130°) within a median 26 weeks total treatment period (range 12-68 weeks). CONCLUSION: Regardless of the construct used, if the distal radius articular surface is well reduced and other principles of fracture fixation are applied, most patients treated with a DSP can expect to regain functional wrist ROM. LEVEL OF EVIDENCE: Level IV-Retrospective review of prospectively collected data.

Modern Perioperative Pain Management Strategies to Minimize Opioids after Total Knee Arthroplasty.

Total Knee Arthroplasty is associated with significant postoperative pain that can limit functional outcomes and patient satisfaction. In recent years, the standard of care for postoperative pain management has reduced reliance on opioids in favor of multimodal analgesia. These regimens consist of systemic medications such as COX-2 inhibitors, acetaminophen, corticosteroids, and gabapentinoids, as well as regional and local approaches such as peripheral nerve blocks and local infiltrative analgesics. Newer therapies, such as cryoneurolysis, are still being studied but have shown promising results. Additional studies are needed to determine the ideal pain regimen that will optimize pain control and eliminate the need for postoperative opioids.