Recovery of Wrist Function after Volar Locking Plate Fixation for Distal Radius Fractures.

BACKGROUND: The purpose of our present study was to examine the recovery of the postoperative wrist function, and to compare the range of motion among each direction ofthe wrist joint during the same time periods after surgery for distal radius fractures. METHODS: Twenty patients treated with a volar locking plate were evaluated. The active range of motion and grip strength were assessed at four weeks, six weeks, three months, six months and one year after surgery. RESULTS: The ratio of the range of motion in pronation and supination recovered significantly earlier than for any other directions within six months after surgery (p = 0.0205), however, the ratio of the range of motion among the six directions was not significantly different at one year after surgery (p = 0.0823). The recovery of the range of motion in flexion was 96.8% compared with the contralateral wrist at one year after surgery, and it was not significantly lower than that in extension, radial deviation or ulnar deviation (97.8%, 93.5%, 94.4%, respectively). The grip strength of dominant hand recovered from 50% after four weeks to 66% after six weeks, 83% after three months, 91% after six months and 106% at the examination performed after one year compared with the uninjured non-dominant hand. The grip strength of non-dominant hand recovered from 52% after four weeks to 59% after six weeks, 79% after three months, 84% after six months and 94% at the examination performed after one year compared with the uninjured dominant hand. The mean DASH score was 5.3. CONCLUSIONS: The range of motion in flexion can achieve similar improvement to that in the other directions by obtaining the appropriate postoperative parameters. The optimal postoperative radiographic parameters were thus identified to be essential for successfully obtaining a recovery of the wrist function for unstable distal radius fractures.

Recurrent dislocations of the atlantooccipital and atlantoaxial joints in a halo vest fixator are resolved by backrest elevation in an elevation angle-dependent manner.

BACKGROUND CONTEXT: Halo fixation is now universally performed in the initial reduction and fixation of unstable upper cervical spine injuries; however, persistent high instability and recurrent dislocations of the atlantooccipital and atlantoaxial joints after fixation are not well recognized. PURPOSE: The aim was to describe persistent instability of traumatic dislocations of the atlantooccipital and atlantoaxial joints after halo fixation and a useful method for preventing instability. STUDY DESIGN: This was a case report of a patient who survived traumatic dislocations of the atlantooccipital and atlantoaxial joints. PATIENT SAMPLE: A 73-year-old woman diagnosed with dislocations of the atlantooccipital and atlantoaxial joints along with multiple other injuries sustained in a traffic accident was included. METHODS: After initial closed reduction and halo fixation, congruity of the atlantooccipital and atlantoaxial joints was evaluated using, condylar gap, atlantodental interval, and flexion angulation of C1-C2 after the initial examination and before surgery. RESULTS: Changes in parameters 12 hours after halo fixation revealed re-dislocations and instability of the joints. Backrest elevation with halo fixation tended to reduce re-dislocations. Therefore, we carefully increased the backrest angle and measured the parameters at several angles of elevation within a range that did not affect vital signs to observe the effectiveness of elevation against re-dislocations. Elevation changed the parameters in an elevation angle-dependent manner, and these changes suggested that elevation was effective for reducing re-dislocation of both the atlantooccipital and atlantoaxial joints during halo fixation. With no major complications, this method enabled us to maintain good congruity of the joints for approximately 2 weeks until posterior spinal fusion with internal fixation. CONCLUSIONS: Backrest elevation with halo fixation appears safe to be performed without any other devices and is beneficial for blocking re-dislocation of both the atlantooccipital and atlantoaxial joints as well as possible secondary damage to the upper cervical spinal cord during the external fixation period.

Open pelvic ring fracture and multiple fractures of the lower extremities: a case report.

A 73-year-old female was hit by a car, and transferred to our hospital. On examination, her consciousness was alert, but her vital signs were unstable. There are three 10-cm open wounds on her right buttock. X-rays showed an unstable pelvic ring fracture, a right femoral shaft, a right proximal tibia and a right tibial plafond fractures. One hour after the injury, transarterial embolization (TAE) followed by external fixation (EF), and retroperitoneal pelvic packing (RPP) was performed. Two days and five days after the injury, thorough debridement of the open wounds was performed. The skin defect on the right buttock and the lower abdomen had enlarged to 40 x 35 cm, therefore, negative pressure wound therapy was applied. On the same day, right femur was fixed using a retrograde intramedullary nailing. 12 days after the injury, the proximal tibial fracture was fixed using a plate, and the tibial plafond fracture was fixed using screws and external fixators. 28 days after the injury, the split-thickness skin graft was performed on the right buttock and the lower abdomen. Seven months after the injury, the open wounds were completely healed without infection. She was able to walk smoothly with a T-cane. For the management of open pelvic ring fractures, it is essential to perform TAE, EF and RPP as soon as possible. Providing aggressive management, including thorough debridement, is mandatory to prevent severe infection and sepsis. We achieved a good clinical outcome by using a combination of TAE, EF, RPP and staged surgery, including thorough debridement.

A Gustilo type IIIB open forearm fracture treated by negative pressure wound therapy and locking compression plates: a case report.

A 91-year-old female sustained injuries to her left forearm while walking across a crosswalk. X-rays showed left radial shaft and ulna shaft fractures, and the injury was a type IIIB open fracture. On the day of admission, irrigation and debridement of the open wound, and temporary fixation of the radius and ulna using an external fixator and a Kirschner wire were peformed. Six days after the surgery, we used negative pressure wound therapy (NPWT) using the V.A.C.ATS system for the open wound. Thirteen days after the first surgery, definitive fixation was performed by using locking compression plates, and full thickness skin grafting was undertaken for the open wound. NPWT is a treatment that accelerates the wound healing process through the delivery of continuous subatmospheric pressure within a closed environment. In our case, we could reduce the healing period of the soft tissue and could convert to the definitive fixation in a timely fashion. NPWT is thought to be a useful adjunct in the management of the soft tissues of open fractures.