Hand Surgeon Reporting of Tendon Rupture Following Distal Radius Volar Plating.

Background: Volar plate fixation with locked screws has become the preferred treatment of displaced distal radius fractures that cannot be managed nonoperatively. This treatment, however, is not without complication. The purpose of this study was to determine what percentage of hand surgeons, over a 12-month period, have experienced a tendon complication when using volar plates for the treatment of distal radius fractures. Methods: A total of 3022 hand surgeons were e-mailed a link to an online questionnaire regarding their observation and treatment of tendon injuries associated with volar plating of distal radius fractures. Responses were reported using descriptive statistics. Results: Of the 596 (20%) respondents, 199 (33%) surgeons reported encountering at least one flexor tendon injury after distal radius volar plating over the past year of practice. The flexor pollicis longus was the most commonly reported tendon injury (254, 75%). Palmaris longus grafting (118, 37%) and tendon transfer (114, 36%) were the most often reported treatments following this complication. A total of 216 respondents (36%) also encountered 324 cases of extensor tendon rupture after volar plating of distal radius fractures, with tendon transfer (88%) being the preferred treatment option. Conclusions: Both flexor and extensor tendon ruptures can be seen after volar plating of distal radius fractures. Surgeons should be aware of these complications. Critical assessment of hardware position at the time of index procedure is recommended to avoid complications. Long-term studies are needed to standardize approaches to managing tendon rupture following volar plating of distal radius fractures.

Patient-related factors influencing ulnar-shortening osteotomy outcomes using the trimed dynamic compression plate.

Ulnocarpal impingement can be surgically managed with various shortening osteotomy techniques. The purpose of this study was to retrospectively examine the outcomes of the ulnar-shortening osteotomy technique using the Trimed dynamic compression plate (Valencia, California) and to determine whether results vary among patient-related factors, including smoking status, occupation, preoperative diagnosis, and workers' compensation status. Twenty-seven patients (28 wrists) operated by a single surgeon underwent ulnar shortening over a 4-year span. Radiographic analysis was obtained preoperatively and at an average 24-month follow-up. A subset of 12 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory; the Patient-Rated Wrist Evaluation (PRWE); and the visual analog scale for pain and underwent clinical evaluation for range of motion and strength. Ulnar variance improved in all cases between pre- and postoperative imaging (P<.05). Grip strength and range of motion were found to be 79% and 90% of the contralateral extremity, respectively. Among the examined patient-related factors, patients involved in a workers' compensation claim demonstrated significantly different DASH (average, 56.8 claim vs 26.8 no claim; P=.037) and PRWE (average, 66.0 claim vs 32.8 no claim; P=.008) scores while also showing a trend toward nonunion (3/10 claim vs 1/18 no claim; P=.105). Results of ulnar-shortening osteotomy using the Trimed system at 2-year follow-up show consistent objective improvements in radiographic ulnar variance. Workers' compensation claims may negatively influence outcomes of ulnar shortening, and this factor should be considered in preoperative patient selection and counseling.

Fix it or discard it? A retrospective analysis of functional outcomes after surgically treated patella fractures comparing ORIF with partial patellectomy.

OBJECTIVES: The goal of this study was to compare functional outcomes of patients with patella fractures treated with open reduction and internal fixation (ORIF) with those treated with partial patellectomy (PP). DESIGN: Retrospective cohort study. SETTING: Urban Level I Trauma Center. PATIENTS: Seventy-three patients with isolated displaced patella fractures underwent operative treatment between January 1, 2002, and December 31, 2009, at our institution. Of these, 52 (71%) patients with isolated patella fractures with minimum 1-year follow-up agreed to participate and were enrolled in the study. INTERVENTION: PP or ORIF. MAIN OUTCOME MEASUREMENTS: Patients completed outcome questionnaires and participated in a physical examination. Outcome instruments included the Knee Outcome Survey-Activities of Daily Living Scale, Short Form (SF)-36 Health Survey, and SF Musculoskeletal Function Assessment Survey. RESULTS: Twenty-six patients underwent PP and 26 underwent ORIF. There were no significant differences in any of the functional outcome instruments, including Knee Outcome Survey-Activities of Daily Living Scale (ORIF: 64.1 ± 11, PP: 62.1 ± 7.9, P = 0.76), SF-36 physical component score (ORIF: 40.8 ± 5.4, PP: 41.1 ± 5.2, P = 0.94), SF-36 mental component (ORIF: 47.7 ± 5.1, PP: 51.8 ± 4.9, P = 0.19), Short Musculoskeletal Function Assessment (SMFA) Function Index (ORIF: 28.6 ± 9.1, PP: 27.7 ± 6.7, P = 0.78), or SMFA Bother Index (ORIF: 26.0 ± 9.7, PP: 23.6 ± 8.8, P = 0.72). Complication rates did not differ significantly between the 2 groups. CONCLUSIONS: This study demonstrates that functional impairment persists after operative treatment of patella fractures. Both ORIF and PP demonstrated similar final range of motion, functional scores, and complication rates. Despite its purported benefits, in this study, ORIF did not result in superior outcomes compared with PP. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.