Low Rates of Hardware Removal and Tendon Rupture for the Acu-Loc 2 Volar Distal Radius Plate: A Minimum One-Year Follow-Up Study.

AIM: Volar locking plates designed for far distal radius fracture fixation can have a significant hardware removal rate and risk of tendon rupture. Plate design has a role in the rate of complications. This study assessed the hardware removal and tendon rupture rate of the Acu-Loc 2 volar distal radius (VDR) plate often used in the treatment of far distal radial fractures. METHOD: We searched our electronic healthcare records system for all patients who had undergone fixation with an Acu-Loc 2 VDR plate (Acumed, Hillsboro, OR, USA) at a tertiary center between January 2017 and December 2021. Patients were excluded if their follow-up time was less than one year or if they could not be contacted by telephone follow-up. Pre-operative radiographs were examined for fracture classification. Follow-up time was defined as the last contact in the clinic or by telephone. RESULTS: A total of 92 patients underwent an open reduction and internal fixation (ORIF) with an Acu-Loc 2 VDR plate. A total of 85 patients met the inclusion criteria for this study. Our cohort included 33 males (38.8%) and 52 females (61.2%). The mean age was 50 years. Twenty-seven fractures (31.0%) were extra-articular, and 60 fractures (69.0%) were intra-articular. The mean follow-up time for the patients was 593.3 days (range 369 to 1185 days). Four patients (4.7%) had their hardware removed. Three (3.5%) patients underwent removal due to tendon irritation and one patient (1.2%) due to a peri-prosthetic fracture around the plate. There were no tendon ruptures recorded. CONCLUSION: The Acu-Loc 2 VDR plate had a low medium-term hardware removal rate and no tendon ruptures. These rates are lower than would be expected when compared with other far distal plate designs.

The Role of Early Post-Operative Radiographs Following Distal Radius Fracture Fixation with a Volar Locking Plate: Time for Change?

Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient's first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9-16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

Isolated ischaemic contracture of medial head of gastrocnemius.

A 47-year-old woman presented with a disabling fixed flexion deformity of the knee and an equinus deformity of the ankle following treatment in a cast for a minor flexion deformity following a tibial plateau fracture. Two years later, the cause was identified as an isolated ischaemic contracture involving the medial head of gastrocnemius. She made a good recovery following extensive corrective surgery and rehabilitation.

Management of shoulder dislocation--are we doing enough to reduce the risk of recurrence?

Young patients with shoulder dislocation are at high risk of recurrence. Traditionally, management has been conservative, but rehabilitative programmes are successful in fewer than 20% of patients. Recent studies suggest that early surgical intervention (arthroscopic lavage or stabilisation) can significantly reduce recurrence in young patients with primary traumatic anterior dislocation. This study demonstrated that in our region, 21% of all patients presenting with shoulder dislocation had already suffered recurrence at 1 year; in the 15-22 years age group this figure was 43%. We propose to offer young patients presenting with primary traumatic anterior dislocations arthroscopic lavage within 10 days of injury. The extra surgical workload is manageable within our current trauma service arrangements, and we believe that this form of treatment would be acceptable to patients.