A Novel Approach for Three-Dimensional Evaluation of Reduction Morphology in Distal Radius Fracture

The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.

Background: Fractures at the distal end of the radius, a prevalent orthopedic concern, challenge clinicians due to their complex nature and the diverse patient demographics they affect. Primary stability is key, especially in cases involving osteoporotic bones or younger patients. The Ellis plate with a locking screw mechanism offers a promising solution to achieve this stability, potentially preventing secondary displacement regardless of bone quality. Aims and Objectives: This study aims to rigorously assess the effectiveness of the Ellis volar locking compression plate in treating distal end radius fractures. It focuses on evaluating functional outcomes post-treatment, providing insights into the efficacy of this approach. Materials and Methods: This study evaluated the efficacy of the Ellis plate in managing distal radius fractures, under ethical approval number KMC/IEC/Ortho/2021-5. Twenty adult patients with unstable fractures were included based on specific criteria and provided informed consent. Exclusion criteria included unwillingness for surgery, medical unsuitability, osteoporosis, minors, and compound fractures with vascular injury. Surgical outcomes were assessed using the Gartland and Werley scoring system, with follow-up appointments scheduled over 1 year to monitor progress and adherence to physiotherapy plans. Results: The study encompassed 20 patients, with a gender distribution of 12 males and eight females and an average age of 43.3 years. Utilizing the Gartland and Werley demerit grading system, the study reported 45% superb outcomes, another 45% good outcomes, 10% fair outcomes, and no poor outcomes. This distribution highlights the potential of the Ellis plate technique in achieving positive results in fracture treatment. Conclusion: The study concludes that the Ellis plate technique is a viable and effective option for stabilizing distal end radius fractures. However, achieving the best possible outcomes depends on several factors, including strict adherence to AO principles, maintaining high standards of aseptic practice, following appropriate post-operative rehabilitation protocols, and ensuring comprehensive patient education. This multifaceted approach is crucial for the successful treatment of these fractures.

Most arthroscopies in the body are carried out infusing water to create an optical working cavity. Under those conditions we found the management of distal radius fractures quite cumbersome, not to say that compartment syndrome risk did exist (11). Furthermore, when we used to use water to distend the joint, performing semi-open operations such as osteotomies, or distal radio-ulnar joint reconstructions, were impracticable. Extrapolating that in other “scopies” in the human body, such as laparoscopy or thoracoscopy, water was not used to maintain the optic cavity, we realized that traction through the fingers was sufficient to maintain the wrist open. Main advantages were that soft tissue extravasation was eliminated, much facilitating any combined open surgery as the tissues maintained their original properties. The dry technique, which in essence is similar to the classic technique but without infusing water, introduces a new set of difficulties derived from vision loss secondary to splashes of blood or soft-tissue debris that may stick to the scope tip. Removing the scope and wiping off the lens with a wet sponge is efficacious but time consuming. Moreover, poor vision quality or being immersed in a “red sea” may make the surgeon abandon this technique that has a lot to offer. This is particularly true for distal radius fractures. Based on our experience with more than 300 dry wrist arthroscopies we have found the following technical tips helpful:

Background: Distal radius fractures are common, and the trend in fixation has included the use of locked volar plating. The duration of splinting required after surgery and the effect splinting has upon outcome of the wrist are not clear. Our aim was to compare outcome of patients treated with early versus late motion protocol after volar plating. Methods: Thirty-three patients with distal radius fractures were prospectively and randomly enrolled into an early versus late motion study including volar plating of the distal radius fracture. Early motion included an active and passive wrist motion protocol by 14 days after surgery and delayed motion was initiated at 5 weeks. Fractures were defined as intra-articular and extra-articular, and those with, and without, ulnar styloid fracture. Motion and outcome scores (Disabilities of the Arm, Shoulder and Hand [DASH]/patient-rated wrist evaluation [PRWE]), and strength were measured through 1 year. Results: Wrist motion, DASH, and PRWE scores were only significantly different at 6 weeks with no significant differences at any later time points up to 1 year. One patient had complex regional pain syndrome (CRPS) and one had adhesive capsulitis in the late motion group. Conclusions: Following locked volar plating of distal radius fractures, early motion favored earlier return of motion along with lower DASH, PRWE, and pain scores within first 6 weeks. Although the late motion group had delayed recovery, there were no long-term significant differences in motion, strength, outcome, or pain scores. The 2 cases with complications (CRPS and adhesive capsulitis) did occur in the late motion group and may implicate late motion with these problems.

Plating of Distal Radius Fracture Using the Wide-Awake Anesthesia Technique.

The optimal management of distal radius fractures remains a challenge for orthopaedic surgeons. The emergence of Artificial Intelligence (AI) and Large Language Models (LLMs), especially ChatGPT, affords significant potential in improving healthcare and research. This study aims to assess the accuracy and consistency of ChatGPT's knowledge in managing distal radius fractures, with a focus on its capability to provide information for patients and assist in the decision-making processes of orthopaedic clinicians. We presented ChatGPT with seven questions on distal radius fracture management over two sessions, resulting in 14 responses. These questions covered a range of topics, including patient inquiries and orthopaedic clinical decision-making. We requested references for each response and involved two orthopaedic registrars and two senior orthopaedic surgeons to evaluate response accuracy and consistency. All 14 responses contained a mix of both correct and incorrect information. Among the 47 cited references, 13% were accurate, 28% appeared to be fabricated, 57% were incorrect, and 2% were correct but deemed inappropriate. Consistency was observed in 71% of the responses. ChatGPT demonstrates significant limitations in accuracy and consistency when providing information on distal radius fractures. In its current format, it offers limited utility for patient education and clinical decision-making.

The purpose of the current study is to meta-analyze the randomized controlled trials in the literature comparing pronator quadratus repair versus no repair alongside volar plating of distal radius fractures. A search of the PUBMED/MEDLINE, EMBASE, and The Cochrane Library databases was performed. Any randomized con- trolled trials comparing pronator quadratus repair versus no repair alongside volar plating of distal radius fractures were included. The relevant information was collected by 2 blinded reviewers using a predetermined data sheet. Clinical outcomes were compared, with all statistical analyses performed using Review Manager Version 5.3. Five randomized controlled trials with 273 patients were included. There was no significant difference in the range of motion in flexion-extension, ulnar-radial deviation, or pronation-supination. There was a significant difference in favor of the no repair group for Disabilities of the Arm, Shoulder and Hand (DASH) Score (MD [Mean Difference]: 2.63, P < .0001) and pronation strength (MD: 13, P < .0001). Furthermore, there was no significant difference in the visual analog scale score. There were 3 complications relating to pronator quadratus repair, in which patients developed carpal tunnel syndrome requiring a release. There was no significant difference in the re-operation rate. This study found that pronator quadratus repair when performing volar plating for distal radius fractures did not result in a significant improvement in functional outcome, range of motion, or strength. I, Systematic Review of Level 1 Studies, Level I, Therapeutic Study.

Complications of Low-Profile Dorsal Versus Volar Locking Plates in the Distal Radius: A Comparative Study

Volar plating in distal radius fractures: A prospective clinical study on efficacy of dorsal tangential views to avoid screw penetration

Aim Complex regional pain syndrome (CRPS), characterized by severe sensitivity to touch, skin changes, and joint stiffness, is a post-traumatic complication affecting the upper and lower extremities. This audit evaluated numerous clinical endpoints in the management of distal radius fracture (DRF) patients who developed CRPS, with the aim of improving service provision. Clinical endpoints were audited against the BSSH guidelines for DRF management. Method DRF patients with CRPS symptoms who underwent hand therapy between January 2023 to October 2024 were included. Clinical endpoints included duration from injury to definitive management and rehabilitation, type and duration of post-injury and post-operative immobilisation, and casting complications. Results Thirteen patients (100% female) were identified. Post-injury, all DRFs were immobilized in a backslab. Six patients (46%) were managed conservatively in a full cast for 6-weeks, on average 4-days from injury. Seven patients (54%), all with an intra-articular DRF, underwent surgery on average 6-days for injury, with six (46%) requiring an open reduction and internal fixation (ORIF) and one (8%) managed with closed reduction and percutaneous pinning (CRPP) and full cast. Post-ORIF, Futura splint immobilization was used for five patients (86%) and backslab followed by Futura splint for one patient (14%), with 6-weeks of immobilization on average. Average duration from casting to physiotherapy was 54-days, in comparison to 35-days post-operatively. Conclusions Patients with intra-articular DRFs underwent surgery on average 6-days post-injury, while BSSH recommends surgery within 72hrs. The average duration of casting and post-operative immobilization was 6-weeks, whereas BSSH recommends 4-weeks. These findings aim to improve the management of DRFs.

D istal radius fractures are among the most common fractures of the upper extremity, and account for approximately 20% of all fractures seen within the emergency room. The distal radius comprises of three articular surfaces, namely the scaphoid facet, lunate facet, and sigmoid notch. Treatment goals are centered on restoration of articular congruity, and where appropriate, early ROM with minimal complications to permit early functional recovery. Numerous fracture classifications exist which aim to define the fracture and guide treatment [1] (Fig. 1). Despite the frequency of these injuries, controversy exists about how best to manage them. The American Academy of Orthopaedic Surgeons practice guidelines on treatment of distal radius fractures recommend operative fixation for radial shortening greater than 3 mm, dorsal tilt greater than 10 from neutral, or intraarticular displacement greater than 2 mm [4]. To explore the controversies that are abound in terms of how to manage these injuries, it is my distinct pleasure to introduce two experts in the field of hand surgery. Ghazi Rayan MD is a Professor of Orthopaedic Surgery at University Oklahoma College of Medicine. Martin Boyer MD is the Jerome T. Loeb Professor of Orthopaedic Surgery at Washington University Medical School, St. Louis.

The Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of distal radius fractures in adults older than 18 years. The scope of this guideline is limited to the treatment of acute distal radius fractures and does not address distal radius malunion. This guideline contains seven recommendations to assist orthopaedic surgeons and all qualified physicians managing patients with acute distal radius fractures based on the best current available evidence. It serves as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.

Background Bridge plating for distal radius fractures is indicated for complex fractures with comminution, extensive articular involvement, and/or cases requiring immediate weight bearing. Bridge plate fixation of distal radius fractures is a well-documented treatment method; however, failures have been reported with repetitive loading through the bridged distal radius fracture. Plate design is implicated as a cause of plate fracture in select clinical studies but few mechanical tests comparing bridge plate designs have been reported. This study sought to determine the impact of plate design on bridge plates intended to allow for immediate weight-bearing. Methods Axial static ( n = 3) and dynamic testing ( n = 3) was performed on three distraction plates designs: bridge plate 1 (BP1) with central holes, bridge plate 2 (BP2) without central holes, and locking compression plate (BP3). Plates were loaded in axial compression with a simulated 10-mm fracture gap. Results Significant static load differences were noted between all groups. Static load to failure for BP1, BP3, and BP2 were 240 ± 5 N, 398 ± 9 N, and 420 ± 3 N, respectively ( p < 0.05). BP1 was the only plate series that failed during dynamic testing; all other plates achieved 100,000 cycles. Failure mode was a fracture occurring through the central screw hole of BP1. Finite element analysis demonstrated the effects of central screw holes on stress, strain, and plastic deformation under loading. Conclusion Unused screw holes are the mechanical weak points; plates designed without these central screw holes are expected to survive greater load values. The threshold for clinical importance will need to be determined by future studies.

Fractures of the distal radius are among the most common injuries of the upper extremity, though treatment has traditionally focused on restoration of the radiocarpal joint and late sequelae may persist. X-ray imaging underestimates sigmoid notch involvement following distal radius fractures. No classification system exists for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures. This study quantifies the anatomy of the sigmoid notch and identifies the landmarks of the articular surface and proximal boundaries of the distal radioulnar joint (DRUJ) capsule. Computed tomography scans of freshly frozen cadaveric hands were used - followed by dissection, and three-dimensional reconstruction of the distal radius and sigmoid notch. The sigmoid notch surface was divided into two surfaces and measured. The Anterior Posterior (AP) and Proximal Distal (PD) widths of the articulating surface were reviewed, along with the radius of curvature, version angle and depth. The study showed that the sigmoid notch is flatter than previously believed - and only the distal 69% of its surface is covered by cartilage. On average, it has about nine degrees of retroversion, and its average inclination is almost parallel to the anatomical axis of the radius. Clinical implications exist for evaluation of the DRUJ involvement in distal radius fractures or degenerative diseases and for future development and evaluation of hemiarthroplasty replacement of the distal radius.

This article discusses recent reports on distal radius fractures. The keyword "distal radius fracture" was used to query the PubMed database of the US National Library of Medicine. From the resulting list, articles published in the Journal of Hand Surgery (American Volume), the Journal of Hand Surgery (European Volume), and the Journal of Orthopaedic Trauma from April 2014 through December 2015 were reviewed. Related commentaries were also evaluated. Case series of fewer than 5 patients were excluded. The 65 studies and commentaries identified are categorized and summarized. [Orthopedics. 2017; 40(3):145-152.].