PURPOSE OF THE STUDY: The aim of the study was to describe the indication criteria and operative technique and to present the first conclusions of a prospective study dealing with an assessment of functional and radiographic findings in patients with concurrent fractures of the distal ulna and distal radius; the former was treated by osteosynthesis using an LCP Distal Ulna Plate (De Puy Synthes, USA) and the latter by plate osteosynthesis. MATERIAL AND METHODS: Between August 2013 and September 2014, 18 patients (3 men and 15 women; average age, 58 years; range, 25-74 years) with a fracture of the distal ulna and a concurrent distal radius fracture were treated by plate osteosynthesis. The indications for surgery included displaced ulnar styloid base fractures in 10 patients, displaced comminuted fractures of the ulnar head in seven patients and a subcapital fracture of the ulna in one patient. The average follow-up was 9 months, with 13 (72%) patients being followed up for 6 months at least. The outcome of surgery was evaluated on the basis of X-ray views and multiplanar reconstruction of CT scans. Functional results were based on measuring the range of motion at wrist and forearm and hand grip strength and on the scores obtained from the Mayo Wrist Score System and Quick DASH Questionnaire. RESULTS: The average values for wrist and forearm range of motion were as follows: 68° in flexion (60-80°), 71° in extension (40- 90°), 87° in pronation (70-90°), 81° in supination (50-90°). This corresponded to a 92% (74-100%) range of motion at the contralateral wrist and forearm. The average hand grip strength measured with a dynamometer was 80.6% (53-100%) of the gripping force exerted by the unaffected extremity. Post-operative X-ray and CT findings showed good reduction of both distal radius and distal ulna fractures as well as good fragment retention by means of LCP implants. During follow-up complete bone union and full stability of the radioulnar joint were achieved in all patients. The functional outcome of treatment was shown by the average Mayo wrist score and Quick DASH score of 84 (55-100) and 7.4 (0-47.7) points, respectively. DISCUSSION: The functional outcome of treatment in our patients corresponded to the severity of their distal forearm fractures. The patients with more serious distal radius fractures, frequently associated with ulnar head fractures, had poorer functional results than the patients with less serious fractures. According to the AO classification, in the distal radius fractures, prevailing fracture types were 23-C3 (78%) and 23-C2 (16%). In relation to the distal ulna fracture type, the patients with ulnar styloid base fractures had better functional results than the patients with ulnar head fractures, because a fracture of the styloid process does not affect the congruency of the distal radioulnar joint (DRUJ). Fractures of the ulnar styloid process base, following distal radius fracture osteosynthesis, were invariably associated with DRUJ instability. This fracture type is always accompanied by injury to the distal radioulnar ligament of the triangular fibrocartilage complex (TFCC) and, in case of a displaced fracture, surgical management is indicated. In agreement with the results of other authors it was found in our study that, when the anatomical position of the distal radioulnar joint had been achieved, both the functional and the radiographic findings were post-operatively very good. The final average values for the range of wrist and forearm motion, hand grip strength and hand and arm function were assessed as very good. CONCLUSIONS The assessment of our results and their comparison with the literature data showed that osteosynthesis of distal ulna fractures with concurrent distal radius fractures managed by open reduction and internal fixation are indicated in displaced fractures of the ulnar styloid process base, displaced comminuted fractures of the ulnar head where fragments interfere with DRUJ congruency, and unstable displaced subcapital fractures of the ulna. The early results of this study provide evidence for the efficiency of plate osteosynthesis in the treatment of distal ulna fractures.
- MeSH
- dospělí MeSH
- fraktury ulny radiografie chirurgie MeSH
- fraktury vřetenní kosti radiografie chirurgie MeSH
- kostní destičky * MeSH
- lidé středního věku MeSH
- lidé MeSH
- obnova funkce MeSH
- polytrauma radiografie chirurgie MeSH
- poranění zápěstí patofyziologie radiografie chirurgie MeSH
- prospektivní studie MeSH
- senioři MeSH
- tříštivé fraktury radiografie chirurgie MeSH
- vnitřní fixace fraktury škodlivé účinky přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- zápěstní kloub fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- hodnotící studie MeSH
x
x
- Klíčová slova
- volární přístup,
- MeSH
- dlahy * MeSH
- dospělí MeSH
- fraktury vřetenní kosti * chirurgie radiografie MeSH
- hojení fraktur MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- obnova funkce MeSH
- ortopedické výkony metody MeSH
- pooperační komplikace MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury * metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- Collesova fraktura chirurgie radiografie MeSH
- fraktury krčku femuru chirurgie radiografie MeSH
- fraktury páteře chirurgie radiografie MeSH
- fraktury vřetenní kosti chirurgie radiografie MeSH
- lidé MeSH
- ortopedické výkony metody MeSH
- osteoporotické fraktury * chirurgie prevence a kontrola radioterapie MeSH
- postmenopauzální osteoporóza komplikace MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
PURPOSE OF THE STUDY: Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR) fixation and 50 with the multidirectional angle-stable plate system (APTUS). The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures.
- MeSH
- dospělí MeSH
- fraktury vřetenní kosti radiografie chirurgie MeSH
- hojení fraktur MeSH
- intramedulární fixace fraktury přístrojové vybavení MeSH
- kostní destičky * MeSH
- kostní šrouby * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- následné studie MeSH
- obnova funkce MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- volární ploténka chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
The purpose of this prospective, randomized and blinded study was to compare the clinical outcomes of distal radial fractures treated with either an intramedullary nail or a volar locking plate. Sixty two patients were enrolled in the study and randomized to treatment with a MICRONAILTM (Group 1, 31 patients) or an adaptive plate (Group 2, 31 patients). Fracture types included were unstable extra-articular metaphyseal distal radial fractures and simple or multifragmentary sagittal articular distal radial fractures (AO classification types A2, A3, B1.1 and B1.2). All patients were evaluated at 6 weeks, 3 months and 12 months after surgery. Outcome measures included standard radiographic parameters, active wrist range of motion, the disabilities of the arm, shoulder and hand (DASH) and Mayo wrist scores. We concluded that treatment of this subset of distal radius fractures with minimally invasive intramedullary nailing gives better clinical outcomes at 6 weeks after surgery than treatment with a volar locking plate. By 3 and 12 months following surgery, there are no significant differences in outcome between the two treatment methods. Disadvantages of the MICRONAIL™ fixation system include risk of injury to the superficial branch of the radial nerve and a narrower spectrum of indications than volar locking plates.
- MeSH
- dospělí MeSH
- fluoroskopie MeSH
- fraktury vřetenní kosti radiografie chirurgie MeSH
- intramedulární fixace fraktury přístrojové vybavení MeSH
- kostní destičky * MeSH
- kostní hřeby * MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury přístrojové vybavení MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
x
- Klíčová slova
- fraktury distálního radia, osteosyntéza,
- MeSH
- dlahy klasifikace využití MeSH
- fixace fraktur metody ošetřování přístrojové vybavení využití MeSH
- fraktury vřetenní kosti diagnóza etiologie chirurgie klasifikace komplikace patologie radiografie terapie MeSH
- hojení fraktur fyziologie MeSH
- kostní šrouby využití MeSH
- lidé MeSH
- pooperační komplikace prevence a kontrola MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY The aim of the study was to evaluate the outcomes of corrective osteotomy for malunited fractures of the distal radius, to assess the degree of correction or its loss, if it happened, after bone union, and to compare the clinical and radiographic results with the relevant literature reports. MATERIAL AND METHODS In the period from September 2002 and October 2004, a total of 16 patients (six men and 10 women) underwent surgery for malunited fractures of the distal radius. The average patient age was 49.3 years, with a range of 23 to 73 years. For the sake of evaluation, records were made of patients' subjective feelings, objective measurements of motion range and muscle strength and exact measurements of relevant parameters on radiographs. Plain radiographs of the distal radius of both upper extremities in anteroposterior and lateral projections were made before and after surgery, and at final follow-up after osteotomy healing. The following parameters were measured: length of the radius, ulnar inclination angle and tilt of the distal articular surface of the radius. Because we evaluated our patients in retrospect, it was not always possible to find the exact values of motion range and muscle strength as they existed before surgery. Therefore, for comparison, we used the values obtained on the unhurt extremity. Corrective surgery included radius opening-wedge osteotomy with bone graft insertion and subsequent fixation with a 3.5-mm T plate. The final evaluation was based on the New York Orthopaedic Hospital Wrist Rating Scale. RESULTS The highest lengthening achieved by corrective osteotomy was 9 mm. The largest change in the ulnar inclination angle was 34 degrees. The best correction of a dorsal deformity was 24 degrees. The result evaluation was: 30 % excellent, 50 % good, and 20 % fair. DISCUSSION Corrective osteotomy of the distal radius with graft insertion is one of the options for the restoration of anatomical conditions following malunited fractures. The timing and technique of the surgical procedure were in agreement with the data reported in the literature, as well as the results achieved in this study. CONCLUSIONS Corrective osteotomy and bone graft insertion are surgical procedures used for the treatment of malunited fractures of the distal radius. They are indicated in active younger patients with proven symptoms and correlating radiographic evidence. The surgery should be preceded by a thorough radiographic examination and pre-operative planning.
- MeSH
- dospělí MeSH
- fraktury vřetenní kosti chirurgie radiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteotomie MeSH
- radius chirurgie MeSH
- senioři MeSH
- špatně zhojené fraktury chirurgie radiografie MeSH
- transplantace kostí MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
I have had a wonderful opportunity over the past 30 years to surgically reconstruct many complex fractures and nonunions in the upper limb in the elderly patient with underlying osteoporosis and prior to the development of the "locked plate". This article will present a number of specific techniques using standard LC-DCP and screw in a variety of applications to provide stable internal fixation. These include the use of long plates; creating a "waved plate" initially described by Blatter and Weber; double plating; 3.5 mm intramedullary plate combined with a larger plate on the cortex; custom and machined blade plates as well as enhancement of screw fixation with bone cement and/or Norian SRS cement.
- MeSH
- fraktury humeru chirurgie radiografie MeSH
- fraktury vřetenní kosti chirurgie radiografie MeSH
- kostní destičky MeSH
- lidé MeSH
- nezhojené fraktury chirurgie radiografie MeSH
- osteoporóza chirurgie radiografie MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
ÚVOD: Zlomeniny distálního předloktí patří mezi nejčastější skeletální poranění dětského věku. Terapeutický přístup je u různých pracovišť rozdílný, od zcela konzervativního postupu až po otevřenou repozici a osteosyntézu. CÍL PRÁCE: Retrospektivní zhodnocení terapeutických postupů dislokované separace distální epifýzy radia na našem pracovišti. MATERIÁL A METODIKA: Soubor 509 pacientů ošetřených na našem pracovišti během 5 let (2004- 2008) se separací distální epifýzy radia. U dislokovaných poranění byl posuzován způsob léčby ve vztahu ke směru dislokace, míře dislokace a stabilitě po zavřené repozici VÝSLEDKY: Z celkového počtu 509 pacientů se separací distální epifýzy radia bylo 352 nedislokovaných a 157 dislokovaných, pouhých 19 pacientů operováno. V případě dorzální dislokace bylo 124 pacientů (94 %) léčeno pouze repozicí a sádrovou imobilizací, žádný pacient nebyl operován primárně a 8 pacientů (6 %) bylo operováno sekundárně pro redislokaci. V případě volární dislokace bylo 14 pacientů (70 %) léčeno pouze repozicí a sádrovou imobilizací, 1 pacient (5 %) byl operován primárně a 5 pacientů (25 %) bylo operováno sekundárně pro redislokaci. ZÁVĚR: Dorzální dislokace je při separaci distální epifýzy radia daleko častější než ventrální dislokace, která je však daleko méně stabilní, a proto je častěji indikována k operačnímu řešení.
INTRODUCTION: Fracture of the distal forearm is one of the most common skeletal injuries in children. The therapeutic approach varies from a non-operative to surgical treatment. OBJECTIVE: Retrospective study of therapeutic methods in simple displaced separation of distal radial epiphysis treated in our department was performed. MATERIAL AND METHODS: During the period of 5 years (2004–2008) 509 patients were treated at our out-patient department with separation of the distal radial epiphysis. We evaluated methods of treatment according to the direction and grade of displacement, and stability after closed reduction. RESULTS: In the cohort of 509 patients we noted 352 non-displaced and 157 displaced separations of distal radial epiphysis. Only 19 patients were indicated to surgical procedure. In the case of dorsal displacement in 124 patients (94 %) the non-operative treatment with closed reduction and plaster cast was used, no patient was operated on primarily and 8 patients (6 %) were operated on for secondary redisplacement. In case of volar displacement 14 children (70 %) were treated with closed reduction and plaster cast, 1 patient (5 %) was operated on primarily and 5 patients (25 %) were operated on for secondary redisplacement. CONCLUSIONS: The dorsal displacement of separation of the distal radial epiphysis is more frequent than the volar one. However, the volar displacement is less stable and therefore more frequently indicated for surgical procedure.
- Klíčová slova
- distální radius, Salter-Harris,
- MeSH
- dislokace kloubu MeSH
- dítě MeSH
- epifýzy radiografie zranění MeSH
- fixace fraktur * statistika a číselné údaje MeSH
- fraktury vřetenní kosti * chirurgie radiografie terapie MeSH
- fyzické omezení * statistika a číselné údaje MeSH
- lidé MeSH
- manipulace ortopedická metody statistika a číselné údaje MeSH
- radius radiografie zranění MeSH
- retrospektivní studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
