Possibilities of complications prevention in plate osteosyntheses of intra-articular distal radius fractures
Authors:
Martin Vlček 1; Jan Pech 1; Petr Višňa 2; Marek Niedoba 1; David Jonáš
Authors place of work:
Teaching Hospital Motol, 1st Clinic of Orthopaedic Surgery, Prague
1; Fakultní nemocnice v Motole, 1. ortopedická klinika 1. LF UK, Praha
1; Regional Hospital Příbram, Department of Orthopeadics and Traumatology, Příbram
2; Oblastní nemocnice Příbram, a. s, ortopedicko-traumatologické oddělení, Příbram
2
Published in the journal:
Úraz chir. 22., 2014, č.1
Summary
Purpose:
Analyzing of the severity of complication in the treatment of intra-articular distal radius fractures using variable angle locking plates and assessment the possibilities of their prevention.
Material and Methods:
Evaluation of the one-year treatment outcomes in file of 167 patients with distal radius fractures. All fractures were stabilized using variable angle locking plates Aptus Radius applied from volar approach. Indications for operative treatment were unsatisfactory position of bone fragments after closed reduction or secondary dislocation during conservative therapy.
Results:
Secondary dislocation of bone fragments occurred in 12.6 %, with significant loss of correct position occurred in 6.6 % of fractures. Nonunion was observed in 0.6 % of cases. Tendon lesions complicated treatment in 2.4 % fractures. Permanent paresthesia in the median nerve innervation region was reported by 1.2 % of patiens, syndorm of carpal tunnel developed in 1.2 % of cases. At 7.8 % developed complex regional pain syndrome, and 1.2 % of patients left permanent functional limitations.
Conclusion:
Multidirectional locking plates allow good stabilization of intra-articular distal radius fractures with a small number of complications. Tendon lesions by volar plating are rare, prevent them by selecting appropriate length of screws is difficult. Damage of nerve structures can be preceded by careful surgical technique. Secondary dislocation of bone fragments occurs especially in porotic bone, is usually minimal and leads to healing in a satisfactory position. Significant dislocation during fracture healing occurs in extremely comminuted intra-articular fractures in the field of good bone quality.
Key words:
Radius fractures, postoperative complication, prevention.
Zdroje
1. Altissimi, M., Antenucci, R., Fiacca, C. et al. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986, 206, 202–210.
2. Arora, R., Gabl, M., Gschwentner, M. et al. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009, 23, 237–242.
3. Arora, R., Lutz, M., Hennerbichler, A. et al. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007, 21, 316–322.
4. Bartoníček, J. Pokroky v operační léčbě zlomenin. Prakt Lék. 2011, 91, 457–464.
5. Bartoníček, J., Džupa, V., Frič, V. et al. Epidemiologie a ekonomie zlomenin proximálního femuru, proximálního humeru, distálního radia a luxačních zlomenin hlezna. Rozhl Chir. 2008, 87, 213–219.
6. Bell, J.S.P., Wollstein, R., Citron, N.D. Rupture of flexor pollicis longus tendon. A complication of volar plating of the distal radius. J Bone Jt Surg Br. 1998, 80, 225–226.
7. Brown, E.N., Lifchez, S.D. Flexor pollicis longus tendon rupture after volar plating of a distal radius fracture: pronator quadratus plate coverage may not adequately protect tendons. Eplasty. 2011, 11, e43.
8. Castaing, J. Les fractures recentes de l‘extremite inferieure du radius chez l‘adulte. Rev Chir Orthop. 1964, 50, 581–696.
9. Chung, K.C., Watt, A.J., Kotsis, S.V. et al. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am. 2006, 88, 2687–2694.
10. Cronier, P., Talha, A., Toulemonde, J.L. et al. Results of distraction by way of external metacarporadial fixation in fracture of the distal end of the radius. Apropos of 97 cases. J Chir (Paris). 1991, 128, 8–12.
11. Cross, A.W., Schmidt, C.C. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg Am. 2008, 33, 164–167.
12. Čižmář, I., Wendsche, P., Brychta, P. et al. Poúrazová korekční osteotomie distálního radia s novou dlahou. Acta Chir orthop Traum čech. 2002, 69, 259–263.
13. Hattori, Y., Doi, K., Sakamoto, S. et al. Delayed rupture of extensor digitorum communis tendon following volar plating of distal radius fracture. Hand Surg. 2008, 13, 183–185.
14. Haug, L.C., Deml, C., Blauth, M. et al. Dorsal screw penetration following implant removal after volar locked plating of distal radius fracture. Arch Orthop Trauma Surg. 2011, 131, 1279–1282.
15. Ho, A.W., Ho, S.T., Koo, S.C. et al. Hand numbness and carpal tunnel syndrome after volar plating of distal radius fracture. Hand (NY). 2011, 6, 34–38.
16. Jeudy, J., Steiger, V., Boyer, P. et al. Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‚versus‘ locked volar plating. Injury. 2012, 43, 174–179.
17. Leung, F., Tu, Y.K., Chew, W.Y. et al. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am. 2008, 90, 16–22.
18. Mehling, I., Scheifl, R., Mehler, D. et al. Are there any differences in various polyaxial locking systems? A mechanical study of different locking screws in multidirectional angular stable distal radius plates. Biomed Tech (Berl). 2013, 1, 1–8.
19. Orbay, J.L., Touhami, A. Current concepts in volar fixedangle fixation of unstable distal radius fractures. Clin Orthop Relat Res. 2006, 445, 58–67.
20. Pacovský, V., Svatoš, F. Korekční osteotomie distálního radia. Acta Chir Orthop Traumatol Cech. 2011, 78, 41–45.
21. Park, J.H., Hagopian, J., Ilyas, A.M. Variable-angle locking screw volar plating of distal radius fractures. Hand Clin. 2010, 26, 373–380.
22. Pech, J., Popelka, S. Reparace extenzorového aparátu zápěstí u ruky revmatiků. Acta Chir Orthop Traumatol Cech. 1994, 61, 344–350.
23. Prommersberger, K.J., Fernandez, D.L. Nonunion of distal radius fractures. Clin Orthop Relat Res. 2004, 419, 51–56.
24. Rampoldi, M., Marsico, S. Complications of volar plating of distal radius fractures. Acta Orthop belg. 2007, 73, 714–719.
25. Rein, S., Schikore, H., Schneiders, W. et al. Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg Am. 2007, 32, 954–961.
26. Rhee, S.H., Kim, J., Lee, Y.H. et al. Factors affecting late displacement following volar locking plate fixation for distal radial fractures in elderly female patients. Bone Joint J Br. 2013, 95, 396–400.
27. Ruedi, T.P., Buckley, R.E., Moran, C.G. AO Principles of Fracture Management. Thieme Verlag, 2007.
28. Shin, E.K., Jupiter, J.B. Current concepts in the management of distal radius fractures. Acta Chir orthop Traum Čech. 2007, 74, 233–246.
29. Ward, C.M., Kuhl, T.L., Adams, B.D. Early complications of volar plating of distal radius fractures and their relationship to surgeon experience. Hand (NY). 2011, 6, 185–189.
30. White, B.D., Nydick, J.A., Karsky, D. et al. Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg Am. 2012, 37, 2035–2040.
31. Young, B.T., Rayan, G.M. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am. 2000, 25, 19–28.
Štítky
Surgery Traumatology Trauma surgeryČlánok vyšiel v časopise
Trauma Surgery
2014 Číslo 1
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
- Current Insights into the Antispasmodic and Analgesic Effects of Metamizole on the Gastrointestinal Tract
- Obstacle Called Vasospasm: Which Solution Is Most Effective in Microsurgery and How to Pharmacologically Assist It?
Najčítanejšie v tomto čísle
- Possibilities of complications prevention in plate osteosyntheses of intra-articular distal radius fractures
- THERAPY OF CHRONIC TIBIA OSTEOMYELITIS BY USING TEMPORARY ANTIBIOTIC SPACER, ROTATORY MUSCLE LOBE, LARVAL THERAPY AND SPONGIOPLASTY WITH PEROSSAL- CASE REPORT
- IS THE PRESSURE IN THE AXIS OF THE LOWER LIMB DURING TOTAL KNEE ARTHROPLASTY SUFFICIENT TO IMITATE WEIGHT-BEARING?
- Negative pressure wound therapy For III grade open fracture AT Trauma centre Ostrava