Surgical treatment of fractures of the distal radius – ORIF vs external fixation with ligamentotaxis
Authors:
M. Hanus; F. Hanák; E. Šťastný; T. Trč
Authors‘ workplace:
Klinika dětské a dospělé ortopedie a traumatologie 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol, Praha
Published in:
Rozhl. Chir., 2020, roč. 99, č. 8, s. 343-349.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2020.99.8.343–349
Overview
Introduction: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification.
Methods: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and O’Brien score at 6 and 12 months after surgery.
Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13°, the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and O’Brien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient.
Conclusion: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.
Keywords:
distal radius fracture − external fixation − open reduction − internal fixation − volar locking plate
Sources
- Pacovský V. Zlomeniny distálního radia. Acta Chir Orthop Traum Čech. 2003;70:108−111.
- Solgard S, Petersen VS. Epidemiology of the distal radius fractures. Acta Orthop Scand. 1985;56:391−393.
- Colles A. On the fracture of the carpal extremity of the radius. Edinburgh Med Surg J. 1814;10:182−186.
- Vlček M, Landor I, Višňa P, et al. Význam multidirekcionálního zavedení šroubů při ošetření zlomenin distálního radia úhlově stabilní dlahou. Acta Chir Orthop Traum Čech. 2011;78:27−33.
- Wendche P, Džupa V. AO sympozium „Biomechanika a kontroverze úhlově stabilních dlah“. Acta Chir Orthop Traum Čech. 2010;77:71.
- Vlček M, Pech J, Višňa P, et al. Možnosti prevence komplikací dlahových osteosyntéz nitrokloubních zlomenin distálního radia. Úraz chir. 2014;22:1−8.
- Suchomel R, Veselý R, Trávník J. Zevní fixace zlomenin distálního radia. Úraz chir. 2014;22:92−94.
- Virak T, Capo J, Warburton M. Distal radius fractures fixation with an intramedullary nail. Tech Hand Upper Extrem Surg. 2005;9:195−201. doi:10.1097/01.bth.0000190818.66285.b6.
- Vlček M, Višňa P. Šestiměsíční funkční a rentgenové výsledky zlomenin distálního radia ošetřených multidirekcionálními zamykatelnými dlahami. Rozhl Chir. 2008;87:486−492.
- Bhinde S, Bajoria RS, Koushal A, et al. Volar locking plate fixation (Ellis plate) of intra – articular distal radius fractures: Prospective randomized study. International Journal of Orthopaedics Sciences 2018;4:732−736. doi:10.22271/ortho.2018.v4.i1k.106.
- Niedoba M, Vlček M, Streck M, et al. Principy indikace nitrokloubních zlomenin distálního radia ke konzervativní nebo operační léčbě pomocí zamykatelných dlah. Úraz chir. 2016;24:36−42.
- Vlček M, Pech J, Musil V, et al. Konzervativní a operační léčba zlomenin distální ulny při současné osteosyntéze zlomenin distálního radia. Acta Chir Orthop Traum Čech. 2015;82:412–417.
- Meluzínová P, Kopp L, Dráč P, et al. Dlahová osteosyntéza zlomenin distální ulny při současné zlomenině distálního radia řešené dlahovou osteosyntézou – časné funkční a rentgenové výsledky. Acta Chir Orthop Traum Čech. 2015;82:369−376.
- Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 2000;31:75−79. doi: 10.1016/S0020-1383(99)00207-7.
- Grewal R, MacDermid JC, King JC, et al. Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg. 2011;36:1899–1906. doi:10.1016/j.jhsa.2011.09.015.
- Shukla R, Jain RK, Sharma NK, et al. External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes. J Orthop Traumatol. 2014;15:265–270. doi:10.1007/s10195-014-0317-8.
- Zhou Y, Zhu Y, Zhang X, et al. Comparison of radiographic and functional results of die-punch fracture of distal radius between volar locking plating (VLP) and external fixation (EF). J Orthop Surg Res. 2019;14:373. doi:10.1186/s13018-019-1442-0.
- Rüedi TP, Buckley RE, Moran CG. AO principles of fracture management. Thieme Verlag 2007.
- Mader K, Penning D. The treatment of severly comminuted intra-articular fractures of the distal radius. Strat Traum Limb Recon. 2006;1:2−17. doi:10.1007/s11751-006-0001-5.
- Shin EK, Jupiter JB. Current concepts in the management of distal radius fractures. Acta Chir Orthop Traum Čech. 2007;74:233−246.
- Zhang X, Zhao Y, Hu CH, et al. Comparative study of type B distal radius fractures with and without lunate facet involvement treated by volar locking plate, an observational study. Int J Surg. 2017;44:317–323. doi:10.1016/j.ijsu.2017.07.040
- Landgren M, Jerrhag D, Tagil M, et al. External or internal fixation in the treatment of non-reducible distal radial fractures? Acta Orthop. 2011;82:610–613. doi:10.3109/17453674.2011.618910.
- Saving J, Enocson A, Ponzer S, et al. External fixation versus volar locking plate for unstable dorsally displaced distal radius fractures—A 3-year follow-up of a randomized controlled study. Journal of Hand Surgery 2019;44:18−26. doi:10.1016/j.jhsa.2018.09.015.
- Williksen JH, Husby T, Hellund JC, et al. External fixation and adjuvant pins versus volar locking plate fixation in unstable distal radius fractures: a randomized, controlled study with a 5-year follow-up. J Hand Surg Am. 2015;40:1333–1340. doi:10.1016/j.jhsa.2015.03.008.
- Esposito J, Schemitsch EH, Saccone M, et al. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury 2013;44:409−416. doi:10.1016/j.injury.2012.12.003.
- Marcheix PS, Dotzis A, Benkö PE, et al. Extension fractures of the distal radius in patients older than 50: a prospective and randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg. (Eur) 2010;35:646–651. doi:10.1177/1753193410364179.
- Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation, The Journal of Hand Surgery 2005;30:289–299. doi:10.1016/j.jhsa.2004.11.014.
- Johnson NA, Cutler L, Dias JJ, et al. Complications after volar locking plate fixation of distal radius fractures. Injury 2014;45(3):528–533. doi:10.1016/j.injury.2013.10.003.
- Richard MJ, Wartinbee DA, Riboh J, et al. Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius. J Hand Surg Am. 2011;36:1614−1620. doi:10.1016/j.jhsa.2011.06.030.
- Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury 2010;41:128–132. doi:10.1016/j.injury.2009.01.001.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2020 Issue 8
Most read in this issue
- Pilonidal sinus disease: Karydakis flap procedure in our patients
- Surgical treatment of fractures of the distal radius – ORIF vs external fixation with ligamentotaxis
- Thyroid tumors at the limit of operability
- Fractures of the surgical neck of the scapula with separation of the coracoid base