PRINCIPLES OF INDICATION OF INTRA-ARTICULAR DISTAL RADIUS FRACTURES FOR CONSERVATIVE OR SURGICAL TREATMENT USING LOCKING PLATES
Authors:
Marek Niedoba; Martin Vlček; Miroslav Streck; Ivan Landor
Authors‘ workplace:
1. Ortopedická klinika 1. LF UK Praha a FN v Motole
; st Orthopaedic Clinic of Motol University Hospital et First Faculty of Medicine, Charles University in Prague, Czech Republic
1
Published in:
Úraz chir. 24., 2016, č.2
Overview
Aim of the study:
Establishing decision-making procedures for indication of conservative or operative treatment of intraarticular fractures of the distal radius using locking plates.
Material and methods:
Evaluation of one-year treatment results of 132 intraarticular fractures of the distal radius. KONZ group includes 29 fractures treated conservatively, APTUS group contains 103 fractures treated with variable angle Aptus radius locking plates applied through a volar approach. We evaluated patient´s estimation, objective functional status, radiographic findings and complications.
Results:
Patient´s estimation, range of motion and X-ray results reached in the groups KONZ and APTUS comparably satisfactory values. In the group KONZ secondary dislocation ocurred in six cases (20.7 %). Complex regional pain syndrome developed in group KONZ in one patient (3.4 %), paresthesia in the innervation area of nervus medianus in one case (3.4 %) and once (3.4 %) developed pressure sore from the plaster cast fixation. The most serious complication of KONZ group was the development of Volkmann´s contracture.
In the group APTUS secondary dislocation ocurred in four cases (3.9 %). Complex regional pain syndrome occured in the APTUS group in two patients (1.9 %). Neurological deficit in the innervation region of nervus medianus was observed three times (2.9 %).
Discussion:
Evaluating only one X-ray finding is insufficient to indicate the correct method of treatment, it is also important to follow-up fracture stability when conservative treatment was indicated. It is always inevitable to perform and evaluate exact X-ray views. The reason of secondary dislocation in the two groups (KONZ 20.7 %, APTUS 3.9 %) is as well patient´s refusal of surgery, as acceptable dislocation according to international criteria during the healing procedure.
Conclusion:
In the treatment of intra-articular fractures of the distal radius correct indication of conservative or surgical therapy is crucial. Conservative therapy is suitable for distal radius fractures, where the radiographic findings during the whole treatment period show satisfactory fragment position according to international criteria (shortening of radial height less than 5 mm, articular incongruity to 2 mm and radial tilt between 20 degree palmary and 10 degree dorsally).
When by closed reduction acceptable position cannot be achieved or secondary dislocation in cast occures, therapy should be switched from conservative to surgical.
Conservative treatment of distal radius fractures can achieve excellent therapeutic results, comparable with osteosynthesis angle locking plates applied from a volar approach. An essential prerequisite for good functional outcomes is correctly done plaster cast fixation and follow-up during conservative therapy and careful surgical technique of locking plate application.
Key words:
Radius fracture, conservative therapy, locking plates, volar approach, complications.
Sources
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Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
2016 Issue 2
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