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In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar−dorsal distance, radial−ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation. [ABSTRACT FROM AUTHOR]

Background: To assess the functional outcome of PHILOS (proximal humerus internal locking system) plating in proximal humerus fractures. Materials and Methods: Twenty-five displaced fractures of proximal humerus (in twenty-five patients) treated with PHILOS(proximal humerus locking system) plate between MAY 2021 and APRIAL 2023. The study was conducted in department of Orthopedics & Traumatology Government General hospital, Rangaraya Medial College Kakinada, Andhra Pradesh, India. Patients between 18 to 49 yrs age with proximal humerus fractures. Results: The present study was done to evaluate functional out come and complication following surgical management of proximal humerus fracture by locking compression plate. (PHILOS PLATE). In PHILOS (proximal humerus internal locking system system) system of the threaded heads of the screws in the plate itself provides for a construct with angular and axial stability, eliminating the possibility of screw toggling or sliding of the screws in the plate holes. Coupled with a divergent or convergent screw orientation to head of humerus provide improved resistance to pull out and failure of fixation. Also, whereas conventional plating systems depend on compression between the plate undersurface and bone for stability, this is not the case for the locking plates. This lessens the chance of stripping the thread in osteoporotic bone, as the plate/bone interface is not loaded along the screw axis. This also allows for a more biological fixation as the underlying periosteum and blood supply to the fractured regions are much less compressed. Conclusion: In conclusion proximal humerus internal locking system (PHILOS) is mechanically and biologically an advantageous implant in proximal humeral fractures particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization. [ABSTRACT FROM AUTHOR]

The main tools used by an orthopaedic surgeon for managing distal radial fracture treatment are recent literature and treatment guidelines. The aim of the present study was to find which factors within the study design influence study outcomes the most. Trials in three major databases (PubMed, Scopus, Embase) comparing surgical and non-surgical treatment options for adolescent and adult distal radial fractures with their original data, between 2013 and 2021, were included. The selected 47 studies were classified according to their outcomes. The relationship between study characteristics and outcomes was statistically analysed. It was more likely to find no difference in outcomes between volar locking plate and less invasive treatments when the sample size was above 100, follow-up was more than 1 year and functional assessments were used. A small sample size and short follow-up time affect study outcomes in favour of a volar locking plate. Readers should focus on the design criteria and read the full text of the studies before making any conclusions. Level of evidence: III [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses a scoping review conducted by Zitek et al. on the palmaris profundus muscle variant and its role in carpal tunnel syndrome. The authors of this letter express their appreciation for the thoroughness of the review and highlight the potential misclassification of the flexor carpi radialis brevis (FCRB) variation as the palmaris profundus type 1 variation in surgical reports. They provide detailed anatomical descriptions of both variations and emphasize the importance of correctly identifying these muscles during surgical procedures. The authors suggest that the underrepresentation of palmaris profundus type 1 variations in surgical case reports may be due to the standard scope of the surgical procedure. They also note the potential confusion caused by similarities in nomenclature. The letter concludes by acknowledging the value of Zitek et al.'s work and aims to raise awareness of the potential underrepresentation of palmaris profundus type 1 variations in surgical reports. [Extracted from the article]

Dynamic compression plating is a common type of fracture fixation used to compress between bone fragments. The quality of compression across the fracture is important for postoperative stability and primary bone healing. Compression quality may be affected by surgical variations in plate prebend, screw location, screw torque, fracture gap, and implant material. Computational modeling provides a tool for systematically examining these factors, and for visualizing the mechanisms involved. The purpose of this study was to develop a finite element model of dynamic compression plating that includes screw insertion under torque control, establish model credibility through sensitivity analyses and experimental validation, and use the model to examine the effects of surgical variables on fracture compression and postoperative stability. Model‐predicted compressive pressures had good agreement with corresponding synthetic bones experiments under a variety of conditions. Models demonstrated that introducing a 1.5 or 3 mm plate prebend (using a 4.5 mm narrow LCP plate) eliminated gapping at the far cortex, which is consistent with clinical recommendations. However, models also revealed that plate prebend led to sharp decreases in fracture compressive force, exceeding 80% in some cases. A 1.5 mm plate prebend resulted in the most uniform pressures across the fracture. Testing of a simplified model form used in previous computational modeling studies showed large inaccuracies for constructs with plate prebend. This study provides the first experimentally validated computational models of dynamic compression plate fracture fixation, and reveals important effects of plate prebend and fracture gap on fracture compression quality. [ABSTRACT FROM AUTHOR]

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Background: In clinical practice, dorsally displaced distal radius fracture (DDDRF) is a common injury. K-wires and open reduction with a volar locking plate (VLP) are the two most common surgical procedures used to fix DDDRF. However, at this time there, is no solid evidence to advise the adoption of one procedure over another. Therefore, the aim of our metaanalysis is to compare the functional outcomes of DDDRE treated by VLP versus k wire and to compare wrist motion, radiographic outcomes, and complications of volar plate versus k wire in patients with displaced distal radius fractures. Method: This meta-analysis reviewed 7 different studies to identify the best option for treatment of distal radial fracture. We looked for clinical studies which compared K-wire fixation of the distal radius to volar locked plate fixation for the treatment of radius shaft fractures in adults. After analyzing the included studies, we pooled the available data about operative time and post-operative data like union time (UT), angulation, complex regional pain trauma (CRPT), disability of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), implant failure, infection, and other surgical wound complications. Results: Open reduction and internal fixation (ORIF) with a VLP and closed reduction with percutaneous Kirschner wire fixation provide comparable excellent clinical and radiographic results in patients with distal radial fractures. ORIF with VLP fixation provided less DASH scores than closed reduction with percutaneous Kirschner wire fixation. Conclusions: K wiring remains a simple and inexpensive option for simple fracture patterns. [ABSTRACT FROM AUTHOR]

Although home exercises are used for postoperative rehabilitation of distal radius fractures (DRF), the superiority of home exercise over supervised physiotherapy rehabilitation is controversial. This study aimed to compare the function of home exercise and supervised physiotherapy rehabilitation during postoperative rehabilitation for DRF. We conducted a multicenter, retrospective study in which we included 1949 patients over 65 years old who underwent volar locking plate fixation for DRF. After propensity score matching, 308 patients were assigned to each of an independent home exercise group (IHG) and supervised physiotherapy group (SPG). Wrist function was assessed after 3, 6, and 12 months postoperatively. The results showed that the Mayo Wrist Score did not differ significantly within the observation period. Range of motion of the wrist was better in the SPG up to 3 months postoperatively but was almost the same as that in the IHG at 6 months. However, the Numerical Rating Scale score was lower in the IHG during all observation periods. Home exercise may be as effective as supervised physiotherapy in the medium term, but supervised physiotherapy rehabilitation should be considered if early recovery and good wrist function are desired. [ABSTRACT FROM AUTHOR]

Postoperative loss of correction is a concern in cases of distal radius fracture with bone loss after surgery. The purpose of this study was to evaluate the usefulness of a β-tricalcium phosphate (β-TCP) with unidirectional pore structure (Affinos®: Kuraray Co., Ltd, Tokyo, Japan) with internal fixation in patients with bone defects during the correction of distal radius fractures. Thirty-nine patients (40 radii) treated between 2016 and August 2020 were included in the study. There were 8 males and 31 females; the mean age was 70.9 (32–88). The mean postoperative observation period was 14.6 (3.4–24) months. The bone defect that occurred in the surgery was filled with Affinos® and fixed with a locking plate. Radial inclination (RI), volar tilt (VT), and ulnar variance (UV) were evaluated after the operation and at the final observation. The start of absorption and the completion of replacement to the host bone of Affinos® were also evaluated. There were no complications associated with grafts of Affinos®. The mean time of translucent findings around artificial bone was 1.85 (0.5–6) months, and that of complete resorption was 10.6 (1.5–16.5) months after surgery. The mean RI was 21.82° after surgery and 21.16° at final observation. The mean VT was 8.54° after surgery and 8.50° at final observation. The mean UV was −0.3 mm after surgery and 0.5 mm at final observation. Affinos® was resorbed relatively early, and host bone formation was observed. Filling of unidirectional pore structure β-TCP with internal fixation showed favorable outcomes in the surgery of distal radius fractures with bone defects. [ABSTRACT FROM AUTHOR]

Background: Both bone forearm fractures in adults are the most commonly encountered fractures in day-to-day practice, accounting for almost 31% of all upper limb fractures. Objectives: Evaluation of the functional outcome of surgical management of both bones for a forearm fracture with a locking compression plate. Materials & Methods: The present prospective study consisted of 60 patients of both genders presenting with fractures of both bones of the forearm presented in the orthopaedic department. Approval was given by the institutional ethical committee, and informed consent was obtained from each patient. Results: Out of 60 patients, 39 (65%) were males and 21 (35%) were females. The patients' ages ranged from 18 to 70 years were included in the present study. The mean age of patients was 34.50 years. The incidence of mode of injury causing both bone forearm fractures was found to be maximum in motorbike accidents 33(55%); 12 patients (20%) sustained fractures due to falls from height; and the minimum caused by physical assault was 3 patients (5%). Conclusion: The present study indicates that open reduction and internal fixation of fractures in both bones of the forearm with a locking compression plate are safe and effective options for fixation and provide excellent functional outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: The most commonly used approach for distal radial fractures is the traditional Henry approach, but the pronator quadratus muscle needs to be cut off during operation. Failure to repair the pronator quadratus muscle will bring a series of complications. OBJECTIVE: To investigate the clinical effect of preserving pronator quadratus muscle and volar locking plate in the treatment of distal radial fractures. METHODS: A retrospective case-control study was conducted to analyze the clinical data of 64 patients with distal radial fractures, including 32 patients in the modified group (preserving pronator quadratus muscle). According to AO classification, there were 8 cases of 23-B1 type, 7 cases of 23-B2 type, 7 cases of 23- B3 type, 6 cases of 23-C1 type, and 4 cases of 23-C2 type. In the traditional group (cutting the pronator quadratus muscle via traditional Henry approach), there were 32 cases. According to AO classification, there were 7 cases of 23-B1 type, 9 cases of 23-B2 type, 3 cases of 23-B3 type, 6 cases of 23-C1 type and 7 cases of 23-C2 type. The postoperative internal fixation, fracture healing, postoperative complications and other conditions of the two groups were observed, and the visual analog scale score of wrist pain was compared between the two groups. The wrist function of the patients was evaluated by Dienst joint score standard and the surgical effect was evaluated by imaging indicators. RESULTS AND CONCLUSION: (1) The average operation time and average intraoperative blood loss were significantly less in the modified group than those in the traditional group (Z=-6.77, P < 0.01; Z=-5.41, P < 0.01). (2) The average healing time in the modified group was shorter than that in the traditional group (Z=-2.08, P < 0.05). (3) At 12 months after operation, the excellent and good rates of the wrist function in the modified group and the traditional group were 94% (30/32) and 88% (28/32) respectively, with no significant difference (χ² = 0.767, P=0.682). (4) There was no significant difference in radial height, palmar inclination and ulnar deviation between the two groups shown by anteroposterior and lateral X-ray examination of wrist joint at 3 days, 1 and 3 months after operation (P > 0.05). (5) The visual analog scale score of the modified group was lower than that of the traditional group at 1 week, 1 and 3 months after operation (P < 0.05), but there was no significant difference in visual analog scale score between the two groups at 12 months after operation (P > 0.05). (6) There was no traumatic arthritis in both groups. In the traditional group, there were two cases of carpal tunnel syndrome (II stage removal of internal fixation device). (7) It is concluded that the modified Henry method with the preservation of pronator quadratus muscle has no significant advantages in the late pronation angle and pain. However, intraoperative surgery can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, and promote early activities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Distal radial fracture involving dorsal ulnar fragment type belongs to unstable fractures, AO classification of 23C type and the middle column fractures of three-column classification. If dorsal ulnar fragment cannot be effectively fixed, it will affect the stability of radial joints and ulnar radial joints. The fixation effect of dorsal volar plate alone on dorsal ulnar fragment is limited. Although the fixation effect of dorsal volar double plate is effective, it increases the trauma and treatment cost, which is not in line with the current Diagnosis Related Groups policy. The addition of dorsal Kirschner wire fixation may be a relatively feasible plan. OBJECTIVE: A finite element model of AO/ASIF 23-C1 distal radial fracture was established to compare the differences in biomechanical stability between volar locking plate and volar locking plate plus dorsal Kirschner wire, especially focusing on the fixation effect of dorsal ulnar fragment, providing a reference for clinical application. METHODS: Using reverse modeling technology, the CT data of healthy femur of a 42-year-old male and internal fixation data were imported into relevant software to establish three-dimensional finite element models of AO/ASIF 23-C1 distal radial fractures with volar locking plate and volar locking plate with dorsal Kirschner wire. The models were subjected to 100 N axial stress, or 1 Nm bending or torsional stress, respectively. The maximum displacement, maximum Von Mises stress and stress distribution of dorsal ulnar fragment were compared between the two groups. RESULTS AND CONCLUSION: (1) The stress on the internal fixation was 2-10 times that on the bone under the two fixation methods, which met the requirements of fracture fixation. (2) Under the three different loads, there was no significant difference between the two groups in the stress peaks of both bone and internal fixation (< 30%). Under an axial load, the peak stress on the internal fixation was 3-4 times that on the bone. However, under bending load, the peak stress of internal fixation was 8-10 times that of bone, while under torsion load, the peak stress of internal fixation was only twice that of bone. (3) Under an axial load, the maximum displacements of the dorsal ulnar fragment between the two groups were very small and the difference was small, only 0.056 mm and 0.047 mm, respectively, indicating good stability of the fragment. Under bending load, the maximum displacement of single plate group was 2.4 times that of Kirschner wire group. Under torsion load, the maximum displacement of the single plate group was 2.7 times that of the Kirschner wire group. (4) It is indicated that the volar locking plate with Kirschner wire can more effectively fix the dorsal ulnar fracture fragment, with more uniform stress distribution, improve the fixation strength, and does not significantly increase the treatment cost. It is more suitable for the treatment of distal radial fractures involving the dorsal ulnar fracture fragment under the current Diagnosis Related Groups policy. [ABSTRACT FROM AUTHOR]

Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues. [ABSTRACT FROM AUTHOR]

Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races. [ABSTRACT FROM AUTHOR]

Background and aim: Radial shortening after distal radius fracture causes ulnar impaction, and a mild reduction loss of radial height occurs even after volar locking plate fixation. This study aimed to determine whether preoperative ulnar-sided sclerosis affects clinical outcomes after volar locking plate fixation for distal radius fracture (DRF). Method: Among 369 patients who underwent volar locking plate fixation for DRF, 18 with preoperative ulnar-sided sclerosis of the lunate were included in Group A and compared to a 1:4 age-, sex- and fracture-pattern-matched cohort without sclerosis (72 patients, Group B). The visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and grip strength were assessed as clinical outcomes. Ulnar variance (UV), radial inclination, radial length, and volar tilt at two weeks after surgery and the final follow-up were measured as radiographic outcomes. Results: The mean VAS and DASH scores and grip strength did not differ between the two groups. The mean UV at two weeks after surgery and the last follow-up was significantly higher in Group A. The mean changes in UV were +0.62 mm in Group A and +0.48 mm in Group B. There were no significant intergroup differences. Neither UV nor its changes showed any association with DASH and VAS scores. Conclusions: Preoperative ulnar-sided sclerosis of the lunate did not affect clinical outcomes after volar locking plate fixation, even if UV increased postoperatively. [ABSTRACT FROM AUTHOR]

Background: Fracture of distal radius may be stable that is extra-articular, non-comminuted without distal radio ulnar joint disruption or unstable that is intra-articular, comminuted displaced with distal radio ulnar joint disruption. Complications of unstable fractures are shortening due to bone loss or due to resorption of the cancellous bone from metaphysis, resistant deformity, residual pain, late collapse, radio carpal arthritis and gross functional impairment. Aims and Objective: The purpose of this study to compare the relative efficacy of external fixation versus plating with regard to functional and radiological outcome. Materials and Methods: Total of 60 patients having intraarticular distal end radius fracture were included in this study and was equally divided into two groups, one group treated by external fixator other group with volar locking compression plate with or without augmentation by k-wire. Follow-up was done after 2 weeks, 4 weeks, 6 weeks and 3, 6 and 12 months. The radiological evaluation was performed with Sarmiento's Modification of Lindstrom's Criteria. With the Modified Mayo Wrist Score, the patient's functional outcomes were assessed and both groups were compared. Results: In this study we found that volar plate group had good to excellent outcome in 73% cases and 07% with fair outcome however with external fixator group found good to excellent in 50% cases and poor in 17% cases. Conclusion: In our study, we showed that the use of an external fixator and a volar locking plate for the treatment of intraarticular distal radial fractures were reliable. The relative simplicity of use, low surgical exposure, and decreased surgical trauma are benefits of external fixation. Despite these volar locking plates augmented with or without k wire had a good to excellent results in terms of early rehabilitation and less complications related to wrist joint. External fixator with ligamentotaxis provide significant good results in communited intraarticular distal end radius fracture. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the results of the locking anatomic plate fixation method with volar intervention according to age groups in the surgical treatment of unstable radius distal end fractures involving the joint. Materials and Methods: In this study, 72 adult patients with distal radius fractures who were treated with open reduction and locked volar plate fixation due to radius distal end fracture in group C according to AO classification between August 2010 and August 2018 were evaluated retrospectively. All our patients were evaluated for a post-op range of motion. We divided the age ranges into four groups: Group 1 for ages 17-30, Group 2 for ages 30-45, Group 3 for ages 45-60, and Group 4 for ages over 60. Results: The mean values of joint range of motion and grip strength in all our patients were; flexion 70.95° (Group 1 76.87°, Group 2 74.00°, Group 3 66.96°, and Group 4 64.16°), extension 67.38° (Group 1 71.87°, Group 2 68.33°, Group 3 61.15° and, Group 4 61.16°), radial deviation 27.02° (Group 1 32.50°, Group 2 29.67°, Group 3 23,08° and, Group 4 21.67°), ulnar deviation 32.86° (Group 1 38.75°, Group 2 36.33°, Group 3 28.46°, and Group 4 25.83°), supination 77.74° (Group 1 85.0°, Group 2 79.67°, Group 3 74.62°, and Group 70.0°), pronation 82.50° (Group 1 85.62°, Group 2 84.33°, Group 3 82.69°, and Group 4 73.33°). Analysis of the data revealed a negative correlation between patient age and post-operative joint range of motion. Our findings indicate a statistically significant difference in joint range of motion among Group 4, Group 1, and Group 2 patients. Conclusion: Volar locking plate surgery in AO type C radius distal fractures is suitable for all age groups thanks to rigid fixation and early mobilization. [ABSTRACT FROM AUTHOR]

Background: Distal radius fracture (DRF) is one of the most common orthopaedic-related traumas. DRF patients with die-punch fractures have a higher risk of loss of reduction, poorer functional outcomes, and increased risk of complications even after open reduction and internal fixation (ORIF). According to the three-column theory, the lunate fossa is an important part of the intermediate column for load bearing. When the distal radius fracture involves the lunate fossa, adequate anatomical reduction can have an important impact on the prognosis of wrist function. Herein, we used the combined volar and dorsal approach, and the dorsal approach was used to assist in bone grafting or dorsal plate fixation in reducing fractures. We compare the combined approach versus the Henry approach for the fixation of die-punch distal radius fractures. Methods: We reviewed patients who were admitted for surgery for die-punch fractures from January 2016 to June 2021. The patients were followed-up after surgery to measure and evaluate their Gartland–Werley wrist score, wrist range of motion (ROM), and follow-up imaging data. Results: There were 21 patients in the volar locking plate (VLP) group and 10 patients in the combined approach group. The majority of fractures in the VLP and combined approach groups were AO B and C fractures, respectively. The cause of injury and AO fracture classification showed significant differences between the two groups, and there was no difference in age or sex between the two groups. There was no significant difference in ROM between the two groups, but the VLP group presented a better Gartland–Werley score and volar tilt angle, and the combined group presented better maintenance in radial height and articular congruity. Conclusions: Reduction through the combined palmar and dorsal approach supplemented by bone grafting or dorsal plate fixation is an effective method for the treatment of die-punch distal radius fractures, which provides a new option for the treatment of die-punch fractures. [ABSTRACT FROM AUTHOR]

(1) Background: Different distal radial fracture types have different prognosis after fixation. Our study aim is to evaluate the differences in radiographic parameters by using variable-angle volar locking plate (VAVLP) fixation according to extra-articular and intra-articular distal radial fracture. (2) Methods: There are two groups: extra-articular group (21) and intra-articular group (25). Forearm radiographs immediately after surgery and at 3 months after operation were reviewed for analyzing radial height (RH), ulnar variance (UV), radial inclination (RI), volar tilt (VT), tear drop angle (TDA), distal dorsal cortical distance (DDD), and Soong classification (SC). (3) Results: There were no significant differences in the above parameters between two groups at either immediately post-operative or at 3-month follow-up, except for TDA (p = 0.048). Most patients in both groups were at low risk of flexor tendon rupture, except for two cases. We observed a positive correlation between post-operative DDD and 3-month change in the intra-articular group, but not the extra-articular group. (4) Conclusions: Our study demonstrates that VAVLP fixation is effective in maintaining the stability of most radiographic parameters and reduces the risk of tendon rupture in both extra-articular and intra-articular distal radial fractures. Post-operative DDD can be used to predict the degree of subsequent displacement in patients with intra-articular fractures fixed with VAVLP. [ABSTRACT FROM AUTHOR]

Background and purpose: Soong classification is used to estimate volar locking plate prominence and evaluate the risk for flexor tendon ruptures after surgical treatment of distal radius fractures (DRFs). However, the scientific community has questioned the Soong classification due to lacking evidence. Therefore, this study aimed to evaluate the accuracy of Soong grading as a predictor for flexor tendon issues and plate removal. Patients and methods: We performed a retrospective single-center review of adult distal radius fracture patients treated with a volar locking plate between 2009 and 2019. In total, 2779 patients were included in the study. The primary outcome was a flexor tendon issue (flexor tendon rupture, tendinitis, or flexor irritation), whereas plate removal was a secondary outcome. Using Soong grade 0 as a reference, we used univariable and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for flexor tendon issues and plate removal. Results: In total, 756 (27%) patients were graded as Soong 0, 1679 (60%) Soong 1, and 344 (12%) Soong 2, respectively. There were 32 (1.2%) patients with flexor tendon issues, of which 4 were flexor tendon ruptures, 8 tendinitises, and 20 flexor irritations. The adjusted OR for flexor tendon issues was 4.4 (CI 1.1–39.7) for Soong grade 1 and 9.7 (CI 2.2–91.1) for Soong grade 2. The plate was removed from 167 (6.0%) patients. Soong grade 1 had a univariable OR of 1.8 (CI 1.2–2.8) for plate removal, and Soong grade 2 had an OR of 3.5. (CI 2.1–5.8), respectively. Conclusion: Flexor tendon ruptures are rare complications after the volar plating of DRFs. A higher Soong grade is a risk factor for flexor tendon issues and plate removal. Trial registration: The trial was retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: The volar locking plates have been widely used in a variety of distal radius fractures, but they still have several limitations when dealing with small fragments located around the watershed line with widely reported complications. The volar rim fragments play a critical role in radiocarpal joint stability and failing to secure the volar rim fragment usually results in carpal instability, subluxation, or even dislocation. This study investigates clinical outcomes in the use of a novel implant, the Trident distal radial (TDR) locking plate to treat distal radius fracture with the intermedium column edge (lunate fossa volar rim) fragment involvement. Methods: A retrospective study of 25 patients was conducted, all patients had intermedium column fractures with lunate fossa volar rim involvement and treat with the TDR between January 2016 and December 2019. The clinical assessment outcomes included VAS Pain, PRWE, and DASH scores. Objective measurements included ROM of the injured wrist and grip strength. Final radiographs were used to evaluate radial inclination, volar tilt, ulnar variance, and distal radioulnar joint instability. Secondary operations related to hardware complications were also recorded. Results: The outcome revealed that the mean VAS Pain Score was 1.3, mean DASH score was 10.5, and mean PRWE score was 9.3. Objective measurements revealed good ROM recovery and an 89% gripping strength recovery compared with contralateral hand. Radiographic measurements revealed good maintenance of volar tilt, radial inclination, and mean ulnar variance. There were no complications related to the implant and all fracture sites were union. Conclusion: We believe that the TDR provided more stable fixation among distal radial fractures that predominantly involved the intermedial column and volar rim fragment, and allowing early rehabilitation. We could obtain excellent results in the wrist ROM, gripping power, and Pain Score (VAS). [ABSTRACT FROM AUTHOR]

Careful distal locking screw insertion into the subchondral zone is necessary to obtain proper mechanical strength of unstable distal radius fractures using volar locking plating. However, subchondral zone screw insertion increases the risk of intra-articular screw penetration, which may remain unrecognized during surgery due to complex distal radial anatomy. The purpose of this study was to evaluate the role of fluoroscopic guidance with a 45° supination oblique view technique for placing distal screws into the subchondral zone during volar locking plating for unstable distal radius fractures and to explore the factors associated with poor screw placement. We retrospectively analyzed 171 wrists of 169 patients treated with variable-angle volar locking plates for unstable radius fractures. The subchondral zone was defined as the metaphyseal area within 4 mm of the articular margin of the distal radius. The location of the distal locking screws and radiographic parameters, including the teardrop angle, were measured using computed tomography scans and X-rays. Clinical and radiographic factors were examined to determine their possible associations with screw placement failure. Of 581 distal screws inserted, 559 screws (96.2%) were inserted into the subchondral zone and 17 screws into the metaphyseal zone (2.9%). Five screws (0.7%) in three wrists showed intra-articular placement: four screws were placed into the lunate fossa and one into the scaphoid fossa. These three wrists also exhibited significantly reduced teardrop angles. The distal screws were significantly closer to the joint line in the lunate fossa than the scaphoid fossa (1.9 ± 0.9 mm vs. 2.8 ± 1 mm, P < 0.000). The 45° supination oblique view technique is a useful fluoroscopic guiding technique for accurate and safe distal screw placement in the subchondral zone in volar locking plate fixation for distal radial fractures. However, a decreased teardrop angle or extended lunate fossa should be corrected before distal screw insertion to avoid intra-articular screw placement. [ABSTRACT FROM AUTHOR]

Introduction: We classified the contact configuration between the volar prominence of volar locking plate (VLP) and flexor pollicis longus (FPL) tendon using ultrasound (US) into indentation contact and smooth contact, and investigated whether the contact configuration is associated with the flexor tendon attrition. Materials and methods: Ninety-four patients who underwent VLP removal were included in this study. We assessed pain using visual analogue scale, grip strength, and Disabilities of the Arm, Shoulder and Hand score for clinical evaluations, radial inclination, palmar tilt, ulnar variance, and Soong classification for radiological evaluations, and contact configuration using US at 1 year after VLP fixation. After these evaluations, we removed the VLP with observation for the presence of fibrillation or wear of FPL tendon substance. Subsequently, we classified the patients into either of FPL attrition and FPL intact group. Results: Twenty-eight patients had indentation contact configuration and 66 patients had smooth contact configuration. The kappa value for inter-observer reliability for the contact configuration was 0.78. Twelve patients were included in the FPL attrition group and 82 in the FPL intact group. There was no significant difference in clinical outcomes and Soong classification between the groups. However, palmar tilt of the flexor tendon attrition group was significantly lower than that of the flexor tendon intact group and the FPL attrition group showed significantly higher indentation contact configuration rate than the FPL intact group. FPL tendon attrition was diagnosed using the contact configuration on US with a sensitivity of 100% and specificity of 80%. Conclusion: This study demonstrated that FPL tendon attrition was significantly associated with indentation contact on US with high sensitivity. Therefore, we recommend selective implant removal in patients with indentation contact configuration. [ABSTRACT FROM AUTHOR]

Bone plates are essential for bone fracture healing because they modify the biomechanical microenvironment at the fracture site to provide the necessary mechanical fixation for fracture fragments. This paper focuses on reducing the stress shielding effect that occurs due to a mismatch between cortical bone and metal plate. fabricating bio composites plates fixation by modeling of femur bone with ANSYS software program. However, Bio-composites that involve Ultra-high molecular weight polyethylene polymer (UHMW-PE) reinforced with nano Titanium dioxide particles n-TiO2 at different fractions (0, 1.5, 2.5, 3.5 and 4.5%) and 5% from carbon and Kevlar fibers were fabricated by hot pressing technique. We tested tensile, elastic modulus, and elongation percentages. The results of this study showed a value of tensile strength and elastic modulus improved with increasing weight fraction of nanoparticles and UHMWPE+4.5% n-TiO2 biocomposite were the best mechanical properties, were tensile strength and elastic modulus was (38.57 ± 1.9285 MPa, 1.15 ± 0.0575 GPa) respectively and elongation percentages reduced to 114.05 ±5.7025% compared with pure UHMWPE 176.68 ± 5.7025%. According to the current study's findings, it is possible to create bio-composites as fixation devices with improved performance by placing different fiber reinforcements. [ABSTRACT FROM AUTHOR]

Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015–2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001). Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: K-wire pinning, volar fixed angle locking plate, enhanced external fixators, and fragment specific fixations are all alternatives for treating comminuted distal radial fractures. Each strategy has pros and downsides, but there is no agreement on which way is the best. Objective: This study aimed to improve the functional outcome in patients with distal radial fractures, treated with a volar locked plate. Patients and Methods: This prospective study included 18 patients with distal radial fractures who were admitted and operated at Orthopedic Department, Zagazig University Hospitals. All patients were subjected to preoperative and postoperative evaluation. The follow up period of the cases ranged from 6 to 12 months. Results: The final outcome in distal radius fracture management is dependent on many factors and can be influenced by accurate restoration of the anatomy, minimal disruption of the surrounding tissues, and early active wrist rehabilitation. Fragment specific fixation can give better results in certain types of distal radius fractures. Conclusion: Volar fixed-angle locked plating is better than external fixation and percutaneous wiring in treating intraarticular distal radial fractures because it affords more stable fixation with anatomical reduction, lower rate of complication and early motion, which results in better functional results. [ABSTRACT FROM AUTHOR]

The use of C-arm fluoroscopy poses a risk of radiation exposure to the surgeons. This study aimed to examine the intraoperative fluoroscopy time of the distal radius plating before and after radiation educational program. A total of 68 cases (48 women and 20 men; average age, 61.8 years) were reviewed between July 2017 and October 2019. All patients were treated with volar locking plate fixation for distal radius fractures. On October 2018, we had a 1-h radiation educational program for orthopedic surgeons. Intraoperative fluoroscopy time was compared between 34 cases in the preintervention group (group A) and 34 cases in the postintervention group (group B). Radiographic correction loss of the fracture was assessed by ulnar variance (UV), radial inclination (RI), and volar tilt (VT) between immediately after surgery and at the time of bone union. A significant difference was found in intraoperative fluoroscopy time between 329 s in group A and 123 s in group B. ΔUV between immediately after surgery and at the time of bone union was 0.6 mm in group A and 0.3 mm in group B; ΔRI was −0.3° in group A, −0.1° in group B, ΔVT is −0.4° in group A, and −0.1° in group B. No significant difference was found among them. After an educational program on radiation exposure, the intraoperative fluoroscopy time was significantly saved in the plating surgery for the distal radius fractures. The shortening of the intraoperative fluoroscopy time did not affect the loss of radiographic correction of the fractures. [ABSTRACT FROM AUTHOR]

Introduction: "Distal end radius fractures" account for almost 16% of all fractures and are the most common kind of upper limb fractures treated in hospital emergency departments. "Distal end radial fractures" occur more often in younger people due to high-energy trauma than in older people due to low-energy trauma. When comparing women and men of the same age, proximal end radii fracture are more prevalent in women than men owing to significant osteoporosis and a higher tendency for accidents in older women. Methodology: This was a prospective interventional study in which participants were divided in to two groups. Result and Conclusion: Both groups in the study had comparable range of motion, with the exception of the forearm", where the "variable angle volar locking plate" excelled. The risk of complications was low in both approaches. Thus we conclude that when it comes to treating "displaced intra-articular distal end radius" fractures, the variable angle volar locking plate is superior than the Ellis locking plate. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the clinical and radiological outcomes of combined titanium elastic nailing and external fixator application (TEN+EFA) with EFA and plate osteosynthesis in patients with humerus diaphysis fractures. Materials and Methods: Data of the patients who underwent surgical treatment for a humerus diaphysis fracture were retrospectively reviewed. The patients were divided into three groups based on the surgical technique. Group 1 consisted of the patients who underwent plate osteosynthesis, Group 2 included those who underwent EFA, and Group 3 included those who went through TEN+EFA. Results: Eighty patients were included. The number of patients in the study groups was 32, 25, and 23 in Group 1, 2, 3, respectively. The duration of surgery was statistically significantly shorter in Groups 2 and 3 than in Group 1 (p=0.02). Nonunion was diagnosed in 3 patients (9.3%) and in 1 patient (4%) in Groups 1 and 2, respectively. The presence of nonunion was not statistically significant. (p=0.28) Malunion was encountered in 2 patients (4%) in Group 2, while no patients experienced malunion in Groups 1 and 3. The presence of malunion was not statistically significant. (p=0.10). Conclusion: The EFA+TEN is a practical, safe and fast procedure providing a minimally invasive surgical treatment option for patients with humerus diaphysis fractures. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical and radiological outcomes of distal radius fractures (DRFs) with displaced dorsal ulnar fragments treated with volar locking plate (VLP) and the "poking reduction" technique. Methods: Between January 2014 and January 2019, 78 unilateral DRFs with displaced dorsal ulnar fragment (AO type C3) treated with VLP were conducted. According to the reduction technique of the dorsal ulnar fragment, the patients were divided into the conventional reduction (CRG) group (33 patients, 14 males and 19 females, mean age 57.2 ± 12.1 years old) and the "poking reduction" (PRG) group (45 patients, 11 males and 34 females, mean age 60.1 ± 12.4 years old). According to the AO classification, there were 21 cases of C3.1 and 12 of C3.2 in the CPG group, 27 cases of C3.1 and 18 of C3.2 in the PRG group. Clinical and radiographic data were extracted from the electronic medical record system. These data were reviewed for clinical outcomes (range of motion, grip strength), radiological outcomes (volar tilt, radial inclination, radial height, step of articular surface), and postoperative complications. The final functional recovery was evaluated by the disabilities of the arm, shoulder, and hand (DASH) score. Results: The mean duration of follow‐up was 27 months (range from 12 to 56). The average operation time and intraoperative blood loss did not significantly differ between groups (p > 0.05). Postoperative CT examination showed that the step of articular surface in CPG group (0.8 ± 0.3 mm) was larger than that in PRG group (0.5 ± 0.2 mm) (p < 0.001). The DASH score did not significantly differ between groups (26.1 ± 4.6 in CRG and 24.7 ± 4.0 in PRG, p > 0.05) at 3 months postoperatively. At 6 months and 12 months postoperatively, the DASH score was better in PRG group (11.8 ± 2.5 and 10.4 ± 2.0) than in CRG group (13.6 ± 2.7 and 12.2 ± 2.5) (p = 0.004, p = 0.001, respectively). At 12 months postoperatively, wrist range of motion did not significantly differ between groups (p > 0.05). There was no significant difference in radiological parameters between the two groups (p > 0.05). The incidence of complications was higher in the CRG group (7/33) than in the PRG group (2/45) (p = 0.009). Conclusion: The "poking reduction" technique is a wise option for reduction of dorsal ulnar fragment in DRFs. This innovative technique could restore smoothness of the radiocarpal joint effectively, and the dorsal ulnar fragment could be fixed effectively combined with the volar plate. [ABSTRACT FROM AUTHOR]

Background: Intra-articular fibromembranous septum in the radiocarpal joint can cause wrist contracture after distal radial fracture, but the mechanism underlying the formation of the septum is unknown. This study examined the clinical outcomes in patients treated with arthroscopic excision of the septum and the factors associated with formation of the septum in patients with and without a septum.Methods: Fifty-three patients (22 with septum and 31 without septum) treated for intra-articular distal radial fracture with arthroscopy using a volar locking plate and secondary removal of the plate were included. Clinical outcomes and radiological assessments were analyzed.Results: In patients with a septum, the range of wrist flexion and total wrist arc before the second operation were significantly more limited than in those without a septum (p < 0.01 and p = 0.03, respectively). The improvement rate (improvement in wrist arc divided by the wrist arc of the healthy side) after arthroscopic excision of the septum and plate removal was greater in patients with a septum than in those without a septum (6.1% vs. 2.0%, p = 0.08). The significant factors affecting formation of the septum were the residual articular gap and the height of the midradial ridge on computed tomography images.Conclusions: Intra-articular fibromembranous septum after surgically treated intra-articular distal radial fracture affects limited range of motion and secondary arthroscopic excision of the septum improves the wrist range of motion. Anatomical reduction and maintenance of the articular fragment, as well as anatomical characteristics might be causes of septum formation. [ABSTRACT FROM AUTHOR]

Background: Few studies have reported the outcomes of primary volar locking plate fixation in Gustilo and Anderson type II and IIIA open distal radius fractures. We report the outcomes of treatment of Gustilo and Anderson type II and IIIA open distal radius fractures using primary volar locking plate fixation. Methods: We retrospectively reviewed 24 patients with open distal radius fractures who were treated using primary volar locking plate fixation. The range of motion (ROM) and modified Mayo wrist scores were measured to assess functional outcomes. Radiological outcomes included the bone union period, radial inclination, volar tilt, radial length and ulnar variance. Results: Functional outcomes, including mean ROM in flexion (39.1°) and extension (52.5°), improved following primary volar locking plate treatment. Radiological outcomes were as follows. Mean bone union period, radial length and ulnar variance were 7.8 months, 10.4 and 0.7 mm, respectively. Two patients had superficial wound infection 2 weeks after surgery and one patient had non-union of the radius that required implant removal, autologous iliac crest bone graft and plate re-fixation. Conclusions: Primary volar locking plate fixation is a safe and reliable treatment option for Gustilo and Anderson type II and IIIA open distal radius fractures. By providing firm stabilisation and allowing early ROM exercise, primary volar locking plate fixation resulted in good functional and radiological outcomes. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

The elderly have conventionally been defined as individuals over the age of 65 and are projected to represent about 21% of the United States (US) population by the year 2030. Distal radius fractures (DRF) in particular are one of the most common fractures among elderly patients and their incidence continues to rise in part due to increased activity levels among the elderly, increased life expectancy, rising rates of obesity, changes to dietary habits, and the prevalence of osteoporosis. Although various treatment options exist for these injuries, nonsurgical treatment of distal radius fractures remains a mainstay among elderly patients with mounting evidence of its non-inferiority to surgical fixation in the literature. Here, we summarize the overall approach to nonsurgical treatment of distal radius fractures in the elderly population while examining its supporting data and highlighting potential risks and limitations to it. [ABSTRACT FROM AUTHOR]

Introduction: Certain type of injury of the triangular fibrocartilage complex associated with distal radius fracture can result in distal radioulnar joint instability (DRUJ). Untreated DRUJ instability may lead to poor result in the treatment of acute distal radius fractures. The aim of this study was to evaluate DRUJ instability in distal radius fractures through dorsal stress radiography comparing the affected and unaffected wrists intraoperatively.Materials and Methods: 49 patients with a distal radius fracture who were operatively treated with a volar locking plate were included. Dorsal stress radiography was used to evaluate both affected and unaffected wrists peri-operatively to detect DRUJ instability. Under general anesthesia, a dorsal stress test was performed on the unaffected wrist. Additionally, after fixation of the affected wrist, a dorsal stress test was performed. The ulnar translation ratio (UTR) was measured through the dorsal stress radiograph. Arthroscopic examination was performed on all affected wrists according to Palmer's and Atzei classification.Results: The UTR of the affected wrist and the TFCC injury Palmer-type IB tendency were positively correlated (odds ratio: 1.18, p-value: 0.002). Additionally, as the UTR difference between the affected and unaffected wrists enlarged, it revealed a significant DRUJ instability tendency due to Palmer-type IB TFCC injury (p-value: 0.000006, Wilcoxon rank-sum test).Conclusions: Dorsal stress radiography is a reliable, simple procedure to evaluate DRUJ instability intraoperatively. UTR value from dorsal stress radiography could be useful for evaluating DRUJ instability associated with distal radius fracture. [ABSTRACT FROM AUTHOR]

The article discusses the use of digital technology in improving the surgical management of distal radius fractures. The authors found that a novel intraoperative three-dimensional software system did not substantially improve upon the existing technological tools, such as a volar locking plate system, digital imaging, and intraoperative fluoroscopy. The publication of these negative findings is important for providing a balanced perspective and preventing future trialists from exploring dead-end approaches. The article also raises questions about the preventability of improperly placed distal radius hardware and the effectiveness of navigation systems in improving clinical outcomes. The authors emphasize the need to target the right technology to the right problem and acknowledge the limitations of software programs in certain cases. [Extracted from the article]

Background: The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails.Aim: The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures.Methods: Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated.Results: All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant.Conclusion: The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery. [ABSTRACT FROM AUTHOR]

Impact microindentation is a new technique that measures the resistance of a patient's bone to micro-indentation but has not yet been implemented in an intraoperative setting. To assess the technique's safety and utility, we acquired microindentation measurements of bone material strength index (BMSi) using the OsteoProbe prior to distal radius fixation with a volar locking plate. Subsequently, the patients received a dual-energy x-ray absorptiometry scan to measure the areal bone mineral density of the proximal femur, lumbar spine, and contralateral distal radius. By assigning the patients to low-energy, fragility fracture (n = 17) and high-energy fracture (n = 11) groups based on clinical history, we investigated whether intraoperative BMSi was sensitive to osteoporosis. Impact microindentation added a maximum of 10 min of operative time and did not result in any intraoperative or postoperative complications. There were, however, no significant differences in BMSi at the radius between these two groups. This study demonstrates the feasibility of performing intraoperative impact microindentation to directly assess a patient's bone quality, but additional research is necessary to establish whether intraoperative microindentation can identify patients with inferior bone matrix quality. [ABSTRACT FROM AUTHOR]

The treatment of scaphoid nonunion can be challenging with increasing defect size. We evaluated the outcome of scaphoid nonunion with a substantial bone defect treated with a multidirectional locking plate combined with cancellous bone grafting only. Thirteen patients with significant osseous defects measuring 6 mm or more suffering from primary nonunion without treatment (n = 6) or recalcitrant nonunion following Herbert screw osteosynthesis (n = 7) were treated and reviewed retrospectively. The stabilization was performed after debridement, autologous cancellous bone grafting and volar locking plate osteosynthesis. After a mean follow-up period of 12 months, 12 of the 13 patients achieved successful unions with a free range of motion and complete remittance of pain in everyday activity. The mean scapholunate angle decreased from 59.7° ± 11 to 43.9° ± 5 (effect strength d:1.7, p < 0.00001), scaphoid humpback deformity angle from 58.9° ± 8 to 45.1° ± 8 (d:1.8, p < 0.0001), whereas strength of the injured hand increased from 36.4 kg ± 10 to 42.4 kg ± 9 (d:1.4, p < 0.0001). One nonunion persisted without fragment dislocation receiving revision after 1 year. Thus, locking plate osteosynthesis with cancellous bone grafting is a valid alternative in scaphoid nonunions with extensive bone defects. Additionally, stable retention of the fragments prevents dislocation even in delayed or persistent nonunion. Further prospective studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively.Methods: Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (PROM), grip strength, range of motion, complications and radiological results.Results: Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. At 3 years the median PRWE was better (0 points) in the VLP-group than in the non-operative treatment group (9 points) p-value: 0.027. No statistically significant difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up.Conclusions: Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance.Trial Registration: The study was registered at : NCT02154620 03/06/2014 and NCT01268397 30/12/2010. Ethical approval was obtained from Ethical Committee in Stockholm, Sweden (2009/37-31/3, 2013/105-31/2, 2014/1041-32, 2017/611-32). [ABSTRACT FROM AUTHOR]

Objectives: The main objective of the study was to compare the dimensional ridge changes and the histological composition after the use of an allograft or xenograft and a resorbable membrane in ridge preservation in molar sites and to evaluate the influence of bone plate thickness on dimensional changes and the need of lateral sinus augmentation following ridge preservation. Materials and methods: Twenty‐four patients in need of maxillary or mandibular first or second molar extraction and subsequent implant placement were included and randomly assigned to a group; allograft or xenograft, plus a collagen membrane. Cone‐beam computed tomographies were obtained after molar extraction and after 5 months. A bone sample was harvested at the time of implant placement and analyzed by histomorphometry. Results: Bone ridge was reduced significantly. Major changes in width occurred at 1 mm from the bone crest (−2.93 ± 2.28 mm) (p =.0002), while in height, the greatest reduction occurred at the buccal area (−1.97 ± 2.21 mm) (p =.0006). However, differences between groups were not significant. Thicker buccal bone plates exhibited less bone remodeling, while histologically, both biomaterials resulted in similar tissue composition. The resulting available bone height in the implant site measured 7.30 ± 3.53 mm initially and 6.8 ± 3.61 mm after 5 months which allowed implant placement without the need for lateral sinus augmentation in all cases. Still, 55% of the preserved areas needed transcrestal sinus lift. Conclusion: Ridge preservation in molar sites using a mineralized allograft or xenograft provides similar dimensional and histomorphometrical results after 5 months. [ABSTRACT FROM AUTHOR]

Background: Fractures of the distal radius represent the most common fracture of the upper limb, and can be managed surgically with volar locking plate osteosynthesis (VLPO). Uncertainty remains regarding the optimal length of the distal locking screws. The aim of this study was to determine the optimal VLPO screw length which provided adequate stability while minimizing complications. Methods: A systematic review of relevant literature published within Cochrane, PubMed, MEDLINE and Embase, including studies up to April 2020, was performed using the Preferred Reporting Items for Systemic Reviews and Meta‐analysis (PRISMA) guidelines. Studies were included if they investigated distal radius fracture fixation with VLPO, screw lengths, complications, and associated imaging. Results: Search results identified 664 relevant studies, of which 14 studies examining 926 radii were included for review. Synthesis revealed that unicortical locking fixation with screws ~75% the depth of the radius, or 2 mm short of the dorsal cortex, provided equivalent stability to bicortical fixation. The lunate may be used as a proxy to determine radial depth at each quartile column. Inadvertent screw protrusion can be assessed by taking four images intra‐operatively; anteroposterior (AP), lateral, 45° supinated and dorsal tangential views (DTVs). Radial shaft screws can have up to 2 mm prominence with no clinical significance. Conclusion: Unicortical locking fixation at least 75% the depth of the distal radius provides equivalent stability to bicortical fixation in extra‐articular fractures with lower complication rates. Imaging should be used to confirm that penetration of the dorsal cortex has not occurred. [ABSTRACT FROM AUTHOR]

Tibial plateau fractures are one of the most common intraarticular fractures. Open reduction and internal fixation procedures is the common technique used to treat it however, it jeopardises the soft tissue. So, the use of a minimally invasive approach to fix plates has been recommended. As a result, the so-called internal fixators were created. So, the present study was conducted with an aim to study the functional outcome of tibial plateau fractures with locking compression plates by using modified Hohl and luck evaluation. A prospective observational study was conducted among 30 patients with fractures of tibial plateau (Schatzker classification Type I,II,III). 73.3% cases had excellent and 16.6% had good outcomes in the study. 6% had stiffness of knee, 3.3% had instability, 3.3% had infection and 3.3% had implant failure. We conclude that better preoperative surgical planning and correct application of principles of LCP (Locking Compression Plate) and MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) technique will yield excellent biological fixation for tibial plateau fractures. [ABSTRACT FROM AUTHOR]

Using simultaneous transplantation of bone graft materials, this study examined the long-term outcomes of a ridge augmentation technique applied to deficient labial alveolar bone plate in the esthetic zone. Results were based on a case series in which study cases (n = 10) were divided into two groups. Group 1 exhibited intact labial alveolar bone, while group 2 alveolar bone was dehiscent at the labial aspect. The clinical outcome was longitudinally monitored using cone beam computed tomography 4 to 7 years after the procedure. The final postoperative examination noted bone augmentation in labial bone width for groups 1 and 2 of 2.48 ± 0.60 and 2.62 ± 0.68 mm, respectively (Mann-Whitney U test, P = .40), indicating the effectiveness of this technique when applied to dehiscent labial bone. More importantly, these measurements did not significantly change during the last 2 to 4 years of follow-up monitoring, suggesting the success of this technique when applied to immediate implant placement. [ABSTRACT FROM AUTHOR]

The primary objective of this pilot study was to evaluate a new socket preservation technique involving the intentional expansion of the extraction socket buccal plate using a flapless internal corticotomy and biomaterials. A total of 11 patients requiring tooth extraction were enrolled in this study. The aim of this technique was to maintain or improve the hard and soft tissue contour of the ridge after tooth extraction. All surgical sites healed uneventfully. Significant alveolar bone dimension changes were observed in the coronal region of the ridge (−1.4 ± 0.9 mm); however, it was only slightly lower at the medium (−0.35 ± 0.7 mm) and apical levels (−0.3 ± 0.8 mm) (P > .05). The ridge dimensional changes were significantly higher in the buccal aspect than in the palatal aspect in all patients. Vertical bone resorption was not significant. Concerning the soft tissue contour, the horizontal distance between the preoperative and postoperative buccal profiles ranged from 0.94 to −2.88 mm. The proposed ridge preservation technique may help maintain the volume of the healed ridge but cannot completely prevent contour changes after tooth extraction. [ABSTRACT FROM AUTHOR]

• Forearm fractures in adults occur in the context of medium- and high-energy trauma, with a high frequency of associated injuries. • The clinical outcomes of theses fractures are satisfactory in nearly 90 % of cases. However, the non-union rate is around 7 %. • Age at the time of the fracture seems the be a predisposing factor for non-union in our study. It is the same for certain fracture subtypes (type B3.3 fractures and type A3.1 fractures). Some authors suggest using autograft during the initial treatment of comminuted fractures to prevent non-union. • As our study did not allow us to clearly identify any risk factors for non-union, it seems essential to follow the recommendations of the AO Surgery Reference: 3.5 mm plates with at least 8 or 9 holes and three bicortical plate screws in each main fracture fragment [33]. • We believe the surgeon should intervene earlier if the XR follow-up of a forearm fracture shows no signs of osteogenesis. Treatment of mid-shaft fractures of both forearm bones in adults typically consists of individual plate fixation of each bone according to AO principles. The primary objective of this multicentre retrospective study was to identify predictive and prognostic factors of failed bone union after internal fixation with a standard plate in adults. 130 mid-shaft fractures of both forearms occurred in 92 men and 38 women, who had a mean age of 35.1 years were reviewed; 42 were open: 31 were Gustilo type I, 10 were type II and 1 was type III. All patients underwent ORIF using a direct approach over the supinator crest for the ulnar fracture and using an anterior approach at the level of the radial fracture by dynamic compression plate in 90 cases and a limited-contact dynamic compression plate in 40 cases, all with 3.5 mm diameter screws. The radiographs from all patients were reviewed after a minimum follow-up of 12 months: primary union of both forearm bones occurred in 121 of the 130 cases after a mean of 4.6 months (±2.6). 104 patients were reviewed clinically with a minimum follow-up of 12 months and a mean of 36 months (±21.7). According to Tscherne-Oestern classification, 79 % of patients had a very good outcome, 6 % had a good outcome, 10 % had a fair outcome and 5 % had a poor outcome Non-union occurred in 9 patients (one septic): 4 times at both fracture sites, 4 times at the ulna only and once at the radius only. The mean age was higher in the patients with non-union: 46.4 years versus 34.2 (P = 0.08). Smoking, alcoholism, associated head trauma, presence of pre-operative nerve deficit and open fracture did not appear to be risk factors for non-union. The type of plate used and the number of screws placed on either side of the fracture site had no effect on union. This patient series had a similar non-union rate to the one reported in other published studies, likely because the technical rules were followed. A lack of statistical power probably prevented us from identifying prognostic factors for bone union. [ABSTRACT FROM AUTHOR]