Volume 16 | Issue 2 | April-June 2021 | Page 26-29 | Nikhil Bhandari, Madhav Khadilkar, Rahul Agrawal, Shantanu Deshpande, Amit Mahajan, Akash Mane
Authers: Nikhil Bhandari [1], Madhav Khadilkar [1], Rahul Agrawal [1], Shantanu Deshpande [1], Amit Mahajan [1], Akash Mane [1].
[1] Department of orthopaedics, Bharati Vidyapeeth (DTU) Medical College, and Hospital, Pune-43.
Address of Correspondence
Dr. Nikhil Bhandari ,
Department of orthopaedics, Bharati Vidyapeeth (DTU) Medical College, and Hospital, Pune-43
E-mail: dr.nikhilbhandari23@gmail.com
Abstract
Introduction: Distal-end radius fractures are one of the most common fractures encountered by an Orthopaedic surgeon. It accounts for 17.5% of the fractures in adult age group, of which 57 to 66% are extra-articular, 9 to 16% are partial articular and 25 to 35% are complete articular fractures. Commonest mode of injury is fall on an outstretched hand with the wrist in dorsiflexion. Closed reduction and cast, with or without K wiring, closed reduction with External fixator or Open reduction (volar or dorsal) with internal fixation with either volar or dorsal plates are the various treatment modalities undertaken.
Till recently volar approach for plate fixation had been a preferred choice for even dorsally displaced distal end radius fracture due to high risk of complications like tendon irritation and rupture in dorsal approach and skin dehiscence. In recent years, due to availability of fragment-specific low profile dorsal plates there has been a renewed interest in dorsal approach for plate fixation in these fractures.
Material and methods: In the present observational study, 7 patients were evaluated who had dorsally displaced distal end radius fractures and underwent dorsal plate fixation by a dorsal approach. The outcomes were measured by Modified Mayo wrist score and VAS score. Patients were evaluated clinically and radiologically at 6 weeks intervals with follow-up after 1 year.
Results: At the end of 1-year, excellent results were observed in 6 of the 7 patients. Significant improvement was noted at 6 months and 1 year follow-up in Modified Mayo wrist score and VAS score. No complications were reported in any of the patients.
Conclusion: We conclude that dorsal plate fixation using a dorsal approach for dorsally displaced fractures of lower end radius with newer generation, low profile fragment-specific plates is a good treatment modality for dorsally displaced distal-end radius fractures.
Keywords: Dorsally displaced distal end radius fracture, dorsal plate fixation, dorsal surgical approach, Modified Mayo Wrist Score (MMWS), VAS Score.
References
1. McQueen MM. Fractures of the distal radius and ulna. Eds: Court-brown CM, Ricci WM, Heckman JD, Tornetta III P, McQueen MM, McKee MD, In: Rockwood and Green’s fractures in adults.Wolter Kluwer. 2015, pp 1057-1120.
2. Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014; 3(4):325-332.
3. Ojha A, Prakash R, Singh SK, Manjhi LB. Dorsally displaced distal radius fractures fixation: Dorsal versus volar plating. A randomized controlled study. Int J Orthop Sci 2018; 4(3):481-485.
4. Schneppendahl J, Windolf J, Kaufmann RA: Distal Radius Fractures: Current Concepts. J Hand Surg 2012; 37A:1718–1725
5. Lutsky K, Boyer M, Goldfarb C. Dorsal Locked Plate Fixation of Distal Radius Fractures. J Hand Surg 2013;38A:1414–1422
6. Chen AC, Chou YC, Cheng CY. Distal radius fractures: Minimally invasive plate osteosynthesis with dorsal bicolumnar locking plates fixation. Indian J Orthop. 2017; 51(1):93-98.
7. Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clinical Orthopaedics and Related Research, 1987; 214:136–147
8. Smith D. Treating Intra-Articular Distal Radius Fractures. BCMJ, 2018; 60(1):17
9. Wichlas F, Haas NP, Disch A, Machó D, Tsitsilonis S. Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures. J Orthop Traumatol. 2014; 15(4):259-264.
10. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007; 21(5):316-322.
11. Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am. 2011; 36(7):1135-41.
12. Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006; 31(3):359-65.
13. Simic PM, Robison J, Gardner MJ, Gelberman RH, Weiland AJ, Boyer MI. Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. The Journal of hand surgery. 2006 Mar 1;31(3):382-6.
14. Abdel-fattah MS, Mohammed AS, Badawy AM. Dorsal Approach For Impacted Comminuted Distal Radius Fracture By Open Reduction And Internal Fixation By Plate And Screws With Bone Grafting. Al-Azhar International Medical Journal. 2021 Mar 1;2(3):54-9.
15. Wei J, Yang TB, Luo W, Qin JB, Kong FJ. Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res. 2013; 41(2):265-75..
How to Cite this article: Bhandari N, Khadilkar M, Agrawal R, Deshpande S, Mahajan A, Mane A. The functional outcome of dorsally displaced distal end radius fractures treated with dorsal plating: A series of 7 cases. Journal of Trauma and Orthopaedic Surgery April-June 2021;16(2): 26-29. |