The Journal of hand surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation.
To compare 2 methods of surgical treatment for displaced intra-articular fractures of the distal radius: open reduction and internal fixation with dorsal plating (Pi Plate; Synthes, Paoli, PA) versus mini open reduction with percutaneous K-wire and external fixation. ⋯ At midterm analysis the dorsal plate group showed a significantly higher complication rate compared with the external fixator group; therefore enrollment in the study was terminated. The dorsal plate group also showed statistically significant higher levels of pain, weaker grip strength, and longer surgical and tourniquet times. Based on these results we cannot recommend the use of dorsal plates in treating complex intra-articular fractures of the distal radius.
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This report describes our technique for identifying the spinal accessory nerve during primary exploration of the brachial plexus in infants with obstetric palsy.
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Radial-sided avulsions of the triangular fibrocartilage complex (TFCC) (Palmer 1D) with distal radioulnar joint (DRUJ) instability remain a challenging pathology to treat. We tested an intra-articular reconstruction that addresses unstable radial-sided TFCC avulsions. ⋯ Current procedures are unable to restore DRUJ stability without a significant limitation of pronation and supination. This intra-articular reconstruction of radial-sided TFCC avulsions succeeded in restoring baseline stability to the DRUJ without interfering with pronation/supination.
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The ulnar-shortening procedure has been adopted widely to reduce pressure between the ulna and ulnar carpus in ulnocarpal abutment syndrome. The hammock-like structure of the triangular fibrocartilage complex (TFCC), which supports and connects the ulnocarpal and distal radioulnar joint (DRUJ), variably is torn in this condition. The degree to which the torn TFCC may be tensioned to restabilize the DRUJ with ulnar recession is uncertain. This study examined changes in the stabilizing effect of the ulnar-shortening procedure in several TFCC tear conditions. ⋯ The ulnar-shortening procedure can stabilize the DRUJ by increasing intrastructural tension of the TFCC, only when the RUL is attached totally or partially to the ulnar fovea. If the RUL is avulsed completely then stability of the DRUJ no longer is obtained by the ulnar-shortening procedure.
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To determine whether volar fixed-angle plate fixation with a new plate system could be used to treat dorsally unstable distal radius fractures. We hypothesized that volar fixed-angle plate fixation with or without radial styloid fixed-angle plate fixation would provide sufficient rigidity to allow early active range of motion without compromising fracture reduction. The initiation of early active motion may improve functional outcomes. ⋯ Volar plate fixation using a new fixed-angle plate system successfully can stabilize dorsally unstable distal radius fractures. Early active range of motion was facilitated without compromising fracture reduction.