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5.8 Complications of galeazzi fractures
ARTICLE IN PRESS 24
strength was 86% of the opposite side. The average DASH score was 13.6. There were 10 poor results, six of them had significant loss the initial reduction. There was significant correlation between our classification and the clinical outcome. Conclusion: AO volar plate fixation of unstable distal radius fractures provides strong fixation that maintains reduction and allows early mobilization.
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
5.8 MANAGEMENT OF COMPLEX DISTAL RADIUS AND ULNA FRACTURES IN POLYTRAUMATIZED PATIENTS: TREATMENT WITH A COMBINED EXTERNAL FIXATOR AND ORIF (INTERNAL PLATE)
U. Valentinotti, B. Bono, D. Capitani, L. Bettella, F. castelli and R. Spagnolo Niguarda Ca’ Granda Hospital Milano, Italy
10.1016/j.jhsb.2006.03.103
5.6 EARLY RESULTS AFTER PALMAR PLATING OF DISTAL RADIUS FRACTURES WITH A NEW FIXED ANGLE IMPLANT AND POLYAXIAL STABILIZATION (MEDARTISr)
J. Sonderegger, S. Schindele, M. Jakubietz and J. Gruenert St. Gallen, Switzerland Background: Palmar plating for dorsally displaced radius fractures with a fixed angle implant becomes increasingly popular to avoid soft-tissue problems associated with dorsal plating. Polyaxial screw fixation ensures an optimal subchondral screw placement in the distal fragment. So far there are few reports on this technique. Aim/objective: To determine the early results and complications after open reduction and palmar plating with a new fixed angle implant (Aptuss Radius 2.5 mm). Patients and methods: A prospective consecutive series including 52 fractures of the distal radius (Colles type) treated with the above-mentioned palmar plate was analysed. Mean follow-up was 12 months, the mean age was 60 years. According to the AO classification, 35% were A- and 65% were intraarticular C-fractures. Patient’s evaluation included clinical exam, DASHscore and radiographs. Results: Ninety-five per cent of patients were satisfied or highly satisfied. The mean DASH-score was 14 points. Active wrist motion averaged 571 extension, 481 flexion, 361 ulnar deviation, 341 radial deviation, 831 pronation and 851 supination. Grip strength was 88% compared to the other side. X-ray analysis showed an average palmar tilt of 41, a radial inclination of 211 and no radial shortening. Bony union was achieved in all cases without bone grafting. One case of hardware failure was encountered. There were no infections, secondary dislocations, tendon attritions, vascular or neural lesions. Conclusion: Palmar stabilization of distal radius fractures with this new implant is a safe procedure with promising early results and a low complication rate. 10.1016/j.jhsb.2006.03.104
Introduction: In high-energy multi-traumatized patients the distal forearm lesions present a particular complexity. Surgical timing and technique must be subordinated to combined injuries. The standard treatment for distal radius fractures is osteosynthesis with a volar plate, in these kind of patients we think it could be better to reconsider and slightly modify this opinion The purpose of this paper is to describe our management of complex fractures of the distal radius and ulna using a combined type of stabilisation, external axial fixator and internal fixation with radial augmentation with plate. Treatment: In a period from 24 July 2002 till today we have treated surgically 50 wrists with complex distal radius fracture secondary to an high-energy trauma in polytraumatized patients. We use the Fernandez–Jupiter classification and AO system. All the patients have been treated by the first author. The patients were controlled from a minimum of 6 months up to a maximum of 40 months. We have adapted in our evaluation the Dash score system. Our protocol of high-energy trauma to the distal forearm, in particular in polytraumatized patients is: 1 – closed reduction and short cast or external fixator if exposed or severely instable, on the day of injury during or just following general stabilisation; 2 – if possible a Tc 3D scan; 3 – internal reduction with plate associated to external fixator a fews days later when the local swelling or skin damage and general condition allow it (from 2 to 7); 4 – removal of external fixator between 3 and 4 weeks and begin a complete functional therapy. Clinical results: In conclusion our experience in timing of treatment indicate that is important to fixate the lesions early, if the priority of treatment of severely injured patients is respected. We believe that a combination of the two fixation systems allow an optimal external stabilization in the first week. Secondary the internal fixator allows an anatomical reduction with a stable fixation for secondary physiotherapy. 10.1016/j.jhsb.2006.03.106
5.9 COMPLICATIONS OF GALEAZZI FRACTURES
P. Angermann, R. Zimmermann, M. Lutz, R. Arora and M. Gabl University Hospital, Innsbruck, Austria Background: Galeazzi fractures are rare injuries often followed by complications.
strength was 86% of the opposite side. The average DASH score was 13.6. There were 10 poor results, six of them had significant loss the initial reduction. There was significant correlation between our classification and the clinical outcome. Conclusion: AO volar plate fixation of unstable distal radius fractures provides strong fixation that maintains reduction and allows early mobilization.
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
5.8 MANAGEMENT OF COMPLEX DISTAL RADIUS AND ULNA FRACTURES IN POLYTRAUMATIZED PATIENTS: TREATMENT WITH A COMBINED EXTERNAL FIXATOR AND ORIF (INTERNAL PLATE)
U. Valentinotti, B. Bono, D. Capitani, L. Bettella, F. castelli and R. Spagnolo Niguarda Ca’ Granda Hospital Milano, Italy
10.1016/j.jhsb.2006.03.103
5.6 EARLY RESULTS AFTER PALMAR PLATING OF DISTAL RADIUS FRACTURES WITH A NEW FIXED ANGLE IMPLANT AND POLYAXIAL STABILIZATION (MEDARTISr)
J. Sonderegger, S. Schindele, M. Jakubietz and J. Gruenert St. Gallen, Switzerland Background: Palmar plating for dorsally displaced radius fractures with a fixed angle implant becomes increasingly popular to avoid soft-tissue problems associated with dorsal plating. Polyaxial screw fixation ensures an optimal subchondral screw placement in the distal fragment. So far there are few reports on this technique. Aim/objective: To determine the early results and complications after open reduction and palmar plating with a new fixed angle implant (Aptuss Radius 2.5 mm). Patients and methods: A prospective consecutive series including 52 fractures of the distal radius (Colles type) treated with the above-mentioned palmar plate was analysed. Mean follow-up was 12 months, the mean age was 60 years. According to the AO classification, 35% were A- and 65% were intraarticular C-fractures. Patient’s evaluation included clinical exam, DASHscore and radiographs. Results: Ninety-five per cent of patients were satisfied or highly satisfied. The mean DASH-score was 14 points. Active wrist motion averaged 571 extension, 481 flexion, 361 ulnar deviation, 341 radial deviation, 831 pronation and 851 supination. Grip strength was 88% compared to the other side. X-ray analysis showed an average palmar tilt of 41, a radial inclination of 211 and no radial shortening. Bony union was achieved in all cases without bone grafting. One case of hardware failure was encountered. There were no infections, secondary dislocations, tendon attritions, vascular or neural lesions. Conclusion: Palmar stabilization of distal radius fractures with this new implant is a safe procedure with promising early results and a low complication rate. 10.1016/j.jhsb.2006.03.104
Introduction: In high-energy multi-traumatized patients the distal forearm lesions present a particular complexity. Surgical timing and technique must be subordinated to combined injuries. The standard treatment for distal radius fractures is osteosynthesis with a volar plate, in these kind of patients we think it could be better to reconsider and slightly modify this opinion The purpose of this paper is to describe our management of complex fractures of the distal radius and ulna using a combined type of stabilisation, external axial fixator and internal fixation with radial augmentation with plate. Treatment: In a period from 24 July 2002 till today we have treated surgically 50 wrists with complex distal radius fracture secondary to an high-energy trauma in polytraumatized patients. We use the Fernandez–Jupiter classification and AO system. All the patients have been treated by the first author. The patients were controlled from a minimum of 6 months up to a maximum of 40 months. We have adapted in our evaluation the Dash score system. Our protocol of high-energy trauma to the distal forearm, in particular in polytraumatized patients is: 1 – closed reduction and short cast or external fixator if exposed or severely instable, on the day of injury during or just following general stabilisation; 2 – if possible a Tc 3D scan; 3 – internal reduction with plate associated to external fixator a fews days later when the local swelling or skin damage and general condition allow it (from 2 to 7); 4 – removal of external fixator between 3 and 4 weeks and begin a complete functional therapy. Clinical results: In conclusion our experience in timing of treatment indicate that is important to fixate the lesions early, if the priority of treatment of severely injured patients is respected. We believe that a combination of the two fixation systems allow an optimal external stabilization in the first week. Secondary the internal fixator allows an anatomical reduction with a stable fixation for secondary physiotherapy. 10.1016/j.jhsb.2006.03.106
5.9 COMPLICATIONS OF GALEAZZI FRACTURES
P. Angermann, R. Zimmermann, M. Lutz, R. Arora and M. Gabl University Hospital, Innsbruck, Austria Background: Galeazzi fractures are rare injuries often followed by complications.