- Email: [email protected]
Hemi-arthroplasty for distal radius fracture in the independent elderly
Accepted Manuscript Title: Hemi-arthroplasty for distal radius fracture in the independent elderly Author: Guillaume Herzberg Lorenzo Merlini Marion Burnier PII: DOI: Reference:
S1877-0568(17)30174-3 http://dx.doi.org/doi:10.1016/j.otsr.2017.03.029 OTSR 1784
To appear in: Received date: Revised date: Accepted date:
4-1-2017 20-3-2017 31-3-2017
Please cite this article as: Herzberg G, Merlini L, Burnier M, Hemi-arthroplasty for distal radius fracture in the independent elderly, Orthopaedics and Traumatology: Surgery and Research (2017), http://dx.doi.org/10.1016/j.otsr.2017.03.029 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1 Original article
Hemi-arthroplasty for distal radius fracture in the independent elderly
ip t
Guillaume Herzberg*; Lorenzo Merlini; Marion Burnier
Service de Chirurgie Orthopédique Membre Supérieur, Hôpital EDOUARD HERRIOT, CHU
us
cr
LYON
Corresponding author:
5 Place d'Arsonval, Lyon, 69003, FRANCE
M
33607826021
an
Hôpital Edouard Herriot, Service de Chirurgie Orthopédique Membre Supérieur
Ac ce p
te
d
[email protected]
Page 1 of 15
2 Abstract: Introduction: The authors report their experience with hemi-arthroplasty in irreparable fresh distal radius fracture in independent elderly patients as first-line treatment (12 fractures in 11 women;
ip t
mean age, 74 years) or in second line after clinically disabling primary failure (4 fractures in 4 women; mean age, 78 years). Results:
cr
In the 12 primary surgeries, at a mean 32 months’ follow-up, there were no complications requiring implant ablation; mean pain score was 1/10, flexion-extension 62°, Lyon Wrist
us
score 75%, and PRWE (Patient-Related Wrist Evaluation) 22 points. In 2 of the 4 secondary surgeries, at a mean 24 months’ follow-up, there were no complications requiring implant
an
ablation; mean pain score was 2.5/10, flexion-extension 62°, Lyon Wrist score 58%, and PRWE 50 points: i.e., slightly poorer results than in primary surgery. Conclusion:
M
Salvage of complex fracture in independent elderly patients by hemi-arthroplasty, whether primary or secondary to failure, seems to be a considerable progress, to be confirmed in larger
d
series.
Ac ce p
te
Key-words: Distal radius fracture; elderly; arthroplasty
Page 2 of 15
3
Introduction Roux (1;16) suggested treating certain very complex fresh fractures in elderly patients by implantation, as has long been done for complex fractures of the superior and distal humerus.
ip t
We recently reported such a series (2). Despite the considerable contribution of Orbay regarding anterior plates (3;4), we think these implants have a role to play in the treatment so-
cr
called “irreparable” fractures in which internal fixation is not feasible. It is essential to define
us
indications precisely. The PAF classification (5;6) defines not only “irreparable” fracture but also candidates for hemi-arthroplasty.
an
The aim of the present study was to update our preliminary experience of hemi-arthroplasty in
M
fresh fracture, both as first-line attitude and secondary to primary treatment failure.
Material and Methods
d
Between 2011 and 2014, 714 fresh (1-7 days post-accident) unilateral distal radius fractures
te
were operated on and prospectively included in the PAF data-base (5;6). 169 intra-articular
Ac ce p
fractures (24%) were in patients aged ≥65 years.
Twelve fresh fractures classified as irreparable by classical internal fixation (7% of the 169 fractures) in 11 patients were managed by emergency hemi-arthroplasty. “Irreparable” status was defined on 6 criteria: type C articular fracture on the AO classification, with high intraand extra-articular displacement scores, anterior fracture line distal to the demarcation line, impaction-separation, and circumferential comminution (2). There was associated ulnar neck fracture in 2 cases, both female, with a mean age of 74 years (eldest, 87 years), independent and living at home. All patients were followed up, for a mean 32 months (range, 24-44 months). Assessment at last follow-up used a 10-point visual analog pain scale, active prono-supination and flexion-
Page 3 of 15
4 extension on goniometry, grip strength on Jamar dynamometry, QuickDash and Lyon Wrist score (2) for analysis of outcome.
ip t
During the same period, 4 hemi-arthroplasties were performed in female independent elderly patients following poor progression after primary distal radius fracture treatment: 1 posterior
cr
dislocation fracture, and 3 cases of painful early malunion, The mean interval between primary treatment and hemi-arthroplasty was 3 months (range, 1-6 months).
us
Hemi-arthroplasty used the radial component of the Remotion total prosthesis (Stryker) in 12
an
cases and a specific fracture implant, Cobra (Lépine), in 4.
M
The technique was described in a previous article (2). Preoperative planning on millimeterscaled radiographs was indispensable, enabling the restored radial height to be foreseen (fig.
Ac ce p
te
d
1).
Preoperative CT scanning was systematic, to enable 3D visualization of the main fragments (7) and assess the feasibility of radial incisura ulnaris repair (sigmoid cavity, sigmoid notch). A longitudinal posterior approach was used. The 3rd compartment of the extensor tendons was opened, the extensor pollicis longus tendon was reclined, and the bottom of the 3rd compartment was opened longitudinally by osteotome to release 2 thick osteotendinous layers on either side, like opening a book. This exposed first the joint region to be resected and then the radial shaft. Extensor tendon compartments 2 and 4 were not opened. The radial implant was then positioned. If bone-suture reconstruction of the radial incisura ulnaris repair (sigmoid cavity, sigmoid notch) was feasible, which was not the case in 2 wrists, the ulnar
Page 4 of 15
5 head was conserved; otherwise, ulnar head resection was associated after exposing the ulna on the same approach. In the present series, the radial implant did not need cementing, as primary stability was sufficient. The 2 osteotendinous layers were then closed around the
ip t
implant and sutured together and to the implant by non-absorbable woven suture. Three weeks’ immobilization was prescribed, with a cast including the elbow. Self-rehabilitation
us
cr
was then initiated, with 3 weeks’ thermoformed dorsal wrist splint leaving the elbow free.
an
Results
In the 12 irreparable fresh fractures, there were no complications requiring implant ablation:
M
dislocation, early loosening or deep infection; there were, however, 3 cases of transient complex regional pain syndrome. One patient, presenting radial deviation 9 months after
d
surgery, required reoperation; using the same dorsal incision, the extensor carpi radialis
correcting the deviation.
te
longus tendon was transferred onto the extensor carpi radialis brevis tendon, successfully
Ac ce p
Pain was effectively relieved at medium-term follow-up, with a mean score not exceeding 1/10. Mean Quick Dash score (8) was 25%, mean PRWE (9) 22 points, and mean Lyon Wrist score (2) 75% (= good).
Mean flexion-extension was 62°, with 35° extension, allowing useful wrist motion. Mean prono-supination was 149°. Full finger-flexion, touching the palm, was possible in all cases. Mean grip strength was 14 kg: i.e., 69% of the contralateral value. Periprosthetic consolidation was achieved in all cases. Some Remotion implants showed abnormal coronal inclination: 1 radial and 3 ulnar inclinations. There were no inclination issues with Cobra implants, with their longer stems. First carpal row tolerance against the
Page 5 of 15
6 metal implant was good in all cases, without osteolysis or absorption. Figure 2 shows an example.
ip t
Results in the 4 secondary hemi-arthroplasties following primary failure were as follows. The patient with primary posterior dislocation fracture showed good results: pain score, 2/10:
cr
Quick Dash, 16%; PRWE, 18 points; Lyon Wrist score, 84% (= good); flexion-extension, 75°, with 50° active extension, allowing useful wrist motion; prono-supination, 140°;
us
complete finger flexion, touching the palm; and 16 kg grip strength, equal to the contralateral
an
value.
Two of the 3 patients treated for painful early malunion had sufficient follow-up (mean, 28
M
months) for their outcome to be assessed, comparing pre- and post-operative values (fig. 3): pain score fell from 6 to 2.5/10; Quick Dash fell from 87.5% to 38.5%; PRWE fell from 85.5
d
to 50 points; Lyon Wrist score increased from 9.5% to 58% (= moderate); they showed
Ac ce p
Discussion
te
complete finger flexion, touching the palm. An example is shown in figures 4 and 5.
Following Roux's 2009 study (1), in 2015 we reported (2) our first clinical results for one-step implantation in fresh irreparable fractures in 11 elderly but independent female patients living at home. In parallel, Ichihara and Liverneaux (10) and Vergnenègre (11;12) recently published their own results in the same indication, but with different implants. Our present results were poorer for secondary than primary implantation, as is logical. Even so, the technique allowed easy recentering of the carpus under the radius, with a method that did not previously exist. All implants were positioned without cement, although cementing could be necessary in the future in case of mismatch between the implant stem and a large,
Page 6 of 15
7 fragile medullary canal. Careful preoperative analysis of any osteoarthritic lesions of the convexity of the first carpal row is mandatory, as they would be a contraindication.
ip t
In irreparable fractures in the elderly, reduction-cast treatment gives unreliable results and Arora (13), in a level-1 study, showed the limitations, drawbacks and frequent complications
cr
of anterior plate treatment (14). Arora also suggested first-line palliative treatment in the most severe cases (13). Richard (15) recently reported internal distraction by dorsal plate, with
us
results comparable to those of hemi-arthroplasty series, but with prolonged immobilization,
an
for a mean 4 months, and reintervention to remove to dorsal plate.
The present small preliminary series confirmed the findings of Roux (1;16), who showed
M
hemi-arthroplasty to be feasible in complex fracture in the independent elderly, either in first line or secondary to failure. Indications are obviously restricted, and treatment by locking
d
plate remains useful for many elderly patients with irreparable fracture. Hemi-arthroplasty,
te
however, provides a simple new solution for fractures that are irreparable: i.e., complex, displaced, distal and impacted, with circumferential comminution. A larger series with longer
Ac ce p
follow-up will be necessary to confirm the present encouraging preliminary results.
The first author declares a conflict of interest regarding the implants manufactured by Groupe Lépine included in the present study..
Page 7 of 15
8
References (1) Roux JL. La prothèse de remplacement et resurfacage du radius distal: un nouveau concept therapeutique. Chirurgie de la Main 2009;28:10.
ip t
(2) Herzberg G, Burnier M, Marc A, Izem Y. Primary wrist hemiarthroplasty for irreparable distal radius fracture in the independent elderly. J Wrist Surg 2015;4:15663.
cr
(3) Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. JHSA 2002;27A:205-15.
us
(4) Orbay JL, Fernandez DL. Volar fixed angle plate fixation for unstable distal radius fractures in the elderly patient. JHSA 2004;29A:96-102.
an
(5) Herzberg G, Izem Y, Al Saati M, Plotard F. PAF analysis of acute distal radius fractures in adults. Preliminary results. Chirurgie de la Main 2010;29:231-5.
M
(6) Burnier M, Herzberg G. Classification PAF des fractures fraîches de l'extrémité distale du radius. Hand Surgery & Rehabilitation 2016;35(6):S34.
d
(7) Herzberg G, Burnier M. Analyse radiologique des fractures fraîches de l'extrémité distale du radius et evaluation clinique des résultats. Hand Surgery & Rehabilitation 2016;35(6):S15.
te
(8) Aasheim T, Finsen V. The DASH and QD instruments. JHSE 2014;39E(2):140.
Ac ce p
(9) MacDermid JC. et al. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 2008;12:577-86. (10) Ichihara S, Liverneaux P. Distal radius isoelastic resurfacing prosthesis: a preliminary report. J Wrist Surg 2015;4:150-5. (11) Vergnenègre G, Mabit C, Arnaud JP, Charissoux JL. Treatment of comminuted DRF by resurfacing prosthesis in elderly patients. Chirurgie de la Main 2014;33(2):112. (12) Vergnenègre G, Hardy J, Mabit C, Charissoux JL, Marcheix PS. Hemiarthroplasty for Complex Distal Radius Fractures in Elderly Patients. J Wrist Surg 2015;4:169-73. (13) Arora R, Gabl M, Pechlaner S, Lutz M. Initial shortening and internal fixation in combination with a Sauvé Kapandji procedure for severely comminuted fractures of the distal radius in elderly patients. J Bone Joint Surg (Br) 2010;92B:1558-62. (14) Day CS, Daly MC. Management of geriatric distal radius fractures. JHSA 2012;37A(12):2619-22. (15) Richard MJ, Ruch DS. Distraction plating for the treatment of highly comminuted DRF in elderly patients. JHSA 2012;37A(5):948-56.
Page 8 of 15
9
Ac ce p
te
d
M
an
us
cr
ip t
(16) Roux JL. Treatment of intra-articular fractures of the distal radius by wrist prosthesis. Orthopaedics & Traumatology: Surgery and Research 2011;97S:S46-S53.
Page 9 of 15
10
ip t
Figures Captions
Figure 1: Irreparable distal radius fracture in an independent elderly. Preoperative evaluation
cr
of the radial height to be restored.
us
Figure 2: Example of primary wrist hemiarthroplasty and ulnar head resection performed at
an
the acute stage for irreparable distal radius fracture in an independent elderly.
M
Figure 3: Pre and post-operative comparison of clinical criteria and average scores of 2
d
female elderly independent patients operated on for incapacitating distal radius malunion.
te
Figure 4: Example of an independent elderly patient who had osteosynthesis at the acute stage for DRF. She presented at 6 months’ follow-up an incapacitating distal radius malunion along
Ac ce p
with volar carpal subluxation.
Figure 5: Same patient as figure 4, two years after hemiarthroplasty and ulnar head resection.
Page 10 of 15
d
te
Ac ce p us
an
M
cr
ip t
11
Page 11 of 15
d
te
Ac ce p us
an
M
cr
ip t
12
Page 12 of 15
d
te
Ac ce p us
an
M
cr
ip t
13
Page 13 of 15
d
te
Ac ce p us
an
M
cr
ip t
14
Page 14 of 15
d
te
Ac ce p us
an
M
cr
ip t
15
Page 15 of 15
S1877-0568(17)30174-3 http://dx.doi.org/doi:10.1016/j.otsr.2017.03.029 OTSR 1784
To appear in: Received date: Revised date: Accepted date:
4-1-2017 20-3-2017 31-3-2017
Please cite this article as: Herzberg G, Merlini L, Burnier M, Hemi-arthroplasty for distal radius fracture in the independent elderly, Orthopaedics and Traumatology: Surgery and Research (2017), http://dx.doi.org/10.1016/j.otsr.2017.03.029 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1 Original article
Hemi-arthroplasty for distal radius fracture in the independent elderly
ip t
Guillaume Herzberg*; Lorenzo Merlini; Marion Burnier
Service de Chirurgie Orthopédique Membre Supérieur, Hôpital EDOUARD HERRIOT, CHU
us
cr
LYON
Corresponding author:
5 Place d'Arsonval, Lyon, 69003, FRANCE
M
33607826021
an
Hôpital Edouard Herriot, Service de Chirurgie Orthopédique Membre Supérieur
Ac ce p
te
d
[email protected]
Page 1 of 15
2 Abstract: Introduction: The authors report their experience with hemi-arthroplasty in irreparable fresh distal radius fracture in independent elderly patients as first-line treatment (12 fractures in 11 women;
ip t
mean age, 74 years) or in second line after clinically disabling primary failure (4 fractures in 4 women; mean age, 78 years). Results:
cr
In the 12 primary surgeries, at a mean 32 months’ follow-up, there were no complications requiring implant ablation; mean pain score was 1/10, flexion-extension 62°, Lyon Wrist
us
score 75%, and PRWE (Patient-Related Wrist Evaluation) 22 points. In 2 of the 4 secondary surgeries, at a mean 24 months’ follow-up, there were no complications requiring implant
an
ablation; mean pain score was 2.5/10, flexion-extension 62°, Lyon Wrist score 58%, and PRWE 50 points: i.e., slightly poorer results than in primary surgery. Conclusion:
M
Salvage of complex fracture in independent elderly patients by hemi-arthroplasty, whether primary or secondary to failure, seems to be a considerable progress, to be confirmed in larger
d
series.
Ac ce p
te
Key-words: Distal radius fracture; elderly; arthroplasty
Page 2 of 15
3
Introduction Roux (1;16) suggested treating certain very complex fresh fractures in elderly patients by implantation, as has long been done for complex fractures of the superior and distal humerus.
ip t
We recently reported such a series (2). Despite the considerable contribution of Orbay regarding anterior plates (3;4), we think these implants have a role to play in the treatment so-
cr
called “irreparable” fractures in which internal fixation is not feasible. It is essential to define
us
indications precisely. The PAF classification (5;6) defines not only “irreparable” fracture but also candidates for hemi-arthroplasty.
an
The aim of the present study was to update our preliminary experience of hemi-arthroplasty in
M
fresh fracture, both as first-line attitude and secondary to primary treatment failure.
Material and Methods
d
Between 2011 and 2014, 714 fresh (1-7 days post-accident) unilateral distal radius fractures
te
were operated on and prospectively included in the PAF data-base (5;6). 169 intra-articular
Ac ce p
fractures (24%) were in patients aged ≥65 years.
Twelve fresh fractures classified as irreparable by classical internal fixation (7% of the 169 fractures) in 11 patients were managed by emergency hemi-arthroplasty. “Irreparable” status was defined on 6 criteria: type C articular fracture on the AO classification, with high intraand extra-articular displacement scores, anterior fracture line distal to the demarcation line, impaction-separation, and circumferential comminution (2). There was associated ulnar neck fracture in 2 cases, both female, with a mean age of 74 years (eldest, 87 years), independent and living at home. All patients were followed up, for a mean 32 months (range, 24-44 months). Assessment at last follow-up used a 10-point visual analog pain scale, active prono-supination and flexion-
Page 3 of 15
4 extension on goniometry, grip strength on Jamar dynamometry, QuickDash and Lyon Wrist score (2) for analysis of outcome.
ip t
During the same period, 4 hemi-arthroplasties were performed in female independent elderly patients following poor progression after primary distal radius fracture treatment: 1 posterior
cr
dislocation fracture, and 3 cases of painful early malunion, The mean interval between primary treatment and hemi-arthroplasty was 3 months (range, 1-6 months).
us
Hemi-arthroplasty used the radial component of the Remotion total prosthesis (Stryker) in 12
an
cases and a specific fracture implant, Cobra (Lépine), in 4.
M
The technique was described in a previous article (2). Preoperative planning on millimeterscaled radiographs was indispensable, enabling the restored radial height to be foreseen (fig.
Ac ce p
te
d
1).
Preoperative CT scanning was systematic, to enable 3D visualization of the main fragments (7) and assess the feasibility of radial incisura ulnaris repair (sigmoid cavity, sigmoid notch). A longitudinal posterior approach was used. The 3rd compartment of the extensor tendons was opened, the extensor pollicis longus tendon was reclined, and the bottom of the 3rd compartment was opened longitudinally by osteotome to release 2 thick osteotendinous layers on either side, like opening a book. This exposed first the joint region to be resected and then the radial shaft. Extensor tendon compartments 2 and 4 were not opened. The radial implant was then positioned. If bone-suture reconstruction of the radial incisura ulnaris repair (sigmoid cavity, sigmoid notch) was feasible, which was not the case in 2 wrists, the ulnar
Page 4 of 15
5 head was conserved; otherwise, ulnar head resection was associated after exposing the ulna on the same approach. In the present series, the radial implant did not need cementing, as primary stability was sufficient. The 2 osteotendinous layers were then closed around the
ip t
implant and sutured together and to the implant by non-absorbable woven suture. Three weeks’ immobilization was prescribed, with a cast including the elbow. Self-rehabilitation
us
cr
was then initiated, with 3 weeks’ thermoformed dorsal wrist splint leaving the elbow free.
an
Results
In the 12 irreparable fresh fractures, there were no complications requiring implant ablation:
M
dislocation, early loosening or deep infection; there were, however, 3 cases of transient complex regional pain syndrome. One patient, presenting radial deviation 9 months after
d
surgery, required reoperation; using the same dorsal incision, the extensor carpi radialis
correcting the deviation.
te
longus tendon was transferred onto the extensor carpi radialis brevis tendon, successfully
Ac ce p
Pain was effectively relieved at medium-term follow-up, with a mean score not exceeding 1/10. Mean Quick Dash score (8) was 25%, mean PRWE (9) 22 points, and mean Lyon Wrist score (2) 75% (= good).
Mean flexion-extension was 62°, with 35° extension, allowing useful wrist motion. Mean prono-supination was 149°. Full finger-flexion, touching the palm, was possible in all cases. Mean grip strength was 14 kg: i.e., 69% of the contralateral value. Periprosthetic consolidation was achieved in all cases. Some Remotion implants showed abnormal coronal inclination: 1 radial and 3 ulnar inclinations. There were no inclination issues with Cobra implants, with their longer stems. First carpal row tolerance against the
Page 5 of 15
6 metal implant was good in all cases, without osteolysis or absorption. Figure 2 shows an example.
ip t
Results in the 4 secondary hemi-arthroplasties following primary failure were as follows. The patient with primary posterior dislocation fracture showed good results: pain score, 2/10:
cr
Quick Dash, 16%; PRWE, 18 points; Lyon Wrist score, 84% (= good); flexion-extension, 75°, with 50° active extension, allowing useful wrist motion; prono-supination, 140°;
us
complete finger flexion, touching the palm; and 16 kg grip strength, equal to the contralateral
an
value.
Two of the 3 patients treated for painful early malunion had sufficient follow-up (mean, 28
M
months) for their outcome to be assessed, comparing pre- and post-operative values (fig. 3): pain score fell from 6 to 2.5/10; Quick Dash fell from 87.5% to 38.5%; PRWE fell from 85.5
d
to 50 points; Lyon Wrist score increased from 9.5% to 58% (= moderate); they showed
Ac ce p
Discussion
te
complete finger flexion, touching the palm. An example is shown in figures 4 and 5.
Following Roux's 2009 study (1), in 2015 we reported (2) our first clinical results for one-step implantation in fresh irreparable fractures in 11 elderly but independent female patients living at home. In parallel, Ichihara and Liverneaux (10) and Vergnenègre (11;12) recently published their own results in the same indication, but with different implants. Our present results were poorer for secondary than primary implantation, as is logical. Even so, the technique allowed easy recentering of the carpus under the radius, with a method that did not previously exist. All implants were positioned without cement, although cementing could be necessary in the future in case of mismatch between the implant stem and a large,
Page 6 of 15
7 fragile medullary canal. Careful preoperative analysis of any osteoarthritic lesions of the convexity of the first carpal row is mandatory, as they would be a contraindication.
ip t
In irreparable fractures in the elderly, reduction-cast treatment gives unreliable results and Arora (13), in a level-1 study, showed the limitations, drawbacks and frequent complications
cr
of anterior plate treatment (14). Arora also suggested first-line palliative treatment in the most severe cases (13). Richard (15) recently reported internal distraction by dorsal plate, with
us
results comparable to those of hemi-arthroplasty series, but with prolonged immobilization,
an
for a mean 4 months, and reintervention to remove to dorsal plate.
The present small preliminary series confirmed the findings of Roux (1;16), who showed
M
hemi-arthroplasty to be feasible in complex fracture in the independent elderly, either in first line or secondary to failure. Indications are obviously restricted, and treatment by locking
d
plate remains useful for many elderly patients with irreparable fracture. Hemi-arthroplasty,
te
however, provides a simple new solution for fractures that are irreparable: i.e., complex, displaced, distal and impacted, with circumferential comminution. A larger series with longer
Ac ce p
follow-up will be necessary to confirm the present encouraging preliminary results.
The first author declares a conflict of interest regarding the implants manufactured by Groupe Lépine included in the present study..
Page 7 of 15
8
References (1) Roux JL. La prothèse de remplacement et resurfacage du radius distal: un nouveau concept therapeutique. Chirurgie de la Main 2009;28:10.
ip t
(2) Herzberg G, Burnier M, Marc A, Izem Y. Primary wrist hemiarthroplasty for irreparable distal radius fracture in the independent elderly. J Wrist Surg 2015;4:15663.
cr
(3) Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. JHSA 2002;27A:205-15.
us
(4) Orbay JL, Fernandez DL. Volar fixed angle plate fixation for unstable distal radius fractures in the elderly patient. JHSA 2004;29A:96-102.
an
(5) Herzberg G, Izem Y, Al Saati M, Plotard F. PAF analysis of acute distal radius fractures in adults. Preliminary results. Chirurgie de la Main 2010;29:231-5.
M
(6) Burnier M, Herzberg G. Classification PAF des fractures fraîches de l'extrémité distale du radius. Hand Surgery & Rehabilitation 2016;35(6):S34.
d
(7) Herzberg G, Burnier M. Analyse radiologique des fractures fraîches de l'extrémité distale du radius et evaluation clinique des résultats. Hand Surgery & Rehabilitation 2016;35(6):S15.
te
(8) Aasheim T, Finsen V. The DASH and QD instruments. JHSE 2014;39E(2):140.
Ac ce p
(9) MacDermid JC. et al. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 2008;12:577-86. (10) Ichihara S, Liverneaux P. Distal radius isoelastic resurfacing prosthesis: a preliminary report. J Wrist Surg 2015;4:150-5. (11) Vergnenègre G, Mabit C, Arnaud JP, Charissoux JL. Treatment of comminuted DRF by resurfacing prosthesis in elderly patients. Chirurgie de la Main 2014;33(2):112. (12) Vergnenègre G, Hardy J, Mabit C, Charissoux JL, Marcheix PS. Hemiarthroplasty for Complex Distal Radius Fractures in Elderly Patients. J Wrist Surg 2015;4:169-73. (13) Arora R, Gabl M, Pechlaner S, Lutz M. Initial shortening and internal fixation in combination with a Sauvé Kapandji procedure for severely comminuted fractures of the distal radius in elderly patients. J Bone Joint Surg (Br) 2010;92B:1558-62. (14) Day CS, Daly MC. Management of geriatric distal radius fractures. JHSA 2012;37A(12):2619-22. (15) Richard MJ, Ruch DS. Distraction plating for the treatment of highly comminuted DRF in elderly patients. JHSA 2012;37A(5):948-56.
Page 8 of 15
9
Ac ce p
te
d
M
an
us
cr
ip t
(16) Roux JL. Treatment of intra-articular fractures of the distal radius by wrist prosthesis. Orthopaedics & Traumatology: Surgery and Research 2011;97S:S46-S53.
Page 9 of 15
10
ip t
Figures Captions
Figure 1: Irreparable distal radius fracture in an independent elderly. Preoperative evaluation
cr
of the radial height to be restored.
us
Figure 2: Example of primary wrist hemiarthroplasty and ulnar head resection performed at
an
the acute stage for irreparable distal radius fracture in an independent elderly.
M
Figure 3: Pre and post-operative comparison of clinical criteria and average scores of 2
d
female elderly independent patients operated on for incapacitating distal radius malunion.
te
Figure 4: Example of an independent elderly patient who had osteosynthesis at the acute stage for DRF. She presented at 6 months’ follow-up an incapacitating distal radius malunion along
Ac ce p
with volar carpal subluxation.
Figure 5: Same patient as figure 4, two years after hemiarthroplasty and ulnar head resection.
Page 10 of 15
d
te
Ac ce p us
an
M
cr
ip t
11
Page 11 of 15
d
te
Ac ce p us
an
M
cr
ip t
12
Page 12 of 15
d
te
Ac ce p us
an
M
cr
ip t
13
Page 13 of 15
d
te
Ac ce p us
an
M
cr
ip t
14
Page 14 of 15
d
te
Ac ce p us
an
M
cr
ip t
15
Page 15 of 15