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Background: The most effective method for the fixation of an intra-articular distal radial fracture has not been established. Two commonly used treatment methods are external fixation combined with percutaneous pin fixation and plate fixation. We performed a prospective multicenter randomized trial to compare these two treatment strategies.Methods: A total of 137 patients with 144 intra-articular distal radial fractures were recruited into the study. The average age of the patients was forty-two years, and all patients were sixty years old or less. The patients were randomized to fracture fixation with one of the two methods. At six, twelve, and twenty-four months postoperatively, the patients were assessed with use of the Gartland and Werley point system and the modified Green and O'Brien scoring system. Arthritis was graded on radiographs according to a modification of the Knirk and Jupiter criteria.Results: Seventy-four (51%) of the fractures were treated with external fixation and percutaneous pin fixation, and seventy were treated with dorsal, volar, or combined plate fixation. At the time of the twenty-four-month follow-up, the results for the plate fixation group were significantly better than those for the external fixation and percutaneous pin fixation group according to the Gartland and Werley point system (p = 0.04) and the radiographic arthritis grading system (p = 0.01). The difference was especially notable among patients with AO group-C2 fractures.Conclusions: Plate fixation is better than external fixation combined with percutaneous pin fixation for the treatment of intra-articular fractures of the distal part of the radius. [ABSTRACT FROM AUTHOR]

Background: The most effective method for the fixation of an intra-articular distal radial fracture has not been established. Two commonly used treatment methods are external fixation combined with percutaneous pin fixation and plate fixation. We performed a prospective multicenter randomized trial to compare these two treatment strategies. Methods: A total of 137 patients with 144 intra-articular distal radial fractures were recruited into the study. The average age of the patients was forty-two years, and all patients were sixty years old or less. The patients were randomized to fracture fixation with one of the two methods. At six, twelve, and twenty-four months postoperatively, the patients were assessed with use of the Gartland and Werley point system and the modified Green and O'Brien scoring system. Arthritis was graded on radiographs according to a modification of the Knirk and Jupiter criteria. Results: Seventy-four (51%) of the fractures were treated with external fixation and percutaneous pin fixation, and seventy were treated with dorsal, volar, or combined plate fixation. At the time of the twenty-four-month follow-up, the results for the plate fixation group were significantly better than those for the external fixation and percutaneous pin fixation group according to the Gartland and Werley point system (p = 0.04) and the radiographic arthritis grading system (p = 0.01). The difference was especially notable among patients with AO group-C2 fractures. Conclusions: Plate fixation is better than external fixation combined with percutaneous pin fixation for the treatment of intra-articular fractures of the distal part of the radius. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "Comparison of External and Percutaneous Pin Fixation With Plate Fixation for Intra-Articular Distal Radial Fractures" by F. Leung, Y. K. Tu, W. Y. C. Chew and S. P. Chow.

VY-plasty is a well-known technique to reconstruct fingertip defects. A simplified method combining pinning of flap and healing of donor site by secondary intention is described. These steps preserve the rounded appearance of the fingertip and restore the convexity of the hyponychium. Flap ischemia due to suture-line tension is also averted.

Purpose: To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint., Methods: We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes., Results: The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection., Conclusions: Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

We present a case of a man who sustained a closed dorsal fracture-dislocation of his left ring finger proximal interphalangeal joint in a fall. The patient was treated surgically with plate and screw fixation via a volar approach. This method theoretically provides more secure fixation than internal fixation with screws alone, allowing early rehabilitation with active range of motion and potentially better functional outcome., (Copyright 2010. Published by Elsevier Inc.)

Introduction: Intra-articular fractures of the distal radius represent high energy, complex, unstable injuries and the optimal method of treatment remains controversial., Materials and Methods: The aim of the paper is to compare the outcomes of external fixation (EF) with open reduction internal fixation (ORIF) with plates and screw fixation in the treatment of intra-articular fractures of the distal radius. Thirty-five patients were enlisted from December 2003 to September 2005 after a failure of initial conservative treatment. The patients were randomised into EF or ORIF groups. The patients were followed-up at 1 week, 3, 6, 12 and 24 months. Clinical and radiological outcomes were measured. They were scored using the Green and O'Brien or the Gartland and Wertley score., Results: Of the 35 patients, 5 defaulted the 6-month follow-up and were excluded. We found that the clinical and radiological outcomes for the 2 groups were not significantly different. Complication rates were also similar., Conclusion: There is no significant difference in the outcome of intra-articular distal radius fractures treated with either EF or ORIF.