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Background and Purpose:  12-18% of patients encounter adverse events after distal radius fracture (DRF) surgery with volar locking plates (VLPs). Risk factors for which preventive measures could be administered are currently scarce. We aimed to examine the incidence of postoperative adverse events and assess the causes and risk factors for the adverse events after VLP fixation of DRFs., Methods:  We performed a single-center retrospective cohort study evaluating all adult DRF patients treated with VLP fixation between 2009 and 2019 at Helsinki University Hospital. Patients with previous disabilities or ulnar fractures, other than styloid process fractures, in the affected extremity were excluded. We examined each patient's treatment using the electronic medical records system and identified postoperative adverse events defined as any deviation from the ordinary postoperative course, showcasing clinical symptoms. We used multivariable binary logistic regression to assess the risk for adverse events., Results:  2,790 cases of DRF were included. The incidence of adverse events was 16%. Hardware complications (8.3%), predominantly intra-articular screws (4.9%), were the most commonly encountered adverse events. Other frequent adverse events included carpal tunnel syndrome (2.8%), tendon complications (2.8%), and surgical site infections (1.5%). In the multivariable analysis, smoking, higher body mass index (BMI), alcohol abuse, C-type fractures, residual intra-articular displacement, and dorsal tilt were found as risk factors for adverse events., Conclusion:  The incidence of adverse events was 16% after VLP fixation of DRFs. We identified several new risk factors for adverse events, which included residual dorsal tilt, intra-articular dislocation, insufficiently corrected inclination, smoking, alcohol abuse, and higher BMI.

Background: This study aims to evaluate the surgical techniques and outcomes of treating elbow dislocations with coronoid and radial head fractures, commonly referred to as the terrible triad of the elbow (TTE), through a single olecranon osteotomy., Methods: A retrospective analysis was performed on 73 patients diagnosed with TTE between January 2015 and April 2022. The cohort included 44 men and 29 women, with an average age of 40.0 ± 15.1 years (range, 18-68 years). Among these patients, Mason Type I, II, and III fractures were identified in 11, 42, and 20 cases, respectively, while Morrey Type I, II, and III fractures were observed in 45, 23, and five cases, respectively. All patients underwent treatment via a single olecranon osteotomy. The average interval between injury and surgery was 5.6 ± 1.6 days (range, 3-8 days). Elbow function was assessed using the Mayo Elbow Performance Score (MEPS), pain was measured via the Visual Analogue Scale (VAS), and quality of life was evaluated using the SF-36 questionnaire., Results: Patients were followed for 15 to 60 months (mean, 37.1 ± 13.3 months). All coronoid and radial head fractures achieved complete healing, with an average recovery time of 4.3 ± 1.1 months (range, 3-6 months). By the final follow-up, all patients had regained normal elbow function. The mean elbow flexion was 124.4° ± 9.2°, extension was 9.6° ± 6.5°, and the total range of flexion-extension was 114.8° ± 11.7°. Forearm pronation averaged 77.3° ± 4.8°, supination 79.2° ± 6.5°, and total forearm rotation 156.5° ± 8.4°. The mean MEPS was 89.3 ± 6.4, with 36 patients achieving excellent scores and 37 obtaining good scores. Preoperative VAS scores averaged 8.78 ± 1.11, which significantly dropped to 0.97 ± 0.83 at the final follow-up ( p  = 0.000). The SF-36 preoperative PCS and MCS scores were 45.77 ± 3.59 and 60.67 ± 3.91, respectively, with postoperative improvements to 93.85 ± 2.65 ( p  = 0.000) and 95.79 ± 3.11 ( p  = 0.000)., Conclusion: This retrospective analysis indicates that a single olecranon osteotomy could be a viable treatment option for TTE. However, additional research involving a control group is essential to substantiate the efficacy of this technique., Competing Interests: The authors declare there are no competing interests., (©2024 Zhou et al.)

Background: Fractures of the distal radius are the most common fractures of the upper extremity. The choice of surgical method has been debated and studies show that short-term differences, in favour of volar locking plates, are indistinguishable at 1 year follow-up. Few studies have investigated long-term outcomes beyond one year. The aim of this study was to investigate long-term (6-10 years) patient-reported outcomes after distal radius fracture surgery, and to determine how fracture pattern/complexity (Buttazzoni fracture type) affects the results., Methods: 303 patients surgically treated for a distal radius fracture, from 2012-2016 were included. The questionnaires used were PRWE, Quick-DASH and EQ-5D. Previous studies have shown that fracture type influences the choice of surgical method and therefore fracture type was adjusted for in the statistical analysis., Results: We found that patients treated with K-wires had significantly better Quick-DASH scores (p <0.05) and a lower degree of pain (PRWE pain scale) (p <0.05) than patients treated with volar locking plates. There was no difference between the two groups regarding the remaining outcome measures for any Buttazzoni type of fracture., Conclusion: On the basis of these results, K-wires can be considered an equivalent option to locking plates because of equal or better long-term outcomes, lower costs, and shorter operation times., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wretö, Fornander. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Distal radius fractures are a common orthopedic injury, particularly prevalent among elderly and osteoporotic patients. Although surgical treatment effectively restores fracture alignment and stabilizes the bone, Complex Regional Pain Syndrome (CRPS) can occur as a postoperative complication, severely impacting patients' rehabilitation and quality of life. Therefore, assessing the risk factors for postoperative CRPS is crucial for early clinical intervention, aiming to improve recovery outcomes and overall patient well-being., Objective: This study aims to dynamically evaluate the risk factors for CRPS following distal radius fracture surgery through a retrospective analysis. The goal is to provide scientific evidence for early clinical identification and intervention., Methods: A retrospective analysis was conducted on 191 adult patients who underwent distal radius fracture surgery between January 2021 and December 2022, comprising 89 males and 102 females, with an average age of 59.7 ± 11.6(18-75) years. Baseline and follow-up data, including demographic information, clinical characteristics, and psychological assessments, were collected. Descriptive statistics, univariate, and multivariate logistic regression analyses were used to identify independent risk factors and assess their dynamic changes over time., Results: Age, gender, occupation, fracture type, surgical method, osteoporosis, pain score (VAS), functional disability score (DASH), anxiety score (GAD-7), depression score (PHQ-9), physical therapy, and occupational therapy significantly affected the incidence of CRPS. Age and VAS scores were consistent risk factors. Female gender, internal fixation surgery, and high DASH scores posed higher risks in the early postoperative period but decreased over time. Occupation and fracture type were more significant in the mid to late postoperative period. Psychological factors were most significant in the midterm, while physical and occupational therapy were protective factors early on., Conclusion: The occurrence of CRPS is the result of many factors. Elderly patients, females, and manual laborers had higher risks, with complex fractures and internal fixation surgery patients showing increased risk later on. Osteoporotic patients had higher risks in the mid to late postoperative period. VAS, DASH, GAD-7, and PHQ-9 scores were significantly associated with CRPS. Early physical and occupational therapy can effectively prevent CRPS, but further research is needed to evaluate their long-term effects., Competing Interests: Declarations Ethical approval and consent to participate This study was approved by the Ethics Committee of Shaoxing Hospital of traditional Chinese medicine. All methods were in accordance with the Helsinki Declaration and its contemporary amendments. All patient-related information was approved by the patient or guardian published. Consent for publication Written informed consent for publication was obtained from all patients included in this study. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Intra-articular fractures of the distal radius require anatomical reduction and stable fixation. When the fracture encompasses the articular facet of the bone, maintaining the reduction is challenging due to the fragment's size and high instability. While specific implants have been developed to fix this fragment, their effectives have been limited. This study evaluates the mechanical performance of a novel hook plate conceived to stabilize the small fragment of the semilunar facet of the radius in non-osteoporotic bones. A simulated lunate facet fracture was created in an adult radius in a virtual model, and a modification of a hook plate was developed using computer-aided design (CAD). Two groups were established for the finite element method (FEM) simulation: a control group (standard plate Medartis™ (Switzerland, A-5500.23) and an angled plate with hooks set at 60º, 90º and 120º. In the FEM simulation, an axial load of 100 N was applied in the Z-axis direction on the fragment. Fracture displacement along the Z axis was more pronounced in the control model (0.32 mm) and less in the angled models, ranging from 0.22 to 0.28 mm. Notably, the plate with a 90° angle showed a more effective reduction in fragment displacement. The distribution of stresses in the system showed the highest levels of stress in the control group (59.31 MPa), followed by the subgroup with a 60° angle (55.78 MPa).In the side view, the control model showed a higher concentration of stresses (59.74 MPa), while the model with a 90° angle showed a lower value of stresses (18.87 MPa). Critical stress regions were identified in the bolts of the control and 120° models (59.47 MPa and 57.64 MPa, respectively). However, in the 90° model, no critical regions were observed in the bolts, which showed lower stress values, reaching 26.33 MPa. In the bone, the greatest concentration of stress occurred in the region where the plate was anchored. Our results showed that the 90° hook plate had a superior mechanical performance in fixing simulate lunate facet fractures at the distal radius. This angle led to minor displacements and minimized stress concentrations in the hardware, thus contributing to enhance the stability of this specific fracture., (© 2024. The Author(s).)

Background: Diaphyseal radius and ulna fractures require surgical fixation in adults. Open reduction and internal fixation (ORIF) have been considered the gold standard of treatment. The recent development of an interlocking intramedullary nail (IMN) has provided an alternative treatment method for these fractures. The objective of this meta-analysis is to compare the outcomes and complications of IMN versus ORIF for diaphyseal forearm fractures in adults., Methods: MEDLINE and Embase were searched from January 1, 2000, through January 7, 2024. All English-language studies were included comparing radiographic and functional outcomes for interlocking IMN fixation and ORIF of diaphyseal forearm fractures in adults (age ≥ 18 years). Study demographics, fracture data, functional outcomes, radiographic outcomes, and complications were extracted. Study quality was determined using the ROBINS-I criteria for cohort studies and the Cochrane risk of bias 2.0 (RoB 2) tool for randomized controlled trials. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Data was analyzed using subgroups of all diaphyseal fractures (including isolated radius or ulna fractures) and those with BBFFs., Results: Nine studies were included for analysis. There were 42 isolated radius, 80 isolated ulna, and 116 both-bone fractures (BBFF) treated with IMN and 36 radius, 81 ulna, and 116 both-bone fractures treated with ORIF. Compared to ORIF, IMN of diaphyseal forearm fractures appeared to be associated with shorter operative times and a lower overall complication rate. Time-to-union and the rate of nonunion following IMN were similar to ORIF. According to the Grace-Eversmann score, functional outcomes tended to be better following IMN, but DASH scores were similar between fixation strategies., Conclusions: Our findings suggest that interlocking IMN can be a safe and effective treatment option for simple and complex diaphyseal forearm fractures in adults. Further high-quality studies are needed to define indications for treating diaphyseal fractures with an interlocking IMN., Level of Evidence: Therapeutic Level IV., (© 2024. The Author(s).)

Purpose: Distal radius fractures may include difficult-to-treat fractures of the volar ulnar corner, colloquially termed as the "critical corner." These fragments are problematic because they are often missed, and their fixation is difficult. We aimed to compare the distal extent of the exposure of the volar surface of the distal radius between the classic Henry approach and the extended flexor carpi radialis (EFCR) approach., Methods: Thirteen matched-pair specimens were randomized to receive either the Henry approach or the EFCR approach to the volar distal radius. A mini Hohmann retractor provided retraction at the level of the critical corner. The force needed to attain a standardized angle of retraction at 60° was measured. A 0.062-inch Kirschner wire was placed at the most distal and most ulnar point that was visible from a position directly above the incision. Each distal radius was removed from the specimens. A digital caliper was used to measure the distance from the pin hole to the articular margin of the lunate fossa, along a line parallel to the long axis of the radius., Results: The pin was significantly closer to the articular margin in the EFCR approach (mean, 2.94 ± 1.69 mm) than in the Henry approach (mean, 9.70 ± 2.70 mm)., Conclusions: Our results demonstrated significantly more distal visualization of the volar distal radius in the EFCR approach compared to the Henry approach., Clinical Relevance: Adequate exposure of the volar surface of the distal radius is crucial for assessment and fixation of the volar ulnar corner. Complete visualization of the volar ulnar corner improves surgeons' ability to detect a volar marginal fragment and adequately fix this fragment., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Aims: We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR)., Methods: We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years)., Results: We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation)., Conclusion: These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings., Competing Interests: L. L. Nowak reports institutional funding via the Orthopaedic Trauma Association Resident Grant, related to this study. M. D. McKee reports royalties or licenses from Stryker, LOWW, Wolters-Kluwer, and Springer, consulting fees from Stryker and Exactech, and is a member of the American Shoulder and Elbow Surgeons nominating committee, all of which are unrelated to this study. E. Schemitsch reports institutional grants from Stryker, Smith & Nephew, Zimmer Biomet and Depuy Synthes, royalties or licenses from Stryker and ITS, consulting fees from Stryker, Smith & Nephew, Amgen, and Sanofi, all of which are unrelated to this study., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Background: Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT., Purpose: To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques., Material and Methods: A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC)., Results: The median osteotomy volume in the OWE group postoperatively was 0.87 cm 3 (range=0.42-2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm 3 (range=0.73-1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97., Conclusion: CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé-Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults., Methods: Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores., Results: The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups., Conclusions: Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO., Type of Study/level of Evidence: Therapeutic II., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: Distal radius fracture (DRF), sarcopenia, and malnutrition have been reported to be interrelated. However, there are few reports on the effects of sarcopenia and malnutrition on DRF patients' postoperative outcomes. This study examined the healthy-side grip strength and preoperative blood tests to determine the presence of possible sarcopenia (PS) and malnutrition in geriatric women with DRF and their impact on postoperative functional outcomes., Methods: Fifty-five woman older than 60 years treated with volar-locking plate fixation for low-energy DRF from standing-level falls were retrospectively studied. Based on the criteria of The Asian Working Group for Sarcopenia 2019, patients with a healthy-side grip strength <18 kg were defined as PS. Nutritional assessment was performed using Onodera's Prognostic Nutritional Index (PNI) before surgery, with a value <50 defined as malnutrition. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for functional assessment at 1 year after surgery. Patients were divided into two groups according to PS, and patient demographic data and postoperative outcomes were compared. Multiple regression analysis was performed to estimate the regression coefficient and 95% confidence intervals for 1-year QuickDASH after surgery with adjustment for age, PS, and malnutrition., Results: Possible sarcopenia was present in 10 patients (18.2%), and malnutrition in 24 patients (43.6%). Possible sarcopenia patients were older, had lower PNI, serum albumin, and both sides grip strength, and worse QuickDASH compared with non-PS patients. In multiple regression analysis, age, PS, and malnutrition were significant predictors of QuickDASH (standardized coefficient β, 0.35, 0.34, and 0.24; 95% confidence interval, 0.22-1.02, 3.52-16.49, and 0.50-10.78)., Conclusions: Possible sarcopenia with a healthy-side grip strength <18 kg and malnutrition with a PNI <50 were associated with worse 1-year QuickDASH after surgery in women DRF patients over 60 years., Type of Study/level of Evidence: Prognostic Ⅳ., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes., Methods: We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication., Results: Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%)., Conclusions: Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.J.R. has received royalties or licenses from Acumed and Field Orthopaedics; consulting fees from Acumed, Bioventus, DJO, and Field Orthopaedics; and payment or honoraria from Acumed, Bioventus, DJO, Field Orthopaedics, and Medartis. D.S.R. has received royalties or licenses from Acumed, consulting fees from Acumed and Field Orthopaedics, and payment or honoraria from Acumed and Field Orthopaedics. T.S.P. has received grant support from Acumed. A.J.G., K.J.C., A.V.P., and C.L.G. have no conflicts of interest to disclose.

Purpose: The purpose of this study was to measure the harms-related reporting among randomized controlled trials (RCTs) cited as supporting evidence for the American Academy of Orthopaedic Surgeons clinical practice guidelines regarding the management of distal radius fractures., Methods: We adhered to the guidance for reporting metaresearch and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines throughout the course of this investigation. We used the American Academy of Orthopaedic Surgeons clinical practice guidelines for distal radius fractures available on Orthoguidelines.org. A linear regression analysis was conducted to model the relationship between the year of publication and the total Consolidated Standards of Reporting Trials percentage adherence over time., Results: Thirty-five RCTs were included in the final sample. The average number of Consolidated Standards of Reporting Trials Extension for Harms items adequately reported across all included RCTs was 9.2 (9.2/18, 50.9%). None of the included trials adequately reported all 18 items. Ten items had a compliance of more than 50% (10/18, 55.6%), 4 items had a compliance of 20%-50% (4/18, 22.2%), and 4 items had a compliance of less than 20% (4/18, 22.2%). The results of the linear regression model showed no significant improvement in Consolidated Standards of Reporting Trials Harms reporting over time., Conclusions: Adverse events are incompletely reported among RCTs cited as supporting evidence for American Academy of Orthopaedic Surgeons clinical practice guidelines for the management of distal radius fractures., Clinical Relevance: Given our findings, specific attention should be paid to improving the standardization of the classification of adverse events to facilitate ease in the reporting process., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: In the lower extremity, studies have suggested an optimal nail diameter to medullary canal diameter (ND/MCD) ratio to minimize postoperative complications. The goal of this study was to determine whether a correlation exists between the occurrence of complications, angulation, and range of motion and the ratio of the ND/MCD in the upper extremity., Methods: A total of 85 radius and ulna fractures treated with flexible intramedullary nails had ND/MCD ratios measured. Random-effects models were developed to determine the association between complications and ND/MCD ratio, angulation and ND/MCD ratio, and range of motion and ND/MCD ratio. The results were reported for unadjusted models and adjusted models., Results: Of the 85 forearm fractures treated with intramedullary nailing, there were 3 complications. The average follow-up was 6 months. The ND/MCD ratios were categorized as <0.50, 0.50 to 0.59, and ≥0.60. There was not a significant association between the different ratios and angulation, or risk of complication. There was an association between the ND/MCD ratio ≥0.60 and decreased pronation of -1.58° (-2.77° to -0.38°) and supination of -2.68° (-4.91° to -0.46°) ( P < .05)., Conclusion: This study found that there was not an association between the nail to canal diameter ratio and postoperative angulation in forearm fractures treated with flexible intramedullary nails. When choosing a flexible nail for forearm fractures, there does not appear to be an optimal ratio; it is therefore reasonable to use the ND that passes more easily., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: One of the authors consults for Axogen and Medartis; has royalties with Springer; and is on committees for Pediatric Orthopaedic Society of North America, American Academy of Pediatrics, American Association for Hand Surgery, American Academy of Orthopaedic Surgeons, and American Society for Surgery of the Hand. The remaining authors declare that they have no conflict of interest.

Purpose: This study investigated the effectiveness of volar plate surgery in patients with distal radius fractures (DRFs) initially treated nonsurgically but later experiencing reduction loss during follow-ups. Specifically, it assessed the impact of early surgery (E) (<3 weeks) versus delayed surgery (D) (3-6 weeks) on wrist function in surgically treated DRFs., Methods: This retrospective study included 131 patients who underwent surgery after loss of reduction. Among them, 42 patients had delayed surgery, whereas 89 received early surgical treatment. The mean follow-up duration was 18 months. The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand scores. Secondary outcomes included Short Form-12 physical component summary and mental component summary scores, postoperative range of motion, and radiological measurements such as radial length, radial inclination angle, and volar tilt angle. Fracture types were categorized using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification based on radiological images., Results: All 131 DRFs achieved radiological union. Mean Disabilities of the Arm, Shoulder, and Hand scores were 8.0 (range, 0-78) and 10.8 (range, 0-73) for groups E and D, respectively, and the difference was not considered clinically relevant. Short Form-12 physical component summary scores (49.4 for E; 45.3 for D) and Short Form-12 mental component summary scores (52.3 for E; 53.5 for D) were similar in the two groups. Radiological measurements and range of motion were similar in the two groups. Complications, including carpal tunnel syndrome, superficial radial nerve neuropraxia, and complex regional pain syndrome, occurred in 12 (13.5%) E group patients and 9 (21.4%) D group patients., Conclusions: Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced DRF were similar. However, complication rates were higher in delayed surgery., Type of Study/level of Evidence: Prognostic IV., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Forearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury., Methods: The study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna., Results: Union was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025)., Conclusion: The ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray., (© 2024. The Author(s).)

Objective: To investigate the clinical effect of coronal bone structure matching(CBSM)in the treatment of distal radius fracture., Methods: A total of 39 cases of distal radius fracture between Jannary 2018 and Jannary 2022 were included in this study. Among them there were 22 males and 17 females with an average age of (48.9±16.3) years old, ranged from 22 to 65 years old. All patients were treated with open reduction and internal fixation with plates. Based on the measurement of CBSM value on the X-ray film the next day after surgery. All patients were divided into matched group and mismatched group according to the coronal bone structure matching in the normal range or not. There were 27 patients in the matched group, including 15 males and 12 females, the age ranged from 22 to 64 years old with an average of (48.0±16.2) years old. AO classification of fracture was C1 in 6 cases and C2 in 21 cases;the operation time ranged from 1 to 6 days after injury;9 cases were complicated with ulnar styloid process fracture. There were 12 patients in the mismatched group, including 7 males and 5 females;the age ranged from 22 to 65 years old with an average of (48.8±15.8) years old. AO classification of fracture was C1 in 4 cases and C2 in 8 cases;the time from injury to operation ranged from 1 to 5 days;4 cases were complicated with ulnar styloid process fracture. The X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months after operation. The range of wrist motion(pronation, supination, palmar inclination and dorsiflexion), function outcomes(Gartland-Werley score) and pain levels (visual analogue scale, VAS) were compared between the two groups at the last follow-up., Results: The average follow-up time of 39 patients were(9.5±4.3)months, ranged from 6 to 14 months. All patients healed in one stage without postoperative infection, fracture nonunion and fracture displacement occurred. Compared with match group at the last follow-up, the VAS in the mismatch group was increased[(2.5±1.3)points vs (1.6±1.0)points], the wrist pronation were decreased[(70.5±12.6)° vs (80.5±9.4)°], with statistically significant difference( P <0.05). There was no significant difference in the range of motion(supination, palmar inclination, dorsiflexion)and excellent good rate between the two groups at last follow-up after operation ( P >0.05)., Conclusion: Wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.

Objective: To observe the effects of groove splint fixation on early hand swelling, blood flow velocity, and clinical function in elderly patients with distal radius fractures., Methods: Between March 2021 and February 2022, 64 patients of unilateral closed distal radius fractures were treated with manual reduction and external fixation with splints. There were 10 males and 54 females, the age ranged from 60 to 78 years old, with an average age of (67.7±4.7) years old. According to the order of admission, the patients were divided into the groove splint group and the conventional splint group, with 32 cases in each group. In the groove splint group, there were 4 males and 28 females, with an average age of (68.6±4.8) years old. There were 13 patients with left-sided fractures, and 19 patients with right-sided fractures, with 22 cases classified as AO type A and 10 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 4.0) h. In the conventional splint group, there were 6 males and 26 females, with an average age of (66.9 ± 4.4) years old. There were 17 patients with left-sided fractures and 15 patients with right-sided fractures, with 20 cases classified as AO type A and 12 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 5.0) h. After manual reduction, patients were treated with groove splint or conventional splint. Swelling, assessed by the difference in limb circumference between the injured and healthy limbs, was measured at 1, 3, 7, and 14 days post-treatment. Blood flow velocities in the superficial palmar arch and dorsal metacarpal veins were measured at 1, 3, and 7 days post-treatment. Radiographic evaluations of radial styloid height, palmar tilt, and ulnar variance were performed preoperatively and 3 months post-treatment. Functional outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score 3 and 12 months post-treatment. Statistical analyses were conducted to compare the outcomes between the two groups., Results: All 64 patients were followed up for the least 12 months. The swelling value of the palm in the groove splint group [(1.897±0.071) cm, (1.200±0.169) cm, (0.994±0.085) cm] was significantly improved compared to the conventional splint group[(2.283±0.268) cm, (1.893±0.269) cm, (1.183±0.126) cm] on days 3, 7, and 14 days posttreatment, with a statistically significant difference ( P <0.001). On the first and third day after splint fixation, the difference in blood flow velocity of the superficial palmar arch in the groove splint group(0.017±0.009), (0.018±0.011) L·min-1 were lower than that in the conventional splint group(0.023±0.011), (0.025±0.013) L·min-1, with statistical significance ( P <0.05). On the 3rd and 7th days, the difference was not statistically significant ( P >0.05). Comparison of blood flow velocity differences between the dorsal metacarpal vein and the two groups showed no statistically significant difference on the first day after splint fixation ( P >0.05). On the 3rd and 7th days, the blood flow velocity difference between the groove splint group[(0.037±0.019), (0.021±0.013) L·min-1] decreased compared to the conventional splint group[(0.062±0.033), (0.037±0.022) L·min-1], and the difference was statistically significant ( P <0.05). There was no statistically significant difference in the palm angle, ulnar deviation angle, and radius height of the distal radius before and after reduction ( P >0.05). The DASH score showed a statistically significant difference at follow-up 3-month[(6.1±2.8) scores vs (8.2±3.7) scores] , P <0.05, but no statistically significant difference at follow-up 12-month ( P >0.05)., Conclusion: Fixing distal radius fractures with groove splints in the early stage can reduce the impact on the blood flow velocity of the superficial palmar arch and dorsal palmar vein, reduce venous reflux obstruction and swelling of injury limb, alleviate wrist and finger joint stiffness, and improve early clinical efficacy of the affected limb. However, it has no significant impact on clinical function one year after injury.

Objective: To investigate the clinical effect in treating AO type B and C distal radius fractures with modified Henry approach., Methods: Retrospectively analysis of 20 patients with AO type B and C distal radius fractures between June 2021 and May 2022, they were treated by modified Henry approach. There were 6 males and 14 females, aged from 35 to 78 years old, 8 patients on the left and 12 on the right. The patients' general data, fracture healing time, postoperative complications, last-time follow up radiographic parameters(volar inclination angle, ulnar deviation angle and radius height), wrist range of motion, range of forearm rotation and functional outcoming of the wrist joint according to Mayo scoring were observed of each patient., Results: All patients were followed-up, the time was (13.3±2.3) months, ranged from 12 to 18 months. All the fractures were healed, the fracture healing time was (12.6±2.5) weeks, ranged from 10 to 16 weeks. There were no complications such as poor wound healing, incision infection, iatrogenic median nerve injury, delayed union, nonunion and malunion during the postoperative follow up. According to the X-ray measurement in the last-time follow up, the volar inclination angle was (11.4±4.0) °, the ulnar deviation angle was (20.9±2.2) ° and the radius height was (10.3±1.2) mm. The wrist range of motion was (65.3±5.8) ° for volar flexion, (60.2±4.2) ° for dorsal extension, (37.8±4.1) ° for ulnar deviation, (27.0±3.7) ° for radial deviation. The range of forearm rotation was(80.4±4.1) ° for pronation, (78.6±3.7) ° for supination. According to Mayo scoring, the wrist function was evaluated as excellent in 12 cases, good in 6 cases and fair in 2 cases, the excellent and good rate was 90%., Conclusion: Modified Henry approach can better expose the ulnar and volar fragments in distal radius, especially useful for reducting the distal radius with complex bi-columnar fractures.

Background: There are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value., Methods: According to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb., Results: Mason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11-26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%., Conclusion: Different types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome., (© 2024. The Author(s).)

Background: Distal radius fractures are highly prevalent among older adults. Ulnar styloid fractures frequently accompany distal radius fractures, raising concerns about treatment outcomes due to the risk of distal radioulnar joint (DRUJ) instability. This study investigated the necessity of surgical intervention (open reduction internal fixation; ORIF) for distal radius fractures in very old patients with coexisting ulnar styloid fractures., Materials and Methods: A retrospective analysis of 96 patients aged ≥ 80 years with AO classification 23-A2 to 23-B3 distal radius fractures with concomitant ulnar styloid fracture between 2019 and 2022 was performed. Patients were excluded if they were aged < 80 years, had a preinjury Barthel index of < 90, or had high-energy multiple trauma. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score assessed at 3, 6, and 12 months. We compared the DASH score and their trajectories between the ORIF and conservative treatment groups., Results: ORIF group demonstrated significantly better DASH functional scores (25.31 ± 4.71) at the 12-month follow-up compared with the conservative group (34.42 ± 8.03; p < 0.001). Treatment choice was identified as a significant predictor of DASH scores at 12 months, with ORIF significantly improved patient's wrist function and demonstrated a β coefficient of - 9.11 (95% confidence interval: -11.95 to - 6.27, p < 0.001). The other factors investigated, namely age, lowest T-score, and medical history of diabetes mellitus, hypertension, coronary artery disease, cerebrovascular accidents, cancer, and dementia, did not exhibit a significant association with the 12-month DASH scores in the adjusted model (p > 0.05)., Conclusions: Our findings suggest that very old patients with distal radius fracture accompanied by ulnar styloid fractures may benefit from ORIF to achieve optimal long-term functional recovery., (© 2024. The Author(s).)

Introduction: Selecting the optimal radial head prosthesis to treat radial head fractures, especially in the context of complex elbow injuries like terrible triad, Monteggia, and Essex Lopresti, can be challenging, as there is currently no consensus in the field that favors a particular design. This study investigated the safety and performance of a Polished Stem Radial Head Prosthesis (PS RHP) compared to other modern RHP designs., Materials and Methods: A systematic review was conducted according to PRISMA guidelines to capture data on a Polished Stem Radial Head Prosthesis (PS RHP) and other Radial Head Prostheses (RHPs). Functional scores, range of motion, complications, and revisions were extracted from published literature and analyzed in parallel with the percentage of complex injuries. Comparison of functional outcomes between groups were based on minimum clinically important differences (MCIDs)., Results: There were 16 articles reporting on 711 cases of the PS RHP and 23 articles reporting on 605 cases of other RHPs included in the systematic literature review. Functional scores and range of motion were similar amongst the groups. The PS RHP design achieved a comparable revision rate as other RHPs despite a higher number of terrible triad injuries. Notably, the PS RHP group showed a significantly lower rate of instability (1.0%) than other RHPs (3.4%) (p < 0.05). Other complication rates were similar amongst the two groups., Conclusions: The PS RHP group had higher rates of terrible triads at baseline compared to the other RHPs group. Regardless of greater injury complexity, the clinical outcomes of the PS RHP group were favorable and resulted in a significantly lower rate of postoperative instability as compared to other RHPs., (© 2024. The Author(s).)

Objective: Prolonged immobilization of joints after distal radius fracture (DRF) causes cerebral disuse-dependent plasticity (DDP) and deterioration of upper extremity function. Action observation therapy (AOT) can improve DDP., Trial Design: This nonrandomized controlled trial (UMIN 000039973) tested the hypothesis that AOT improves hand-use difficulties during activities of daily living in patients with DRF., Method: Right-handed women with volar locking plate fixation for DRF were divided into AOT and Non-AOT groups for a 12-week intervention. The primary outcome was difficulty in using the fractured hand, assessed with the Japanese version of the Patient-related Wrist Evaluation (PRWE). The secondary outcomes were range of motion (ROM) of the injured side and gap between measured ROM and patient-estimated ROM. The survey was administered immediately post operation and at postoperative weeks 4, 8, and 12. The AOT group used a head-mounted display and three-dimensional video during ROM exercises. The Non-AOT group used active ROM exercises alone. A generalized linear model (GLM) was used to confirm interactions and main effects by group and time period, and multiple comparisons were performed., Results: Thirty-five patients were assigned to the AOT group (n = 18, median age, 74 years) or the Non-AOT group (n = 17, median age, 70 years). In the GLM, PRWE Total, PRWE Specific, and PRWE Usual scores revealed interactions between groups and periods. The post-hoc test revealed that the PRWE Specific scores (z = 3.43, p = 0.02) and PRWE Usual scores (z = 7.53, p<0.01) were significantly lower in the AOT group than in the Non-AOT group at 4 weeks postoperatively, whereas PRWE Total scores (z = 3.29, p = 0.04) were lower at 8 weeks postoperatively., Conclusions: These results suggested that AOT can improve hand-use difficulties in right-handed women after DRF surgery. AOT positively affects the motor imagery of patients with DRF and can reverse the patient's perceived difficulty in using the fractured hand during rehabilitation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Usuki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background/Objectives : The treatment of periarticular distal radius fractures remains challenging. Different surgical treatment options have been proposed as alternatives to conservative treatment. This systematic review aims to compare the functional outcomes, radiological outcomes, and complications among volar locking plates (VLPs), Kirschner-wire fixations, and external fixations (EFs) for distal radius fractures in patients aged 60 years and older. Methods : We conducted a comprehensive search of PubMed, Cochrane, and Science Direct databases assessing the effects of VLP, EF, and K-wire treatments for distal radius fractures in patients aged 60 years and over. The primary outcome was the evaluation of the range of motion (ROM) degrees after three surgical procedures, trying to assess the best treatment option. The secondary outcome included evaluation of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, quick-DASH score, Patient-Rated Wrist Evaluation (PRWE) score, Visual Analog Scale (VAS) score, grip strength, radiographic assessment, and complications comparing VLPs, EFs and K-wires. Results : A total of 23 studies were included, comparing VLP, EF, and K-wire fixation. The overall population comprised 5618 patients, with 4690 females and 1015 males, of which 4468 patients were treated with VLP, 503 with EF, and 647 with K-wire. The most common complications among the VLP group were complex regional pain syndrome (7.5%) and carpal tunnel syndrome (6.8%); for the EF group, infections (9.8%) and carpal tunnel syndrome (6.8%); and for the K-wire group, carpal tunnel syndrome (7.5%) and infections (6.9%). Conclusions : VLP showed better clinical outcomes in the first few months after treatment. However, these differences decreased over time and became similar after one year. EF and K-wire fixations remain easier to manage during surgery.

Bilateral anterior shoulder dislocation (BASD) is a rare condition typically associated with a history of trauma. This case report presents a patient with BASD resulting from trauma and discusses treatment options. A 51-year-old male patient was admitted to the emergency department following a fall from a height. Radiographic examination revealed BASD and a comminuted intra-articular fracture of the distal end of the left radius. The patient did not have any other additional pathologies. After a preoperative evaluation, the patient was urgently taken to the operating room, where both shoulders underwent reduction using the Hippocratic maneuver under sedation anesthesia. Immediately after this procedure, the left wrist was reduced closed, and a penning-type external fixator was inserted under fluoroscopic guidance. Following the reductions, both shoulders were wrapped with a Velpeau bandage and immobilized. An elastic bandage was wrapped around the wrist. By the end of the third week, shoulder mobility exercises were initiated, with a gradual increase in the intensity of the exercises. The wrist fixator was removed in the fifth week after radiographic evaluations, followed by the initiation of passive and then active exercises. Given the rarity of BASD, it is crucial to obtain a detailed clinical history, conduct a comprehensive clinical examination, and perform detailed imaging studies-radiography, computed tomography, and magnetic resonance imaging to avoid overlooking such pathologies in emergency situations. Bilateral anterior shoulder dislocation is a pathology that results from major trauma. It is important to remember that this particular type of pathology may be accompanied by various other pathologies, such as fractures (of the tuberculum majus), rotator cuff injuries, and neurovascular injuries.

Introduction: The distal radius fracture is considered the most common fracture in humans. For fractures classified as Arbeitsgemeinschaft für Osteosynthese (AO) 23-C1 + C2, there is no consensus on treatment in older patients due to inconsistent study results. The aim of this study was to compare conservative and surgical treatment in relation to wrist function and satisfaction in patients older than 65 years., Methods: In this prospective randomized clinical trial, patients aged older than 65 years who suffered an isolated AO-classified C1 or C2 distal radius fracture were randomized to surgical treatment using palmar plate osteosynthesis or conservative treatment. Patient-rated wrist evaluation (PRWE) score and disabilities of arm, shoulder, and hand (DASH) was assessed 3, 6 and 12 months post-interventionally. Satisfaction, range of motion (ROM) and pain scores were evaluated at 6 weeks and 3, 6 and 12 months post-interventionally., Results: A total of 80 patients with a mean age of 77.3 years (± 6.1 years) in the conservative group and 72.5 years (± 5.3 years) in the surgery group were included. Both the PRWE score, and the DASH score showed a statistically significant difference between the two groups after 3 months, 6 months and 12 months (p < 0.001). Patients in the surgical cohort showed a statistically significant higher satisfaction at the 6-week, 6-month and 12-month follow-up (p < 0.001 6 weeks + 12 months; p = 0.004 6 months)., Conclusion: In this prospective randomized study, surgical treatment proved to be superior to conservative treatment in terms of the primary outcome variable PRWE score. Satisfaction was significantly better in the surgical group., (© 2024. The Author(s).)

Aims: The aim of this study was to evaluate the outcome of complex radial head fractures at mid-term follow-up, and determine whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) should be recommended for surgical treatment., Methods: Patients who underwent surgery for complex radial head fractures (Mason type III, ≥ three fragments) were divided into two groups (ORIF and RHA) and propensity score matching was used to individually match patients based on patient characteristics. Ultimately, 84 patients were included in this study. After a mean follow-up of 4.1 years (2.0 to 9.5), patients were invited for clinical and radiological assessment. The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score were evaluated., Results: Patients treated with ORIF showed significantly better postoperative range of motion for flexion and extension (121.1° (SD 16.4°) vs 108.1° (SD 25.8°); p = 0.018). Postoperative functional scores also showed significantly better results in the ORIF group (MEPS 90.1 (SD 13.6) vs 78 (SD 20.5); p = 0.004). There was no significant difference between the groups in terms of the complication rate (RHA 23.8% (n = 10) vs ORIF 26.2% (n = 11)). Implant-related complications occurred in six cases (14.3%) in the RHA group and in five cases (11.9%) in the ORIF group., Conclusion: Irrespective of the patient's age, sex, type of injury, or number of fracture fragments, ORIF of the radial head should be attempted initially, if a stable reconstruction can be achieved, as it seems to provide a superior postoperative outcome for the patient compared to primary RHA. If reconstruction is not feasible, RHA is still a viable alternative. In the surgical treatment of complex radial head fractures, reconstruction shows superior postoperative outcomes compared to RHA. Good postoperative results can be achieved even after failed reconstruction and conversion to secondary RHA. Therefore, we encourage surgeons to favour reconstruction of complex radial head fractures, regardless of injury type or number of fragments, as long as a stable fixation can be achieved., Competing Interests: None declared., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Objectives: To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures., Design: Secondary use of longitudinal data., Setting: Single Level-1 trauma center in Oxford, United Kingdom., Patient Selection: English-speaking adults with isolated proximal humerus, elbow, or distal radius fracture managed operatively or nonoperatively were included, and those with multiple fractures or cognitive deficit were excluded., Outcome Measures and Comparisons: Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2-4 weeks, and 6-9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on OTA/AO classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture-related aspects., Results: Among 703 included patients (age 59 ± 21 years, 66% women, 16% high-energy injury), 4 statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β = 4.1, 3: β = 7.5, and 4: β = 17) and pain intensity (group 3: β = 0.70 and 4: β = 1.4) (P < 0.01). Higher fracture severity (β = 4.5), high-energy injury (β = 4.0), and nerve palsy (β = 8.1) were associated with worse baseline incapability (P < 0.01), and high-energy injury (β = 0.62) and nerve palsy (β = 0.76) with worse baseline pain intensity (P < 0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β = 1.3, β = 7.0) and pain intensity (β = 0.19, β = 1.1) (P < 0.02)., Conclusions: Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high-energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: To break or not to break-That is the question that has been asked in pediatric traumatology for many years regarding the treatment of greenstick fractures of the diaphyseal forearm shaft., Objective: The frequency of greenstick fractures of the forearm shaft in children and adolescents; the influence of breaking the fracture on the refracture rate., Methods: Analysis and discussion of relevant articles, analysis of the refracture rate of pediatric greenstick fractures of the forearm shaft in our own patient population., Results: Greenstick fractures frequently occur in the area of the forearm shaft and incomplete consolidation leads to an increased refracture rate. In the patient collective of the authors of 420 children with greenstick fractures of the diaphyseal forearm, there was a refracture rate of 9.5%; however, the rate for non-completed fractures was significantly higher compared to the group with completed fractures (15.2% vs. 3%). While in the subgroup of conservatively treated fractures (n = 234), breaking the intact cortex significantly reduced the refracture rate, breaking the intact cortical bone during surgical treatment with elastic stable intramedullary nailing (ESIN) did not change the refracture rate., Conclusion: As part of the conservative treatment of greenstick fractures of the diaphyseal forearm, completing the fracture can be recommended in order to lower the refracture rate. Completing the fracture does not appear to be necessary during surgical treatment using ESIN., (© 2024. The Author(s).)

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of 8 and 12 years old are more frequently affected, whereby a cubitus valgus variant can be a predisposing factor. The main trauma mechanism is a fall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while a surgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using a elastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires a comprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic).

Background: Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults., Methods: We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction., Results: Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau 2  = 5.4, I 2  = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau 2  = 0.9, I 2  = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low., Conclusion: The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted., (© 2024 Acta Anaesthesiologica Scandinavica Foundation.)

We investigated outcomes of clinic-based hand therapy combined with a home-based exercise programme after anterior plating for distal radial fractures. A total of 102 patients were randomly assigned to one of three groups: a home-based exercise programme alone; a home-based exercise programme combined with four hand therapy sessions in the clinic; and a home-based exercise programme with seven sessions in the clinic. Mean Patient-Rated Wrist Evaluation scores at 6 weeks were significantly better for the group of patients with seven sessions in the clinic than in those with only home exercises (12 vs. 30), but the difference was no longer significant at 12 weeks. Grip strength was significantly better at 6 and 12 weeks. Combined home- and clinic-based hand therapy may facilitate an earlier return of function after anterior plating for distal radius fractures. Level of evidence: II., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Fractures of the distal radius in childhood are frequent but rarely lead to relevant growth disturbances., Objective: The experiences of a pediatric trauma center over 15 years are exemplarily presented and discussed., Material and Methods: Osteotomies of the distal radius were selected and the clinical and radiological findings were recorded and analyzed., Results: Posttraumatic growth disturbances were corrected in 10 cases with a median age of 13 ½ years. In six cases an iatrogenic cause was also possible. In two cases callus distraction with secondary palmar plate osteosynthesis was used for consolidation. In eight cases primary ad hoc corrections were carried out using palmar plate osteosynthesis (six with iliac crest and two with allogeneic grafts). In five cases the distal ulnar growth plate was also addressed. During follow-up breakage of one plate was registered. After an average of 31 months postoperatively, 9 children had full range of motion (ROM) and in 1 case there was an extension deficit of 10 o ., Conclusion: It is important to evaluate the cause of the mostly partially inhibiting growth disturbances to draw preventive conclusions. From a clinical perspective the visible deformity is given priority and the pain and functional limitations are less relevant. The indications for corrective surgery must include the age of the patient, remaining growth potential, size and localization of the growth plate bridge, the deformity and the individual wishes of patients and parents. In most cases a full correction is possible with palmar plate osteosynthesis and an iliac crest graft. External fixation and callus distraction is an alternative in cases where the correction is more extensive. The distal ulnar growth plate should be controlled concerning further growth potential before hardware removal., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: This study aims to investigate the characteristics of concomitant distal radius and scaphoid fractures and determine outcome differences of operative and nonoperative management., Methods: A retrospective search of a level-1 trauma center's database over a 15-year period (2007-2022) for concomitant distal radius and scaphoid fractures in adult patients was completed. In all, 31 cases were reviewed for mechanism of injury, method of fracture management, distal radius fracture AO Foundation/Orthopaedic Trauma Association classification, scaphoid fracture classification, time to radiographic scaphoid union, time to motion, and other demographics. A multivariate statistical analysis was completed comparing outcomes in operative versus conservative management of the scaphoid fracture in these patients. Outcomes were defined as time to radiographic union and time to motion., Results: In all, 22 cases of operative fixation of the scaphoid and 9 cases of nonoperative management of the scaphoid were reviewed. One case of nonunion was identified in the operative group. Operative management of scaphoid fractures resulted in a statistically significant reduction in time to motion (2-week reduction) and time to radiographic union (8-week reduction)., Conclusions: This study demonstrates that operative management of scaphoid fractures in the setting of a concomitant distal radius fracture reduces the time to radiographic union and time to clinical motion. This suggests that operative management is ideal in patients who are good candidates for surgery and desire earlier return of motion. However, conservative management should be considered, as nonoperative care showed no statistical difference regarding union rates of scaphoid or distal radius fractures., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R.R. is a consultant for Medartis. All other authors have no conflicts of interests to disclose.

Purpose: Previous studies evaluating weight bearing of distal radius fractures treated through dorsal spanning bridge plates used extra-articular fracture models, and have not evaluated the role of supplementary fixation. We hypothesized that supplementary fixation with a spanning dorsal bridge plate for an intra-articular wrist fracture would decrease the displacement of individual articular pieces with cyclic axial loading and allow for walker or crutch weight bearing., Methods: Thirty cadaveric forearms were matched into 3 cohorts, controlling for age, sex, and bone mineral density. An intra-articular fracture model was fixed with the following 3 techniques: (1) cohort A with a dorsal bridge plate, (2) cohort B with a dorsal bridge plate and two 1.6-mm k-wires, and (3) cohort C with a dorsal bridge plate and a radial pin plate. Specimens were axially loaded cyclically with escalating weights consistent with walker and crutch weight-bearing with failure defined as 2-mm displacement., Results: No specimens failed at 2- or 5-kg weights, but cohort A had significantly more displacement at these weights compared with cohort B. Cohort A had significantly more failure than cohort C. Both cohort A and cohort B had significantly more displacement at crutch weight bearing compared with cohort C. The supplementary fixation group had significantly lower displacement at crutch weight-bearing compared with cohort A in all gaps. Survival curves demonstrated the fixation cohort to survive higher loads than the nonfixation group., Conclusion: There was significantly less displacement and less failure of intra-articular distal radius fractures treated with a spanning dorsal bridge plate and supplementary fixation. Our model showed that either type of fixation was superior to the nonfixation group., Clinical Significance: When considering early weight-bearing for intra-articular distal radius fractures treated with a spanning dorsal bridge plate, supplementary fixation may be considered as an augmentation to prevent fracture displacement., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Dorsal spanning plate fixation can be used to treat comminuted distal radius fractures not amenable to volar plating. However, there is a relative paucity of outcomes data; so, the aim of this retrospective study was to investigate outcomes and complications after dorsal spanning plate fixation for distal radius fractures., Methods: Distal radius fractures treated with dorsal spanning plate fixation at a level-1 trauma center were retrospectively identified via Current Procedural Terminology coding and chart review from 2014 to 2019. Patient demographics, fracture pattern characteristics, fixation techniques, and clinical outcomes were all obtained via chart review using the electronic medical record., Results: In all, 43 dorsal plates were identified out of 369 operatively treated distal radius fractures (12%). Of these, 84% were AO type C, 28% were open fractures, and 86% resulted from falls. At the time of dorsal plating, 28% had an additional procedure. One patient had a major complication after surgery, requiring unplanned surgery for a radius nonunion. Average final follow-up occurred 9 weeks after dorsal plate removal, with mean range of motion at the wrist measuring: 36° flexion, 48° extension, 75° pronation, and 63° supination. Finger flexion was also measured, using either tip of finger to palm distance or total active motion, depending on the available data. These were measured at an average of 1.2 cm and 194°, respectively., Conclusions: Dorsal spanning plate fixation provides a safe and effective method for treating complex distal radius fractures. In our series, patients had good functional outcomes with few complications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The purpose of this study was to determine the influence of chronic preoperative opioid use on complications, reoperation rates, and postoperative opioid use among patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures., Methods: A retrospective review of 111 patients who underwent ORIF of a distal radius fracture from 2019 to 2021 at an academic medical center by the same fellowship-trained orthopedic hand surgeon was conducted. Patient demographics, medical comorbidities, perioperative details, surgical complications, and patient-reported outcome measures were analyzed. The SCRIPTS database was used to obtain opioid prescription data., Results: A total of 10 patients (9.01%) were identified as preoperative chronic opioid users. This group was not associated with risk of increased complication. However, they were more likely to continue using narcotics at 90 and 180 days postoperatively. Patients with a history of substance use were at an increased risk of hardware complications and prolonged postoperative pain. In addition, these patients were more likely to receive narcotics at 90 and 180 days, and to have more refills postoperatively., Conclusion: Patients with preoperative opioid use are not at an increased risk of surgical complication following ORIF of distal radius fractures. However, they are at an increased risk of prolonged postoperative opioid use. Patients with a known history of substance use were at an increased risk of hardware complications, prolonged pain, and increased postoperative opioid use. Surgeons should consider these associations to better manage individual patients in the postoperative period., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Severe open forearm fractures commonly involve segmental bone defects. Although several methods have been proposed to treat segmental bone defects with such fractures, research comparing the radiological and clinical outcomes of free vascularized fibular grafts (FVFG) and the Masquelet technique (MT) is rare., Methods: Data on 43 patients with open forearm fractures and segmental bone defects treated surgically in our hospital from January 2005 to January 2021 were retrospectively analyzed, and these patients were divided into an FVFG group (18 cases) and an MT group (25 cases). Clinical and radiological evaluations were performed regularly, and the minimum follow-up was 18 months., Results: All 43 patients were followed up for 18 to 190 months, with a mean of 46.93 months. The mean follow-up time was significantly longer in the FVFG group than in the MT group (p = 0.000). Bone healing time was 3-16 months, with a mean of 4.67 months. The QuickDASH score at the last follow-up was 0-38.6, with a mean of 17.71, and there was no statistically significant difference between the two groups. Operative time, hospital stay, and intraoperative bleeding for bone defect reconstruction were higher in the FVFG group compared to the MT group (p = 0.000), whereas the number of procedures was lower in the FVFG group than in the MT group (p = 0.035)., Conclusions: FVFG and the MT showed satisfactory clinical results for segmental bone defects of the forearm. Compared with FVFG, the MT exhibited a lower operative time, hospital stay, and intraoperative bleeding., Level of Evidence: Level IV. Trial registration This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2300067675; registered 17 January 2023), https://www.chictr.org.cn/showproj.html?proj=189458 ., (© 2024. The Author(s).)

Objective: To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children., Methods: A retrospective analysis was performed on 23 children with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation (arthrography with elastic nail group) from January 2019 to December 2022, including 12 males and 11 females, aged from 2 to 12 years old with an average of (7.36±1.89) years old;According to Judet fracture types, 14 children were type Ⅲ and 9 children were type Ⅳ. In addition, 23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation (elastic nail group), including 11 males and 12 females, aged from 2 to 14 years old with an average of (7.50±1.91) years old;Judet classification included 15 children were type Ⅲ and 8 children were type Ⅳ. Operative time and intraoperative fluoroscopy times were compared between two groups. Metaizeau evaluation criteria was used to evaluate fracture reduction, and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups., Results: Both groups were followed up for 12 to 24 months with an average of (16.56±6.34) months. Operative time and intraoperative fluoroscopy times of elastic nail group were (56.64±19.27) min and (21.13±7.87) times, while those of joint angiography with elastic nail group were (40.33±11.50) min and (12.10±3.52) times;there were difference between two groups ( P <0.05). According to Metaizeau evaluation, 11 patients got excellent result, 9 good and 3 fair in joint angiography with elastic nail group, while in elastic nail group, 5 excellent, 13 good, 4 acceptable, and 1 poor;the difference between two groups was statistically significant ( P <0.05). According to Tibone-Stoltz criteria, 14 patients got excellent result, 8 good, and 1 fair in joint arthrography with elastic nail group;while in elastic nail group, 12 patients got excellent result, 9 good, 1 fair and 1 poor;there was no significant difference between two groups ( P >0.05)., Conclusion: Compared to percutaneous elastic intramedullary nail fixation, closed reduction assisted by arthrography has advantages of reduced operation time, decreased intraoperative fluoroscopy frequency, and improved fracture reduction. Arthrography enables clear visualization of the anatomical structures of radius, head, neck, bone, and cartilage in children, facilitating comprehensive display of fracture reduction and brachioradial joint alignment. This technique more precisely guides the depth of elastic intramedullary nail implantation in radius neck, thereby enhancing surgical efficiency and success rate.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs), yet their efficacy compared to cast immobilization remains debated. This meta-analysis aimed to compare VLPs versus cast immobilization for DRFs across various follow-up durations. Randomized controlled trials reporting patient-reported functional scores, wrist range of motion (ROM), radiological assessments, and complications were included. Meta-analysis was performed for 6-week, 3-month, 6-month, 12-month, and >12-month follow-ups. Subgroup analysis stratified studies by age group, ≥ 60 years and < 60 years. VLPs showed significantly lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 6 weeks (p < 0.001), 3 months (p < 0.001), 12 months (p = 0.012), and > 12 months (p < 0.001), and lower PRWE scores at 6 weeks (p < 0.001), 3 months (p = 0.048), and >12 months (p = 0.032). Wrist ROM favored VLPs at 6 weeks (p < 0.05), with higher flexion and supination at 3 months (p = 0.027) and 12 months (p = 0.003). Radiologically, VLPs showed improved parameters at 3- and 12-month follow-up. Overall complications did not significantly differ. Subgroup analysis in patients < 60 years generally supported these findings, while in patients ≥ 60 years, radiological outcomes aligned, yet only lower DASH scores were observed with VLPs at 3 months (p < 0.001). VLPs may offer superior clinical, functional, and radiological outcomes compared to cast immobilization at 3- and 12-month follow-up for patients < 60 years, with comparable safety profiles. For patients ≥ 60 years, VLPs may yield better radiological outcomes at 3- and 12-month follow-up, though clinical benefits remain uncertain.

Plate fixation is a common treatment option for radial head fractures (RHFs). Due to the benefits of less invasiveness and fewer complications of internal fixation, the application of small-diameter headless compression screws (HCSs) to treat RHFs has become a new trend. This study aimed to compare the mechanical stability of four distinct internal fixation protocols for transversely unstable RHFs via finite element analysis. Using computed tomography data from 10 patients, we developed 40 patient-specific FE models of transversely unstable RHFs fixed by parallel, crossed, and tripod HCSs and mini-T plate (MTP). Under simulated physiological loading of the elbow joint, the construct stiffness, displacement, and von Mises stresses were evaluated and verified by a biomechanical experiment. Under shear loading, the MTP group exhibited lower construct stiffness, larger displacement, and higher Von Mises stress than the HCSs group. The stiffness of tripod HCSs was greater than parallel and crossed screw fixation techniques. There was a strong relationship between apparent bone density and construct stiffness (R = 0.98 to 0.99). In the treatment of transversely unstable RHFs, HCSs have superior biomechanical stability than MTP. The tripod technique was also more stable than parallel and crossed fixation., (© 2024. The Author(s).)

Background: Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment., Methods: Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes., Result: A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I 2  = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I 2  = 0%)., Conclusion: Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications., (© 2024. The Author(s).)

Background: The tripod screw configuration has been shown to offer similar stiffness characteristics to a laterally placed plate. However, concern has been raised that the construct may be prone to failure in scenarios where the screw intersects at the fracture line. We performed a finite element analysis to assess potentially ideal and unideal screw placements in the tripod construct among Mason III radial head fractures., Methods: A 3-dimensional proximal radius model was developed using a computed tomography scan of an adult male radius. The fracture site was simulated with a uniform gap in transverse and sagittal planes creating a Mason type III fracture pattern comprising 3 fragments. Three configurations were modeled with varying screw intersection points in relation to the radial neck fracture line. A fourth configuration comprising an added transverse interfragmentary screw was also modeled. Loading scenarios included axial and shear forces to simulate physiological conditions. Von Mises stress and displacement were used as outcomes for analysis., Results: Some variation can be seen among the tripod configurations, with a marginal tendency for reduced implant stress and greater stiffness when screw intersection is further from the neck fracture region. The construct with an added transverse interfragmentary screw demonstrated greater stiffness (2269 N/mm) than an equivalent tripod construct comprising 3 screws (612 N/mm)., Conclusion: The results from this study demonstrate biomechanical similarity between tripod screw constructs including where screws intersect at the radial neck fracture line. An added fourth screw, positioned transversely across fragments, increased construct stiffness in our model., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

This study reports the long-term results of a randomized controlled trial comparing anterior locking plate fixation with cast immobilization for extra-articular distal radial fractures. After 5.3 years of follow-up, no clinically relevant functional differences were found., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This systematic review and meta-analysis compare the incidences of complications, reoperations and hardware removal between anterior and dorsal plating after corrective osteotomy for dorsally angulated distal radial malunions. A total of 403 patients were included; 253 patients underwent anterior corrective osteotomy and 150 underwent dorsal corrective osteotomy. Mean follow-up was 30 months. Anterior plating was associated with fewer reoperations (9% vs. 28%), less hardware removal (3% vs. 18%) and comparable major complications (5% vs. 6%) compared to dorsal plating. The adjusted model showed a significant reduction (approximately 85%) in the odds of reoperation and hardware removal in the anterior group. There was no difference in major or minor complications between the groups. Surgeons should be fully aware of the increased risks when using dorsal plate fixation after corrective osteotomy for dorsally angulated distal radial malunions.

Purpose: Distal radius fractures are the most common upper limb fractures in adults (up to 18% of all fractures in the Emergency Department). Conservative management is possible for the majority, the preferred surgical technique being volar plate fixation. Dorsal bridge plating (DBP) is an alternative method of treatment for complex fractures. DBP acts as an internal fixator and can be used in patients needing early rehabilitation. This systematic review assesses the demographics, functional and radiological outcomes and complications of using DBP in patients with distal radius fractures compared to volar plate fixation., Methods: A literature search of PubMed, Cochrane, EMBASE and Google Scholar was performed according to PRISMA guidelines. Seven hundred and sixty-one articles were found; 11 articles met the inclusion criteria. Cadaveric studies and case studies of less than five patients were excluded. Primary outcome measures were functional and radiological outcomes. Complications were recorded as secondary outcomes., Results: Three hundred and ninety-four patients were included in the study with an average age of 54.8 years (53.9% male and 46.1% female). Weighted mean follow-up was 55.2 weeks; the mean time to plate removal was 17.3 weeks with a mean DASH score of 25.7. The weighted range of movement was 46.9° flexion, 48.8° extension, 68.4° pronation and 67.5° supination. The radiological parameters show satisfactory outcomes with a mean radial height of 10mm, volar tilt of 3.1°, ulnar variance of 0.5mm and radial inclination of 18.8°. The complication rate was 11.4%. Digital stiffness was the most common complication but improved if tenolysis was performed at plate removal., Conclusions: DBP is a good alternative to volar plating for complex distal radius fractures. The functional outcomes showed a slight loss of range of movement, whereas the radiological outcomes were within recommended limits. A significant disadvantage of the plate is the need for further surgical removal., (© 2024. Crown.)