Aims. The aim of this study was to investigate whether intraoperative 3D fluoroscopic imaging outperforms dorsal tangential views in the detection of dorsal cortex screw penetration after volar plating of an intra-articular distal radial fracture, as identified on postoperative CT imaging. Methods. A total of 165 prospectively enrolled patients who underwent volar plating for an intra-articular distal radial fracture were retrospectively evaluated to study three intraoperative imaging protocols: 1) standard 2D fluoroscopic imaging with anteroposterior (AP) and elevated lateral images (n = 55); 2) 2D fluoroscopic imaging with AP, lateral, and dorsal tangential views images (n = 50); and 3) 3D fluoroscopy (n = 60). Multiplanar reconstructions of postoperative CT scans served as the reference standard. Results. In order to detect dorsal screw penetration, the sensitivity of dorsal tangential views was 39% with a negative predictive value (NPV) of 91% and an accuracy of 91%; compared with a sensitivity of 25% for 3D fluoroscopy with a NPV of 93% and an accuracy of 93%. On the postoperative CT scans, we found penetrating screws in: 1) 40% of patients in the 2D fluoroscopy group; 2) in 32% of those in the 2D fluoroscopy group with AP, lateral, and dorsal tangential views; and 3) in 25% of patients in the 3D fluoroscopy group. In all three groups, the second compartment was prone to penetration, while the postoperative incidence decreased when more advanced imaging was used. There were no penetrating screws in the third compartment (extensor pollicis longus groove) in the 3D fluoroscopy groups, and one in the dorsal tangential views group. Conclusion. Advanced intraoperative imaging helps to identify screws which have penetrated the dorsal compartments of the wrist. However, based on diagnostic performance characteristics, one cannot conclude that 3D fluoroscopy outperforms dorsal tangential views when used for this purpose. Dorsal tangential views are sufficiently accurate to detect dorsal screw penetration, and arguably more efficacious than 3D fluoroscopy. Cite this article: Bone Joint J 2020;102-B(7):874–880

The aims of this study were to assess the efficacy of a newly designed radiological technique (the radial groove view) for the detection of protrusion of screws in the groove for the extensor pollicis longus tendon (EPL) during plating of distal radial fractures. We also aimed to determine the optimum position of the forearm to obtain this view. We initially analysed the anatomy of the EPL groove by performing three-dimensional CT on 51 normal forearms. The mean horizontal angle of the groove was 17.8° (14° to 23°). We found that the ideal position of the fluoroscopic beam to obtain this view was 20° in the horizontal plane and 5° in the sagittal plane. We then intra-operatively assessed the use of the radial groove view for detecting protrusion of screws in the EPL groove in 93 fractures that were treated by volar plating. A total of 13 protruding screws were detected. They were changed to shorter screws and these patients underwent CT scans of the wrist immediately post-operatively. There remained one screw that was protruding. These findings suggest that the use of the radial groove view intra-operatively is a good method of assessing the possible protrusion of screws into the groove of EPL when plating a fracture of the distal radius. Cite this article: Bone Joint J 2013;95-B:1372–6

The Pronator Quadratus (PQ) is commonly damaged in the surgical approach to the distal radius during volar plating. This study explored the functional strength of the PQ muscle, 12 months after volar plating of a distal radial fracture. Testing of treated and contralateral forearms was carried out using a custom-made Torque Measuring Device (TMD) and surface Electromyography (sEMG). To assess both the direct and indirect function of PQ in participants treated with volar plating and compared to the contralateral non-injured forearms. The angle of elbow flexion was varied from 45o, 90o and 135o when measuring forearm pronation. Mean peak torque of the major pronating muscles, PQ and Pronator Teres (PT) was directly measured with the TMD and the indirect activation of the PQ and PT was measured with sEMG. In total 27 participants were studied. A statistically significant reduction in mean peak pronation torque was observed in the volar plated forearms (P<0.05 SE 0.015, CI 95%). This is unlikely to be of clinical significance as the mean reduction was small (13.43Nm treated v 13.48Nm none treated). Pairwise comparison found no statistically significant reduction in peak torque between 45o, 90o and 135o of elbow flexion. There was an increase in PQ muscle activation at 135o compared to 45o elbow flexion. The converse was identified in PT. The small but statistically significant difference in mean peak torque in treated and uninjured forearms is unlikely to be of clinical significance and results suggest adequate functional recovery of the PQ after volar plating

Aims. The aim of this study was to investigate the difference in functional outcome after repair and non-repair of the pronator quadratus muscle in patients undergoing surgical treatment for a distal radial fracture with volar plating. Patients and Methods. A total of 72 patients with a distal radial fracture were included in this randomized clinical trial. They were allocated to have the pronator quadratus muscle repaired or not, after volar locked plating of a distal radial fracture. The patients, the assessor, the primary investigator, and the statistician were blinded to the allocation. Randomization was irreversibly performed using a web application that guaranteed a secure and tamper-free assignment. The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) after 12 months. Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, pronation strength, grip strength, the range of pronation and supination, complications, and the operating time. Results. Of the 72 patients, 63 (87.5%) completed follow-up for the primary outcome measure: 31 (86.1%) from the non-repair group and 32 (88.9%) from the repair group. At the 12-month follow-up, the mean difference in PRWE of 5.47 (95% confidence interval (CI) -4.02 to 14.96) between the repair (mean 18.38 (95% CI 10.34 to 26.41)) and non-repair group (mean 12.90 (95% CI 7.55 to 18.25)) was not statistically significant (p = 0.253). There was a statistically significant difference between pronation strength, favouring non-repair. We found no difference in the other secondary outcomes. Conclusion. We found that repairing pronator quadratus made no difference to the clinical outcome, 12 months after volar plating of a distal radial fracture. We conclude that there is no functional advantage in repairing this muscle under these circumstances and advise against it. Cite this article: Bone Joint J 2019;101-B:1498–1505

Purpose: Distal radius fractures are common and rising in incidence as orthopaedists treat an increasingly aged population. Both external fixation and volar plating have demonstrated satisfactory results, however the orthopaedic literature lacks comparative data on radial column plating. The purpose of this prospective study was to compare functional and radiographic data from patients randomized to three surgical modalities – external fixation, volar plating, and radial column plating. Method: This study included 40 patients with closed, unilateral, unstable distal radius fractures distributed as follows: 20 patients treated with external fixation, 10 patients with volar plating, and 10 patients with radial column plating. When classified according to the OTA system, the fractures included types A3, B3, and C1 C3. Patients were followed post-operatively at 2, 4, 6, 12, 24, and 52 weeks. At each visit, patients completed a DASH questionnaire, grip and lateral pinch strength, and range of motion for both wrists. Radiographs were evaluated for lateral tilt, radial inclination, ulnar variance and radial height. Statistical analyses employed single-factor three-way ANOVA of all outcomes at each follow-up period. Results: No significant difference (p> 0.05) was found between mean DASH scores at each follow-up period for all three patient groups. However, each group achieved significant improvement in DASH scores at 1-year follow-up compared to baseline scores (external fixation, p0.05), with final flexion-extension and supination-pronation ranging 78–94% and 92–96% (of the un-injured wrist), respectively. All radiographic measurements demonstrated no significant differences. Reduction was maintained among all three groups without implant failure or complications. Conclusion: At all follow-up periods, analysis of functional and radiographic outcomes showed no significant difference among all groups. Based on this data, no one method of fixation is superior to the others, giving orthopaedists multiple options for surgically reducing the unstable distal radius. Moreover, the diversity in approach of these methods allows additional flexibility in selecting an appropriate technique for each patient

A retrospective analysis of the treatment of distal radius fractures with an angularly stable locking plate (Matrix Plate, Stryker, UK) via a dorsal approach performed at Southend University Hospital in the United Kingdom. 91 fractures were treated over a three year period between 2004 and 2007. Dorsally angulated and displaced (including intraarticular) fractures were included. All patients commenced early mobilization without splintage on the first post-operative day. The study group consisted of 42 men and 49 women with a mean age of 63 years. The average time to follow up was 19 months (range 6–29). The average tourniquet time was 44 minutes (20–81). Assessment consisted of range of motion and grip strength measurement, Mayo wrist score, quick DASH questionnaire and Gartland and Werley scoring. Complications consisted of 1 EPL rupture and 3 patients suffered extensor irritation. To date only 5 plates (5.4%) have been removed. We demonstrate that dorsal plating using a low profile, angularly stable plate produces comparable results to volar plating. The combination of a low profile, angular stable plate, together with a modification of the standard dorsal approach, a sub-periosteal approach via the fourth and deep to the third extensor compartment reduces the incidence extensor tendon irritation. The modified approach has the benefit of direct visualization of the articular surface and direct reduction with the plate being used in both and angularly stable and buttress mode

Increased use of locking volar plates for distal radius fractures led to a number of reports in literature of flexor tendon injuries from impingement and attrition against hardware. Repair of the pronator quadratus is critical in preventing tendon injury. We present a pronator quadratus sparing approach to the distal radius. The senior author has used a pronator quadratus sparing lateral pillar approach for for the past five years. A lateral incision is used over the radial styloid. The first dorsal compartment is released and APL and EPB tendons retracted. The underlying brachio-radialis tendon and insertion fascia is split and the palmar portion elevated off the distal radius with the pronator quadratus as a single contiguous sheet. The distal edge of the pronator quadratus is elevated from the wrist capsule by sharp dissection. The radial artery is protected by the retracted tissue. Repair of the brachio-radialis tendon and insertion fascia is much more robust than that of the pronator quadratus covering the entire plate. Since 2004, the senior author has used the pronator quadratus sparing approach for volar plating of the distal radius, in 183 cases. At last follow-up there were no instances of flexor tendon injury, which was considered to be one of the outcome measures and end-points. There was no impingement in the first dorsal compartment, except in two cases of lateral pillar hardware impingement from additional lateral pillar plate fixation through the same approach. Nine cases had minor persistent superficial radial nerve parasthesia. One case had a superficial wound infection requiring drainage. The repaired pronator quadratus formed a barrier protecting the plate. The infection was aggressively treated and the plate left in situ for three months till fracture union. Cultures from the retrieved plate showed no organisms. Another implant had two of the locking screws back out. The pronator quadratus fascia was tented with an underlying haematoma. The fascia however only showed minimum screw penetration and no flexor tendon injury. Average wrist dorsiflexion was 72 deg and palmar flexion 65 deg. Average pronation was 81 deg and average supination 69 deg. Supination range was slow to recover in younger patients. One explanation could be the tight pronator quadratus repair. Average PRWE and DASH scores were 19. The quadratus sparing approach to the volar distal radius is easy to perform and protects the flexor tendons at the wrist. Cases demonstrated that an intact pronator quadratus can act as an effective barrier to prominent hardware and superficial infection. Supination range may be reduced by this approach due to a tight repair, though a palmar DRUJ capsule contracture may also be an explanation

Objective: Osteoporotic fractures of the distal forearm are demanding in terms of operative therapy and implants used. Volar fixed angle plating has become a standard procedure for these fractures. Recently intra-medullary nailing was introduced in clinical practice for the use in distal radial fractures. This randomized multi-center study compares both fixation techniques in terms of clinical and radiological outcome as well as quality of life score. Material and Methods: Up to now a total of 85 patients with extra- and intraarticular unstable fractures of the distal radius were included. 53 patients (Targon DR®, B. Braun-Aesculap: n=24; 2.4 mm plate, Synthes: n=29) completed the 6 months follow-up. Follow up examinations included an osteodensitometry using pQCT, X-ray analysis and a detailed clinical function examination. In addition the SF36 questionaire for quality of life assessment was carried out. Results: The operation time for volar plating was significantly longer than for intramedullary nailing (50.3±20.2 min versus 40.2±13.4 min), as was the time in hospital (5.4±1.8 days versus 2.2±0.6 days) (MW±SD; p< 0.05; Student-t-Test, post hoc: Bonferonni). The Gartland an Werley function score averaged 2.7±1.1 versus 1.9±0.8 for volar plating in comparision to treatment with the Targon DR® nail and thus just failed to reach statistical significance (p = 0.052). Radiological Evaluation revealed bony healing in all patients of both groups. Radial length was maintained in all but one patient (96%) in the nailing group and all but 2 patients (93%) in the plating group. A loss of volar tilt −5°was seen in 1 patient in the nailing group (4%) and 3 patients in the plating group (10%). Of interest radiological signs of bony healing developed much faster after intramedullary nailing. The Quality of life as measured by the SF36 was minimaly diminished in both groups (body/social function: Targon DR®: 56.3±25.1/63.4±21.2 points − 2.4 mm plate: 52.8±23.3/60.5±23.3 points). Osteoporotic bone loss was detected in a total of 72% of patients. Osteoporosis had no adverse effects on bony healing or functional parameters. We encountered two complications. One mild CRPS (volar plating) and in one case paraesthesia of the R. superficialis n. radialis (intramedullary nailing). Conclusion: Both intramedullary nailing with the Targon DR® nail and volar plating using a 2.4 mm volar fixed angle plate allows stable fixation of osteoporotic distal forearm fractures. Lower operation time and minimally invasive operative procedure of intramedullary nailing is accompanied by faster mobilization

Distal radius fractures have an incidence rate of 17.5% among all fractures. Their treatment in case of comminution, commonly managed by volar locking plates, is still challenging. Variable-angle screw technology could counteract these challenges. Additionally, combined volar and dorsal plate fixation is valuable for treatment of complex fractures at the distal radius. Currently, biomechanical investigation of the competency of supplemental dorsal plating is scant. The aim of this study was to investigate the biomechanical competency of double-plated distal radius fractures in comparison to volar locking plate fixation. Complex intra-articular distal radius fractures AO/OTA 23-C 2.1 and C 3.1 were created by means of osteotomies, simulating dorsal defect with comminution of the lunate facet in 30 artificial radii, assigned to 3 study groups with 10 specimens in each. The styloid process of each radius was separated from the shaft and the other articular fragments. In group 1, the lunate facet was divided to 3 equally-sized fragments. In contrast, the lunate in group 2 was split in a smaller dorsal and a larger volar fragment, whereas in group 3 was divided in 2 equal fragments. Following fracture reduction, each specimen was first instrumented with a volar locking plate and non-destructive quasi-static biomechanical testing under axial loading was performed in specimen's inclination of 40° flexion, 40° extension and 0° neutral position. Mediolateral radiographs were taken under 100 N loads in flexion and extension, as well as under 150 N loads in neutral position. Subsequently, all biomechanical tests were repeated after supplemental dorsal locking plate fixation of all specimens. Based on machine and radiographic data, stiffness and angular displacement between the shaft and lunate facet were determined. Stiffness in neutral position (N/mm) without/with dorsal plating was on average 164.3/166, 158.5/222.5 and 181.5/207.6 in groups 1–3. It increased significantly after supplementary dorsal plating in groups 2 and 3. Predominantly, from biomechanical perspective supplemental dorsal locked plating increases fixation stability of unstable distal radius fractures after volar locked plating. However, its effect depends on the fracture pattern at the distal radius

Extensor tendon ruptures have been reported in up to 8.8% of patients after volar plating and long screws have been implicated. The dihedral dorsal surface of the distal radius hinders accurate screw length determination using standard radiographic views (lateral; pronation and supination). A ‘dorsal tangential’ view has recently been described, but has not been validated. To validate this view, we mounted a plate-instrumented sawbone onto a jig. Radiographs at different angles were reviewed independently by 11 individuals. Skyline views clearly demonstrated all screw tips, whereas only 69% of screw tips were identifiable on standard views. With screws 2mm proud of the dorsal surface, skyline views detected 67% of long screws (sensitivity). The best of the standard views achieved only 11% sensitivity. At 4mm long, skyline sensitivity was 85%, compared with 25% for standard views. At 6mm long, 100% of long screws were detected on skylines, but only 50% of 8mm long screws were detected by standard views. Inter and intra-observer variability was 0.97 (p=0.005). For dorsal screw length determination of the distal radius, the skyline view is superior to standard views. It is simple to perform and its introduction should reduce the incidence of volar plate-related extensor tendon rupture

We performed a prospective, randomised trial to evaluate the outcome after surgery of displaced, unstable fractures of the distal radius. A total of 280 consecutive patients were enrolled in a prospective database and 88 identified who met the inclusion criteria for surgery. They were randomised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws. Both groups were similar in terms of age, gender, hand dominance, fracture pattern, socio-economic status and medical co-morbidities. Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist, this advantage diminished with time and in absolute terms the difference in range of movement was clinically unimportant. Radiologically, there were no clinically significant differences in the reductions, although more patients with AO/OTA (Orthopaedic Trauma Association) type C fractures were allocated to the external fixation group. The function at one year was similar in the two groups. No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group

Aim: The use of volar plates in the management of distal radius fractures has increased dramatically over the last decade. Our aim was to ascertain if long term outcome could be predicted at clinical review four months following operation.

Patients and Methods: Between January 2003 and January 2005, all patients presenting with unilateral distal radius fractures and treated with volar locking plate fixation (Synthes) were invited to participate in long-term follow up. The decision to use a volar plate and the operative procedure itself was undertaken by the on-call consultant and his team. Patients who agreed to enter the study were evaluated at 4, 6 and 12 months following operation. Patient demographics, hand dominance and fracture type were recorded. Assessment of grip strength and wrist movements were undertaken and expressed as a percentage of the contralateral, uninjured side.

Results: A total of 76 out of 100 eligible patients agreed to participate in the study. Of those patients, 23 (30%) failed to attend all their follow-up appointments, leaving a dataset of 53 patients (70%) available for analysis. There were 28 females (53%) and the mean patient age was 55 years (range 28–83).

Grip strength, pinch grip, wrist flexion, wrist extension, radial deviation, ulnar deviation, pronation and supination all showed graded improvement in the year following fracture, achieving a mean range of 73% to 95% of function compared to the contralateral side at 12 months. Wrist flexion and ulnar deviation showed near maximum improvement by 6 months, whereas the other variables continued to show significant improvement between 6 and 12 months.

Logistic regression analysis suggested that improvement in wrist extension at four months was the best predictor of a good outcome at one year.

Discussion: Use of volar plate fixation is an increasingly common method of managing distal radius fractures. Our study suggests that good functional results can be achieved by this method of treatment. Failure to regain reasonable wrist extension by four months appears to predict higher risk of poor outcome and therefore patients in this group should be followed up more closely.

With the advent of locked volar radial plates there has been a wave of enthusiasm in the fixation of distal radial fractures with these devices. This study was designed to look at potential complications and pitfalls of this treatment modality. 80 consecutive cases treated by the author with locked volar radial plates were analysed. Complications were divided into major and minor groups and recorded exhaustively. Major complications included 6 patients requiring further wrist related surgery, 1 patient with an iatrogenic radial artery injury, 1 patient with an iatrogenic palmer branch of median nerve partial injury, 1 patient with a complex regional pain syndrome and 6 patients with a less than adequate return of range of movement. ^ minor complications were recorded. With attention to detail and by avoiding several recurring pitfalls volar locked plating is a safe and effective procedure

Introduction: Distal radial volar locking plating systems (DRVLP) are commonly used for complex fractures of the distal radius in all ages. There have been few studies in the current literature that analyse the success of volar locking plating systems. Those studies with functional outcome and complications data have yet to be. The purpose of the study is assess whether the surgeon can predict which fractures will have a good versus a poor outcome in terms of clinical, radiological and functional outcome assessment. Method: Patients who sustained a distal radial fracture managed with a radial volar locking plate were identified from hospital audit data systems, after appropriate research ethical approval. Retrospective data was collected on all patients from patient case notes, radiographs performed pre- and postoperatively and functional data by completed patient rated wrist evaluation scores (PRWE). Demographic, clinical, radiographic and functional data was collected and statistically analysed by a bio-statistician. Results: 153 patients were included (116 female, 38 male). Patients were included from all 11 surgeons at the Geelong Hospital between November 2004 and February 2008. The age range was 17 to 91 years. Average age was 53.7 years at time of injury. 24% patients had concomitant other injuries. In terms of AO fracture classification 53% patients had type C1 – C3 fractures. 147 patients had the AO Synthes DRVLP, 6 patients had other volar locking plate systems. 27% patients had an exogenous bone graft insertion. The major complication rate was 12% (18/153) with 94% of these cases requiring further surgery. Post operative radiographs demonstrated an average increase in ulnar variance by 1.25mm, radial inclination by 7 deg, radial length by 4mm and radial tilt by 16 deg (volar angulation) compared to pre-operative radiographs that was statistically significant. 90% patients returned a PRWE form and. Discussion: Predictive parameters for a poor functional outcome were: men, dominant hand injury, other concomitant injuries, pre operative reduced inclination and volar tilit & high ulnar variance on radiographs. Poor functional outcome correlated with poor radiological outcome

Distal radius fractures (DRF) are the most common fracture type in all age groups combined. Unstable DRF may be surgically managed with volar or dorsal plate fixation. Dorsal plating has traditionally been associated with decreased range of motion (ROM). However, this assumption has not been recently assessed to determine whether functional ROM is achievable (approximately 54 degrees of flexion and 60 degrees of extension) with recent advances in lower profile dorsal plate design. The aim of this study was therefore to compare ROM and patient reported outcome measures between volar and dorsal plating methods for DRF. A meta-analysis was performed to directly compare ROM and Disabilities of Arm, Shoulder and Hand (DASH) scores between dorsal and volar plate fixation for DRF. Separate literature searches for each plating method were performed using MedLine and EMBase on January 28, 2018. Exclusion criteria consisted of non-English articles, basic science articles, animal/cadaver studies, case studies/series, combined operative approaches, papers published more than 20 years ago and paediatric studies. Only articles with at least one year patient follow-up and a) ROM and AO-OTA distal radius fracture classification, or b) DASH scores were included. Raw data was extracted from all articles that met inclusion criteria to compile a comprehensive dataset for analysis. Descriptive statistics with z-score comparison for AO-OTA classification or a two-tailed independent samples t-tests for ROM and DASH scores for dorsal versus volar plating were performed. Significance was defined as p < 0 .05. After rigorous screening, six dorsal plating and 43 volar plating articles met inclusion criteria for ROM/AO-OTA classification versus six dorsal plating and 44 volar plating articles for DASH scores. The weighted means of flexion (dorsal 54.9 degrees, SD 9.3, n=257, volar 61.3 degrees, SD 11.5, n=1906) and extension (dorsal 60 degrees, SD 12, n=257, volar 62.8 degrees, SD 11.4, n=1906) were significantly different (both p < 0 .001) between the two plating methods. The volar plating group had a significantly higher proportion of type C fractures (dorsal 0.5, n =169, volar 0.6, n=1246, p < 0 .001). The weighted means of reported DASH scores were not significantly different between dorsal (14, SD 14.8) versus volar (13.6, SD 12.8) plating (p=0.54). Though mean wrist flexion and extension were statistically different between the dorsal versus volar plating methods, the difference between group means was less than 5-degrees, which is unlikely to be clinically significant. Additionally, there was no significant difference in DASH scores between the two plating methods. Taken together, these findings imply that the statistical difference in ROM outcomes are likely not clinically significant and should therefore not dictate choice of plating method for fixation of DRF

Distal radius fractures (DRF) are the most common fracture type in all age groups combined. Unstable DRF may be surgically managed with volar or dorsal plate fixation. Dorsal plating has traditionally been associated with decreased range of motion (ROM). However, this assumption has not been recently assessed to determine whether functional ROM is achievable (approximately 54o of flexion and 60o of extension) with recent advances in lower profile dorsal plate design. The aim of this study was therefore to compare ROM and patient reported outcome measures between volar and dorsal plating methods for DRF. A meta-analysis was performed to directly compare ROM and DASH scores between dorsal and volar plate fixation for DRF. Separate literature searches for each plating method were performed using MedLine and EMBase on January 28, 2018. Exclusion criteria consisted of non-English articles, basic science articles, animal/cadaver studies, case studies/series, combined operative approaches, papers published more than 20 years ago and paediatric studies. Only articles with at least one year patient follow-up and a) ROM and AO distal radius fracture classification, or b) DASH scores were included. Raw data was extracted from all articles that met inclusion criteria to compile a comprehensive dataset for analysis. Descriptive statistics with z-score comparison for AO classification or a two-tailed independent samples t-test for ROM and DASH scores for dorsal versus volar plating were performed. Significance was defined as p < 0 .05. After rigorous screening, 6 dorsal plating and 43 volar plating articles met inclusion criteria for ROM/AO classification versus 6 dorsal plating and 44 volar plating articles for DASH scores. The weighted means of flexion (dorsal 54.9o, SD 9.3, n=257, volar 61.3o, SD 11.5, n=1906) and extension (dorsal 60.0o, SD 12, n=257, volar 62.8o, SD 11.4, n=1906) were statistically significantly different (both p < 0 .001) between the two plating methods. The volar plating group had a significantly higher proportion of AO type C fractures (dorsal 0.5, n =169, volar 0.6, n=1246, p < 0 .001). The weighted means of reported DASH scores were not significantly different between dorsal (14.01, SD 14.8) versus volar (13.6, SD 12.8) plating (p=0.54). Though mean wrist flexion and extension were statistically different between the dorsal versus volar plating methods, the difference between group means was less than 5o, which is unlikely to be clinically significant. Additionally, we did not find a significant difference in DASH scores between the two plating methods. Taken together, these findings imply that the statistical difference in ROM outcomes are likely not clinically significant and should therefore not dictate choice of plating method for fixation of DRF

Introduction: To improve the therapeutic results for AO type C intraarticular distal radius fractures in young and middle-aged patients, it is important to achieve and maintain anatomical reduction, and evaluate and treat soft-tissue injuries. We previously employed arthroscopically assisted reduction and percutaneous pinning (ARPP) combined with external fixation. Since 2003, we have employed ARPP combined with open reduction and internal fixation (ORIF) using volar locking plates.

Methods: The subjects were twenty-six patients under 60 years old. The patients comprised thirteen men and thirteen women aged from 16 to 57 (mean 43.5) years. The type of fracture according to the AO classification was C1 in six patients, C2 in ten, and C3 in ten. The follow-up period was 12–18 (mean 13.5) months. The radial inclination (RI), volar tilt (VT), and ulnar variance (UV) were measured radiographically at the time of injury, immediately after surgery, and at final evaluation. The Mayo wrist score was used for clinical evaluation.

Results: Union was achieved in all patients. The triangular-fibrocartilage complex injury was detected in nineteen patients, the scapholunate-interosseous ligament injury in twenty-three, and the lunotriquetral-interosseous ligament injury in nineteen. Radiographic evaluation showed that the mean RI, VT, and UV at presentation, immediately after surgery, and at final evaluation was 12.8, 21.0, and 20.9 degrees, −15.4, 9.7, and 9.6 degrees, and 3.10, 0.30, and 0.35 mm, respectively. The Mayo wrist score averaged 87.6 points.

Conclusion: Although treatment of AO type C intraarticular distal radius fractures is difficult, ARPP combined with ORIF achieved relatively good results.

This article is a systematic review of the published literature about the biomechanics, functional outcome and complications of intramedullary nailing of fractures of the distal radius. We searched the Medline and EMBASE databases and included all studies which reported the outcome of intramedullary (IM) nailing of fractures of the distal radius. Data about functional outcome, range of movement (ROM), strength and complications, were extracted. The studies included were appraised independently by both authors using a validated quality assessment scale for non-controlled studies and the CONSORT statement for randomised controlled trials (RCTs). The search strategy revealed 785 studies, of which 16 were included for full paper review. These included three biomechanical studies, eight case series and five randomised controlled trials (RCTs). . The biomechanical studies concluded that IM nails were at least as strong as locking plates. The clinical studies reported that IM nailing gave a comparable ROM, functional outcome and grip strength to other fixation techniques. . However, the mean complication rate of intramedullary nailing was 17.6% (0% to 50%). This is higher than the rates reported in contemporary studies for volar plating. It raises concerns about the role of intramedullary nailing, particularly when comparative studies have failed to show that it has any major advantage over other techniques. Further adequately powered RCTs comparing the technique to both volar plating and percutaneous wire fixation are needed. Cite this article: Bone Joint J 2015;97-B:1370–6

The results of the DRAFFT (distal radius acute fracture fixation trial) study, which compared volar plating with Kirschner (K-) wire fixation for dorsally displaced fractures of the distal radius, were published in August 2014. The use of K-wires to treat these fractures is now increasing, with a concomitant decline in the use of volar locking plates. We provide a critical appraisal of the DRAFFT study and question whether surgeons have been unduly influenced by its headline conclusions. Cite this article: Bone Joint J 2016;98-B:298–300

Aims. The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities. Methods. Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year. Results. Of the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, six of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle. Conclusion. The majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference. Cite this article: Bone Joint Open 2020;1-9:549–555