bipolar fixation in the treatment of distal radius fractures. catagni m.a., lovisetti l

8/6/2019 Bipolar fixation in the treatment of distal radius fractures. Catagni M.A., Lovisetti L.

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Bipolar fixation in the treatment ofdistal radius fractures

Catagni M.A., Lovisetti L.

Ospedale A.ManzoniLecco-Italia

Bipolar fixation in the treatment ofBipolar fixation in the treatment ofdistal radius fracturesdistal radius fractures

CatagniCatagni M.A., Lovisetti L.M.A., Lovisetti L.

OspedaleOspedale A.ManzoniA.ManzoniLeccoLecco--ItaliaItalia


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Fractures of distal radius

Greatest frequency in women between 60 and69 years

Fractures of distal radiusFractures of distal radius

Greatest frequency in women between 60 andGreatest frequency in women between 60 and69 years69 years


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I Bending (Colles, Smith)

II Shearing (Bartons, reversed Bartons, simple

articular fracture)

III Compression (intra articular comminutedfractures ,die punch)

IV Avulsion (radio carpal fracture dislocation)

V Combinations (high energy injuries)

I BendingI Bending ((CollesColles, Smith), Smith)

II ShearingII Shearing (Barton(Bartons, reversed Bartons, reversed Bartons, simples, simplearticulararticular fracture)fracture)

III CompressionIII Compression (intra(intra articulararticular comminutedcomminutedfractures ,die punch)fractures ,die punch)

IV AvulsionIV Avulsion (radio carpal fracture dislocation)(radio carpal fracture dislocation)

V CombinationsV Combinations (high energy injuries)(high energy injuries)

Fernandez Jupiter Classification of distal radiusfractures ( 1997)

Mechanism of injury

Fernandez Jupiter Classification of distal radiusFernandez Jupiter Classification of distal radiusfractures ( 1997)fractures ( 1997)

Mechanism of injuryMechanism of injury


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Traditional treatmentClosed reduction and plaster

TraditionalTraditional treatmenttreatmentClosedClosed reductionreduction andand plasterplaster


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The plaster becomes larger after resolution of oedemaTheThe plasterplaster becomesbecomes largerlarger afterafter resolutionresolution ofofoedemaoedema

Manteining reduction is difficult50-70% secondary displacementsManteiningManteining reductionreduction isis difficultdifficult5050--70%70% secondarysecondary displacementsdisplacements


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External skeletal fixationExternalExternal skeletalskeletal fixationfixation


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radial length and inclination are re-established and maintained with

ligamentotaxis

More difficult is to restore the palmar tilt(palmar radiocarpal ligaments reach maximum length

before the dorsal ligaments )

Bartosh and Saldana 1990

radial length and inclination are reradial length and inclination are re--established and maintained withestablished and maintained with

ligamentotaxisligamentotaxis

More difficult is to restore theMore difficult is to restore the palmarpalmar tilttilt((palmarpalmar radiocarpalradiocarpal ligaments reach maximum lengthligaments reach maximum length

before the dorsal ligaments )before the dorsal ligaments )

BartoshBartosh and Saldana 1990and Saldana 1990

M. A. CatagniM. A. CatagniM. A. Catagni


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Better articular congruity onradiographic follow up

Harley et al. J Hand Surg (Am) 2004

BetterBetter articulararticular congruitycongruity ononradiographicradiographic followfollow upup

HarleyHarley etet al.al. JJ HandHand SurgSurg ((AmAm) 2004) 2004



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Low risk of complications

pin track infectionPin loosening

reflex simpathetic disthrophystiffness

radial shorteningloss of radial tilt

Radial sensory neuritis

Low risk of complicationsLow risk of complications

pin track infectionpin track infectionPin looseningPin loosening

reflexreflex simpatheticsimpathetic disthrophydisthrophystiffnessstiffness

radial shorteningradial shorteningloss of radial tiltloss of radial tilt

Radial sensory neuritisRadial sensory neuritis



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New trend:Internal fixation

New trend:New trend:InternalInternal fixationfixation



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31(27%)1(3%)13(26%)6(14%)Total

1(1%)Intra articular screwdisplacement

3(7%)Malunion2(2%)1(2%)

Screw loosening

5(4%)1(3%)3(6%)Complex regional painsyndrome

3(3%)Delayed fracturehealing

3(3%)1(2%)Carpal tunnelsyndrome

4(4%)1(2%)Extensor tendontenosynovitis

9(8%)2(5%)Flexor tendontenosynovitis

2(2%)1(12%)Roptured tendonextensor pollicislongus

2(2%)6 (12%)Roptured tendon flexorpollicis longus

114405041Patients

Arora et al2007

Kamano etal 2005

Drobetz et al2003

Rozentalet al 2006


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there is a need for well designed clinical,biomechanical and cost benefit studies to compare

locking plate systems with other treatments.Ultimately, the current enthusiasm for

volar fixed angle plates should be

tempered until outomes andadvantages are securely validated byhard sience.

Management of distal radial fracturesNeal C. Chen, Jesse B. JupiterJ Bone Joint Surg Am 2007

there is a need for well designed clinical,biomechanical and cost benefit studies to compare

locking plate systems with other treatments.Ultimately, the current enthusiasm for

volar fixed angle plates should betempered until outomes and

advantages are securely validated byhard sience.

Management of distal radial fracturesNeal C. Chen, Jesse B. JupiterJ Bone Joint Surg Am 2007



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Our treatment of distal radiusfractures

Severe open fractures

External skeletal

fixation

Our treatment of distal radiusOur treatment of distal radiusfracturesfractures

Severe openSevere open fracturesfractures

ExternalExternal skeletalskeletal

fixationfixation



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Severe open fracture of forearm ( 2Severe open fracture of forearm ( 2) associated to humeral fracure) associated to humeral fracurewith radial nerve palsywith radial nerve palsy

Lecco Ilizarov UnitLecco Ilizarov Unit


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Debridement, open reduction and K.Debridement, open reduction and K.Wire intramedullary fixationWire intramedullary fixation

Sintesi omero con chiodo di SeidelSintesi omero con chiodo di Seidel



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External fixation with Ilizarov frameExternal fixation with Ilizarov frame

Hand support for radial nerve palsyHand support for radial nerve palsy



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Post operative X raysPost operative X rays



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After 165 days removal of frame and internal fixation withAfter 165 days removal of frame and internal fixation withplating and grafting because of delay of unionplating and grafting because of delay of union



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Closed fracturesExternal fixation plaster

Ligamentotaxis

Closed fracturesClosed fracturesExternal fixationExternal fixation plasterplaster

LigamentotaxisLigamentotaxis


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Lorenz Boehler (1885-1973)Bipolar fixation 1929

LorenzLorenz BoehlerBoehler (1885(1885--1973)1973)Bipolar fixation 1929Bipolar fixation 1929


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Pin and plaster methods since Boehlers original description in 1929Pin and plaster methods sincePin and plaster methods since BoehlerBoehlerss original description in 1929original description in 1929



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Lembrochage des fracturesinfrieures du radius

A.Ledoux, A.Rauis et M.Van der GhinstBruxelles

Revue de Chirurgie Orthopdique 1973, 59, 427-438

LLembrochageembrochage des fracturesdes fracturesinfinfrieuresrieures du radiusdu radius

A.LedouxA.Ledoux,, A.RauisA.Rauis etet M.VanM.Van derder GhinstGhinstBruxellesBruxelles

Revue deRevue de ChirurgieChirurgie OrthopOrthopdiquedique 1973, 59, 4271973, 59, 427--438438


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TechniqueTechniqueTechnique


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Simplicit dexecution,

innocuit, efficacitLow cost

SimplicitSimplicit ddexecutionexecution,,

innocuitinnocuit,, efficacitefficacitLow costLow cost


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Fracture III type ( compression)Fracture III type ( compression)


R d i d i


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Reduction and tractionReduction and tractionReduction and traction


K i i i iK i i i i


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K, wires positioningK, wires positioningK, wires positioning


Pl i l di K iPl i l di K iPl t i l di K i


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Plaster including K wiresPlaster including K wiresPlaster including K wires


D i l hil i iD i l t hil t ti iD i l t hil t ti i


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Doing plaster while traction ismanteined

Doing plaster while traction isDoing plaster while traction ismanteinedmanteined



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P.O. X raysP.O. X rays



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From 2000 more than 800 cases

Review of 75 cases treated in 2006

54 women 21 men

Type I 58Type II 3Type III 11

Type IV -Type V 3

From 2000 more than 800 cases

Review of 75 cases treated in 2006

54 women 21 men

Type I 58Type II 3Type III 11

Type IV -Type V 3



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Radial inclination( averages 23)

RadialRadial inclinationinclination(( averagesaverages 2323))



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Palmar tilt( averages 11)

PalmarPalmar tilttilt(( averagesaverages 1111))



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Radial length( averages 11mm)

RadialRadial lengthlength(( averagesaverages 11mm)11mm)


RL


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Type III(compression)

Type III(compression)


P iP t ti


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Post operativePost operative



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Radial inclinationPalmar tilt

Radial inclinationPalmar tilt


F llFollow up


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Follow upFollow up



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Pronation and supinationPronation and supination


Type I ( bending)Type I ( bending)


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P O X raysP O X rays


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Radiological evaluationRadiological evaluation


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P O X raysP O X rays


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Type III ( compression)Type III ( compression)



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R di l i l l tiRadiological evaluation


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P.O. X raysy



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At follow up 6 monthsAt follow up 6 months


Follow upFollow up


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Follow upFollow up


ComplicationsComplications


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Complications

Infections (radial wire) 2/75(Healed with removal of wire and antibiotic therapy)

Algodysthrophy (recovery with Rehabilitation )

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Loss of radial tilt 7/75

Radial shortening 4/75

Complications

Infections (radial wire) 2/75(Healed with removal of wire and antibiotic therapy)

Algodysthrophy (recovery with Rehabilitation )

8/75Loss of radial tilt 7/75

Radial shortening 4/75



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Radiological Results (according toCastaings criteria)

Very good reduction 53/75

Good reduction 19/75Bad reduction 3/75

Radiological Results (according toCastaings criteria)

Very good reduction 53/75

Good reduction 19/75Bad reduction 3/75


Functional Results


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111Poor

13178Good

625867Very good

MuscularforceMobilitySubjective

ConclusionsConclusions


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Conclusions

Bipolar fixation of fractures ofdistal radius prevents secondarydisplacements within the cast, is

simple method, free of severecomplications and with a low cost

Conclusions

Bipolar fixation of fractures ofdistal radius prevents secondarydisplacements within the cast, is

simple method, free of severecomplications and with a low cost


bipolar fixation in the treatment of distal radius fractures. catagni m.a., lovisetti l

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