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Radiographic outcomes of volar locked plating for distal radius fractures.
Mignemi ME, Byram IR, Wolfe CC, Fan KH, Koehler EA, Block JJ, Jordanov MI, Watson JT, Weikert DR, Lee DH
(2013) J Hand Surg Am 38: 40-8
MeSH Terms: Adolescent, Adult, Aged, Bone Plates, Female, Fracture Fixation, Internal, Humans, Intra-Articular Fractures, Logistic Models, Male, Middle Aged, Radiography, Radius Fractures, Retrospective Studies, Treatment Outcome, Wrist Joint, Young Adult
Show Abstract · Added May 30, 2014
PURPOSE - To assess the ability of volar locked plating to achieve and maintain normal radiographic parameters for articular stepoff, volar tilt, radial inclination, ulnar variance, and radial height in distal radius fractures.
METHODS - We performed a retrospective review of 185 distal radius fractures that underwent volar locked plating with a single plate design over a 5-year period. We reviewed radiographs and recorded measurements for volar tilt, radial inclination, ulnar variance, radial height, and articular stepoff. We used logistic regression to determine the association between return to radiographic standard norms and fracture type.
RESULTS - At the first and final postoperative follow-up visits, we observed articular congruence less than 2 mm in 92% of fractures at both times. Normal volar tilt (11°) was restored in 46% at the first follow-up and 48% at the final one. Radial inclination (22°) was achieved in 44% at the first follow-up and 43% at the final one, and ulnar variance (01 ± 2 mm) was achieved in 53% at the first follow-up and 53% at the final one. In addition, radial height (14 ± 1mm) was restored in 14% at the first follow-up and 12% at the final one. More complex, intra-articular fractures (AO class B and C and Frykman types 3, 4, 7, and 8) were less likely to be restored to normal radiographic parameters. However, because of the small sample size for some fracture types, it was difficult to discover significant associations between fracture type and radiographic outcome.
CONCLUSIONS - Volar locked plating for distal radius fractures achieved articular stepoff less than 2 mm in most fractures but only restored and maintained normal radiographic measurements for volar tilt, radial inclination, and ulnar variance in 50% of fractures. The ability of volar locked plating to restore and maintain ulnar variance and volar tilt decreased with more complex intra-articular fracture types.
TYPE OF STUDY/LEVEL OF EVIDENCE - Therapeutic IV.
Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
0 Communities
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17 MeSH Terms
Transthoracic vertebrectomy for metastatic spinal tumors.
Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam JB, Wildrick DM, Swisher SG, Abi-Said D, Sawaya R
(1998) J Neurosurg 89: 599-609
MeSH Terms: Adult, Aged, Analgesics, Opioid, Back Pain, Bone Cements, Bone Plates, Bone Screws, Breast Neoplasms, Cervical Vertebrae, Female, Humans, Kidney Neoplasms, Kyphosis, Lumbar Vertebrae, Lung Neoplasms, Male, Melanoma, Methylmethacrylate, Methylmethacrylates, Middle Aged, Muscle Weakness, Pain Measurement, Pain, Intractable, Pulmonary Atelectasis, Pulmonary Embolism, Reconstructive Surgical Procedures, Retrospective Studies, Sarcoma, Spinal Neoplasms, Survival Rate, Thoracic Vertebrae, Treatment Outcome, Walking
Show Abstract · Added March 27, 2014
OBJECT - Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region.
METHODS - Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p < 0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p < 0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%.
CONCLUSIONS - These results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.
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33 MeSH Terms
The spinal nail: a new implant for short-segment anterior instrumentation of the thoracolumbar spine.
Dawson JM, DeBoer DK, Spengler DM, Schwartz HS
(1996) J Spinal Disord 9: 299-305
MeSH Terms: Animals, Biomechanical Phenomena, Bone Nails, Bone Plates, Evaluation Studies as Topic, Lumbar Vertebrae, Spinal Cord Compression, Swine, Thoracic Vertebrae
Show Abstract · Added March 5, 2014
The biomechanics of a new spinal implant were evaluated and its dependence on an anterior strut graft was determined. Six fresh-frozen adult porcine spines were used. An L3 corpectomy was created. The spinal nail was inserted intraosseously into the middle column of the L2-L4 vertebral bodies in a trough. Implant drill holes were made for proximal and distal locking bolts in L2 and L4. A locking plate bridged the L2 and L4 trough and anchored the exposed ends of the locking bolts. Testing was performed in axial compression, torsion, and flexion. The axial and torsional stability of the spine instrumented with the spinal nail are similar to results with other devices when used with anterior strut grafting. The axial and flexural stiffnesses of the instrumented spine are independent of strut grafting. This study suggests that this device may be useful for reconstruction of the anterior spine because of instability.
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1 Members
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9 MeSH Terms