title: Operative treatment and outcome of unstable distal radial fractures using a palmar T-miniplate at a non-specialized institution.
abstract: Treatment options for displaced distal radial fractures are still a controversial topic of discussion. Although good results for the palmar plating of high-volume centers have been published, evidence of its successful use in smaller institutions is still lacking. We report the clinical and radiological results of the treatment for 84 distal radial fractures with a single 2.4-mm T-miniplate in an institution performing <30 procedures per year. According to the AO classification system, there were 30 A, 5 B, and 49 C fractures with a patients mean age of 64 years. After a minimum of 12-month follow-up, we found very good and good results according to the Gardland and Sarmiento scores and a DASH of 5.6. Only five patients were classified as having a moderate outcome. A remaining intra-articular step-off of more than 1 mm was seen in 15 patients. In a comparison of grip strength between the injured and uninjured hands, we saw a difference of 6.8 % less on the injured side. We saw two instances of tendon rupture and one of tendon irritation due to prominent dorsal screws and necessitating revision surgery. Flexor tendon irritation was noted in one patient, requiring a second operation. Modern treatment for distal radial fractures can be performed successfully and with good clinical outcome in smaller institutions. Based on the high and increasing incidence of distal radial fractures, there is no need to transfer these patients into high-volume centers. Level of evidence Case study, Level IV.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitsklinikum Köln, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Skouras
authors.forename: Y
authors.initials: Y
authors.lastname: Hosseini
authors.forename: V
authors.initials: V
authors.lastname: Berger
authors.forename: K
authors.initials: K
authors.lastname: Wegmann
authors.forename: T C
authors.initials: TC
authors.lastname: Koslowsky
references.citation: Clin Orthop Relat Res. 2006 Oct;451:218-22
references.pmid: 16770281
references.citation: J Hand Surg Am. 2005 Nov;30(6):1185-99
references.pmid: 16344176
references.citation: Orthop Clin North Am. 1984 Apr;15(2):217-36
references.pmid: 6728444
references.citation: Injury. 2010 Mar;41(3):306-11
references.pmid: 20176171
references.citation: Iowa Orthop J. 2004;24:53-9
references.pmid: 15296207
references.citation: J Bone Joint Surg Am. 2003 Oct;85(10):1956-60
references.pmid: 14563804
references.citation: J Am Acad Orthop Surg. 2005 Jan-Feb;13(1):28-36
references.pmid: 15712980
references.citation: Osteoporos Int. 2001;12(7):555-8
references.pmid: 11527052
references.citation: J Orthop Trauma. 2009 Apr;23(4):237-42
references.pmid: 19318865
references.citation: J Bone Joint Surg Am. 1975 Apr;57(3):311-7
references.pmid: 1123382
references.citation: Acta Orthop. 2009 Aug;80(4):478-85
references.pmid: 19857180
references.citation: J Bone Joint Surg Am. 2009 Jul;91(7):1568-77
references.pmid: 19571078
references.citation: J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:96-106
references.pmid: 20194348
references.citation: J Bone Joint Surg Am. 1951 Oct;33-A(4):895-907
references.pmid: 14880544
references.citation: Am J Ind Med. 1996 Jun;29(6):602-8
references.pmid: 8773720
references.citation: J Bone Joint Surg Am. 2009 Sep;91(9):2086-93
references.pmid: 19723984
references.citation: J Bone Joint Surg Br. 1996 May;78(3):404-9
references.pmid: 8636175
references.citation: Hand Clin. 2010 Feb;26(1):43-53
references.pmid: 20006243
references.citation: J Bone Joint Surg Am. 1986 Jun;68(5):647-59
references.pmid: 3722221
references.citation: J Bone Joint Surg Am. 2010 Aug 4;92(9):1851-7
references.pmid: 20686059
references.citation: J Bone Joint Surg Am. 2009 Jan;91(1):55-65
references.pmid: 19122079
references.citation: J Hand Surg Am. 2006 Apr;31(4):615-22
references.pmid: 16632057
references.citation: Clin Orthop Relat Res. 2006 Apr;445:30-41
references.pmid: 16505730
references.citation: Cochrane Database Syst Rev. 2003;(2):CD000314
references.pmid: 12804395
references.citation: Injury. 2010 Feb;41(2):184-9
references.pmid: 19819447
references.citation: J Trauma. 2010 Apr;68(4):992-8
references.pmid: 20065876
references.citation: Hand (N Y). 2008 Jun;3(2):111-7
references.pmid: 18780086