bipolar fixation in the treatment of distal radius fractures. catagni m.a., lovisetti l
TRANSCRIPT
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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
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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
M. A. CatagniM. A. CatagniM. A. Catagni
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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
M. A. CatagniM. A. CatagniM. A. Catagni
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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
Lecco Ilizarov UnitLecco Ilizarov Unit
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External fixation with Ilizarov frameExternal fixation with Ilizarov frame
Hand support for radial nerve palsyHand support for radial nerve palsy
Lecco Ilizarov UnitLecco Ilizarov Unit
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Lecco Ilizarov UnitLecco Ilizarov Unit
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Post operative X raysPost operative X rays
Lecco Ilizarov UnitLecco Ilizarov Unit
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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
Lecco Ilizarov UnitLecco Ilizarov Unit
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Lecco Ilizarov UnitLecco Ilizarov Unit
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Lecco Ilizarov UnitLecco Ilizarov Unit
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Lecco Ilizarov UnitLecco Ilizarov Unit
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Lecco Ilizarov UnitLecco Ilizarov Unit
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Lecco Ilizarov UnitLecco Ilizarov Unit
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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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M. A. CatagniM. A. CatagniM. A. Catagni
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Fracture III type ( compression)Fracture III type ( compression)
M. A. CatagniM. A. CatagniM. A. Catagni
R d i d i
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Reduction and tractionReduction and tractionReduction and traction
M. A. CatagniM. A. CatagniM. A. Catagni
K i i i iK i i i i
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K, wires positioningK, wires positioningK, wires positioning
M. A. CatagniM. A. CatagniM. A. Catagni
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
M. A. CatagniM. A. CatagniM. A. Catagni
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)
M. A. CatagniM. A. CatagniM. A. Catagni
RL
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Type III(compression)
Type III(compression)
M. A. CatagniM. A. CatagniM. A. Catagni
P iP t ti
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Post operativePost operative
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Radial inclinationPalmar tilt
Radial inclinationPalmar tilt
M. A. CatagniM. A. CatagniM. A. Catagni
F llFollow up
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Follow upFollow up
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Pronation and supinationPronation and supination
M. A. CatagniM. A. CatagniM. A. Catagni
Type I ( bending)Type I ( bending)
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Type I ( bending)Type I ( bending)
M. A. CatagniM. A. CatagniM. A. Catagni
P O X raysP O X rays
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P.O. X raysP.O. X rays
M. A. CatagniM. A. CatagniM. A. Catagni
Radiological evaluationRadiological evaluation
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Radiological evaluationRadiological evaluation
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P O X raysP O X rays
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P.O. X raysP.O. X rays
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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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P.O. X raysP.O. X rays
M. A. CatagniM. A. CatagniM. A. Catagni
R di l i l l tiRadiological evaluation
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Radiological evaluationRadiological evaluation
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M. A. CatagniM. A. CatagniM. A. Catagni
Type I ( bending)Type I ( bending)
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Type I ( bending)Type I ( bending)
M. A. CatagniM. A. CatagniM. A. Catagni
P.O. X raysP.O. X rays
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P.O. X raysy
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At follow up 6 monthsAt follow up 6 months
M. A. CatagniM. A. CatagniM. A. Catagni
Follow upFollow up
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Follow upFollow up
M. A. CatagniM. A. CatagniM. A. Catagni
ComplicationsComplications
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Complications
Infections (radial wire) 2/75(Healed with removal of wire and antibiotic therapy)
Algodysthrophy (recovery with Rehabilitation )
8/75
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
M. A. CatagniM. A. CatagniM. A. Catagni
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
M. A. CatagniM. A. CatagniM. A. Catagni