Patients and methods
systemic disease, polytraumas, ulna fracture, trauma, fracture, substance abuse, cognitive deficits, dementia, fractures, psychiatric, intra-articular radiocarpal fracture, carpal injury, injuries, Fractures
SYSTEMIC DISEASE, RECRUITMENT, DISORDERS, COMPLEX REGIONAL PAIN SYNDROME, CARPAL TUNNEL SYNDROME, NEUROLOGICAL DISORDERS
This study was conducted according to the principles of the Declaration of Helsinki. It was approved by the local institutional review board (protocol number 2339/2016). All patients provided written informed consent to participate. The study protocol was registered and uploaded at clinicaltrials.gov (NCT03474445).In this study, we consecutively included patients with unstable distal radius fractures scheduled for volar plating at our department. Fractures with at least one of the following criteria were considered unstable: dorsal angulation > 20°; dorsal comminution; intra-articular radiocarpal fracture; associated ulna fracture [Exclusion criteria were severe systemic disease (≥ ASA 3); polytraumas; previous trauma to the affected wrist and/or hand, including fractures during childhood and adolescence; associated carpal injury; previous injuries to the contralateral wrist, including fractures during childhood and adolescence; neurological disorders affecting the upper limb, including a history of carpal tunnel syndrome; cognitive deficits, including dementia; substance abuse; severe psychiatric disorders; non-adherence to the postoperative rehabilitation protocol; delayed definitive surgical treatment of more than 18 days after the injury; previous temporary surgical fixation (e.g. external fixation); signs and symptoms of complex regional pain syndrome (Fig. Consolidated Standards of Reporting Trials (CONSORT) flow chart showing the recruitment of patients with DRF. Upon written informed consent, patients were randomly allocated to SVA or PqSA treatment prior to surgery by picking a sealed envelope from a box locked in the principal investigator’s office. A person other than the operating surgeon picked each envelope. Patients were blinded to treatment until completion of the study. Irrespective of the allocated treatment modality, surgeries were performed by orthopaedic and trauma surgery residents undergoing training and under supervision by an attending surgeon; by attending surgeons in orthopaedic and trauma surgery; and by hand-specialized orthopaedic and trauma surgeons. Prior to study initiation, the principal investigator explained and demonstrated the PqSA to all participating surgeons.The department’s SVA for a DRF was a trans-FCR approach. After visualizing the PQ muscle, the superficial head of the PQ was incised at the radial edge, and the muscle was lifted off the bone to visualize the fracture (Fig. Intraoperative photographs of two approaches for treating distal radius fractures. Identical to the SVA, the PqSA started with a trans-FCR approach. After carefully exposing the PQ muscle, a transverse incision was made just distal to the superficial head of the PQ, and the muscle was undermined to enable the sliding of the plate proximally underneath the muscle. The remaining steps were identical to those for the SVA. Screws were inserted through mini-incisions in the PQ, as required. To facilitate sliding the plate underneath the superficial head of the PQ, we used a plate with a low profile on the proximal plate end (INTEOS®—2.5 Radius Y-Plate, Hofer GmbH and Co KG, Austria; Fig. All patients were immobilized with a forearm brace for 2–4 weeks, depending on the intra-operative bone stock, reduction quality, and surgeon preference. Depending on the timing of cast removal, physiotherapy was initiated at 2 or 4 weeks. This therapy focused on wrist/hand range of motion, strengthening, and activities of daily living, as per the institutional standard protocol.Radiological and functional follow-up assessments were performed after 8 weeks, 3 months, 6 months, and 12 months. The primary outcome measure was the validated Patient-Rated Wrist Evaluation (PRWE) [All patients underwent standard radiographs and CT scans of the wrist pre-operatively. The standardized radiographic wrist assessment included posteroanterior and lateral projections. The CT scans (Somatom Edge plus, Siemens Healthineers, Germany) were performed in the prone position with the arm stretched over the head and the forearm and wrist in the neutral position. CT scans were evaluated with sagittal, coronal, and axial reconstructions in the bone window. Fractures were classified by three independent observers according to the AO/OTA classification [