METHOD: Between June 2020 and May 2021, all patients with AO-23B3 and AO-23C (1-3) distal radius fractures who were treated with a volar rim plate fixation were included in this study. At 12 months after surgery, the patients were evaluated utilizing DASH score as a routine as well as evidence of flexor tendon rupture or irritation.
RESULTS: Twenty-five patients were finally included in this study. Of these, three required additional dorsal plating for dorsal subluxation, four required fixation of ulna styloid with tension band wiring, and the rest (18) had volar rim plate fixation in isolation. The mean DASH score was 16.3. Two of the patients had flexor tendon irritations; one in the middle finger and another in the ring and little finger. None had flexor tendon rupture.
CONCLUSION: The volar rim plate is designed to tackle complex intra-articular distal fractures which are near the watershed line. There was no evidence of flexor tendon irritation on routine follow-up. The outcome was satisfactory in this small series despite the complexity of the fractures. Evidence of flexor tendon irritation requires prompt attention to enable early implant removal.
MATERIALS AND METHODS: Thirty-eight avascular scaphoid non-unions in 37 patients who were treated with a free osteoperiosteal or osteochondral MFC graft were retrospectively evaluated (mean follow-up 16 months). Bone union, the scapholunate and the radiolunate angles were evaluated on X-ray images. The range of motion, grip strength, VAS, DASH and PRWE scores were evaluated clinically.
RESULTS: The overall union rate was 95%. Bone union was achieved in 27 out of 29 (93%) scaphoids treated with a free osteoperiosteal MFC grafts and in 9 out of 9 (100%) scaphoids treated with a free osteochondral MFC graft. The range of motion remained almost unchanged, while grip strength increased significantly (34 kg vs. 44 kg) and the VAS (22-5), DASH (59-19) and PRWE (62-30) score decreased significantly. The scapholunate (71°-65°) and radiolunate (28°-18°) angle decreased. No major donor site morbidity was observed. Postoperative complications were observed in eight cases (21%).
CONCLUSIONS: The vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.