RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of the candidate : Dr . KARTHEEK REDDY.M
2 .Name of the Institution: Kempe Gowda Institute of Medical
Sciences.
3. Course of the study and subject: M.S. ORTHOPAEDICS
4. Date of admission to the course: 31st May 2008
5. Title of the topic: Surgical Management of Intra-Articular Fractures of Distal End of
The Radius by Internal Fixation.
6. Brief resume of the intendent work
6.1 Need for the study
Thirty years ago distal radial fractures were considered benign and conservative treatment was the rule. Unaesthetic mal unions were noticed but deemed unimportant.
Since then, a growing number of young males, manual workers and sport enthusiasts have suffered high velocity injuries, often resulting in complex intra - articular fractures
Pain and disability have resulted from subsequent mal unions .
Recently surgical treatment has been widely recommended and performed on emergency basis to prevent these sequel.The aim of the treatment is to obtain a good reduction especially for intra –articular fractures.
INCIDENCE
Intra –articular
Comminuted colles’- 23.8 %
Chauffeur- 6.3 %
Comminuted smith - 2.5 %
Palmar barton - 1.3 %
Combined dorsal barton and chauffeur - 1.3 %
Dorsal barton - 0.5 %
Combined palmar barton and chauffeur - 0.3% 1
There is evidence to suggest that anatomical articular reduction greatly reduce the incidence of post traumatic Osteoarthritis 2
The quality of the reduction relates directly to the final out come 3
Treatment of displaced intra – articular fractures of distal radius by open reduction &internal fixation has previously been shown to produce acceptable results 4
There are many ways to surgically stabilize the fracture and there are various forms of surgical stabilization devices available for surgical management of intra – articular fractures of distal end radius. Of all those forms of devices used , percutaneous direct pining, plate fixation , bone grafting , bone cementing ,Wrist arthroscopyand combined methods 1
This study is taken up to analyze the surgical management of fracture using various internal fixation devices .
6.2 Review of literature
Fracture of the distal radius often have been considered primarily extra - articular injuries of elderly females. However there are increasing reports of distal Radial fractures causing serious articular damage and profoundly effecting the wrists of a great population.
Clearly the distal radial articulations of the young patients are being exposed to increasly sever trauma.
Better understanding of the spectrum of distal radial fractures is leading to changing concepts of management.
Basic among these is the need to differentiate the more serious articular fractures from the extra - articular injuries commonly called colles’ and smiths fractures. First the articular injuries are more frequntly comminuted, unstable and less suitable for the traditional methods of closed manipulations and cast immobilizations.
Second the articular fractures are associated with a significantly higher rate of complications
And it is increasly clear that preservation of the distal radical articular surfaceses is necessary for the maximum recovery. Maximum recovery require not only precise correction of articular disruption , but also prompt recognition and repair of any concomitant soft tissue or skeletal injuries.5
Rodriguez et.al studied plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age ,from 40 patients with unstable frykman III –VIII distal radius fractures resulting from a fall .
Conclusion :The best anatomic and functional results were obtained by percutaneous pinning .although the cost of pins and plaster treatment is significantly greater than the plaster treatment, the author believes that the positive end result justifies the cost. 6.
L . benson et.al studied the outcome of intra –articular distal radius fractures with fragment specific fixation, in a retrospective review of 81 patients with 85 intra-articular distal radius fractures who were treated with a fragment specific fixation was performed.
Conclusion :Fragment specific fixation is a reasonable alternative for treating intra- articular fractures of the distal radius. At final follow-up evaluations , patients had good to excellent results with respective to range of motion, grip strength ,radiographic alignment, and satisfaction scores . Stable fixation allowed starting active and passive motion of the wrist without compromising post- operative alignment. 7
Beharrie et.al studied functional outcomes after open reduction and internal fixation for tratment of displaced distal radius fractures in patients over 60 years of age , 18 patients with an average of 71 years (range 60-86) .
Conclusion:The study suggest that ORIF with plates and screws in patients 60 years and older with displaced and comminuted fractures of the distal radius represents a safe and effective treatment alternative. 8
Yngvar krukhaug et.al studied experience with the AO π Plate for displaced intra- articular fractures of the distal radius , 29 patients were followed up after a mean of 23[9-46] months, Conclusion:The AO π – PLATE is an EXCELLENT action for the most comminuted fractures of the distal radius . 9
Low –Profile Dorsal Plating for Dorsally Angulated Distal Radius Fractures : An Outcome Study.The median patient age at surgery was 59 years. The median follow-up period was 18 months .According to the AO clssification system , there were 4 type –A , 5 type- B ,& 21 type – C fractures
Conclusion:The study show that patient can expect to have 80% of their range of motion and strength after dorsal plating for distal radius fractures. Moreover ,93% of the patients will have good to excellent functional outcomes .10
6.3 Objective of the study
To asses the functional outcome of the wrist joint in intra – articular fractures of distal end of radius by opting surgical intervention
7 . Material and methods :
7.1 source of data
All patients with intra - articular fracture of distal end radius admitted at K.I.M.S Hospital ,meeting the inclusion& exclusion criteria (as given below) are taken up for the study.
Numbers – 30 patients
7.2 Method of collection of data(including sampling procedure ,if any)
Method of collection of data
Inclusion criteria
All patients were evaluated with
A) Recent simple intra-articular fracture of the distal end radius above the age of 18 years
B) Fracture occurred within 1 week .
C) Frykmans classification III,IV,V,VI,VII&VIII.Gartland and Werley classifications type III.
Exclusion criteria
A) Fractures extra articular of distal end of radius .
B) Frykmans type – I & II are excluded.
C) Gartlands I and II are excluded.
D) Patients with fracture more than1 week old.
E) Medically unfit patients.
F) Patients with pathological fracture.
G) Patients who were unable to give informed consent.
Sample procedure - purposive sampling
Study design - case series
Duration - 02 years
METHODS
PROCEDURES
Open reduction and internal fixation.
Closed reduction and internal fixation.
various forms of surgical stabilization devices available for surgical management of intra – articular fractures of distal end of radius. Of all those forms of devices used , percutaneous direct pining , plate fixation , bone grafting , bone cementing and combined methods .
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
The study requires the following investigations:
1) X-ray of wrist (AP &Lateral views).
Pre – operative.
Post – operative.
2) X-ray of wrist AP & Lateral view taken at the interval of 3,6,12,and 24 weeks till complete union.
7.4 Has ethical clearance been obtained from your institution in case of 7.3.
yes
8. List of references (About 4-6)
1 Philippe Saffar,William P. Cooney III ;Fractures of the distal radius ;chapter-2,pg-12,13,14 , chapter-17 ,pg-136.
2.Knirk JL,Jupiter JB(1986).Intra-articular fractures of the distal end of the radius in young adults. Journal of Bone and Joint Surgery,68A: 647-659 .
3. Boyd LG ,Horne JG ( 1988). The outcome of the fractures of the distal of radius in young adults. Injury , 19:97-100.
4. Fernandez DL , Geissler WB (1991). Treatment of displaced articular fractures of the radius. Journal of Hand Surgery , 16A:375-384. Fitoussi F .Ip WY, Chow SP (1997). Treatment of intra - articular fractures of the distal end of the radius with plates. Journal of Bone and Joint Surgery, 79A:1303-1312.
5. Charles P . Melone, Jr., M.D.* Articular Fractures of the Distal Radius. Orthopaedics Clinics of North America- Vol. 15, No. 2, April 1984.
6.Rodriguez – Merchan, E. Carlos. Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age. Journal of Orthopaedic Trauma.11(3):212-217, April 1997.
7. L . Benson , K . Minihane , L. Stern , E. Eller , R . Seshadri . The outcome of intra –articular distal radius fractures treated with fragment specific fixation. The Journal of Hand Surgery, volume 31 , Issue 8 , pages 1333 – 1339 .
8. Beharrie , Andrew W. MD ; Beredjiklian , Pedro K . MD ; Bozentka , David J. MD . Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age. Journal of Orthopaedic Trauma. 18( 10 ) : 680 – 686 ,November / December 2004 .
9. Yngvar Krukhaug ª ; Leiv Hove ª . Experience with the AO π plate for displaced intra – articular fractures of the distal radius. Scandinavian Journal of Plastic and Reconstruvtive Surgery and Hand Surgery ,Volume 38 , Issue 5 November 2004 ,pages 293 – 296 .
10. Atul F.Kamath,David Zurakowski,Charles S. Day. Low –profile dorsal plating for dorsally angulated distal radius fractures: An outcomes study.The Journal of Hand Surgery, volume 31,Issue 7,September 2006,pages 1061-1067.
9. Signature of the candidate:
10.Remarks of the guide:
11. Name & Designation of (in block letters)
11.1 Guide: Dr. H.B. SHIVA KUMAR
Associate professor,
Department of Orthopaedics ,KIMS.
11.2 Signature :
11.3 Co-guide ( if any): -
11.4 Signature:
11.5 Head of the Department : Dr. J.N.SRIDHARA MURTHY.
Professor &Head, Department of Orthopaedics ,KIMS.
11.6 signature:
12.1 Remarks of the chairman & Principal :
12.2 Signature: