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Salvage procedure after malunited distal radius fractures and management of pain and stiffness

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Abstract

Indications for surgical treatment of distal radius fractures (DRF) remain controversial in the literature, especially in elderly patients. Complication rates after operatively treated DRF are low and well documented. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. If conservative treatment fails then salvage procedures are necessary. This review summarizes the therapeutic options available to treat degenerative osteoarthritis after malunited distal radius fractures, regardless of the initial operative or conservative treatment.

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(Figs. 2–4 from [38])

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(Figure 14 was taken from Quadlbauer et al. [74] and reproduced with permission from Springer)

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References

  1. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 138:1773–1782. https://doi.org/10.1007/s00402-018-3051-5

    Article  PubMed  Google Scholar 

  2. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2017) Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 137:579–584. https://doi.org/10.1007/s00402-017-2659-1

    Article  CAS  PubMed  Google Scholar 

  3. Schlickum L, Quadlbauer S, Pezzei C et al (2018) Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3081-z

    Article  PubMed  Google Scholar 

  4. Schermann H, Kadar A, Dolkart O et al (2018) Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg 138:591–596. https://doi.org/10.1007/s00402-018-2904-2

    Article  PubMed  Google Scholar 

  5. Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137:1187–1191. https://doi.org/10.1007/s00402-017-2743-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Rotman D, Schermann H, Kadar A (2019) Displaced distal radius fracture presenting with neuropraxia of the dorsal cutaneous branch of the ulnar nerve (DCBUN). Arch Orthop Trauma Surg 139:1021–1023. https://doi.org/10.1007/s00402-019-03191-x

    Article  PubMed  Google Scholar 

  7. Weschenfelder W, Friedel R, Hofmann GO, Lenz M (2019) Acute atraumatic carpal tunnel syndrome due to flexor tendon rupture following palmar plate osteosynthesis in a patient taking rivaroxaban. Arch Orthop Trauma Surg 139:435–438. https://doi.org/10.1007/s00402-019-03116-8

    Article  PubMed  Google Scholar 

  8. Rubin G, Orbach H, Chezar A, Rozen N (2017) Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique. Arch Orthop Trauma Surg 137:49–54. https://doi.org/10.1007/s00402-016-2592-8

    Article  PubMed  Google Scholar 

  9. Lutz M, Erhart S, Deml C, Klestil T (2016) Arthroskopisch gesteuerte Osteosynthese der dislozierten intraartikulären distalen Radiusfraktur. Oper Orthop Traumatol 28:279–290. https://doi.org/10.1007/s00064-016-0448-6

    Article  CAS  PubMed  Google Scholar 

  10. Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J (2016) Die palmare winkelstabile Plattenosteosynthese bei Extensionsfrakturen des distalen Radius. Oper Orthop Traumatol 28:47–64. https://doi.org/10.1007/s00064-015-0433-5

    Article  CAS  PubMed  Google Scholar 

  11. Kastenberger T, Kaiser P, Schwendinger P et al (2020) Arthroscopic assisted treatment of distal radius fractures and concomitant injuries. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03373-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 06:102–112. https://doi.org/10.1055/s-0036-1587317

    Article  Google Scholar 

  13. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2020) Rehabilitation after distal radius fractures—is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03367-w

    Article  PubMed  PubMed Central  Google Scholar 

  14. Esenwein P, Sonderegger J, Gruenert J et al (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133:1155–1162

    Article  CAS  PubMed  Google Scholar 

  15. Yu YR, Makhni MC, Tabrizi S et al (2011) Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 36:1135–1141. https://doi.org/10.1016/j.jhsa.2011.04.004

    Article  PubMed  Google Scholar 

  16. Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129:661–669. https://doi.org/10.1007/s00402-009-0830-z

    Article  PubMed  Google Scholar 

  17. Quadlbauer S, Pezzei C, Hintringer W et al (2018) Clinical examination of the distal radioulnar joint. Orthopade 47:628–636

    Article  CAS  PubMed  Google Scholar 

  18. Suda AJ, Schamberger CT, Viergutz T (2019) Donor site complications following anterior iliac crest bone graft for treatment of distal radius fractures. Arch Orthop Trauma Surg 139:423–428. https://doi.org/10.1007/s00402-018-3098-3

    Article  PubMed  Google Scholar 

  19. Gologan RE, Koeck M, Suda AJ, Obertacke U (2019) > 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT. Arch Orthop Trauma Surg 139:877–881. https://doi.org/10.1007/s00402-019-03186-8

    Article  PubMed  Google Scholar 

  20. Erhart S, Toth S, Kaiser P et al (2018) Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 138:879–885. https://doi.org/10.1007/s00402-018-2925-x

    Article  CAS  PubMed  Google Scholar 

  21. Schnetzke M, Fuchs J, Vetter SY et al (2018) Intraoperative three-dimensional imaging in the treatment of distal radius fractures. Arch Orthop Trauma Surg 138:487–493. https://doi.org/10.1007/s00402-018-2867-3

    Article  PubMed  Google Scholar 

  22. Rosenauer R, Pezzei C, Quadlbauer S et al (2020) Complications after operatively treated distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03372-z

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hintringer W, Rosenauer R, Pezzei C et al (2020) Biomechanical considerations on a CT based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03405-7

    Article  PubMed  PubMed Central  Google Scholar 

  24. Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am 68:647–659

    Article  CAS  Google Scholar 

  25. Pezzei C, Quadlbauer S (2019) Radiocarpal pain and stiffness. In: del Piñal F (ed) Distal radius fractures and carpal instabilities. Georg Thieme, Stuttgart

    Google Scholar 

  26. Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031

    Article  Google Scholar 

  27. Gabl M, Arora R, Klauser AS, Schmidle G (2016) Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture. Arch Orthop Trauma Surg 136:1181–1188. https://doi.org/10.1007/s00402-016-2490-0

    Article  CAS  PubMed  Google Scholar 

  28. Disseldorp DJG, Hannemann PFW, Poeze M, Brink PRG (2016) Dorsal or volar plate fixation of the distal radius: does the complication rate help us to choose? J Wrist Surg 05:202–210. https://doi.org/10.1055/s-0036-1571842

    Article  CAS  Google Scholar 

  29. Dayican A, Unal VS, Ozkurt B et al (2003) Conservative treatment in intra-articular fractures of the distal radius: a study on the functional and anatomic outcome in elderly patients. Yonsei Med J 44:836. https://doi.org/10.3349/ymj.2003.44.5.836

    Article  PubMed  Google Scholar 

  30. Lameijer CM, Ten Duis HJ, van Dusseldorp I et al (2017) Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 137:1499–1513. https://doi.org/10.1007/s00402-017-2765-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lameijer CM, Ten Duis HJ, Vroling D et al (2018) Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 138:1699–1712. https://doi.org/10.1007/s00402-018-3046-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC (2011) A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 36:824–835. https://doi.org/10.1016/j.jhsa.2011.02.005

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chen Y, Chen X, Li Z et al (2016) Safety and efficacy of operative versus nonsurgical management of distal radius fractures in elderly patients: a systematic review and meta-analysis. J Hand Surg Am 41:404–413. https://doi.org/10.1016/j.jhsa.2015.12.008

    Article  PubMed  Google Scholar 

  34. Song J, Yu A-X, Li Z-H (2015) Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 8:17023–17035

    PubMed  PubMed Central  Google Scholar 

  35. Hohendorff B, Knappwerth C, Franke J et al (2018) Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138:1479–1485. https://doi.org/10.1007/s00402-018-2999-5

    Article  PubMed  Google Scholar 

  36. Herisson O, Delaroche C, Maillot-Roy S et al (2017) Comparison of lateral and skyline fluoroscopic views for detection of prominent screws in distal radius fractures plating: results of an ultrasonographic study. Arch Orthop Trauma Surg 137:1357–1362. https://doi.org/10.1007/s00402-017-2759-y

    Article  PubMed  Google Scholar 

  37. Leixnering M, Rosenauer R, Pezzei C et al (2020) Indications, surgical approach, reduction and stabilization techniques of distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03365-y

    Article  PubMed  PubMed Central  Google Scholar 

  38. Quadlbauer S, Pezzei C (2020) Palmare radioskapholunäre (RSL)-arthrodese. In: Unglaub F (ed) Meistertechniken in der operativen orthopädie und unfallchirurgie—hand und handgelenk. Springer, Berlin, pp 191–201

    Google Scholar 

  39. Brigstocke G, Hearnden A, Holt CA, Whatling G (2013) The functional range of movement of the human wrist. J Hand Surg Eur 38:554–556

    Article  CAS  Google Scholar 

  40. Palmer AK, Werner FW, Murphy D, Glisson R (1985) Functional wrist motion: a biomechanical study. J Hand Surg Am 10:39–46. https://doi.org/10.1016/S0363-5023(85)80246-X

    Article  CAS  PubMed  Google Scholar 

  41. Wilhelm A (2001) Denervation of the wrist. Tech Hand Up Extrem Surg 5:14–30

    Article  CAS  PubMed  Google Scholar 

  42. Weinstein LP, Berger RA (2002) Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation. J Hand Surg Am 27:833–839. https://doi.org/10.1053/jhsu.2002.35302

    Article  PubMed  Google Scholar 

  43. Hofmeister EP, Moran SL, Shin AY (2006) Anterior and posterior interosseous neurectomy for the treatment of chronic dynamic instability of the wrist. Hand 1:63–70. https://doi.org/10.1007/s11552-006-9003-5

    Article  PubMed  PubMed Central  Google Scholar 

  44. Burke D, Gandevia SC, Macefield G (1988) Responses to passive movement of receptors in joint, skin and muscle of the human hand. J Physiol 402:347–361. https://doi.org/10.1113/jphysiol.1988.sp017208

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Hagert E, Lluch A, Rein S (2016) The role of proprioception and neuromuscular stability in carpal instabilities. J Hand Surg (European) 41:94–101. https://doi.org/10.1177/1753193415590390

    Article  CAS  Google Scholar 

  46. Salva-Coll G, Garcia-Elias M, Hagert E (2013) Scapholunate instability: proprioception and neuromuscular control. J Wrist Surg 02:136–140. https://doi.org/10.1055/s-0033-1341960

    Article  Google Scholar 

  47. Gay A, Harbst K, Hansen DK et al (2011) Effect of partial wrist denervation on wrist kinesthesia: wrist denervation does not impair proprioception. J Hand Surg Am 36:1774–1779. https://doi.org/10.1016/j.jhsa.2011.07.027

    Article  PubMed  Google Scholar 

  48. Patterson RW, Van Niel M, Shimko P et al (2010) Proprioception of the wrist following posterior interosseous sensory neurectomy. J Hand Surg Am 35:52–56. https://doi.org/10.1016/j.jhsa.2009.10.014

    Article  PubMed  Google Scholar 

  49. del Piñal F, Moraleda E, Rúas JS et al (2018) Effectiveness of an arthroscopic technique to correct supination losses of 90° or more. J Hand Surg Am 43:676.e1–676.e6. https://doi.org/10.1016/j.jhsa.2018.01.006

    Article  Google Scholar 

  50. Kamal RN, Ruch DS (2017) Volar capsular release after distal radius fractures. J Hand Surg Am 42:1034.e1–1034.e6. https://doi.org/10.1016/j.jhsa.2017.08.002

    Article  Google Scholar 

  51. van Schoonhoven J (2016) Arthroskopische operationen am handgelenk. Oper Orthop Traumatol 28:231–232. https://doi.org/10.1007/s00064-016-0464-6

    Article  PubMed  Google Scholar 

  52. Löw S, Herold A, Eingartner C (2014) Die standardisierte arthroskopie des handgelenks. Oper Orthop Traumatol 26:539–546. https://doi.org/10.1007/s00064-014-0311-6

    Article  PubMed  Google Scholar 

  53. Damert H-G (2019) Handgelenkendoprothetik—ein erfahrungsbericht. Orthopade 48:402–412. https://doi.org/10.1007/s00132-019-03725-6

    Article  PubMed  Google Scholar 

  54. Boeckstyns MEH (2019) Functional outcomes after salvage procedures for the destroyed wrist: an overview. J Hand Surg Eur. https://doi.org/10.1177/1753193419876063

    Article  Google Scholar 

  55. Boeckstyns MEH (2014) Wrist arthroplasty—a systematic review. Dan Med J 61:A4834

    PubMed  Google Scholar 

  56. Yeoh D, Tourret L (2015) Total wrist arthroplasty: a systematic review of the evidence from the last 5 years. J Hand Surg Eur 40:458–468. https://doi.org/10.1177/1753193414539796

    Article  CAS  Google Scholar 

  57. Berber O, Garagnani L, Gidwani S (2018) Systematic review of total wrist arthroplasty and arthrodesis in wrist arthritis. J Wrist Surg 7:424–440. https://doi.org/10.1055/s-0038-1646956

    Article  PubMed  PubMed Central  Google Scholar 

  58. Boeckstyns MEH, Herzberg G (2017) Current European practice in wrist arthroplasty. Hand Clin 33:521–528. https://doi.org/10.1016/j.hcl.2017.04.004

    Article  PubMed  Google Scholar 

  59. Köhler S, Koch K, Arsalan-Werner A et al (2017) Wrist arthrodesis with a fixed-angle, ‘low-profile’ fusion plate without carpometacarpal joint fixation. Oper Orthop Traumatol 29:416–430. https://doi.org/10.1007/s00064-017-0517-5

    Article  PubMed  Google Scholar 

  60. Hernekamp J-F, Kneser U, Kremer T, Bickert B (2017) Mediokarpale teilarthrodese mit winkelstabiler plattenosteosynthese. Oper Orthop Traumatol 29:409–415. https://doi.org/10.1007/s00064-017-0514-8

    Article  PubMed  Google Scholar 

  61. Spies C, Unglaub F (2017) (Teil-)Arthrodesen an hand und handgelenk. Oper Orthop Traumatol 29:373. https://doi.org/10.1007/s00064-017-0518-4

    Article  CAS  PubMed  Google Scholar 

  62. Mannerfelt L, Malmsten M (1971) Arthrodesis of the wrist in rheumatoid arthritis: a technique without external fixation. Scand J Plast Reconstr Surg Hand Surg 5:124–130. https://doi.org/10.3109/02844317109042952

    Article  CAS  Google Scholar 

  63. Hastings H, Weiss APC, Quenzer D et al (1996) Arthrodesis of the wrist for post-traumatic disorders. J Bone Jt Surg Ser A. https://doi.org/10.2106/00004623-199606000-00013

    Article  Google Scholar 

  64. Nydick JA, Watt JF, Garcia MJ et al (2013) Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 38:899–903. https://doi.org/10.1016/j.jhsa.2013.02.013

    Article  PubMed  Google Scholar 

  65. Krimmer H, Schandl R, Wolters R (2020) Corrective osteotomy after malunited distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03370-1

    Article  PubMed  PubMed Central  Google Scholar 

  66. Terzis A, Koehler S, Sebald J, Sauerbier M (2020) Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03374-x

    Article  PubMed  Google Scholar 

  67. McNary SM, Heyrani N, Volk I et al (2019) The effect of radioscapholunate fusion with and without distal scaphoid and triquetrum excision on capitolunate contact pressures. J Hand Surg Am 44:420.e1–420.e7. https://doi.org/10.1016/j.jhsa.2018.07.009

    Article  Google Scholar 

  68. Bain GI, Ondimu P, Hallam P, Ashwood N (2009) Radioscapholunate arthrodesis—a prospective study. Hand Surg 14:73–82. https://doi.org/10.1142/S021881040900427X

    Article  PubMed  Google Scholar 

  69. Liechti R, Beeres FJP, Hug U (2019) Triquetrum excision in radioscapholunate arthrodesis for posttraumatic radiocarpal osteoarthritis with ulnar impaction syndrome. Tech Hand Up Extrem Surg. https://doi.org/10.1097/BTH.0000000000000251

    Article  PubMed  Google Scholar 

  70. Garcia-Elias M, Lluch A (2001) Partial excision of scaphoid: is it ever indicated? Hand Clin 17:687–695

    CAS  PubMed  Google Scholar 

  71. Garcia-Elias M, Lluch A, Ferreres A et al (2005) Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy. J Hand Surg Am 30:8–15. https://doi.org/10.1016/j.jhsa.2004.09.001

    Article  PubMed  Google Scholar 

  72. Mühldorfer-Fodor M, Ha HP, Hohendorff B et al (2012) Results after radioscapholunate arthrodesis with or without resection of the distal scaphoid pole. J Hand Surg Am 37:2233–2239. https://doi.org/10.1016/j.jhsa.2012.08.009

    Article  PubMed  Google Scholar 

  73. Montoya-Faivre D, Pomares G, Calafat V et al (2017) Clinical and radiological outcomes following radioscapholunate fusion. Orthop Traumatol Surg Res 103:1093–1098. https://doi.org/10.1016/j.otsr.2017.07.012

    Article  CAS  PubMed  Google Scholar 

  74. Quadlbauer S, Leixnering M, Rosenauer R et al (2020) Palmar radioscapholunate arthrodesis with distal scaphoidectomy. Oper Orthop Traumatol. https://doi.org/10.1007/s00064-020-00651-1

    Article  PubMed  Google Scholar 

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We thank Rose-Marie Sedlacek for proof reading this article. Without her help, this English publication would not have been possible.

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Keuchel-Strobl, T., Quadlbauer, S., Jurkowitsch, J. et al. Salvage procedure after malunited distal radius fractures and management of pain and stiffness. Arch Orthop Trauma Surg 140, 697–705 (2020). https://doi.org/10.1007/s00402-020-03369-8

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