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Regardless of method of radius fixation, ulnar styloid tip fractures should be fixed to preserve DRUJ stability
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0/156
Placing a VLP proximal to the watershed line increases the likelihood for flexor tendon injury
1%
1/156
Wound complications are higher in the VLP
2/156
Both methods of fixation will yield satisfactory results
70%
109/156
Pillar pain is likely in both groups
26%
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Both external fixation (EF) and volar locking plate (VLP) produce successful results in the treatment of distal radius fractures. Williksen et al. randomized 111 unstable distal radius fractures to VLP or EF. At 5 years there was no difference in DASH. For AO/OTA type C2 fractures, VLP had mildly superior supination, flexion, grip strength, Mayo wrist score, and less ulnar shortening. In the VLP cohort, 21% required HWR for surgical complications. The authors concluded that both methods of fixation achieved satisfactory outcomes at 5 years. Agee reviewed multiplanar ligamentotaxis in the reduction and stabilization of distal radius fractures. Ligamentotaxis refers to the tension applied across a fracture by the surrounding soft tissues. Dr. Agee contends that use of an EF allows for adjustments in many planes which in turn helps restore anatomic alignment until the distal radius fracture heals. Egol et al. randomized 120 wrist fractures that received EF for fracture stabilization into three groups for pin site care: weekly dry dressings, daily pin site care with hydrogen peroxide, and chlorhexidine discs around the pins. The fixators remained in place for 5.9 weeks and 19% had a pin tract complication. There were no differences between the three groups in terms of the prevalence of pin-site complications. However, increasing the age of the patient was correlated to pin-track complications. Incorrect answers: Answer 1: Ulnar styloid tip fixation is not necessary and an ulnar styloid tip non-union likely does not affect outcomes. Answer 2: Placement of the VLP distal to the watershed line increases the risk for flexor tendon injury. Answer 3: Wound complications (pin tract infections) are higher in the EF cohort. Answer 5: Pillar pain is frequent in carpal tunnel release, but not necessarily in distal radius fracture fixation.
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