Health Matters: 5 February 2013

The next Health Matters public lecture will be held on Tuesday 5 February 2013, from 7-8pm, in the Lecture Theatre, Education & Training. The talk will be presented by Dr Rubina Japanwala, Consultant Orthogeriatrician, and is entitled “Bone Health Matters, or does it?”

The aim of the talk is to increase awareness to improve bone health and to prevent falls and fractures, and will give information about osteoporosis, falls, vitamin D, and fractures.
Dr Japanwala is also the Falls Lead for the Trust.

Members of staff are very welcome to attend this interesting talk.  If you would like to attend please contact the Communications & Engagement Team on ext 1560 (01625 661560) or email us at ecn-tr.YourVoice@nhs.net.

NB:
This article “Discrepancies in predicted fracture risk in elderly people” is published in the BMJ (Jan 2013) looks at calculators used to estimate fracture risk in elderly people which give widely different results. Mark Bolland and colleagues argue that treatment decisions should be based on calculators using 3-5 year estimates of risk.  Click for full article

Singhal R, Shakeel M, Dheerendra S, Morapundi S, Waseem M: Journal of Bone and Joint Surgery

Comparison between aptus and DVR plate as the preferred method of distal radius fracture fixation.   This article was submitted for publication by Drs’ R SinghalM ShakeelS Dheerendra,  S MorapudiM Waseem of MDGH and P Ralte.

  1. J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXVI 66 

Background Volar locking plates have revolutionised the treatment for distal radius fractures. The DVR (Depuy) plate was one of the earliest locking plates which were used and they provided fixed angle fixation. Recently, newer volar locking plates, such as the Aptus (Medartis), have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. The aim of our study was to compare the outcomes of DVR and Aptus volar locking plates in the treatment of distal radial fractures.

Methods   Details of patients who had undergone open reduction and internal fixation of distal radii from October 2007 to September 2010 were retrieved from theatre records. 60 patients who had undergone stabilisation of distal radius fractures with either DVR (n=30) or Aptus (n=30) plate were included in the study.

Results Mean age of patients undergoing fixation using DVR plate was 56.6 years (n=30) with 22 females and 8 males. Fractures in this group included 20 type 23-C, three type 23-B and seven type 23-A. The patients were followed up for an average of 5.5 months (2-16 months). 3 patients underwent revision of fixation due to malunion (n=1), non-union (n=1) and failure of fixation (n=1). Four patients had reduced movements even after intensive physiotherapy necessitating removal of plate.

Mean age of patients undergoing Aptus volar locking plate fixation was 56.38 years (n=30) with 21 females and 9 males. There were 27 type 23-C, two type 23-B and one type 23-A fractures according to AO classification. The patients were followed up for an average of 4.1 months (2-11 months). 2 patients developed complex regional pain syndrome (CRPS) and 1 patient underwent removal of screws due to late penetration of screws into the joint.

Conclusion Complex and unstable fractures of the distal radius can be optimally managed with volar locking plates. Both systems are user friendly. Aptus plates provide an additional advantage of flexibility in implant positioning and enhanced intra-fragmentary fixation compared to the DVR plate. In our study Aptus plates had lower secondary surgical procedures compared to DVR plates.