Category Archives: Traumatology

External Fixator to Volar Plate

by Alejandro Badia, MD

It was not too long ago that the standard of care for a distal radius fracture with displacement was the application of an external fixator. Like the brief internment in a penal colony, the patient was left to deal with this cumbersome device for several months. I highly doubt that many of the little old ladies who had this device applied appreciated its “minimally invasive” nature.

Over 10 years ago, I remember my partner and I applying the standard volar plate from the synthes set to ALL distal radius fractures, regardless of direction of  displacement. I think neither Mrs. Smith nor Mrs. Colles cared about their Frykman classification but likely appreciated the fact that a small palmar based plate on the wrist, as an outpatient under regional anesthesia, could allow them to get right back to their daily routine simply using a small splint or fiberglass cast as protection.

I remember just a few years later lecturing on this very topic in Ho Chi Minh City, or even Buenos Aires, and realizing that this had very quickly become the standard of care worldwide. It was gratifying to be part of a revolution that truly improved patient care of this ubiquitous fracture.

Alejandro Badia, MD

Badia Hand to Shoulder Center

Miami, FL, USA

How Urgent are Open Fractures?

Dahners photo

Dr. Laurence Dahners

by Laurence E. Dahners, M.D.

A relatively new factor to consider in the treatment of trauma victims with open fractures is the fact that the data do not support the concept that open fractures are “emergencies requiring surgical debridement within six hours.” Initial studies were in pediatric open fracture but recently papers regarding infection rates in adults have been published as well. None of these studies has shown a statistically significant difference in infection rates in fractures debrided in less than six hours as compared to those debrided between six and twenty-four hours. The “trends” (non statistical differences) lean toward higher infection rates in those debrided in the first six hours! It does make a huge difference how soon the antibiotics are started so this remains very important. It is difficult to rationalize why early debridement would not lower infection rates but I hypothesize that it may be easier to differentiate necrotic from viable tissue when the debridement is carried out after six hours. In any case I now perform debridement during the daylight hours.

Dr. Dahners is a Professor of Orthopaedic Surgery at the UNC School of Medicine in Chapel Hill, NC, USA.  His clinical focus is on trauma and his research interests are in ligament physiology, ligament healing, ligament growth and contracture, and bone healing and the biomechanics of internal fixation.  You can see his “Pearls of Orthopaedics” on OrthopaedicList.com.