CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

ADVANCEMENTS IN THE MANAGEMENT OF UPPER EXTREMITY FRACTURES: NEW RESEARCH AND INNOVATIONS

Erdi İmre

İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye

İmre E. Advancements in The Management of Upper Extremity Fractures: New Research and Innovations. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.409-414.

ABSTRACT

Recent technological developments and innovations have improved the diagnosis, classification, and treatment of upper extremity fractures and associated soft tissue injuries with minimal morbidity. In this article, the innovations in upper extremity fractures were reviewed. Minimally invasive techniques have shown successful results in upper extremity fractures. Anatomical locking nails show promise for forearm fractures with extensive soft tissue damage, due to their minimally invasive nature; however, higher-quality studies that include various fracture types and associated soft tissue injuries are needed. Similarly, arthroscopic-assisted techniques, although requiring more specialized equipment, have demonstrated promising results, however, their use has not yet become widespread. Currently, 3D printing technology is increasingly being used in the preoperative planning of upper extremity fractures by using thin-section CT-scan or MRI images and showing promising for reducing surgical time and radiation exposure results by helping preoperative planning of complex fractures. Custom-made 3D-printed plates and guides have been successfully applied in challenging cases, such as distal humerus and scaphoid fractures, though the technology is still evolving. Artificial intelligence has demonstrated high accuracy in diagnosing and classifying upper extremity fractures. Its use in this area has the potential to become part of the routine workflow in orthopedic practice. In summary, recent technological developments and innovations increase patient satisfaction. These technologies are anticipated to find more use in daily orthopedic practices.

Keywords: Upper extremity; Minimally invasive surgical procedures; 3D printing; Artificial intelligence; Inventions

Referanslar

  1. Zhang XF, Huang JW, Mao HX, Chen WB, Luo Y. Adult diaphyseal both-bone forearm fractures: A clinical and biomechanical comparison of four different fixations. Orthop Trau matol Surg Res 2016;102:319-25. [Crossref]  [PubMed]
  2. Kibar B, Kurtulmuş T. Treatment of adult isolated ul İmre Advancements in The Management of Upper Extremity Fractures: New Research and Innovations nar diaphyseal fractures: A comparison of new-generation locked intramedullary nail and plate fixation. Eklem Hastalık Cerrahisi 2019;30:246-51. [Crossref]  [PubMed]
  3. Köse A, Aydın A, Ezirmik N, Yıldırım Ö S. A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures. Ulus Travma Acil Cerrahi Derg 2017;23:235-44. [Crossref]
  4. Lee SK, Kim KJ, Lee JW, Choy WS. Plate osteosynthesis versus intramedullary nailing for both forearm bones fractures. European Journal of Orthopaedic Surgery & Traumatology 2014;24:769-76. [Crossref]  [PubMed]
  5. Behnke NM, Redjal HR, Nguyen VT, Zinar DM. Internal fixation of diaphyseal fractures of the forearm: A retrospective comparison of hybrid fixation versus dual plating. J Orthop Trauma 2012;26:611-6. [Crossref]  [PubMed]
  6. Karjalainen VL, Harris IA, Räisänen M, Karjalainen T. Minimal invasions: Is wrist arthroscopy supported by evidence? A systematic review and meta-analysis. Acta Orthop 2023;94:200-6. [Crossref]  [PubMed]  [PMC]
  7. Saab M, Guerre E, Chantelot C, Clavert P, Ehlinger M, Bauer T. Contribution of arthroscopy to the management of intra-articular distal radius fractures: Knowledge update based on a systematic 10-year literature review. Orthop Traumatol Surg Res 2019;105:1617-25. [Crossref]  [PubMed]
  8. Román-Veas J, Gutiérrez-Espinoza H, Campos-Jara C, Martínez-García D. Arthroscopic assistance in surgical management of distal radius fractures: A systematic review and meta-analysis. J Wrist Surg 2024;13:86-95. [Crossref]  [PubMed]  [PMC]
  9. Pérez-Úbeda MJ, Arribas P, Gimeno García-Andrade MD, et al. Adjuvant arthroscopy does not improve the functional outcome of volar locking plate for distal radius fractures: A randomized clinical trial. Arthroscopy 2024;40:305-17. [Crossref]
  10. Del Piñal F, Clune J. Arthroscopic management of intra-articular malunion in fractures of the distal radius. Hand Clin 2017;33:669-75. [Crossref]  [PubMed]
  11. Guerra E, Marinelli A, Tortorella F, et al. Elbow arthroscopy for the treatment of radial head fractures: Surgical technique and 10 years of follow up results compared to open surgery. J Clin Med 2023;12. [Crossref]  [PubMed]  [PMC]
  12. Zhang Y, Chang N, Athwal GS, King GJ. Arthroscopic reduction and internal fixation of capitellar and trochlear fractures: A case series. Shoulder Elbow 2023;15:75-81. [Crossref]  [PubMed]  [PMC]
  13. You C, Cheng Z, Xia Y, et al. Good outcomes of elbow arthroscopy-assisted absorbable screw fixation for capitellum fracture of the humerus in children: A case series. Front Pediatr 2023;11:1202537. [Crossref]  [PubMed]  [PMC]
  14. Weng L, Zhang G, Zhou H, Liu X, Cao Y, Zhang Y. Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children. Injury 2024;55:111309. [Crossref]  [PubMed]
  15. Lin IH, Lin TL, Chang HW, et al. Arthroscopy-assisted reduction and internal fixation versus open reduction and internal fixation for glenoid fracture with scapular involvement: A retrospective cohort study. J Clin Med 2022;11. [Crossref]  [PubMed]  [PMC]
  16. Fidanza A, Caggiari G, Di Petrillo F, Fiori E, Momoli A, Logroscino G. Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: Preoperative planning, patient satisfaction, and improved resident skills. J Orthop Traumatol 2024;25:11. [Crossref]  [PubMed]  [PMC]
  17. You W, Liu LJ, Chen HX, et al. Application of 3d printing technology on the treatment of complex proximal humeral fractures (neer3-part and 4-part) in old people. Orthop Traumatol Surg Res 2016;102:897-903. [Crossref]  [PubMed]
  18. Wu RJ, Zhang W, Lin YZ, et al. Influence of preoperative simulation on the reduction quality and clinical outcomes of open reduction and internal fixation for complex proximal humerus fractures. BMC Musculoskelet Disord 2023;24:243. [Crossref]  [PubMed]  [PMC]
  19. Jirangkul P, Lorsuwannarat N, Wanichjaroen N. Precontoured dynamic compression plate using patient-specific 3d-printed models in minimally invasive surgical technique for midshaft clavicle fractures. Arch Orthop Trauma Surg 2024;144:103-11. [Crossref]  [PubMed]
  20. Cao C, Xing H, Cao F, Du Z, Wang G, Wang X. Three-dimensional printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager: A case report. Medicine (Baltimore) 2023;102:e32507. [Crossref]  [PubMed]  [PMC]
  21. Shuang F, Hu W, Shao Y, Li H, Zou H. Treatment of intercondylar humeral fractures with 3d-printed osteosynthesis plates. Medicine (Baltimore) 2016;95:e2461. [Crossref]  [PubMed]  [PMC]
  22. Yang L, Grottkau B, He Z, Ye C. Three dimensional printing technology and materials for treatment of elbow fractures. Int Orthop 2017;41:2381-7. [Crossref]  [PubMed]
  23. Luenam S, Kosiyatrakul A, Charoenlap C, Puncreobutr C, Lohwongwatana B. Radial head replacement with the 3d-printed patient-specific titanium prosthesis: Preliminary results of a multi-centric prospective study. J Orthop Surg (Hong Kong) 2024;32:10225536241236806. [Crossref]  [PubMed]
  24. Guebeli A, Thieringer F, Honigmann P, Keller M. Inhouse 3d-printed custom splints for non-operative treatment of distal radial fractures: A randomized controlled trial. J Hand Surg Eur Vol 2024;49:350-8. [Crossref]  [PubMed]
  25. Xiao Y-P, Xu H-J, Liao W, Li Z-H. Clinical application of instant 3d printed cast versus polymer orthosis in the treatment of colles fracture: A randomized controlled trial. BMC Musculoskeletal Disorders 2024;25:104. [Crossref]  [PubMed]  [PMC]
  26. El Khoury G, Libouton X, De Boeck F, Barbier O. Use of a 3d-printed splint for the treatment of distal radius fractures: A randomized controlled trial. Orthop Traumatol Surg Res 2022;108:103326. [Crossref]  [PubMed]
  27. Sebastián Giraldo P, Elvira Soler M, Fernández Kang A, Martínez Martínez F, García López A. Randomized clinical trial on the usefulness of 3d printing in intra-articular fractures of the distal radius. Rev Esp Cir Ortop Traumatol 2023.
  28. Lin F, Li S, Sun K, Jiang L, Shi J. The clinical application of individualized three-dimensional printing guiding template for assisting scaphoid fracture fixation through dorsal approach. Acta Orthop Belg 2022;88:749-56. [Crossref]  [PubMed]
  29. Yin HW, Xu J, Xu WD. 3-dimensional printing-assisted percutaneous fixation for acute scaphoid fracture: 1-shot procedure. J Hand Surg Am 2017;42:301.e1-.e5. [Crossref]  [PubMed]
  30. Rong C, Zhang Q, Zhu S, et al. 3d printed guide-assisted percutaneous screw fixation for minimally displaced scaphoid waist fractures with delayed diagnosis or presentation. BMC Musculoskeletal Disorders 2024;25:127. [Crossref]  [PubMed]  [PMC]
  31. Chung SW, Han SS, Lee JW, et al. Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthop 2018;89:468-73. [Crossref]  [PubMed]  [PMC]
  32. Zech JR, Jaramillo D, Altosaar J, Popkin CA, Wong TT. Artificial intelligence to identify fractures on pediatric and young adult upper extremity radiographs. Pediatr Radiol 2023;53:2386-97. [Crossref]  [PubMed]
  33. Kekatpure A, Kekatpure A, Deshpande S, Srivastava S. Development of a diagnostic support system for distal humerus fracture using artificial intelligence. Int Orthop 2024;48:1303-11. [Crossref]  [PubMed]