***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Outcome measurement following surgery is increasingly the focus of attention in current health-care debates because of the rising costs of medical care and the large variety of operative options . The purpose of the present study was to correlate quality of life after volar locked plate fixation of unstable intra-articular distal radial fractures with functional and radiographic results as well as with quality -of-life data from population norms . METHODS Fifty-four consecutive patients with intra-articular distal radial fractures and a mean age of sixty-three years were managed with a volar locked plate system .  Range of motion , grip strength , and radiographs were assessed at a mean of six years postoperatively . The wrist-scoring systems of Gartl and and Werley and Castaing were adopted for the assessment of objective outcomes . The Disabilities of the Arm , Shoulder and H and and Short Form-36 question naires were completed as subjective outcome measures , and the results were compared with United States and Austrian population norms . RESULTS Functional improvement continued for two years postoperatively . At the time of the latest follow-up , > 90 % of all patients had achieved good or excellent results according to the scoring systems of Gartl and and Werley and Castaing . The results of the Short Form-36 question naire were similar to the United States and Austrian population norms . The mean Disabilities of the Arm , Shoulder and H and score was 5 points at two years , and it increased to 13 points at six years . The twenty patients with radiocarpal arthritis had significantly poorer results in the physical component summary measure of the Short Form-36 question naire ( p = 0.012 ) . CONCLUSIONS The results of the present single-center study show that , following distal radial fracture fixation , wrist arthritis may affect the patient 's subjective well-being , as documented with the Short Form-36 , without influencing the functional outcome . Well- design ed longitudinal clinical trials are needed to confirm the findings of the present investigation in terms of quality of life after surgical treatment of intra-articular distal radial fractures Different methods exist to treat distal radius fractures . A prospect i ve r and omized study was conducted to establish whether palmar plate fixation with locking screws gave better results than percutaneous K-wire fixation in patients over 50 years of age . Only fractures with dorsal displacement after a simple fall were included in the study . Twenty wrists were treated with  K-wires  and 20 with a  plate .  Radiological parameters were measured on preoperative radiographs and at five weeks postoperatively . Clinical results and DASH scores were determined at three months postoperatively and at more than one year . No significant difference in radial inclination , palmar tilt , clinical outcome and DASH score was found between plating and K-wires , but the mean difference in ulnar variance between pre- and postoperative radiographs was significantly better with plates . It can be concluded that plates were superior to K-wires in restoring ulnar variance , but functional outcome was similar with both techniques INTRODUCTION Malunion following open reduction and internal fixation of distal radius fracture threatens wrist function . Fixed-angle palmar plates provide rigid fixation that is stable over time ; however , the pronator quadratus sectioning required by the anterior approach entails a risk of pronation strength loss and of distal radioulnar joint destabilization . The present study assessed recovery of grip , pronation and supination strength following such internal fixation . PATIENTS AND METHOD A prospect i ve study included 26 distal radial fractures with dorsal displacement , osteosynthesized using a fixed-angle palmar plate , in 25 patients ( mean age : 47.5 years ; range : 17 - 72 years ) . Assessment concerned the classical parameters , plus grip and pronosupination strength recovery . RESULTS At a mean 14 months follow-up ( range : 6 - 30 months ) , patients had recovered 91 % grip strength , 88 % pronation strength and 85 % supination strength with respect to the healthy side . Complications comprised three cases of malunion , two of reflex sympathetic dystrophy syndrome , and four of post-traumatic carpal tunnel syndrome . DISCUSSION A study of the literature found 75 - 95 % grip strength recovery following osteo synthesis using fixed-angle plates . Few studies , however , have focused on pronosupination strength , and none reported its evolution following osteo synthesis . CONCLUSION The present study found no drawbacks associated with a technique which usually involves sectioning the pronator quadratus . Except in case of malunion or joint stiffness , fixed-angle palmar plate osteo synthesis was followed by recovery of grip and pronosupination strength . LEVEL OF EVIDENCE Level IV : prospect i ve non-r and omized , non-comparative observational study PURPOSE To compare minimally invasive intramedullary nails ( IMN ) and volar locking plates ( VLP ) for the treatment of unstable distal radius fractures by evaluating postoperative subjective , radiographic , and functional outcomes . The hypothesis was that IMN patients would have less pain and required less pain medication in the early postoperative period and returned to work earlier than VLP patients . METHODS Sixty patients with closed , displaced , unstable , extra-articular , metaphyseal fractures of the distal radius were r and omized to receive a VLP or an IMN for internal fixation . Functional outcomes ( Quick Disabilities of the Arm , Shoulder , and H and , Michigan H and Question naire ) , radiographic measurements ( ulnar variance , radial height , inclination , and volar tilt ) , and range of motion were assessed until final follow-up at 2 years after surgery . Narcotic pain medication use was documented for 5 weeks following surgery . RESULTS There were 2 groups of 30 patients with IMN ( mean age , 55 ± 14 y ) or VLP ( mean age , 55 ± 16 y ) with similar demographics and comorbidities . Patients with IMN  regained extension earlier but had similar range of motion to patients with VLP at final follow-up . There was similar improvement in Michigan H and Question naire , Quick Disabilities of the Arm , Shoulder , and H and , and strength between groups . Five weeks after surgery , fewer IMN patients required narcotic pain medication ( 13 % ) than VLP patients ( 33 % ) . Radiographic outcomes were similar at final follow-up . There were 3 failures with IMN versus 1 failure with VLP . All 10 employed patients with IMN  returned to previous work compared with 10 of the 12 employed patients with VLP . Time to return to work was similar for both groups . CONCLUSIONS In a cohort of similar patients , IMN and VLP provided comparable improvement in functional and radiographic outcomes . Patients with IMN required less narcotic pain medication after surgery than VLP patients . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic II ABSTRACT The purpose of this study was to determine whether volar locking plate fixation for distal radius fracture benefits the fragility fracture population as much as it benefits the non-fragility fracture population . This matched case-control study was conducted based on a multi-center clinical prospect i ve cohort . A comparison of treatment outcomes after volar locking plate fixation was made between females 55 years of age and older ( fragility fracture population ) and males less than 75 years of age ( non-fragility fracture population ) by evaluating clinical , radiological , and subjective outcomes using H and 20 , a vali date d patient-rated disability instrument . A total of 170 patients were enrolled in this study . The two cohorts were matched in terms of AO fracture type . The fragility fracture population group and the non-fragility fracture population group each consisted of 50 patients . All objective measurements including wrist range of motion and radiological evaluations , but excluding grip strength , were not significantly different between the two groups . However , the H and 20 at 18 months after surgery was worse in the fragility fracture population group than in the non-fragility fracture population group . Carpal tunnel syndrome was the most frequently encountered complication in the fragility fracture population group , with one case ( 2 % ) in the non-fragility fracture population group and six cases ( 12 % ) in the fragility fracture population group , but the difference was not significant . In conclusion , there was a significant deficit in the improvement in disability despite favorable radiological and functional outcomes in fragility fracture population patients . Therefore , the fragility fracture population , especially middle-aged or older women , needs to be informed about prolonged disability and the higher risk of upper extremity disorders prior to surgery Objectives : The purpose of this study was to compare the postoperative radiologic and clinical outcomes of conventional plate osteo synthesis ( C ) with minimally invasive plate osteo synthesis ( M ) using a transverse skin incision without cutting the pronator quadratus muscle for distal radius fractures . Design : Retrospective consecutive cohort with prospect i ve data collection . Setting : One community teaching hospital . Surgical treatment was performed by a single surgeon . Patients : Sixty-six patients ( C group , 36 ; M group , 30 ) underwent open reduction and internal fixation of dorsally displaced distal radius fractures with the volar locking plating system from June 2006 to August 2008 . Their mean age was 63.5 years and the mean follow-up period was 22.7 months . Main Outcome Measures : Radiologic parameters ( volar tilt , radial inclination , ulnar variance ) , range of motion , grip strength , and Disability of the Arm , Shoulder , and H and score were evaluated at each examination . The visual analog scale of wrist pain and evaluations of cosmetic problems were assessed at the final follow-up . Results : The groups did not differ significantly in all main outcomes . In the M group , the mean values of the Disability of the Arm , Shoulder , and H and score at 2 weeks postoperatively ( P = 0.06 ) and visual analog scale ( P = 0.07 ) were lower and the mean value of the patient 's satisfaction score of cosmetic problems ( P = 0.08 ) was higher than those in the C group , but no statistically significant differences were apparent in these values . Conclusion : No significant differences were found between the minimally invasive plate osteo synthesis and conventional plating for distal radius fractures based on the data from postoperative radiologic and clinical outcomes Background Current surgical approaches to the distal radius include dorsal and palmar plate fixation . While palmar plates have gained widespread popularity , few reports have provided data on long term clinical outcomes in comparison . This paper reports the result of a r and omised clinical study comparing dorsal Pi plates and palmar , angle-stable plates for treatment of comminuted , intraarticular fractures of the distal radius over the course of twelve months . Methods 42 patients with unilateral , intraarticular fractures of the distal radius were included and r and omised to 2 groups , 22 were treated with a palmar plate , 20 received a dorsal Pi-plate . Results were evaluated after 6 weeks , 3 , 6 and 12 months postoperatively focussing on functional recovery as well as radiological results . Results The palmar plate group demonstrated significantly better results regarding range of motion and grip strength over the course of 12 months . While a comparable increase in function was observed in both groups , the better results from the early postoperative period in the palmar plate group prevailed over the whole course . Radiological results showed a significantly increased palmar tilt and carpal sag in dorsal plates , with other radiological parameters being comparable . Pain levels were decreased in dorsal plates after hardware removal and failed to show significant differences after 12 months . However , complications such as tendon ruptures were more frequent in the dorsal plate group . Conclusions Functional advantage of palmar plates gained within the first 6 weeks prevails over the course of a year . Both groups demonstrate further gradual increase of function after 6 months , although dorsal plates did not catch up completely . Improved early postoperative function seems to be the cornerstone for the best possible results . Patients with dorsal plates benefit from hardware removal more than palmar plates in terms of reduction of pain levels . The advantage of palmar plates is a faster functional recovery with lower complication rates . This is especially important in the elderly population . Radiological results did not show a superiority of palmar plates over dorsal plates Introduction : Distal radius fracture ( DRF ) is a common injury and various treatment modalities including open reduction and internal fixation ( ORIF ) with volar locking plate are available . More recently , a non-invasive external fixator has been used . Aims : To prospect ively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group . Methods : Consecutive patients with closed DRF were included in a prospect i ve case-controlled study . Patients were assigned to non-invasive external fixator or ORIF . Minimum follow-up was two years . Follow-up was at weeks 2 , 4 , 6 , 8 , 12 , 26 and at one and two-year post-operatively . The outcome measures included demographic details , injury mechanism , AO fracture type , risk factors , body mass index ( BMI ) , ulnar styloid fracture and dorsal comminution , radiographs , grip strength and DASH score . Results : Consecutive 50 patients were treated either with non-invasive external fixator ( 25/50 ) or with ORIF ( 25/50 ) and the mean age of the two groups was 53 years ( SD 17.1 ) and 49 years ( SD 19.5 ) , respectively . Demographics were matched in two groups . In the non-invasive external fixator group , there were 10 AO Type-A , 5 Type-B and 10 Type-C fractures . The ORIF group included 8 Type-A , 6 Type-B and 11 Type-C fractures . The mean DASH score at three-months and one- 
    Output:
    
There was a diversity of removal rate and reasons in the studies over the world .
High frequent VLP removal did not contribute to better clinical outcomes