Plating Of Distal Radius Fractures Research Articles

Computer tomography aided 3D analysis of the distal dorsal radius surface and the effects on volar plate osteosynthesis

The aims of this study were to measure the size of Lister's Tubercle, the extent of the extensor pollicis longus (EPL) groove and the dihedral angle of the distal dorsal radius. Computer tomography scans of 30 forearms were performed by using a 64-slice Siemens SOMATOM Sensation CT system (Resolution 0.6 mm). DICOM raw data were calculated to 3D by MIMICS software (Materialise, Leuven, Belgium). The size of Lister's Tubercle varied from 1.4 to 6.6 mm (average 3.3 mm) in height radial to the tubercle, and from 5.6 to 18.6 mm (average 13.2 mm) in length. The depth of the EPL groove varied from 0.6 to 3.2 mm (average 1.6 mm). The height on the ulnar side, between the depth of the groove and the tip of the tubercle, varied from 2.2 to 5.8 mm (average 3.4 mm). The dihedral angle of the distal dorsal radius varied from 110 degrees to 135 degrees (average 123 degrees). The variations in height of Lister's Tubercle and in depth of the EPL groove are considerable. This needs to be taken into account when performing volar plating of distal radius fractures otherwise screws may inadvertently penetrate the dorsal cortex of the radius potentially leading to EPL rupture.

The Effect of Ulnar Styloid Fractures on Patient-rated Outcomes after Volar Locking Plating of Distal Radius Fractures: Level 2 Evidence

The Effect of Ulnar Styloid Fractures on Patient-rated Outcomes after Volar Locking Plating of Distal Radius Fractures: Level 2 Evidence

Volar plating of distal radius fractures using a locked anatomically contoured plate

Background Distal radius fractures are the most common injury to present to orthopaedic fracture clinics. Displaced extra- or intra-articular fractures require reduction to allow a good outcome. Historically fractures were treated with manipulation and casting, with or without wire fixation. Modern plating techniques allow accurate reduction and internal fixation with early mobilisation.

Flexor Tendon Injuries Following Locked Volar Plating of Distal Radius Fractures

Flexor Tendon Injuries Following Locked Volar Plating of Distal Radius Fractures

Morphometric Analysis of Lister's Tubercle and Its Consequences on Volar Plate Fixation of Distal Radius Fractures

The objective of this study was to measure the size and shape of Lister's tubercle and the depth of the extensor pollicis longus (EPL) groove to assess the risk of injury to the EPL tendon when performing volar plating of distal radius fractures. The length and height of Lister's tubercle and the depth of the EPL groove were measured in 100 cadavers. The size of Lister's tubercle varied from 2 to 6 mm (average, 3.6 mm) in height radial to the tubercle and from 6 to 26 mm (average, 18.3 mm) in length. The depth of the EPL groove varied from 1 to 5 mm (average, 2.8 mm), with 63% being greater than 2 mm in depth. The height between the depth of the groove and the tip of the tubercle varied between 4 and 10 mm (average, 7.1 mm). No correlation was found with gender or right-side or left-side specimens. The individual and combined height of Lister's tubercle and the depth of the EPL groove are considerable. This fact needs to be considered when performing volar plating of distal radius fractures because of the possibility that it might be difficult to determine precisely the presence and amount of past-pointing of the distal screws.

Fixed-Angle Volar Plate Fixation for Distal Radius Fractures in Immunosuppressed Patients

The aim of this study was to define the outcome and complications following open reduction and internal fixed-angle plating of distal radius fractures for patients on chronic immunosuppression medications. A retrospective study identified 11 patients with distal radius fractures that had been on chronic immunosuppressive medication. The mean patient age was 59.9 years (40-82 years). According to the Orthopedic Trauma Association classification, there was one 23A3, one 23B3, and nine 23C type fractures. There were two open fractures. All patients received preoperative antibiotics and underwent reduction and fixation with a volar, fixed-angle plate. Postoperative measurements included postoperative and final radiographic indices, wrist flexion and extension, forearm rotation, and grip strength. Clinical follow-up averaged 13 months, and radiographic follow-up averaged 14.9 months. Statistical analysis was performed comparing means of various parameters with a two-sided t test with an alpha value < or = 0.05. All fractures healed, and there were no infections. The final mean ulnar variance, volar tilt, and radial inclination were -0.1 mm (ulnar negative; -2.0 to +2.5 mm), 13 degrees (5-23 degrees), and 21 degrees (15-27 degrees), respectively. The mean articular gap or step was 0.4 mm. There was a small but significant decrease between the final and postoperative mean ulnar variance (p = 0.03). Mean wrist flexion was 47 degrees, extension 47 degrees , pronation 77 degrees, and supination was 76 degrees. Grip strength averaged 16.3 kg versus 25.1 kg for the opposite extremity. The one major complication included a postoperative carpal tunnel syndrome. Fixed-angle volar plate fixation for distal radius fractures in patients with chronic immunosuppression was associated with union (with acceptable radiographic alignment), no wound-healing problems or infections, and with functional wrist and forearm motion and grip strength.

Flexor Tendon Injuries Following Locked Volar Plating of Distal Radius Fractures

We present 2 cases showing that flexor pollicis longus and flexor digitorum profundus index injury can occur after placement of 2 commonly used locked volar plates. In contrast with the literature, the radii healed in an anatomic position without plate lift-off. The patients presented 6 and 8 months after surgery with new onset of radial wrist pain and tenderness at the site of the plate and absence or weakness of the flexor pollicis longus. In both cases, the plate was positioned anterior to the distal radial rim on the lateral radiograph. We suggest close follow-up of all fractures in which the distal end of the plate is anterior to the radial rim and removal of hardware if symptoms suggest tendon irritation.

DELAYED RUPTURE OF EXTENSOR DIGITORUM COMMUNIS TENDON FOLLOWING VOLAR PLATING OF DISTAL RADIUS FRACTURE

We present a case of delayed rupture of extensor digitorum communis tendon seven years after volar plating of distal radius fracture. Drill bit penetration during surgery and prominent screw tips into the fourth extensor compartment have a potential risk to damage the tendons. Careful and accurate use of internal fixation instruments is necessary to avoid this complication.

Complications of Volar Locking Plates for Distal Radius Fractures: Experience of a District General Hospital

Background: The role of volar locking plates in the treatment of distal radial fractures is unsettled. The objective of this study is to evaluate the complications of this treatment method in a district general hospital setting. Methods: We retrospectively reviewed the radiological and clinical records of 52 consecutive patients who were treated using volar locking plates between November 2004 and August 2006. Results: Forty-eight patients were available for review at an average follow-up of 14 months (6-26 months). Fifteen patients had one or more complications; median nerve compression symptoms (nine patients), hard-ware related complications (four patients), superficial wound infection and stitch abscess (three patients), malunion (two patients), failure of fixation and loss of reduction (two patients) and complex regional pain syndrome (two patients). A total of seven re-operations were performed. Discussion & Conclusions: Due to the high complication rate in this study, we recommend a more reserved attitude toward the use of distal radial volar locking plates.

Rupture of the Flexor Pollicis Longus Tendon After Volar Fixed-Angle Plating of a Distal Radius Fracture: A Case Report

We report a case of complete rupture of the flexor pollicis longus tendon 13 months after volar fixed-angle plating of a distal radius fracture. Tendon disruption was associated with a prominent distal volar lip of the plate. The plate was placed at the volar distal lip of the radius, at the location recommended by the manufacturer. Most previous reports of flexor tendon ruptures after volar plating of distal radius fractures have been in improperly placed plates, custom-made plates that were later taken off the market, or in physiologically abnormal tendons. This may be a unique case of flexor pollicis longus rupture with a currently commercially available volar fixed-angle plate, placed at the site recommended by the manufacturer, in a patient without other predisposition to tendon rupture.

橈骨遠位端骨折に対するDistal radius plateとLocking compression plateによる固定の比較検討

橈骨遠位端骨折に対するDistal radius plateとLocking compression plateによる固定の比較検討

Simple and secure technique of volar locking plating for distal radius fracture

Simple and secure technique of volar locking plating for distal radius fracture

Clinical results of volar locking plate for distal radius fracture

Clinical results of volar locking plate for distal radius fracture

Low-Profile Dorsal Plating for Dorsally Angulated Distal Radius Fractures: An Outcomes Study

Controversy exists surrounding the effectiveness and complications associated with dorsal plating for distal radius fractures. This study evaluated the functional outcome of dorsal plating for dorsally angulated distal radius fractures at a single institution. Thirty patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. The functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Gartland and Werley scoring system. The median patient age at surgery was 59 years. The median follow-up period was 18 months. According to the AO classification system, there were 4 type A fractures, 5 type B fractures, and 21 type C fractures. The median preoperative dorsal angulation was 30 degrees, and the median postoperative angulation was -4 degrees volar. Sixteen patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points, and 28 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. One patient lost reduction, 1 patient needed a tenolysis of the extensor pollicis longus tendon, and 2 patients required the removal of a single metaphyseal screw. Results from this study show that patients can expect to have 80% of their range of motion and strength after dorsal plating for distal radius fractures. Moreover, 93% of the patients will have good to excellent functional outcomes. Complications from dorsal plating may be caused by the specific plate used, rather than by the technique itself, supporting a dorsal approach for dorsally angulated distal radius fractures.

5.6 Early results after palmar plating of distal radius fractures with a new fixed angle implant and polyaxial stabilization (medartis ©)

5.6 Early results after palmar plating of distal radius fractures with a new fixed angle implant and polyaxial stabilization (medartis ©)

Bridge Plating of Distal Radius Fractures

High-energy comminuted distal radius fractures treated at Level 1 trauma centers represent unique treatment challenges. In particular, two groups of patients require special consideration: patients with high-energy injuries that have fracture extension into the radius and ulna diaphysis and patients with multiple injuries that require load bearing through the injured wrist to assist with mobilization. We report our experiences treating these injuries with a bridge plating technique. The bridge plate acts as an "internal fixator" and depends on ligamentotaxis for fracture reduction. The technique has been found to be performed easily and achieves the goals of maintenance of fracture reduction, allows weightbearing through the injured extremity, and is associated with few complications. We describe the technique and review our experience with a retrospective chart review of 62 consecutive patients. Therapeutic study, level IV (case series).

Locking volar plates for distal radius fractures in patients with high activity

Locking volar plates for distal radius fractures in patients with high activity

DELAYED RUPTURE OF FLEXOR POLLICIS LONGUS TENDON AFTER VOLAR PLATING OF THE DISTAL RADIUS

Flexor tendon rupture following distal radius fracture is rare. We described a case of flexor pollicis longus rupture, presented five years after volar plating of distal radius fracture.

Carpal canal pressures after volar plating of distal radius fractures

Elevated pressures within the carpal canal are known to occur after distal radius fractures. Controversy exists regarding prophylactic carpal tunnel release after open reduction with internal fixation of distal radius fractures. The purpose of this study was to determine the tissue pressures within the carpal canal after volar plating of distal radius fractures. This study was a prospective, observational, IRB approved research study. Ten consecutive patients undergoing volar plating of distal radius fractures were enrolled. After the distal radius fractures were reduced and fixed with volar plates, slit catheters were inserted into the carpal canals for continuous postoperative pressure monitoring for 24 hours. The maximum recorded pressure was 65 mmHg, which occurred in the only patient with fracture blisters. Peak pressures remained at 40 mmHg or less (range 16-40, mean 29) in all patients without fracture blisters. At the conclusion of data collection, all pressures were at 31 mmHg or less. No patient complained of median nerve dysfunction during the study period. Routine prophylactic carpal tunnel release is not recommended after volar plating of distal radius fractures based on these pressure recordings.

The effects of implant composition on extensor tenosynovitis in a canine distal radius fracture model

Dorsal plating of distal radius fractures with titanium plates has resulted in clinically observed tenosynovitis and tendon rupture. The goal of this study was to investigate whether titanium-based implants result in more extensor tendon inflammation than matched stainless-steel implants in a canine fracture model. An osteotomy was created in the distal radius of 18 beagles and fixed with 2.7-mm 4-hole plates composed of commercially pure titanium, titanium alloy (Ti-Al6-V4), or 316L stainless steel. Animals were killed at an average of 4 months. Tendon gliding was assessed by applying a force at the extensor musculotendinous junction and noting gliding. Histologic grading (mild, moderate, severe) was based on cellular hypertrophy, hyperplasia, and leukocytic infiltration. Tendons glided freely in 100% stainless-steel specimens, 75% of titanium alloy, and 43% of commercially pure titanium groups. A severe inflammatory reaction was identified in 60% of the titanium alloy (Ti-A16-V4) group, 57% of the pure titanium group, and 0% of the stainless-steel group. Dorsal plating of the canine radius with commercially pure titanium or titanium alloy implants produced a greater inflammatory peritendinous response than matched stainless-steel implants.