Fixed-angle Volar Plate Research Articles

Volar fixed plating of distal radius fractures: optimizing plate position for enhanced clinical outcomes

BackgroundThe precise influence of plate position on clinical outcomes in the context of volar fixed-angle plating for distal radius fractures is not fully understood. This article aims to investigate the influence of plate position on clinical results, and functional outcomes in patients treated with volar fixed plating for distal radius fractures.MethodsA total of 58 patients with 64 distal radius fractures were included in the study. Patient demographics, fracture characteristics, surgical details, and radiographic data were collected. Post-operative AP and Lat views of all patients taken on the first day after surgery were evaluated. Volar Tilt, Radial Inclination and Radial Height measurements were used as reduction criteria. In the follow-up, the patients were called for their last control, flexion and extension angles of the wrist and Mayo Wrist Scores, the distance of the plate to the joint line and the angle between the plate and the radial shaft were measured and recorded.ResultsA total of 64 distal radius fractures, with a mean age of 46.9 years, and the mean follow-up period 24.9 months were included in this study. There was a significant relationship between the Radial Inclination and Plate-Shaft Angle variables and the Mayo Wrist Score at a 99% confidence interval. Additionally, a relationship was observed between the Radial Height variable and the Mayo Score at a 90% confidence interval. A significant positive association was observed between radial inclination and achieving a Good-to-Excellent Mayo score (OR = 1.28, 95% CI [1.08–1.51], p = 0.004). Plate distance to joint line demonstrated a marginally significant positive association with a Good-to-Excellent Mayo score (OR = 1.31, 95% CI [0.97–1.77], p = 0.077). Univariate analysis revealed a significant negative association between plate-shaft angle and achieving a Good-to-Excellent Mayo score (OR = 0.71, 95% CI [0.52–0.99], p = 0.045). This negative association remained statistically significant in the multivariate analysis (p = 0.016).ConclusionRadial inclination, plate distance to joint line, and angle between plate and radius shaft were identified as significant factors associated with improved Mayo Wrist Scores.

Nascent Malunion of Distal Radius Fractures Treated with Fixed Angled Volar Plates without Using Bone Grafts.

Malunion of the distal radius is a common complication. Using bone grafts is common to restore the bone to an acceptable level. This study aimed to verify if it is necessary to use bone grafts in nascent malunion of distal radius fractures treated with fixed angled volar plates and which radiographic parameters are essential to obtain satisfactory outcomes. This single-centered prospective study included 11 patients who underwent corrective osteotomy of the radius for malunion. Patients with a metaphyseal, extraarticular osteotomy stabilized by a volar fixed angle plate within 3months after the fracture are included. Patients underwent a standard radiological evaluation at postoperative 1month, 3months, 6months, 1year, and annually thereafter. Radial inclination, radial height, ulnar variance, and palmar tilt were measured. Wrist ranges of motion are measured throughout follow-up with a goniometer. Grip strength is measured using a Jamar Hand Dynamometer. The function is evaluated via the Gartland-Werley (GW) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. The mean age of 11 patients, 9 (81.82%) males, included in the study was 41.45 ± 14.89years. The mean post-fracture admission time is 39.3 ± 15.1days. Radial inclination, radial length, and ulnar variance improved significantly after surgery (p = 0.0023, 0.0002, 0.0037). Radial inclination values are within normal limits for all patients at admission. The radial length was in the normal range for 72.73%, the ulnar variance was in the normal range for 72.73%, and palmar tilt was in the normal range for 100% of the patients. Extension 54.55%, flexion 72.73%, radial deviation 81.82%, ulnar deviation 63.64%, pronation 90.91%, and supination 72.73% were achieved after surgery. GW average was 3.09 ± 3.24 DASH score average was 12.24 ± 13.48. The mean grip strength was 29.27 ± 7.21 on the operated side, while it was 34.91 ± 5.32, on the healthy side, with a significant difference (p = 0.0108). It is possible to get good results without using bone grafts in corrective osteotomy of distal radius malunions.

Comparative clinical and radiographic outcomes between early and delayed wrist mobilization after volar fixed-angle plate fixation of distal radius fracture

Postoperative immobilization protocols after volar fixed-angle plate fixation of distal radius fractures (DRF) vary among surgeons. This study aimed to compare functional outcomes, radiographic parameters, and complications between early and delayed mobilization after volar fixed-angle plate fixation of DRF. This study is a randomized controlled trial. The early group was allowed to perform wrist motion exercise immediately after surgery and the delayed group was allowed to perform it after 2 weeks of external immobilization. Postoperative patient-rated wrist evaluation (PRWE), disabilities of arm, shoulder, and hand (DASH), wrist range of motion, visual analog scale (VAS) pain score, and grip strength were evaluated. Forty-eight patients with DRF were enrolled and randomly allocated to the early or delayed mobilization groups. The PRWE, DASH, VAS pain score, grip strength, and wrist motion of both groups significantly improved over time. However, there were no significant differences between groups at any timepoint. Radiographic parameters were not different between groups. There were no significant differences in functional outcomes, radiographic parameters, and complications between early and delayed mobilization after volar fixed-angle plate of DRF. Immediate postoperative wrist range-of-motion exercise can be safely initiated after volar fixed-angle plate fixation of DRF without external immobilization.Clinical trial registration: Thaiclinicaltrials.org identifier: TCTR20180927005. Registered 27/09/2018—retrospectively registered. https://www.thaiclinicaltrials.org/show/TCTR20180927005.

Column-Specific Distal Radius Fracture Fixation

Despite the popularity and success of volar fixed angle plating, variations in distal radius fracture presentation underscore the importance of understanding different surgical treatment options to maximize patient outcomes. The 3-column theory of wrist mechanics provided the foundation for using a column-specific fixation approach. Implant placement within the ulnar column can be challenging because of anatomical constraints. Some have described "safe zones" for implant position to decrease the potential for tendon impingement. A thorough understanding of the surrounding anatomy can allow fixation decisions based on fracture fragment location. Literature reports have shown excellent results when using fragment specific fixation constructs and similar outcomes when comparing these constructs with volar locked plating. Achieving optimal outcomes in surgically treated distal radius fractures requires the surgeon to be competent along a spectrum of surgical approaches and fixation constructs.

Distal Radius Fractures: Recognizing and Treating Complex Fracture Patterns.

Volar fixed-angle plate fixation is a commonly used treatment modality for distal radius fractures. However, not all fracture patterns are amenable to this type of fixation strategy. In this article, we review pertinent anatomy and radiographic landmarks that together highlight key differences when considering treatment strategies for complex distal radius fractures.

A comparative study between variable and fixed angle volar locking plates in management of unstable intra-articular distal radius fractures

<p><strong>Background:</strong> The current study is conducted to assess and compare the radiological and functional outcomes between variable and fixed angle volar plating in unstable intra-articular distal radius fractures.</p><p><strong>Methods:</strong> A prospective study was conducted from May 2018 to May 2020. A total of 156 patients were randomised into two groups A and B of 78 patients each. The plates were T or oblique fixed angle volar plate in group A and variable angle volar plate in group B. Patients were followed up for minimum 12 months. The functional outcome was measured by patient rated hand wrist evaluation score (PRHWE) and radiological outcome by radial height, volar tilt and radial inclination. The secondary objective was to correlate complications.</p><p><strong>Results:</strong> In our study average PRHWE score was better in group B (p<0.05). Radial height, volar tilt, radial inclination was much closer to anatomical wrist radiology was seen in group B. The most common complication was finger and wrist stiffness in group A.</p><p><strong>Conclusions:</strong> Patients treated with variable angle volar plate showed better results in functional and radiological outcomes at 12 months follow-up but limitations include short duration of follow up.</p>

Volar PEEK plate for distal radius fracture: analysis of adverse events.

The aim of the present retrospective study was to evaluate complications following carbon-fiber-reinforced polyetheretherketon (CFR-PEEK) volar plating in distal radius fracture in a large cohort of patients. As an alternative to conventional metallic devices, CFR-PEEK plates have been introduced over the last few years. We performed a retrospective study including all patients who were treated for distal radius fracture using a volar fixed-angle plate DiPHOS-RM (Lima Corporate, Udine, Italy). All CFR-PEEK plates implanted were reviewed between May 2012 and December 2017. Plate removal, second surgery and adverse events were collected by reviewing medical records. A total of 110 patients were included with a mean follow-up of 4years. Adverse side effects were observed in 9 cases (8%), developed during or after treatment. The most frequent complication was represented by intraoperative plate rupture (4%). Infection was reported in one case. The rate of complications of PEEK volar plates seems to be similar to those occurring with plates of different materials. Advantages of PEEK plates are the absence of the cold-welding phenomenon and the absence of exuberant bone callus on the plate, ensuring an easy hardware removal. Intraoperative rupture remains the main complication correlated with PEEK material. These complications can be reduced with an accurate surgical technique, especially at the beginning of the learning curve. Therapeutic IV.

Biomechanical Stability of Volar Plate Only Versus Addition of Dorsal Ulnar Pin Plate: A Dorsal Ulnar Fragment, C-3-Type, Distal Radius, Cadaver Fracture Model.

To determine if the addition of a dorsal ulnar pin plate provides improved stability characteristics in the management of intra-articular distal radius fractures with an associated dorsal ulnar fragment. OTA/AO type C3 fractures, with a dorsal ulnar fragment of one-third or one-half the width of the distal radius, were simulated in 9 matched pairs of fresh-frozen cadaveric arms randomized between fixed-angle volar plate only versus volar plate with addition of a dorsal ulnar pin plate. Prepared specimens were mounted in a custom load frame and loaded in extension with stepwise cyclic load increase. Dorsal plane interfragmentary displacements were compared between the 2 fixation constructs at 50-N and 100-N cyclic load. The addition of the dorsal ulnar pin plate significantly reduced interfragmentary displacements for the dorsal ulnar fragment at the 50 N load application, resulting in mean interfragmentary displacements of -0.1 ± 0.2 mm in comparison to -0.3 ± 0.2 mm with the volar plate-only construct. No other interfragmentary displacement comparisons were significant. No differences were found comparing the one-third and one-half size fragments. The addition of a dorsal ulnar pin plate improved stability characteristics with respect to the dorsal ulnar fragment. The addition of the dorsal ulnar pin plate, although statistically significant, improved displacement by less than 0.3 mm on average and thus may not prove to be important in clinical scenarios.

Results of open reduction and fixed angle locked volar plate fixation for fracture lower end of radius

<p class="abstract"><strong>Background:</strong> The fracture of lower end radius is the most common fracture of upper extremity encountered in practice. Intra-articular fractures of distal radius present a challenging task to the operating surgeon. Open reduction and internal fixation using volar fixed-angle plates has shown to be a valid treatment option for unstable, dorsally displaced distal radial fractures. The present study was undertaken to evaluate the functional outcome of unstable distal radius fractures treated with fixed angle volar locking plate.</p><p class="abstract"><strong>Methods:</strong> The current study aimed at using fixed angle volar locking plate to treat unstable distal radius fractures. A total of 25 patients records were studied comprising of 19 males and 6 females with a mean of 44.5 years and followed up for a maximum of 1.5 year. Fractures were classified using the AO classification. The interpretation of functional outcome was done according to Mayo Wrist Score.<strong></strong></p><p class="abstract"><strong>Results:</strong> At final functional assessment, according to the Mayo wrist score, the scores of 6 patients were excellent, 10 patients good, 8 patients satisfactory and 1 patient poor. No non-union was reported in any patients. 3 patients developed minor complications in the form of superficial infection, hypertrophic scar and reflex sympathetic dystrophy and 1 patient developed major complication in the form of deep infection.</p><p class="abstract"><strong>Conclusions:</strong> Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, better functional outcome and minimizes chances of complications and thereby is the treatment of choice for fracture distal end of radius.</p>

Functional outcome of distal end radius fractures managed using locking compression plates

In our study, 30 patients with unstable, displaced, comminuted, intra-articular fracture of distal radius were treated and followed up with open reduction and internal fixation using 2.4 mm anatomical locking plates in a tertiary care hospital from May 2012 to October 2014. Patient were evaluated with mayo score at 3 weeks, 3 months, 6 months and 1 year. At 1 year the mayo score suggest, 93.3% patients were pain free with only 6.33% patients having mild occasional pain and average mayo score for pain was 24.67, 53.33% patients have equal hand grip as compare to opposite side and average mayo score for hand grip was 20.83, 40% of patients has equal range of movements as compare to opposite side with remaining were between 75-99% of opposite side and average mayo score for range of movement was 22, 93.33% patients had returned to their pre-injury employment and average mayo score for their functional status was 24.67. We concluded that volar fixed angle plating is a effective means of treatment for comminuted, displaced, intra-articular distal radius fracture.

Management of Unstable Distal Radius Fractures: A Survey of Hand Surgeons.

Background Length of immobilization after operative fixation of unstable distal radius fractures and management in elderly patients is an area of debate. Purpose The purpose of this study is to delineate common practices of fellowship-trained hand surgeons and how they compare with current evidence-based protocols. Methods Surveys were distributed to American Society for Surgery of the Hand members on preferred methods of fixation, postoperative immobilization, and variations in treatment of elderly patients with unstable distal radius fractures. Responses were analyzed in comparison to a literature review. Subgroups were compared with regard to training, practice type, and years in practice. Results Four-hundred eighty-five surveys were analyzed. Volar fixed-angle plating was the most common choice of fixation (84.7%). Patients are most often immobilized for 1 to 2 weeks (40.0%) with range of motion (ROM) therapy begun most commonly between 1 and 4 weeks (47.2%). The majority of surgeons do not treat fractures differently in patients more than 65 years old. Physicians with more than 20 years of experience were significantly more likely to begin wrist ROM sooner with volar plating versus other fixation techniques compared with physicians with less than 20 years of experience (40.7% vs. 34.2%, respectively). Also, physicians in academic-only practices were more likely to immobilize patients for a shorter time after volar plating compared with those in privademics. Conclusion Volar fixed-angle plating is the dominant fixation method for unstable distal radius fractures among fellowship-trained hand surgeons. Elderly patients are not treated more conservatively and rigid immobilization after operative fixation remains the treatment of choice despite current evidence-based protocols.

Reduced-dose computed tomography to detect dorsal screw protrusion after distal radius volar plating

Background: Tenosynovitis and tendon rupture caused by screw penetration of the dorsal cortex are common complications after fixed-angle volar plating of a distal radius fracture. Detecting screw prominence with plain radiography is difficult due to the topography of the distal radius dorsal cortex. Computed tomography (CT) offers more detailed imaging of the bone topography, but is associated with radiation exposure. The present cadaveric study compared reduced-dose and standard-dose CT protocols in the detection of dorsal screw protrusion after fixed-angle volar plating of distal radius fracture. If found equivalent, a reduced-dose protocol could decrease the total radiation exposure to patients. Methods: Standard size distal radius volar locking plates were placed using a standard Henry approach in 3 matched pairs of cadaver wrists. A total of 3 distal locking screws were placed at 3 different lengths for a total of 3 rounds of CT scans per wrist pair. Each wrist pair was imaged by CT using standard-dose and reduced-dose protocols. Dorsal screw penetration was measured in each imaging protocol by 3 radiologists at two time periods to calculate inter- and intra-observer variability. Variability was calculated using the concordance correlation coefficient (CCC), intra-class correlation coefficient (ICC), and Pearson correlation coefficient (PCC). Bland-Altman plots were used and assessed 95% limits of agreement. Results: Intra- and inter-observer variabilities, either with the reduced-dose or standard-dose protocol, were >0.85. Pairwise CCC, ICC, and PCC were >0.91. In the comparison of reduced dose versus standard dose between radiologists, correlations were always >0.95. Conclusions: Comparison of a reduced-dose CT protocol and a standard-dose CT protocol for the detection of dorsal penetrating screws after fixed-angle volar plating showed >0.95 correlation in this cadaveric model. A reduced-dose CT protocol is equivalent to a standard dose CT protocol for orthopedic imaging and should reduce radiation exposure.

Management of osteoporotic extracapsular fractures of the proximal femur with proximal femur locking plate: A prospective study

Distal radius fractures are one of the most common orthopaedic injuries encountered in clinical practice. Owing to the increase in the number of road traffic accidents, these injuries are being seen with increasing frequency in younger people. Several treatment modalities have been described which includes closed reduction and application of plaster cast, bridging external fixation and open reduction and internal fixation (ORIF) by dorsal or volar conventional or locked plates. The aim of the present study was to assess the functional outcome of AO type B (partial articular) and type C (complete articular) fractures of distal radius among the patients undergoing ORIF by volar locked plate. A prospective study was conducted where patients of age more than 18 years of either sex having intraarticular fractures of the distal radius were enrolled in the study. Standard Henry’s volar approach was used and a standard 3.5 mm volar locking plate was applied over the volar aspect of radius. 53 patients were included in the study. The mean age of patients was 48.74 years. At the end of one year follow up, 12 patients (22.6%) had no pain, 33 had mild, occasional pain, 8 patients (15%) had moderate but tolerable pain. As far as functional status is concerned, most (91%) returned to their previous routine activities. Locked volar fixed angle plate fixation is a relatively safe and effective option for the management of partial articular (AO Type B) and completely articular fractures (AO Type C)

Functional outcome of volar locked plate fixation in AO Type B and C fractures of distal end radius

Distal radius fractures are one of the most common orthopaedic injuries encountered in clinical practice. Owing to the increase in the number of road traffic accidents, these injuries are being seen with increasing frequency in younger people. Several treatment modalities have been described which includes closed reduction and application of plaster cast, bridging external fixation and open reduction and internal fixation (ORIF) by dorsal or volar conventional or locked plates. The aim of the present study was to assess the functional outcome of AO type B (partial articular) and type C (complete articular) fractures of distal radius among the patients undergoing ORIF by volar locked plate. A prospective study was conducted where patients of age more than 18 years of either sex having intraarticular fractures of the distal radius were enrolled in the study. Standard Henry’s volar approach was used and a standard 3.5 mm volar locking plate was applied over the volar aspect of radius. 53 patients were included in the study. The mean age of patients was 48.74 years. At the end of one year follow up, 12 patients (22.6%) had no pain, 33 had mild, occasional pain, 8 patients (15%) had moderate but tolerable pain. As far as functional status is concerned, most (91%) returned to their previous routine activities. Locked volar fixed angle plate fixation is a relatively safe and effective option for the management of partial articular (AO Type B) and completely articular fractures (AO Type C)

Examination of Skill Acquisition and Grader Bias in a Distal Radius Fracture Fixation Model

Primary: Assess the ability of faculty graders to predict the objectively measured strength of distal radius fracture fixation. Secondary: Compare resident skill variation and retention related to other knowable training data. Residents were allowed 60 minutes to stabilize a standardized distal radius fracture using an assigned fixed-angle volar plate. Faculty observed and subjectively graded the residents without providing real-time feedback. Objective biomechanical evaluation (construct strength and stiffness) was compared to subjective grades. Resident-specific characteristics (sex, PGY, and ACGME case log) were also used to compare the objective data. A simulated operating room in our laboratory. Post-graduate year 2, 3, 4, and 5 orthopedic residents. Primary: Faculty were not successful at predicting objectively measured fixation, and their subjective scoring suggests confirmation bias as PGY increased. Secondary: Resident year-in-training alone did not predict objective measures (p = 0.53), but was predictive of subjective scores (p < 0.001). Skills learned were not always retained, as 29% of residents objectively failed subsequent to passing. Notably, resident-reported case-specific experience alone was inversely correlated with objective fixation strength. This testing model enabled the collection of objective and subjective resident skill scores. Faculty graders did not routinely predict objective measures, and their subjective assessment appears biased related to PGY. Also, in vivo case volume alone does not predict objective results. Familiar faculty teaching consistency, and resident grading by external faculty unfamiliar with tested residents, might alter these results.

Cannulated Self-Drilling, Self-Tapping Pins for Displaced Extra-articular Distal Radius Fractures.

Displaced unstable extra-articular radius fractures are common and frequently treated with open reduction and internal fixation with a fixed-angle volar plate. Although this treatment yields good results, it might be more invasive than necessary for management of this often relatively simple fracture. In this article, we present the technique of using a cannulated self-drilling, self-tapping (CSDT) construct that can be employed in a minimally invasive fashion. The CSDT offers a minimally invasive alternative to volar fixed-angle plating for unstable extra-articular distal radius fractures. It also can be useful in isolated displaced radial styloid fractures. Placed appropriately, implants rarely have to be removed. The CSDT also allows for early motion and rapid return to activities with anticipated satisfactory range of motion andfunction.

Volar locking plate fixation (Ellis plate) of intra-articular distal radius fractures: Prospective randomized study

Background: Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed volar plate for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose: The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with compound fracture of distal radius grade III and above. Patients and Methods: This prospective randomized study comprised 60 patients with displaced intra-articular (Frykman type IV-VIII) distal end radius fractures treated with volar locking plates. The patients were followed up at 2nd week, 6th week, 12 week, 6 months and 1 year after surgery. The assessment of pain, range of motion, grip strength and activity were assessed at each follow-up visit and scored according to the Green and O’Brien scoring system. Results: At the end of 1 years, In volar plate group out of 60 patients, excellent result was achieved in 08 patients (13%), good in 48 patients (80%), fair in 04 patients (7%). No poor outcome seen. Conclusions: Irrespective of the direction and amount of initial displacement, a great majority of intra articular fractures of the distal radius can be managed with a fixed angle volar plate through a single volar approach.

Biomechanical Comparison of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer-Bioresorbable Balloon Osteosynthesis and a Volar Locking Plate for Treatment of Distal Radius Fractures

Background: There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the “surgical modality of choice”. While outcomes with each modality are usually good to excellent, each has its share of shortcomings and complications. Thus, there is scope for improvements to existing modalities and/or introduction of new ones. Study Purpose: We introduce a novel modality, namely, the prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system, and investigated its plausibility. Experimental Procedures: The biomechanical performance of a construct comprising a synthetic distal radius (fourth-generation Sawbones?) on which a simulated fracture was created (4-mm wide osteotomy positioned 25 mm from the most distal end of the radius) and fixated with a placement of the IPBO system (SIPBO Construct) was compared to that when the fixation was with an approved Ti-6Al-4V alloy VLP system (SVLP Construct), under a clinically-relevant compressive loading protocol. Performance involved determination of quantitative parameters of the construct (initial longitudinal stiffness (ICLS), final longitudinal stiffness (FCLS), and load-to-failure (Pf)) and observation and recording of features of the construct at the fracture point. We also determined the quantitative parameters for the intact synthetic distal radius (control). Results: For each of the quantitative parameters, the range of values for SIPBO Construct was within that for SVLP Construct, suggesting that the IPBO System is a plausible modality. Also, for SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Construct, some failure features were fracture of the cortical wall and of the dorsal proximal fragments. Conclusion: The findings suggest that the IPBO system is plausible. As such, it merits further study; for example, determination of the influence of fracture gap fill ratio (defined as the proportion of the fracture gap that is filled by the expanding balloon as the polymer is injected into the balloon) on a large collection of quantitative biomechanical parameters.

Comparing Dorsal Tangential and Lateral Views of the Wrist for Detecting Dorsal Screw Penetration after Volar Plating of Distal Radius Fractures.

Background The dorsal tangential (DT) view has been shown to improve the detection of dorsal screw perforation during volar distal radius fracture fixation. Here we performed a cadaveric imaging survey study to evaluate if the DT view was uniformly beneficial for all screws. Methods Standardized placement of fixed-angle volar distal radius plates was performed on two cadavers. Fluoroscopic images depicting variable screw perforation of each of the four screw holes on the plate were generated. A 46-image survey was distributed at a large academic medical center. Respondents were asked to answer if the screw was perforating through the dorsal cortex in each image. Statistical analysis was performed using Fisher's exact test. A p value < .05 was considered significant. Results The DT view offered a significantly more reliable determination of dorsal screw penetration than traditional lateral imaging for the radial-most screw at all degrees of perforation and the middle two screws at 2 mm of perforation. Residents and attendings had more accurate screw readings overall using the DT view. Conclusions The DT view is superior to traditional lateral imaging in the detection of small amounts of dorsal perforation of the radial-most three screws of a fixed-angle volar plate.

Morphology of distal radius curvatures: a CT-based study on the Malaysian Malay population.

The purpose of this study was to examine the differing curves of the volar distal radius of healthy Malaysian Malays, so as to obtain detailed morphological information that will further the understanding of volar plate osteosynthesis in Malaysian Malays. Computed tomography with three-dimensional reconstruction was performed on the wrists of 16 healthy Malaysian Malay volunteers. Profile measurements were made using a software program. A novel parameter, the pronator quadratus curve angle, was explored and introduced in this study. Interclass correlation coefficients were calculated to assess the level of agreement between the data collected by the principal investigator and that collected by an independent radiologist. The mean ± standard deviation of the arc radii on the radial aspect was 17.50° ± 5.40°, while the median (interquartile range [IQR]) of the arc radii on the ulnar aspect was 25.27° (IQR 5.80°). The mean ± standard deviation of the curvature of the pronator quadratus line was 40.52° ± 2.48°. The arc radii on the radial aspect was significantly lower than the arc radii on the ulnar aspect (p = 0.001). Different radial and ulnar arcs were observed in 56.25% of the radii; the arc was deeper on the ulnar aspect in 93.75% of the radii. Based on the findings of this study, the likelihood of achieving anatomical reduction with uniformly curved, fixed-angle volar plates is questionable. Changes in the design of these implants may be needed to optimise their usage in the Malaysian Malay population.