Comparison Between External Fixators and Fixed-Angle Volar-Locking Plates in the Treatment of Distal Radius Fractures

AbstractThe volar rim of the distal radius is the only bony restraint to volar carpal subluxation. Higher loads across the volar rim require stable and rigid fixation to maintain reduction and allow healing while rehabilitation begins. Volar marginal fragments are not amenable to buttressing by fixed angle volar locking plates. Appropriate management of volar marginal fragments comprises two steps—recognition of their presence and rigid anatomical repair. The best opportunity for success in the presence of a volar marginal fragment is its adequate initial treatment. The purpose of this review is to reinforce the importance of a complete preoperative and intraoperative evaluation of distal radius fractures. Volar marginal fragments can easily be overlooked even following initial reduction and fixation. Understanding the relevant anatomy and loading parameters can facilitate intraoperative decisions on approach and fixation, which are integral to achieving optimal clinical outcomes.

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Letter Regarding “Biomechanical Comparison of Volar Fixed-Angle Locking Plates for AO C3 Distal Radius Fractures: Titanium Versus Stainless Steel With Compression”

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2016.04.022 ◽

2016 ◽

Vol 41 (7) ◽

pp. e225

Author(s):

Adrian Spiegel

Keyword(s):

Stainless Steel ◽

Distal Radius ◽

Distal Radius Fractures ◽

Locking Plates ◽

Radius Fractures ◽

Fixed Angle ◽

Biomechanical Comparison

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Biomechanical Comparison of Volar Fixed-Angle Locking Plates for AO C3 Distal Radius Fractures: Titanium Versus Stainless Steel With Compression

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2015.06.098 ◽

2015 ◽

Vol 40 (10) ◽

pp. 2032-2038 ◽

Cited By ~ 8

Author(s):

Tyler Marshall ◽

Amit Momaya ◽

Alan Eberhardt ◽

Nilesh Chaudhari ◽

Thomas R. Hunt

Keyword(s):

Stainless Steel ◽

Distal Radius ◽

Distal Radius Fractures ◽

Locking Plates ◽

Radius Fractures ◽

Fixed Angle ◽

Biomechanical Comparison

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Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x12851639107151 ◽

2011 ◽

Vol 93 (1) ◽

pp. 57-60 ◽

Cited By ~ 14

Author(s):

DC Perry ◽

DMG Machin ◽

JA Casaletto ◽

DJ Brown

Keyword(s):

High Risk ◽

Distal Radius ◽

Plate Fixation ◽

Tendon Injury ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Extensor Pollicis Longus ◽

Fixed Angle ◽

Volar Plate Fixation

INTRODUCTION Rupture of extensor pollicis longus (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific ‘high-risk’ holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of ‘high-risk’ holes and appropriate minor alterations in surgical technique may consequently decrease the incidence of EPL irritation and rupture.

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