Intraoperative Fluoroscopy Versus Postoperative Radiographs in Assessing Distal Radius Volar Plate Position: Reliability of the Soong Classification

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.

Download Full-text

A New Volar Plate DiPhos-RM for Fixation of Distal Radius Fracture

Techniques in Hand and Upper Extremity Surgery ◽

10.1097/bth.0b013e31827700bc ◽

2013 ◽

Vol 17 (1) ◽

pp. 41-45 ◽

Cited By ~ 8

Author(s):

Luigi Tarallo ◽

Raffaele Mugnai ◽

Roberto Adani ◽

Fabio Catani

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Volar Plate ◽

Radius Fracture

Download Full-text

Fixation Strength in Full and Limited Fixation of Osteoporotic Distal Radius Fractures

Hand ◽

10.1177/1558944717708032 ◽

2017 ◽

Vol 13 (4) ◽

pp. 461-465 ◽

Cited By ~ 1

Author(s):

P. Kaveh Mansuripur ◽

Joseph A. Gil ◽

Dale Cassidy ◽

Patrick Kane ◽

Augusta Kluk ◽

...

Keyword(s):

Distal Radius ◽

Peak Load ◽

Distal Radius Fractures ◽

Volar Plate ◽

Fixation Strength ◽

Joint Surface ◽

Clinical Failure ◽

Radius Fractures ◽

Yield Load ◽

Load Peak

Background: The purpose of this investigation is to determine whether osteoporotic intra-articular distal radius fractures surgically treated by filling all 7 distal screws of a volar plate will have a higher load to failure than those treated by filling only 4 distal screws. Methods: Ten matched pairs of fresh frozen cadaveric forearms were randomized within each pair to be treated by using either all 7 of the distal holes of a volar plate or only 4 distal screws. The distal radius fixation was performed with unicortical screws going to but not through the dorsal cortex, and the most distal screws were placed within 4 mm of the joint surface. An AO C2 type fracture was then created. All specimens were tested cyclically, with an axial load of 60 N, at 3 Hz for 1000 cycles to simulate early postoperative motion. All specimens were subsequently tested to mechanical failure. Results: There were no failures in either group during cyclic testing. There was no difference detected between groups for mean stiffness, yield load, peak load, or load to clinical failure. In both groups, the yield load, peak load, and load to clinical failure were higher than the 60- to 100-N forces encountered during postoperative rehabilitation. Conclusions: There was no difference detected between osteoporotic intra-articular distal radius fractures treated by utilizing all 7 of the distal screws of a volar plate compared with those treated with only 4 distal screws.

Download Full-text

FIXATION OF AN ULNODORSAL FRAGMENT WHEN TREATING AN INTRA-ARTICULAR FRACTURE IN THE DISTAL RADIUS

Hand Surgery ◽

10.1142/s0218810414970016 ◽

2014 ◽

Vol 19 (01) ◽

pp. 139-144 ◽

Cited By ~ 7

Author(s):

Kazuo Ikeda ◽

Naoki Osamura ◽

Kaoru Tada

Keyword(s):

Distal Radius ◽

Surgical Procedure ◽

Plate Fixation ◽

Volar Plate ◽

Dorsal Approach ◽

Articular Fracture ◽

Low Profile ◽

Volar Plate Fixation ◽

Mini Plate

If fixation of an ulnodorsal fragment in an intra-articular fracture of the distal radius is not stable, it is sometimes caused by dorsal displacement after surgery. Hence, we recommend the volar plate fixation with an additional dorsal approach and fixation of irreducible ulnodorsal fragments using a low-profile dorsal mini plate. The details of the surgical procedure and indications are discussed in this article.

Download Full-text

Volar Plate Fixation with AO Distal Radius Plate (DRP) for Distal Radius Fractures

Orthopedics & Traumatology ◽

10.5035/nishiseisai.54.611 ◽

2005 ◽

Vol 54 (3) ◽

pp. 611-616

Author(s):

Kazunobu Arakaki ◽

Hikaru Tashima ◽

Yosuke Asahara ◽

Chikara Deguchi ◽

Futoshi Kuga

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Volar Plate Fixation

Download Full-text

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate

Journal of Wrist Surgery ◽

10.1055/s-0040-1702931 ◽

2020 ◽

Vol 09 (03) ◽

pp. 219-224 ◽

Cited By ~ 1

Author(s):

Kamil Yamak ◽

Hüseyin Gökhan Karahan ◽

Berrak Karatan ◽

Cemil Kayalı ◽

Taşkın Altay

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Flexor Tendon ◽

Plate Fixation ◽

Volar Plate ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Volar Plate Fixation

Abstract Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17–88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

Download Full-text

Relationship between the Length of Distal Locking Screws and Diaphyseal Screws in Volar Plate Fixation of Distal Radius Fractures

Journal of the Korean Society for Surgery of the Hand ◽

10.12790/jkssh.2013.18.3.118 ◽

2013 ◽

Vol 18 (3) ◽

pp. 118 ◽

Cited By ~ 2

Author(s):

Sung-Woo Huh ◽

Joo-Yup Lee ◽

Nam Hyuk Kim ◽

Il-Jung Park ◽

Yang-Guk Chung ◽

...

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Distal Locking ◽

Locking Screws ◽

Volar Plate Fixation

Download Full-text

Distal radius fractures – A volar plate is not just a volar plate

Trauma ◽

10.1177/1460408617721947 ◽

2017 ◽

Vol 20 (3) ◽

pp. 203-207

Author(s):

Richard Knight ◽

Lucy Elliott ◽

Mark Brewster ◽

Michelle Spiteri ◽

Dominic Power

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Cost Savings ◽

Fracture Pattern ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Potential Cost ◽

Plate Design ◽

Column Variable

Introduction Increasingly complex distal radius plate designs are available for treating distal radius fractures. As a result, many fractures are being ‘over-treated’ with more complex volar plate designs than necessary. We hypothesise that significant cost savings could be made by rationalising the use of complex locking plate designs. Methods Over a two-year period, radiographs of 250 consecutive distal radius fractures fixed with volar locking plates were reviewed and the type of plate, and type and number of screws used for fixation were noted. Preoperative radiographs were independently reviewed to ascertain if it would have been possible to stabilise the fracture with a simpler, extra-articular plate design. Potential cost savings were then calculated. Results It was deemed that 89 (36.5%) of the 250 cases originally treated with a more complex 2 column variable angle plate could have been treated with an extra-articular construct, leading to potential savings of £19,224. Conclusion It is clear from our data that many distal radius fracture patterns are being ‘over-treated’ with complex locking plate designs with multiple rows of screws and that substantial cost savings could be made by selecting an appropriate construct to suit the fracture pattern.

Download Full-text

Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

Journal of Wrist Surgery ◽

10.1055/s-0038-1667302 ◽

2018 ◽

Vol 07 (05) ◽

pp. 409-414

Author(s):

J. Hill ◽

Gabriel Bouz ◽

Ali Azad ◽

William Pannell ◽

R. Alluri ◽

...

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Outcome Measures ◽

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Dash Score ◽

Radius Fractures ◽

Volar Plate Fixation

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

Download Full-text