scholarly journals Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

2019 ◽  
Vol 08 (06) ◽  
pp. 482-488 ◽  
Author(s):  
Peter Kaiser ◽  
Hannes Gruber ◽  
Fanny Loth ◽  
Gernot Schmidle ◽  
Rohit Arora ◽  
...  
Keyword(s):  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Distal Radius Fractures ◽  
Ultrasound Images ◽  
Flexor Pollicis Longus ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
X Ray ◽  
Flexor Pollicis Longus Tendon

Abstract Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.

Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

2017 ◽  
Vol 43 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Daniel Martinez-Mendez ◽  
Alejandro Lizaur-Utrilla ◽  
Joaquin de-Juan-Herrero
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Distal Radius ◽  
Articular Surface ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

scholarly journals Volar Plating: Imaging Modalities for the Detection of Screw Penetration

2019 ◽  
Vol 08 (06) ◽  
pp. 520-530
Author(s):  
Minke Bergsma ◽  
Katharina Denk ◽  
Job N. Doornberg ◽  
Michel P. J. van den Bekerom ◽  
Gino M. M. J. Kerkhoffs ◽  
...  
Keyword(s):  
Distal Radius ◽  
Imaging Modality ◽  
Distal Radius Fractures ◽  
Imaging Modalities ◽  
In Vivo Studies ◽  
Volar Plating ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Additional Imaging ◽  
Screw Penetration

Abstract Background Volar plating for distal radius fractures exposes the risk of extensor tendon rupture, mechanical problems, and osteoarthritis due to protruding screws. Purposes The purpose of this review was to identify the best intraoperative diagnostic imaging modality to identify dorsal and intra-articular protruding screws in volar plating for distal radius fractures. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for this review. In vitro and in vivo studies that analyzed the reliability, efficacy, and/or accuracy of intraoperatively available imaging modalities for the detection of dorsal or intra-articular screw protrusion after volar plating for distal radius fractures were included. Results Described additional imaging modalities are additional fluoroscopic views (pronated views, dorsal tangential view [DTV], radial groove view [RGV], and carpal shoot through [CST] view), three-dimensional (3D) and rotational fluoroscopies, and ultrasound (US). For detection of dorsal screw penetration, additional fluoroscopic views show better results than conventional views. Based on small (pilot) studies, US seems to be promising. For intra-articular screw placement, 3D or 360 degrees fluoroscopy shows better result than conventional views. Conclusion Based on this systematic review, the authors recommend the use of at least one of the following additional imaging modalities to prevent dorsal protruding screws: CST view, DTV, or RGV. Tilt views are recommended for intra-articular assessment. Of all additional fluoroscopic views, the DTV is most studied and proves to be practical and time efficient, with higher efficacy, accuracy, and reliability compared with conventional views. Level of Evidence The level of evidence is Level III.

scholarly journals Correlation of Flexor Pollicis Longus Tendon Status by Ultrasonography with Plate Position on Radiographs Following Volar Plate Fixation of Distal Radius Fractures with Pronator Quadratus Repair

2021 ◽  
Author(s):  
Anil. K. Bhat ◽  
Ashwath. M. Acharya ◽  
Prajwal P. Mane ◽  
Lakshmikanth. H. Karegowda
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Flexor Pollicis Longus ◽  
Radius Fractures ◽  
Pronator Quadratus ◽  
Longus Tendon ◽  
Flexor Pollicis Longus Tendon ◽  
Grade One

Abstract Background Purpose was to correlate flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs following volar locked compression plate fixation (LCP) in patients who have undergone pronator quadratus (PQ) repair for distal radius fractures. Methods Status of flexor pollicis longus tendon was analyzed by ultrasonography in patients who underwent volar locked compression plating with pronator quadratus repair at a minimum of one year follow up. Soong’s criteria was used to assess the plate position and then correlated the ultrasonography findings of flexor pollicis longus. Results There were 33 patients included in our study, of which 15 belonged to Soong’s grade zero, 10 were grade one and eight were grade two. Flexor pollicis longus attrition was noted in all cases with grade two plating. Conclusion Pronator quadratus repair may not prevent attritional changes in higher grades of Soong’s, hence follow up may be required in these patients to identify attritional changes and early implant removal to prevent complications.

The Dorsal Tangential X-Ray View to Determine Dorsal Screw Penetration During Volar Plating of Distal Radius Fractures

2015 ◽  
Vol 40 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Alexander Brunner ◽  
Christin Siebert ◽  
Claudia Stieger ◽  
Alexander Kastius ◽  
Björn-Christian Link ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
X Ray ◽  
Screw Penetration

Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia

2020 ◽  
Vol 45 (8) ◽  
pp. 857-863
Author(s):  
Ruben Dukan ◽  
Elie Krief ◽  
Remy Nizard
Keyword(s):  
Distal Radius ◽  
Local Anaesthesia ◽  
Regional Anaesthesia ◽  
Plate Osteosynthesis ◽  
Clinical Results ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Wide Awake ◽  
No Tourniquet

Surgical fixation of distal radius fractures under local anaesthesia with the patient wide awake allows an intraoperative testing of the fixation stability under active mobilization. We evaluated the feasibility and clinical results of this technique in 45 patients prospectively in two matched comparable groups: wide-awake local anaesthesia no tourniquet and loco-regional anaesthesia. We found that the pain scores during the anaesthetic administration and the surgical procedure were similar in two groups. Ranges of wrist motion and QuickDASH scores were improved significantly in the wide-awake local anaesthesia no tourniquet group at 6 weeks and 3 months and similar at 6 months compared with those receiving loco-regional anaesthesia. Patients in wide-awake local anaesthesia no tourniquet returned to work significantly earlier than the loco-regional anaesthesia group. We conclude that osteosynthesis of distal radius fractures can be safely performed under wide-awake local anaesthesia no tourniquet, leading to no increase in pain level and similar functional outcomes compared with those under loco-regional anaesthesia. Level of evidence: III

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mulrain ◽  
K Joshi ◽  
F Doyle ◽  
A Abdulkarim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Volar Plating ◽  
Radius Fractures ◽  
Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

Classification and Management of Failed Fixation of the Volar Marginal Fragment in Distal Radius Fractures

2021 ◽  
Author(s):  
M. Carolina Orbay ◽  
Jorge L. Orbay
Keyword(s):  
Distal Radius ◽  
Patient Characteristics ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Volar Plating ◽  
Radius Fractures ◽  
Fracture Patterns ◽  
Loss Of Reduction ◽  
Operative Fixation ◽  
Specific Fracture

AbstractGreater understanding of specific fracture patterns following distal radius fractures has arisen with the advent of volar plating. The volar marginal fragment (VMF) is a small peripheral piece of bone which is critical to carpal stability. Failure to achieve good fixation of the VMF can result in volar subluxation of the carpus and distal radioulnar joint instability. Due to its small, distal nature, this fragment can be easily missed and difficult to fix. Loss of reduction of the VMF following operative fixation presents specific challenges and surgical considerations dictated by patient characteristics and timing. Our goal of this review is to present a classification system for these failed VMFs which can help guide surgical treatment as well as expected outcomes.

The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex

2016 ◽  
Vol 41 (5) ◽  
pp. 516-520 ◽  
Author(s):  
K. Kasapinova ◽  
V. Kamiloski
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Triangular Fibrocartilage Complex ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Wrist Arthroscopy ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage ◽  
A Prospective Study

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. Level of evidence: III

Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study

2017 ◽  
Vol 42 (5) ◽  
pp. 487-492 ◽  
Author(s):  
M. J. Park ◽  
J. P. Kim ◽  
H. I. Lee ◽  
T. K. Lim ◽  
H. S. Jung ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
The Elderly ◽  
Plaster Cast ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Cast Immobilization ◽  
Level Of Evidence

We conducted a prospective randomized, multicentre study to compare short arm and long arm plaster casts for the treatment of stable distal radius fracture in patients older than 55 years. We randomly assigned patients over the age of 55 years who had stable distal radius fracture to either a short arm or long arm plaster cast at the first review 1 week after their injury. Radiographic and clinical follow-up was conducted at 1, 3, 5, 12 and 24 weeks following their injury. Also, degree of disability caused by each cast immobilization was evaluated at the patient’s visit to remove the cast. There were no significant differences in radiological parameters between the groups except for volar tilt. Despite these differences in volar tilt, neither functional status as measured by the Disabilities of the Arm, Shoulder and Hand, nor visual analogue scale was significantly different between the groups. However, the mean score of disability caused by plaster cast immobilization and the incidence rate of shoulder pain were significantly higher in patients who had a long plaster cast. Our findings suggest that a short arm cast is as effective as a long arm cast for stable distal radius fractures in the elderly. Furthermore, it is more comfortable and introduces less restriction on daily activities. Level of evidence: II

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