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

Journal of Wrist Surgery ◽

10.1055/s-0041-1735885 ◽

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.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417727139 ◽

2017 ◽

Vol 43 (2) ◽

pp. 142-147 ◽

Cited By ~ 27

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

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

Journal of Wrist Surgery ◽

10.1055/s-0038-1675792 ◽

2018 ◽

Vol 08 (04) ◽

pp. 335-343 ◽

Cited By ~ 2

Author(s):

Ara A. Salibian ◽

Karl C. Bruckman ◽

Jonathan M. Bekisz ◽

Joshua Mirrer ◽

Vishal D. Thanik ◽

...

Keyword(s):

Elderly Patients ◽

Distal Radius ◽

Distal Radius Fractures ◽

Current Evidence ◽

Evidence Based ◽

Years Of Experience ◽

Volar Plating ◽

Radius Fractures ◽

Fixed Angle ◽

Operative Fixation

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.

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Plate coverage predicts failure for volarly unstable distal radius fractures with volar lunate facet fragments

SICOT-J ◽

10.1051/sicotj/2020026 ◽

2020 ◽

Vol 6 ◽

pp. 29

Author(s):

Yuta Izawa ◽

Yoshihiko Tsuchida ◽

Kentaro Futamura ◽

Hironori Ochi ◽

Tomonori Baba

Keyword(s):

Distal Radius ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Longitudinal Dimension ◽

Loss Of Reduction ◽

Operative Fixation ◽

Displacement Group

Introduction: Loss of reduction after operative fixation of volarly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function. We hypothesized that the indicator of loss of reduction of the VLF after fixation is plate coverage of the bony fragment. We investigated the relationship between the plate coverage of the VLF and loss of reduction after fixation, and calculated the plate coverage that was associated with failure of fixation of the VLF. Materials and methods: We conducted a retrospective review. We included patients with surgically treated volarly unstable distal radius fractures with VLF with a volar locking plate who had a minimum follow-up of 6 months. A total of 33 patients (35 wrists) met criteria for inclusion into the study. The patients were divided into a displacement group and a non-displacement group. We calculated and compared longitudinal dimension and plate coverage of the VLF between the two groups to reveal the risk factors for loss of reduction. Results: At final follow-up, 25 fractures maintained radiographic alignment and 10 (28.6%) lost reduction. Univariate analysis between the two groups showed that plate coverage against the transverse and longitudinal dimension of the VLF was correlated with loss of reduction after operative fixation. In multivariate logistic regression analysis, only plate coverage against the longitudinal dimension of the VLF remained a significant predictor of failure. With 64.7% as the cut-off point for plate coverage against the longitudinal dimension of the VLF, the sensitivity and specificity of the prediction were 96% and 80%, respectively. Conclusion: The predictor of loss of reduction after fixation of volarly unstable distal radius fractures with a VLF was plate coverage against the longitudinal dimension of the VLF.

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

British Journal of Surgery ◽

10.1093/bjs/znab135.012 ◽

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.

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