Unstable Distal Radius Fractures in the Elderly Patient—Volar Fixed-Angle Plate Osteosynthesis Prevents Secondary Loss of Reduction

Abstract Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III–V.

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Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-009-0830-z ◽

2009 ◽

Vol 129 (5) ◽

pp. 661-669 ◽

Cited By ~ 48

Author(s):

Markus Figl ◽

Patrick Weninger ◽

Michael Liska ◽

Marcus Hofbauer ◽

Martin Leixnering

Keyword(s):

Distal Radius ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Fixed Angle

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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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Volar locking plate vs epibloc system for distal radius fractures in the elderly

Injury ◽

10.1016/j.injury.2016.07.056 ◽

2016 ◽

Vol 47 ◽

pp. S84-S90 ◽

Cited By ~ 5

Author(s):

Giuseppe Solarino ◽

Giovanni Vicenti ◽

Antonella Abate ◽

Massimiliano Carrozzo ◽

Girolamo Picca ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

The Elderly ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures

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Distal Radius Fractures in the Elderly

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-15-00676 ◽

2017 ◽

Vol 25 (3) ◽

pp. 179-187 ◽

Cited By ~ 27

Author(s):

L. Scott Levin ◽

Joshua C. Rozell ◽

Nicholas Pulos

Keyword(s):

Distal Radius ◽

The Elderly ◽

Distal Radius Fractures ◽

Radius Fractures

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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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Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1729439 ◽

2021 ◽

Author(s):

Lili E. Schindelar ◽

Richard M. McEntee ◽

Robert E. Gallivan ◽

Brian Katt ◽

Pedro K. Beredjiklian

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Functional Outcomes ◽

Open Reduction ◽

The Elderly ◽

Distal Radius Fractures ◽

Implant Design ◽

Complication Rates ◽

Radius Fractures ◽

Hardware Failures

Abstract Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417690464 ◽

2017 ◽

Vol 42 (5) ◽

pp. 487-492 ◽

Cited By ~ 7

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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