Optimal screw length in volar locking plate osteosynthesis for distal radius fractures: a systematic review

Background: The objective of the study was to compare the results of conservative management and volar locking plate by assessing the functional and radiological parameters using Stewart et al. system (1) and Sarmiento’s modification of Gartland and Werley scores (2) respectively in cases of unstable distal radius fractures. Materials & Methods: This was a prospective comparative study, which included 50 cases of distal radius fractures with 32 cases in the conservative group and 18 cases in the operative group. Radiographic and functional outcomes were assessed at 2 weeks, 3 months and 6 months using Stewart et al. system and Sarmiento’s modification of Gartland and Werley scores respectively. Results: In operative group, radiological results were well to excellent results in 100% of the patients while in conservative group, 30% had excellent results, 17% had good results and 53% had fair result. At 6 months after surgery, functional results in both groups were improved. In operative group, 100% had excellent results while in conservative group 48% had excellent, 44.44% had good, and 7% had fair results. Conclusion: This study shows that volar locking plates evidently has better results in terms of achieved faster and accelerated functional recovery.

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Comparison of a ceiling-mounted 3D flat panel detector vs. conventional intraoperative 2D fluoroscopy in plate osteosynthesis of distal radius fractures with volar locking plate systems

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04784-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Raphael Seuthe ◽

Andreas Seekamp ◽

Bodo Kurz ◽

Julian Pfarr ◽

Jost Philipp Schaefer ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Fracture Reduction ◽

Volar Locking Plate ◽

Radius Fractures ◽

Flat Panel ◽

Flat Panel Detector

Abstract Objectives To compare intraoperative 3D fluoroscopy with a ceiling-mounted flat panel detector in plate osteosynthesis of distal radius fractures (AO/OTA 2R3C1.2) with volar locking plate systems to conventional 2D fluoroscopy for detection of insufficient fracture reduction, plate misplacement and protruding screws. Methods Using a common volar approach on 12 cadaver forearms, total intraarticular distal radius fractures were induced, manually reduced and internally fixated with a 2.4 distal radius locking compression plate. 2D (anterior-posterior and lateral) and 3D (rotational) fluoroscopic images were taken as well as computed tomographies. Fluoroscopic images, Cone Beam CT (CBCT), 360° rotating sequences (so called “Movies”) and CT scans were co-evaluated by a specialist orthopedic surgeon and a specialist radiologist regarding quality of fracture reduction, position of plate, position of the three distal locking screws and position of the three diaphyseal screws. In reference to gold standard CT, sensitivity and specifity were analyzed. Results “Movie” showed highest sensitivity for detection of insufficient fracture reduction (88%). Sensitivity for detection of incorrect position of plate was 100% for CBCT and 90% for “Movie.” For intraarticular position of screws, 2D fluoroscopy and CBCT showed highest sensitivity and specifity (100 and 91%, respectively). Regarding detection of only marginal intraarticular position of screws, sensitivity and specifity of 2D fluoroscopy reached 100% (CBCT: 100 and 83%). “Movie” showed highest sensitivity for detection of overlapping position of screws (100%). When it comes to specifity, CBCT achieved 100%. Regarding detection of only marginal overlapping position of screws, 2D fluoroscopy and “Movie” showed highest sensitivity (100%). CBCT achieved highest specifity (100%). Conclusion As for assessment of quality of fracture reduction and detection of incorrect position of plate as well as overlapping position of the three diaphyseal screws CBCT and “Movie” are comparable to CT – especially when combined. Particularly sensitivity is high compared to standard 2D fluoroscopy.

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Complications of Volar Plating of Distal Radius Fractures: A Systematic Review

Journal of Wrist Surgery ◽

10.1055/s-0038-1667304 ◽

2018 ◽

Vol 08 (03) ◽

pp. 255-262 ◽

Cited By ~ 7

Author(s):

Todd H. Alter ◽

Kristin Sandrowski ◽

Gregory Gallant ◽

Moody Kwok ◽

Asif M. Ilyas

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Complication Rate ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Complication Rates ◽

Volar Locking Plate ◽

Radius Fractures ◽

Total N

Background In recent years, there has been an increased utilization of volar locking plate fixation of distal radius fractures (DRFs). However, reported long-term complication rates with this technique remain unclear. Purpose The purpose of this systematic review was to investigate the pooled incidence of complications associated with volar locking plating of DRF. Methods A search of the Scopus database was performed from 2006 through 2016. Studies were considered eligible if they had a diagnosis of a DRF and were treated with a volar locking plate with an average of 12 months or longer follow-up. Results The literature search yielded 633 citations, with 55 eligible for inclusion in the review (total n = 3,911). An overall complication rate of 15% was identified, with 5% representing major complications requiring reoperation. The most common complication types identified included nerve dysfunction (5.7%), tendon injury (3.5%), and hardware-related issues (1.6%). Conclusion Nerve complications were reportedly higher than tendon and hardware-related complications combined. However, despite varying complication rates in the literature, this systematic review reveals an overall low complication rate associated with volar locking plating of DRF.

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