MALUNITED FRACTURES OF THE DISTAL RADIUS TREATED WITH CORRECTIVE OSTEOTOMY USING VOLAR LOCKING PLATE AND A CORTICOCANCELLOUS BONE GRAFT FOLLOWING IMMEDIATE MOBILISATION

We describe our experience of using a volar locking plate for corrective osteotomy and bone grafting combined with early mobilisation in the treatment of distal radius malunions. Corrective osteotomy of the distal radius was performed through a volar approach, and fixated by a volar locking plate associated with corticocancellous iliac bone grafting in three patients aged 16, 71 and 75 years. Two patients had had volarly displaced malunion and one dorsally displaced malunion. Wrist motin was started immediately after surgery. The average follow-up was 15 months (range, 12–20 months). All osteotomies healed at an average 5.7 weeks post-operatively, resulting in a total arc of wrist motion of 133°, forearm rotation of 167°, and grip strength of 70% of that of the contralateral side. This treatment method proved to be effective and safe.

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Corrective distal radius osteotomy following fracture malunion using a fixed-angle volar locking plate

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413497636 ◽

2013 ◽

Vol 39 (4) ◽

pp. 431-435 ◽

Cited By ~ 8

Author(s):

S. Opel ◽

S. Konan ◽

E. Sorene

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Wrist Joint ◽

Corrective Osteotomy ◽

Volar Locking Plate ◽

Short Term ◽

Fixed Angle ◽

Post Traumatic ◽

Radiological Union

Post-traumatic distal radius deformity may cause severe morbidity, and corrective osteotomy is often necessary to realign the functional axis of the wrist to correct symptomatic malunion. The aim of this retrospective study was to review the short-term results of a single surgeon’s series of distal radius corrective osteotomies following fracture malunion using a fixed-angle volar locking plate for 20 patients (26 women) of an average age of 57 (range 19–83) years. At short-term follow up (average 14 months, range 12–15 months), no complications were noted and radiological union was confirmed in all cases at an average of 3 months. The average post-operative Disability of the Arm, Shoulder and Hand score was 13.48 (range 0–48.33) and an objective improvement was noted in movements at the wrist joint. A statistically significant improvement was achieved in ulnar variance, radial inclination, dorsal tilt, and supination.

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Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835516400051 ◽

2016 ◽

Vol 21 (02) ◽

pp. 133-139 ◽

Cited By ~ 8

Author(s):

Tsuyoshi Murase

Keyword(s):

Bone Graft ◽

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Corrective Osteotomy ◽

Extensor Tendon ◽

Radius Fracture ◽

Soft Tissue Release ◽

Dorsal Plate ◽

Volar Locking Plate

The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius.

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Comparison of distal radius fracture intra-articular step reduction with volar locking plates and K wires: a retrospective review of quality and maintenance of fracture reduction

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416669502 ◽

2016 ◽

Vol 42 (2) ◽

pp. 144-150 ◽

Cited By ~ 8

Author(s):

N. A. Johnson ◽

J. J. Dias ◽

C. J. Wildin ◽

L. Cutler ◽

B. Bhowal ◽

...

Keyword(s):

Distal Radius ◽

Retrospective Review ◽

Locking Plate ◽

Treatment Method ◽

Volar Locking Plate ◽

Initial Displacement ◽

Level Of Evidence ◽

Initial Reduction ◽

Multiple Variables ◽

K Wires

This study investigated the accuracy and maintenance of reduction of intra-articular steps achieved with closed reduction and percutaneous K wires and open reduction and a volar locking plate for the treatment of intra-articular distal radius fractures. We performed a retrospective review of 359 patients with an intra-articular fracture of their distal radius. Multivariate linear regression was undertaken to investigate the influence of multiple variables such as age, gender, initial displacement and treatment method on reduction despite differences between groups. A total of 36% of patients treated with K wires and 29% with volar locking plate had a step greater than or equal to 1 mm present on the first post-operative radiograph. A total of 23% treated with K wires and 28% with volar locking plate had a residual step of 1 mm or more on the last available radiograph. There was no difference identified between the two techniques for quality of initial reduction or persisting step on the last available radiographs. Step behaviour and further reduction of step post-operatively was similar for both treatment methods. Initial displacement and increased age influenced initial reduction. Initial fracture displacement shown radiologically was the only variable identified that influenced the persistence of a step on post-operative radiographs. Level of evidence: IV

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A Prospective Study on Treatment of Distal Radial Fractures Using Volar Locking Plate

10.33140/ijor.03.01.07 ◽

2020 ◽

Vol 3 (1) ◽

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Open Reduction ◽

Locking Plate ◽

Small Sample ◽

Care Hospital ◽

Volar Locking Plate ◽

Distal Radial Fractures ◽

Compression Plating

Introduction: Distal radius fractures are one of the most common injuries which come to the orthopaedic surgeons. Displaced extra-or intra-articular fractures require anatomical reduction for a good outcome. Historically, these fractures were treated with manipulation and casting, with or without Kirschner (K) wire fixation. Modern plating techniques have been advocated to restore anatomical alignment and allow early mobilisation. Despite the wide variety of treatment options available there is still debate about the best way to treat these fractures. The aim of this study was to evaluate fifty cases of fracture distal end radius treated by open reduction and internal fixation using locking compression plating (LCP). Methods: The present study was carried out on 50 cases of acute fracture distal radius admitted at a tertiary care hospital treated by open reduction and internal fixation using locking compression plating (LCP) between January 2018 and December 2018. Functional results were rated at the end of the study as excellent, good or poor as criteria laid down by Gartland and Werley’s combined subjective and objective criteria. Results: 50 cases of fracture distal radius were selected for study that fulfill the inclusion criteria, were operated and studied. 10 fractures were fixed using Extra-articular Locking Compression T-Plates, 40 fractures were fixed using Juxtaarticular Locking Compression T-Plates. According to the Gartland and Werley’s rating scale, 20 had excellent results, 23 good results, and 07 fair results during latest follow up. Conclusion: Notwithstanding a very small sample size and a short follow up, Volar locking plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist.

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Corrective osteotomy of distal radial deformities: a new method of guided locking fixed screw positioning

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411433227 ◽

2011 ◽

Vol 38 (1) ◽

pp. 29-34 ◽

Cited By ~ 8

Author(s):

M. Farshad ◽

F. Hess ◽

L. Nagy ◽

A. Schweizer

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Corrective Osteotomy ◽

Standard Technique ◽

New Method ◽

New Technique ◽

Clinical Use ◽

Volar Locking Plate ◽

New Device ◽

Radial Inclination

Corrective osteotomy for distal radial malunion is a valuable but at times technically challenging operation. We have developed a new device to aid in the performance of the operation. We compared clinical use of the new technique with the standard technique. In 11 patients treated with the new technique the volar locking plate needed repositioning only once. With the standard technique in 17 patients the plate was repositioned in nine cases and needed bending in six cases. The new method corrected radial inclination (SD of 3° vs. 9°) and ulnar variance (SD of 0.9 mm vs. 1.4 mm) more predictably than the standard technique but there was no advantage in correction of volar tilt (SD of 6° vs. 4°). In our experience the new device makes corrective osteotomy of the distal radius easier and more reliable.

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Study of clinicoradiological and functional outcomes in intraarticular distal end radius fractures managed by volar locking plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192092 ◽

2019 ◽

Vol 5 (4) ◽

pp. 599

Author(s):

Pravin Agrawal ◽

Samadhan Mundhe ◽

Sajal Mitra

Keyword(s):

Functional Outcomes ◽

Locking Plate ◽

Volar Locking Plate ◽

Radius Fractures ◽

Interventional Study ◽

Volar Approach ◽

Mayo Score ◽

Locking Compression Plates ◽

The Mean

Background: Various modalities of fixation are available for management of distal end radius fractures. Assessment of the functional and radiological outcomes of intra-articular distal end radius fractures managed with volar locking plate was attempted with the present study.Methods: In this prospective interventional study, thirty adult patients with closed distal radius fractures with intra-articular extension were comprehensively evaluated and managed. Open reduction and internal fixation (ORIF) was performed via volar approach (modified Henry`s approach) using 2.7mm volar locking compression plates (LCPs). Patients were followed up at 2 weeks, 1 month, 3 months and 6 months after surgery. The patients were evaluated functionally by Mayo score and radiologically by Lidstrom classification.Results: There were 18 (60%) patients having excellent, 8 (26.7) good, 2 (6.7%) fair and 2 (6.7%) with poor result according to Mayo scoring. According to Lidstrom scoring, at the last follow up, 16 (53.3%) patients had excellent, 11 (36.7%) patients good, 2 (6, 7%) patients fair and 1 (3.3%) patient had poor result. The functional status of the patient improved significantly from at 1month (20±3.47) to 6 months post-operative follow up (23.67±2.91). The mean range of motion improved significantly at 1 month, 6 months and last post-operative follow-up.Conclusions: Volar locking plate gives good to excellent clinico-radiological and functional outcomes in most of the fractures of the distal end radius with intraarticular extension.

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Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500061 ◽

2019 ◽

Vol 24 (01) ◽

pp. 30-35 ◽

Cited By ~ 1

Author(s):

Takeshi Katayama ◽

Hiroshi Ono ◽

Shohei Omokawa

Keyword(s):

Clinical Outcomes ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Wrist Flexion ◽

Radius Fractures ◽

Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

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Immediate Mobilisation Following Corrective Osteotomy of Distal Radius Malunions with Cancellous Graft and Volar Fixed Angle Plates

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2006.09.002 ◽

2007 ◽

Vol 32 (1) ◽

pp. 88-92 ◽

Cited By ~ 20

Author(s):

M. HENRY

Keyword(s):

Distal Radius ◽

Cancellous Bone ◽

Iliac Crest ◽

Corrective Osteotomy ◽

Forearm Rotation ◽

Heavy Smoking ◽

Cancellous Bone Grafting ◽

Wrist Motion ◽

Fixed Angle ◽

Volar Approach

The purpose of the study was to examine the reliability with which a specific technique of corrective osteotomy of malunions of the distal radius combined with early mobilisation could both restore the normal anatomic parameters of the radius and achieve a functional range of motion with good strength. Corrective osteotomy of the distal radius was performed through a volar approach using a fixed angle volar plate and cancellous bone graft from the iliac crest in 19 patients of mean age 50 years with initial malunions with a mean dorsal tilt of 36° and 7 mm of ulnar variance. An immediate mobilisation programme was started. All healed at a mean of less than 12 weeks (including two heavy smoking patients who required repeat cancellous bone grafting to achieve final union) to achieve a total arc of wrist motion around 120°, forearm rotation of 158° and grip strength which was 80% of contralateral. This treatment strategy was judged to be straightforward and effective.

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Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

10.21203/rs.3.rs-564409/v1 ◽

2021 ◽

Author(s):

Xue-yang Gui ◽

Zhao-hui Cheng ◽

Hongfei Shi ◽

Yi-xin Chen ◽

Jin Xiong ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Fixation ◽

Articular Fractures ◽

Metaphyseal Comminution

Abstract Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

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A COMPARATIVE STUDY OF VOLAR LOCKING PLATE VERSUS EXTERNAL FIXATION FOR DISPLACED INTRAARTICULAR DISTAL END RADIUS FRACTURES AT ORTHOPAEDICS DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/2026085 ◽

2021 ◽

pp. 1-3

Author(s):

Kunal Shankar ◽

Vikash M. Harinandan ◽

Laljee Chaudhary ◽

Debarshi Jana

Keyword(s):

External Fixation ◽

Distal Radius Fracture ◽

Distal Radius ◽

External Fixator ◽

Locking Plate ◽

Plate Versus ◽

Radius Fracture ◽

Volar Locking Plate ◽

Radius Fractures

Background: Distal radius fracture is more common accounting for 1/6th of the all fractures. With this background, this study was carried out to compare the functional outcome of volar locking plate and external fixator to the displaced intra-articular distal end radius fractures using Modified Mayo Wrist Score (MMWS). Materials and methods: This study included those patients with distal radius fracture attending the Orthopaedic Department of DMCH, Laheriasarai, Bihar, during January 2019 to December 2019. Patients were randomised based on - even and odd day of the week. This included two set of group with twenty patients in each group- one with volar locking plating and other with external fixation. Patients were followed up at 6 months and 1 year. At each follow up, the pain and range of movements were assessed by MMWS score which was entered in Microsoft excel and analysed in SPSS 20. Results: At the end of one year after surgery, we observed that external fixation technique was superior for treating displaced intra-articular comminuted distal end radius fractures than volar locking plate. Conclusion: External fixator showed more advantageous than volar locking plates after 1year of follow up.

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