Three Year Review of Dorsal Plating for Complex Intra-Articular Fractures of the Distal Radius

2018 ◽  
Vol 23 (02) ◽  
pp. 221-226 ◽  
Author(s):  
Michelle Spiteri ◽  
Wayne Ng ◽  
Jamie Matthews ◽  
Dominic Power ◽  
Mark Brewster
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Extensor Tendon ◽  
Bony Union ◽  
Dorsal Plate ◽  
Volar Approach ◽  
Articular Fractures ◽  
Loss Of Reduction ◽  
Removal Of Metal ◽  
Dorsal Plating

Background: The volar approach is commonly used for plating intra-articular fractures of the distal radius. Despite this, certain fracture configurations are more suitable for dorsal plate fixation. This technique has not gained favour due to the reported high incidence of extensor tendon irritation and attrition ruptures. With the advent of lower profile plates this risk has decreased. Methods: We report on forty-six cases performed in a tertiary hand centre between January 2011 and May 2014. Patients were identified from a database of distal radius fractures treated with open reduction and internal fixation. Pre-operative radiographs and computed tomogram (CT) scans were reviewed to classify fractures and evaluate fracture configurations. Dorsal displacement of fracture fragments was present in all cases. Records and imaging were reviewed to assess bony union and complications including tendon irritation, rupture and need for further surgery. Results: Plate placement was dependent on the degree of comminution in each fracture component. The combination of a dorsal and radial styloid plate was used in 52% of cases. There were no cases of tendon rupture and one case of post-operative loss of reduction. Removal of metal was performed in ten patients, mainly to improve motion and for tendon irritation (four cases each). Conclusions: Even though technically challenging, dorsal plating is useful in cases of dorsal fragment displacement and comminution, as well as complex AO-23C3 fractures with involvement of the lunate fossa. It allows stable reduction of the dorso-ulnar fragment which is important to restore DRUJ anatomy. The rate of tendon irritation and rupture is lower when compared to earlier plate designs, and removal of metal is only necessary in a few cases.

scholarly journals Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases

2021 ◽  
Author(s):  
Haval Ghafoor ◽  
Mathias Haefeli ◽  
Regula Steiger ◽  
Philipp Honigmann
Keyword(s):  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Distal Radius Fractures ◽  
Dorsal Plate ◽  
Radius Fractures ◽  
Radiographic Findings ◽  
Radiographic Measurements ◽  
Loss Of Reduction ◽  
Level Of Experience ◽  
Dorsal Plating

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.

Operative Treatment of Distal Radius Fractures

2008 ◽  
Vol 97 (4) ◽  
pp. 290-296 ◽  
Author(s):  
J. Vasenius
Keyword(s):  
Distal Radius ◽  
Extensor Tendon ◽  
Distal Radius Fractures ◽  
Fixation Method ◽  
Complication Rates ◽  
Radius Fractures ◽  
Articular Fractures ◽  
Radiocarpal Joint ◽  
Median Nerve Neuropathy ◽  
Dorsal Plating

The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.

Open reduction and plate fixation of dorsally displaced fractures of the distal radius: surgical technique, clinical and radiological outcome

2009 ◽  
Vol 35 (1) ◽  
pp. 56-60 ◽  
Author(s):  
T. E. J. Hems ◽  
B. Rooney
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Articular Surface ◽  
Plate Fixation ◽  
Young Patients ◽  
Extensor Tendon ◽  
Articular Fractures ◽  
Clinical And Radiological Outcome ◽  
Evaluation Measure

Thirty-five unstable dorsally displaced fractures of the distal radius in 34 patients (mean age 39) were studied; 28 fractures were intra-articular. All fractures had open reduction and fixation, through a dorsal approach, with mini-fragment plates placed between the first and second dorsal tendon compartments and deep to the fourth compartment. A congruous reduction of the articular surface was obtained in all cases. Twenty-four patients were available for follow-up (median 38 months). The Modified Mayo wrist score was excellent in 12 cases, good in four, and fair in eight. The median Patient Evaluation Measure score was 23.5. There were no cases of extensor tendon rupture. Radiographic assessment at follow-up showed a mean palmar angle of 6°. There was evidence of osteoarthritis in six patients who had had intra-articular fractures. Open reduction and plating gives satisfactory medium term results for treatment of displaced intra-articular fractures of the distal radius in young patients.

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

2016 ◽  
Vol 21 (02) ◽  
pp. 133-139 ◽  
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.

A Comparative Study between Longitudinal and “T” Incisions for Dorsal Plating of the Distal Radius

2003 ◽  
Vol 28 (6) ◽  
pp. 568-570 ◽  
Author(s):  
S. GANGOPADHYAY ◽  
G. PACKER
Keyword(s):  
Patient Satisfaction ◽  
Comparative Study ◽  
Distal Radius ◽  
Retrospective Review ◽  
Open Reduction ◽  
The Other ◽  
Dorsal Plate ◽  
Radius Fractures ◽  
Dorsal Aspect ◽  
Dorsal Plating

A retrospective review of 24 patients with dorsal incisions for open reduction and internal fixation of Frykman VII/VIII distal radius fractures using a dorsal plate was performed. Half of them had a longitudinal incision while the other half had a T-shaped incision. No difference in the healing properties or wound morbidity could be demonstrated between the two groups. However, the T incision provided improved exposure of the distal radius and patient satisfaction with its cosmetic result was superior. The horizontal limb was well camouflaged within the transverse skin crease on the dorsal aspect of the wrist. The vertical limb did not extend into the dorsum of the hand and could, therefore, be hidden by appropriate clothing.

DORSAL PLATING FOR COMMINUTED INTRA-ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS

Hand Surgery ◽  
2004 ◽  
Vol 09 (02) ◽  
pp. 181-190 ◽  
Author(s):  
D. Osada ◽  
K. Tamai ◽  
A. Iwamoto ◽  
S. Fujita ◽  
K. Saotome
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Articular Fractures ◽  
Radial Length ◽  
Comminuted Fractures ◽  
Dorsal Plating

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry® plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23°, volar tilt 7°, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5° during follow-up in ten patients. Use of dorsal Symmetry® plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.

Pearls and Pitfalls of the Volar Locking Plating for Distal Radius Fractures

2016 ◽  
Vol 21 (02) ◽  
pp. 125-132 ◽  
Author(s):  
Jin-Hyung Im ◽  
Joo-Yup Lee
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Extensor Tendon ◽  
Distal Radius Fractures ◽  
Fixation Strength ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Locking Plate Fixation ◽  
Distal Locking

Volar locking plate fixation has been widely accepted method for the treatment of unstable distal radius fractures. Although the results of volar locking plate fixation are encouraging, it may cause implant-related complications such as flexor or extensor tendon injuries. In depth understanding of anatomy of the distal radius is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid these complications. This article will review the anatomic characteristics of the distal radius because selecting proper implant and positioning of the plate is closely related to the volar surface anatomy of the distal radius. The number and the length of distal locking screws are also important to provide adequate fixation strength to maintain fracture fixation. We will discuss the pros and cons of the variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation. Finally, we will discuss about correcting radial length and volar tilt by using eccentric drill holes and distal locking first technique.

Sign in / Sign up

Export Citation Format

Share Document