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.

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.

scholarly journals Open reduction and fixation with a supporting plate for treatment of unstable fractures of distal radius with volar displacement

2002 ◽  
Vol 10 (4) ◽  
pp. 05-09
Author(s):  
Luís Eduardo Lima de Andrade ◽  
Décio José de Oliveira ◽  
José Wagner de Barros
Keyword(s):  
Distal Radius ◽  
Open Reduction ◽  
Plate Fixation ◽  
Functional Results ◽  
Unstable Fracture ◽  
Wrist Function ◽  
Supporting Plate ◽  
Buttress Plate ◽  
Unstable Fractures

Eigtheen patients with unstable fracture of the distal radius were evaluated. They have undergone open reduction and buttress plate fixation. The average follow-up was 21 months. Radiographies and wrist function were analysed. It was concluded that this technique was good, allowing good functional results.

LOCKING PALMAR PLATE FIXATION FOR DORSALLY DISPLACED FRACTURES OF THE DISTAL RADIUS: A PRELIMINARY REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 263-269 ◽  
Author(s):  
Koji Moriya ◽  
Hidehiko Saito ◽  
Yuji Takahashi ◽  
Hiroyuki Ohi
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Functional Results ◽  
Wrist Pain ◽  
Point System ◽  
Articular Fractures ◽  
Palmar Plate ◽  
Ulnar Wrist Pain

We reviewed a series of 62 consecutive patients with dorsally displaced fractures of the distal radius, including 20 extra-articular and 42 intra-articular fractures. All patients were treated with palmar locking plate systems at our institution between 2002 and 2006. After a minimum follow-up time of 12 weeks, the fractures had healed with satisfactory radiographic and functional results. According to the demerit point system of Gartland and Werley, 35 patients were rated excellent, 26 good, and one fair. In the good and fair groups, the demerit points were almost all for ulnar wrist pain. Our results suggest that palmar locking plate systems enable early functional mobilization with good reproducible radiographic and clinical outcomes. Since nine out of 62 patients had residual ulnar wrist pain at the final follow-up evaluation, further investigation of the pathogenesis of ulnar wrist pain is necessary to obtain better functional outcomes.

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

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.

scholarly journals Early Correction of Distal Radius Partial Articular Malunion Leads to Good Long-term Functional Recovery at Mean Follow-up of 4 Years

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 276-280 ◽  
Author(s):  
T. David Luo ◽  
Fiesky A. Nunez ◽  
Elizabeth A. Newman ◽  
Fiesky A. Nunez
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Articular Surface ◽  
Corrective Osteotomy ◽  
Young Patients ◽  
Posttraumatic Arthritis ◽  
Volar Approach ◽  
Pain Scores

Background: Distal radius articular step-off or deformity may cause posttraumatic arthritis and poor functional outcome. The purpose of this study was to evaluate pain and functional outcomes in patients with malunited partial articular distal radius fractures who underwent corrective osteotomy. We hypothesized that anatomic restoration of distal radius articular surface after a malunited partial articular distal radius fracture results in improvement in pain and functional measures and delays the development of posttraumatic arthritis. Methods: Seven consecutive patients with mean age of 38 years underwent corrective osteotomy via either a standard dorsal approach or combined dorsal and volar approach. Mean time from injury to corrective osteotomy was 10 weeks. Patients were assessed with respect to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), forearm and wrist range of motion, pain, and grip strength. Results: At mean follow-up of 44 months, significant improvements in pain scores (7.1-0.9, P < .001), QuickDASH (38.7-11.6, P < .001), grip strength (21.4-30.0 kg, P = .01) were achieved. All range of motion measurements demonstrated significant improvements except forearm pronation. One patient demonstrated radiographic evidence of osteoarthritis but had no pain at final follow-up. No patients required secondary surgery for removal of symptomatic hardware. Conclusions: Based on these findings, we recommend that early corrective osteotomies should be considered in young patients with intra-articular distal radius malunions before considering salvage procedures such as partial or complete wrist arthrodesis.

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 Hook Plate for Volar Rim Fractures of the Distal Radius: Review of the First 23 Cases and Focus on Dorsal Radiocarpal Dislocation

2018 ◽  
Vol 08 (02) ◽  
pp. 093-099 ◽  
Author(s):  
Marco Biondi ◽  
Marco Keller ◽  
Letizia Merenghi ◽  
Markus Gabl ◽  
Giulio Lauri
Keyword(s):  
Distal Radius ◽  
Case Series ◽  
Attachment Site ◽  
Hook Plate ◽  
Level Of Evidence ◽  
New Device ◽  
Articular Fractures ◽  
Clinical And Radiological Outcome ◽  
Dorsal Radiocarpal Dislocation

Background Fragment-specific fixation of the distal radius is born to fix each articular fragment with limited surgical approach and low-profile devices. Over time, many devices with different designs and characteristics have been developed. However, many of them have showed the inability to securely fix marginal, small, and comminuted fragments as bony ligament avulsions and bony compression injuries. Purpose The purpose of this study was to evaluate the clinical and radiological outcome of a new device born to treat marginal articular fractures of the distal radius. Patients and Methods A retrospective review was conducted on 23 patients with a mean follow-up of 21 months including postoperative clinical evaluation, grip strength, computed tomography scan, and X-ray control. Results All fragments healed and maintained reduced until the final follow-up. The carpus was aligned with the distal radius in all patients presenting with a radiocarpal dislocation. Conclusion The volar rim fragment is an attachment site for the short radiolunate and the volar distal radioulnar ligament. Its unstable fixation can lead to articular incongruity, volar or dorsal subluxation of the carpus, and distal radioulnar instability. The involvement of this fragment on distal radius fractures is relatively common and many studies of the literature have been focused on its treatment. The Hook Plate stabilizes distal fragments at their bone–ligament interface. In addition to bony reduction, the device permits to stabilize the capsule and ligaments, as volar bony ligament avulsions, in a picture of dorsal radiocarpal dislocation. Level of Evidence This is a Level IV, case series.

scholarly journals Midterm surgical treatment outcomes of unstable distal radius fractures

2019 ◽  
Vol 26 (1) ◽  
pp. 17-26
Author(s):  
K. A Yeghiazaryan ◽  
A. P Ratiev ◽  
A. V Grigoriev ◽  
A. V Germanov ◽  
M. A Danilov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
External Fixation ◽  
Distal Radius ◽  
Conflict Of Interest ◽  
Open Reduction ◽  
Wrist Joint ◽  
Plate Fixation ◽  
Young Patients ◽  
Second Stage ◽  
Radiocarpal Joint

Background. Fracture of the distal radius is the most common injures bones of the forearm. Multifragmentary articular injures have occupied a special place among all fractures of the distal radius This factor due to the severity of the injury wrist joint, young patients and difficult rehabilitation. Purpose of study: Improvement results surgical treatment unstable fractures of the distal radius. Patients and methods. All patients were depended into two groups: The first group consisted of 34 patients. The first stage of treatment include close reduction and external fixations. If after external fixation we have persisting fractures dislocation, we take conversion external fixation, open reduction and plate fixation. The second group were included 30 person. In this group we take open reduction and plate fixation. Results. 6 or 12 month after surgery in 1 group we have receiver 87% excellent results. In the the second group we have received 77% excellent results. In the first group 2 cases have slow fractures consolidation, infection complication not found. In the second group we have 2 complication: CRPS and infection. Conclusion. Results in two groups of patients are assessed as good and excellent. The results of the study showed that external fixation in first stage of treatment allows to achieved better restoration radiocarpal joint anatomy (except for type B fractures), and without secondaly displacement tendency. The last fact is very important for patient with delayed the second stage of treatment. This patients with multiple injuries, open fractures and presence of an infected wound and etc. The second stage of treatment consisted of open reduction and plate fixation. Achieved full anatomy restoration radiocarpal joint with possible early rehabilitation. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding

Radiographic Outcomes following K-Wire Augmentation of Dorsal Spanning Plate Fixation for Intra-Articular Fractures of the Distal Radius

2021 ◽  
Author(s):  
Harsh A. Shah ◽  
Anthony R. Martin ◽  
Joseph S. Geller ◽  
Hariharan Iyer ◽  
Seth D. Dodds
Keyword(s):  
Distal Radius ◽  
Articular Surface ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Surface Alignment ◽  
Radiographic Outcomes ◽  
Wire Fixation ◽  
Polytrauma Patients

Abstract Background Restoration of articular surface alignment is critical in treating intra-articular distal radius fractures. Dorsal spanning plate fixation functions as an internal distraction mechanism and can be advantageous in the setting of highly comminuted fracture patterns, polytrauma patients, and patients with radiocarpal instability. The addition of K-wires to support articular surface reduction potentially augments fracture repair stability. Questions/Purposes We examined the radiographic outcomes and maintenance of reduction in patients with comminuted intra-articular distal radius fractures treated with K-wire fixation of articular fragments followed by dorsal spanning plate application. Patients and Methods We reviewed 35 consecutive patients with complex intra-articular distal radius fractures treated with dorsal spanning plate and K-wire fixation between April 2016 and October 2019. AO classification was recorded: B1 (3), B3 (2), C2 (2), C3 (28). A two-tailed paired t-test was used to compare findings immediately post-dorsal spanning plate surgery and at final follow-up after dorsal spanning plate removal. Results Mean patient age was 43.3 years (19–78 years). Mean follow-up was 7.8 months (SD 4.3 months) from surgery and 2.5 months from pin removal (SD 2.6 months). All patients achieved radiographic union. Radial height (mean interval change (MIC) 0.2 mm, SD 2.2, p = 0.63), articular step-off (MIC 0.1 mm, SD 0.6 mm, p = 0.88), and radial inclination (MIC −1.1 degrees, SD 3.7 degrees, p = 0.10) did not change from post-surgery to final follow-up. Ulnar variance (MIC −0.9 mm, SD 2.0 mm, p = 0.02) and volar tilt (MIC −1.5 degrees, SD 4.4 degrees, p = 0.05) were found to have decreased. Conclusion Dorsal spanning plate augmented with K-wire fixation for comminuted intra-articular distal radius fractures in polytrauma patients allows for immediate weightbearing and maintains articular surface alignment at radiographic union and may provide better articular restoration than treatment with dorsal spanning plate alone. Level of Evidence This is a Level IV, therapeutic study.

scholarly journals Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xue-yang Gui ◽  
Zhao-hui Cheng ◽  
Hong-fei 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 single 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 single 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 single volar locking plating. Trial registration This study has been registered on the ClinicalTrials.gov.

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