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

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

ANZ Journal of Surgery ◽

10.1111/ans.17390 ◽

2021 ◽

Author(s):

Rajitha Gunaratne ◽

Omid Nazifi ◽

Harry D'Souza ◽

Aaron Tay

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Screw Length ◽

Locking Plate Osteosynthesis

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COMPARATIVE STUDY EVALUATING OUTCOMES OF CONSERVATIVE VERSUS VOLAR LOCKING PLATE OSTEOSYNTHESIS FOR UNSTABLE DISTAL RADIUS FRACTURES

10.36106/ijar/4600486 ◽

2020 ◽

pp. 9-11

Author(s):

Abhimanyu Kakralia ◽

Zakir Hussain ◽

Amit Jain ◽

R.C. Meena

Keyword(s):

Comparative Study ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Functional Results ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Conservative Group ◽

Prospective Comparative Study

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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A prospective study to assess the functional outcome of AO Type 23.B3 distal radius fractures treated with volar locking plate osteosynthesis

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i4l.2427 ◽

2020 ◽

Vol 6 (4) ◽

pp. 831-834

Author(s):

Dr. Pradeep E ◽

Dr. Sathik Babu MB ◽

Dr. Prajin Raj M ◽

Dr. Dinesh Kumar S

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Osteosynthesis ◽

A Prospective Study

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OS4-29 Outcome of conservative versus volar locking plate osteosynthesis for unstable distal radius fractures: a comparative study

Injury ◽

10.1016/s0020-1383(16)30515-0 ◽

2016 ◽

Vol 47 ◽

pp. S11

Author(s):

A.M. Teja ◽

R.C. Banshiwal

Keyword(s):

Comparative Study ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Osteosynthesis

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Clinical Results of Volar Locking Plate for Distal Radius Fractures: Conventional versus Minimally Invasive Plate Osteosynthesis

Yearbook of Orthopedics ◽

10.1016/j.yort.2011.09.014 ◽

2012 ◽

Vol 2012 ◽

pp. 130-132

Author(s):

M.F. Swiontkowski

Keyword(s):

Minimally Invasive ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Clinical Results ◽

Distal Radius Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Volar Locking Plate ◽

Radius Fractures

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Volar Locking Plate Fixations for Displaced Distal Radius Fractures: An Evaluation of Complications and Radiographic Outcomes

Hand ◽

10.1177/1558944717717505 ◽

2017 ◽

Vol 13 (4) ◽

pp. 466-472 ◽

Cited By ~ 2

Author(s):

James Wilson ◽

Jeremy J. Viner ◽

Kavan S. Johal ◽

Michael J. Woodruff

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Complication Rates ◽

Volar Locking Plate ◽

Radius Fractures ◽

Time To Surgery ◽

Radiographic Outcomes ◽

Plate Design

Background: A volar locking plate (VLP) is the most frequently used form of implant used for open reduction and internal fixation of distal radius fractures. They are known to have a complication rate of up to 27%. We hypothesized that plate design could influence complication rates. Methods: We performed a review of patients undergoing VLP fixation for distal radius fracture. A total of 228 patients underwent fixation with the Distal Volar Radial Anatomical (DVR) plate; 388 patients underwent fixation with the VariAx plate. Independent observers performed blinded case note and radiographic review, to assess for the quality of reduction, and complications for the inserted VLP. Results: Mean time to surgery was 6.0 days; mean follow-up was 17.5 weeks. Mean age was 56.5 years. The quality of reduction was classified as anatomical (46%), good (36.3%), moderate (13.0%), or poor (3.9%). Complications were identified in 109 patients (17%). Plate prominence was seen in 133 patients (21%). The DVR plate was less prominent ( P < .001) and had better overall radiographic appearances ( P = .025). Flexor tendon complications were related to plate prominence ( P = .005). Inferior reduction was associated with increased time to surgery ( P = .020). Conclusions: This study highlights the importance of prompt surgery, effective fracture reduction, and careful plate positioning to avoid volar prominence.

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