Intra articular distal radius fractures and volar plate fixation: a prospective study

Background: Despite being one of the most common fractures encountered in patients, intra-articular distal radius fractures still pose therapeutic challenge to Orthopaedic surgeons. With the advent of locking plates, the fixation of these fractures has been made better, specifically by fixed angle volar locking plate. This study investigates the efficacy of these plates using volar approach, functional and clinical outcome, in addition to the radiological alignment.Methods: Thirty patients with closed distal radius fractures, with AO TYPE B3, B4, AND C fracture pattern, operated with distal radius plate fixation using volar approach, were included in the study during the period of August 2014 to August 2016. With a minimum follow up of six months, radiological outcome was analysed and functional outcome recorded (Gartland and Werley’s demerit scoring system).Results: With a mean age of 42 years and follow up of six months, the range of movement of the wrist was very satisfactory, and the mean grip strength was 80% of the opposite wrist. Radiological parameters were well‑maintained, and functional parameters by Gartland and Werley showed a significant improvement in most of the patients during the follow‑up period. The complication rate was less and insignificant.Conclusions: Primary volar plate fixation of intraarticular distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion.

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Minimising the risk of extensor pollicis longus rupture following volar plate fixation of distal radius fractures: a cadaveric study

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x12851639107151 ◽

2011 ◽

Vol 93 (1) ◽

pp. 57-60 ◽

Cited By ~ 14

Author(s):

DC Perry ◽

DMG Machin ◽

JA Casaletto ◽

DJ Brown

Keyword(s):

High Risk ◽

Distal Radius ◽

Plate Fixation ◽

Tendon Injury ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Extensor Pollicis Longus ◽

Fixed Angle ◽

Volar Plate Fixation

INTRODUCTION Rupture of extensor pollicis longus (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific ‘high-risk’ holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of ‘high-risk’ holes and appropriate minor alterations in surgical technique may consequently decrease the incidence of EPL irritation and rupture.

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Volar Plate Fixation with AO Distal Radius Plate (DRP) for Distal Radius Fractures

Orthopedics & Traumatology ◽

10.5035/nishiseisai.54.611 ◽

2005 ◽

Vol 54 (3) ◽

pp. 611-616

Author(s):

Kazunobu Arakaki ◽

Hikaru Tashima ◽

Yosuke Asahara ◽

Chikara Deguchi ◽

Futoshi Kuga

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Volar Plate Fixation

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Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate

Journal of Wrist Surgery ◽

10.1055/s-0040-1702931 ◽

2020 ◽

Vol 09 (03) ◽

pp. 219-224 ◽

Cited By ~ 1

Author(s):

Kamil Yamak ◽

Hüseyin Gökhan Karahan ◽

Berrak Karatan ◽

Cemil Kayalı ◽

Taşkın Altay

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Flexor Tendon ◽

Plate Fixation ◽

Volar Plate ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Volar Plate Fixation

Abstract Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17–88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

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Relationship between the Length of Distal Locking Screws and Diaphyseal Screws in Volar Plate Fixation of Distal Radius Fractures

Journal of the Korean Society for Surgery of the Hand ◽

10.12790/jkssh.2013.18.3.118 ◽

2013 ◽

Vol 18 (3) ◽

pp. 118 ◽

Cited By ~ 2

Author(s):

Sung-Woo Huh ◽

Joo-Yup Lee ◽

Nam Hyuk Kim ◽

Il-Jung Park ◽

Yang-Guk Chung ◽

...

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Radius Fractures ◽

Distal Locking ◽

Locking Screws ◽

Volar Plate Fixation

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Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

Journal of Wrist Surgery ◽

10.1055/s-0038-1667302 ◽

2018 ◽

Vol 07 (05) ◽

pp. 409-414

Author(s):

J. Hill ◽

Gabriel Bouz ◽

Ali Azad ◽

William Pannell ◽

R. Alluri ◽

...

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Outcome Measures ◽

Distal Radius ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Plate ◽

Dash Score ◽

Radius Fractures ◽

Volar Plate Fixation

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

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