scholarly journals A comparative study between variable and fixed angle volar locking plates in management of unstable intra-articular distal radius fractures

2020 ◽  
Vol 6 (6) ◽  
pp. 1222
Author(s):  
Chhagan Lal Regar ◽  
Siddharath Sharanappa Parmeshwar ◽  
Ramesh Chandra Meena ◽  
Shyoji Lal Sharma ◽  
Jitesh Kumar Jain
Keyword(s):  
Distal Radius ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Fixed Angle ◽  
Radial Inclination ◽  
Variable Angle ◽  
Group A ◽  
Group B

<p><strong>Background:</strong> The current study is conducted to assess and compare the radiological and functional outcomes between variable and fixed angle volar plating in unstable intra-articular distal radius fractures.</p><p><strong>Methods:</strong> A prospective study was conducted from May 2018 to May 2020. A total of 156 patients were randomised into two groups A and B of 78 patients each. The plates were T or oblique fixed angle volar plate in group A and variable angle volar plate in group B. Patients were followed up for minimum 12 months. The functional outcome was measured by patient rated hand wrist evaluation score (PRHWE) and radiological outcome by radial height, volar tilt and radial inclination. The secondary objective was to correlate complications.</p><p><strong>Results:</strong> In our study average PRHWE score was better in group B (p&lt;0.05). Radial height, volar tilt, radial inclination was much closer to anatomical wrist radiology was seen in group B. The most common complication was finger and wrist stiffness in group A.</p><p><strong>Conclusions:</strong> Patients treated with variable angle volar plate showed better results in functional and radiological outcomes at 12 months follow-up but limitations include short duration of follow up.</p>

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

2011 ◽  
Vol 93 (1) ◽  
pp. 57-60 ◽  
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.

scholarly journals Hematoma block for distal radius fractures – prospective, randomized comparison of two different volumes of lidocaine

2018 ◽  
Vol 46 (11) ◽  
pp. 4535-4538 ◽  
Author(s):  
Hagay Orbach ◽  
Nimrod Rozen ◽  
Barak Rinat ◽  
Guy Rubin
Keyword(s):  
Distal Radius ◽  
Analgesic Efficacy ◽  
Fracture Site ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Vas Score ◽  
Significant Difference ◽  
Group A ◽  
Vas Scores ◽  
Group B

Objective This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. Methods Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. Results Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. Conclusion VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

USE OF THE VOLAR FIXED ANGLE PLATE FOR COMMINUTED DISTAL RADIUS FRACTURES AND AUGMENTATION WITH A HYDROXYAPATITE BONE GRAFT SUBSTITUTE

Hand Surgery ◽  
2011 ◽  
Vol 16 (01) ◽  
pp. 29-37 ◽  
Author(s):  
Akira Goto ◽  
Tsuyoshi Murase ◽  
Kunihiro Oka ◽  
Hideki Yoshikawa
Keyword(s):  
Elderly Patients ◽  
Bone Graft ◽  
Distal Radius ◽  
Bone Graft Substitute ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Radius Fractures ◽  
Fixed Angle ◽  
Radial Inclination ◽  
Metaphyseal Comminution

Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone.We treated elderly patients suffering from distal radius fractures with metaphyseal comminution, using both volar fixed angle plate with or without augmentation with a hydroxyapatite bone graft substitute to investigate the benefit of augmentation for maintaining a fracture reduction. We evaluated the differences among radiographic parameters including palmar tilt, radial inclination, and ulnar variance on immediate postoperative and final follow-up radiographs to analyse the maintenance of the initial reduction.There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05).It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.

Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

2017 ◽  
Vol 22 (04) ◽  
pp. 423-428 ◽  
Author(s):  
Yoshihiro Abe ◽  
Masahiro Suzuki ◽  
Hiromasa Wakita
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ulnar Variance ◽  
Locking Plates ◽  
Radius Fractures ◽  
Radial Inclination ◽  
The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

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

2017 ◽  
Vol 3 (3) ◽  
pp. 589 ◽  
Author(s):  
Atin Kumar Kundu ◽  
Nitin Wale ◽  
Satyendra Phuljhele ◽  
Deepak Ghritlahre ◽  
Harjot Singh Gurudatta
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Range Of Movement ◽  
Volar Approach ◽  
Volar Plate Fixation

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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).<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients

2013 ◽  
Vol 3 (1) ◽  
pp. 93-98
Author(s):  
Leonid I Katolik ◽  
Douglas P Hanel ◽  
Daniel A Wartinbee ◽  
David Ruch
Keyword(s):  
Elderly Patients ◽  
Distal Radius ◽  
The Elderly ◽  
Distal Radius Fractures ◽  
Dash Score ◽  
Trauma Centers ◽  
Radius Fractures ◽  
Radial Inclination ◽  
Internal Distraction

ABSTRACT Purpose To evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures. Materials and methods A retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained. Results Thirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32. Conclusion In the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures. Level of evidence Therapeutic, Level IV (Retrospective case series). Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.

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