Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius

2011 ◽  
Vol 1 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Daniel A Wartinbee ◽  
Michael Miller ◽  
Jonathan Riboh
Keyword(s):  
Grip Strength ◽  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Volar Plate ◽  
Complication Rates ◽  
Distal Radial Fractures ◽  
Fixation Group ◽  
Vas Scores ◽  
Volar Plate Fixation

ABSTRACT Background Much attention has been given recently to the complication profile of volar plate fixation of distal radial fractures. The purpose of this investigation was to compare complication rates among patients with distal radial fractures treated with volar plating versus those treated with external fixation. Methods Two parallel series of patients with comminuted intra-articular distal radius fractures were reviewed. 59 patients were treated with external fixation and 56 patients with volar plate fixation. Postoperative radiographs, range of motion, grip strength, DASH scores, and VAS pain questionnaires were analyzed, and complications were described. Results The external fixation group had a significantly higher overall complication rate (p = 0.021) than the volar plate fixation group. In the volar plate group, there were more tendon complications and median nerve pathology. Radial shortening was greater in the external fixation group when compared to the volar plate fixation group. DASH scores and VAS scores were significantly higher in the external fixation group. Clinically, the patients in the volar plate fixation group had significantly greater arcs of motion in pronation-supination (p < 0.0001) and flexion-extension (p = 0.002) with a trend towards better grip strength (p = 0.0062). Conclusions Volar plate fixation for fractures of the distal radius provides an overall decreased incidence of complications, significantly less radial shortening, and significantly greater postoperative wrist motion when compared to external fixation. Volar plate fixation is also associated with lower VAS scores when compared to external fixation as well as DASH scores that approach statistical significance. Level of evidence III (retrospective comparative study).

scholarly journals Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

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.

External Fixation of Distal Radius Fractures

2009 ◽  
Author(s):  
David Slutsky
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Volar Plate ◽  
Radius Fractures ◽  
Wrist Motion ◽  
Volar Plate Fixation ◽  
Over Time

External fixation has been used for the treatment of distal radius fractures for more than 50 years. Although the fixator configurations have undergone considerable modification over time, the type of fixator itself is not as important as the underlying principles that provide the foundation of external fixation. Although volar plate fixation is currently in vogue, the indications for external fixation remain largely unchanged. New fixator designs have also expanded hrte traditional usage to include nonbridging applications that allow early wrist motion. The following discussion focuses on the myriad uses for external fixation as well as the shortcomings and potential pitfalls.

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.

145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Mulrain ◽  
K Joshi ◽  
F Doyle ◽  
A Abdulkarim
Keyword(s):  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Distal Radius Fractures ◽  
Complication Rates ◽  
Volar Plating ◽  
Radius Fractures ◽  
Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

FIXATION OF AN ULNODORSAL FRAGMENT WHEN TREATING AN INTRA-ARTICULAR FRACTURE IN THE DISTAL RADIUS

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 139-144 ◽  
Author(s):  
Kazuo Ikeda ◽  
Naoki Osamura ◽  
Kaoru Tada
Keyword(s):  
Distal Radius ◽  
Surgical Procedure ◽  
Plate Fixation ◽  
Volar Plate ◽  
Dorsal Approach ◽  
Articular Fracture ◽  
Low Profile ◽  
Volar Plate Fixation ◽  
Mini Plate

If fixation of an ulnodorsal fragment in an intra-articular fracture of the distal radius is not stable, it is sometimes caused by dorsal displacement after surgery. Hence, we recommend the volar plate fixation with an additional dorsal approach and fixation of irreducible ulnodorsal fragments using a low-profile dorsal mini plate. The details of the surgical procedure and indications are discussed in this article.

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

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

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

2020 ◽  
Vol 09 (03) ◽  
pp. 219-224 ◽  
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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