Volar Locking Plate
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2021 ◽  
Vol 26 (03) ◽  
pp. 410-416
Michiro Yamamoto ◽  
Masahiro Tatebe ◽  
Yasunobu Nakagawa ◽  
Shigeru Kurimoto ◽  
Katsuyuki Iwatsuki ◽  

Background: The usefulness of radial osteotomy for older patients remains unclear. The purpose of this study was to compare the clinical and radiological outcomes of radial osteotomy with volar locking plate between younger and older patients with Kienböck disease stages II to IIIB. Methods: This was a retrospective comparative study of 21 consecutive patients treated at our department. Lichtman’s classification was used for staging, and four patients had stage II, six patients had stage IIIA, and 11 patients had stage IIIB disease. We divided them into two groups to compare the radiological and clinical results between younger (younger than 40 years) and older patients. The mean follow-up periods in the younger and older groups were 4 and 3.6 years, respectively. For radiological assessment, we evaluated the carpal height ratio (CHR), Stahl index, and union of the fractured lunate. For clinical assessment, we examined the range of motion of the wrist, grip strength, numeric rating scale (NRS) for pain, and the patient-reported Hand20 score preoperatively and at the final follow-up. Results: There were 12 patients in the younger group with a mean age of 23 years (range, 12–37 years), and 9 in the older group with a mean age of 56 years (range, 40–74 years). There were no intra- and post-operative complications in either group. Radiological improvement, including CHR, Stahl index, and union of the fractured lunate, was more common in the younger group than in the older one, as was the case for clinical improvement. However, even in the older group, significant clinical improvement, including the range of motion of the wrist, NRS for pain, and the Hand20 score, was seen postoperatively. Conclusions: Radial osteotomy appears to be a safe and reliable option in older symptomatic patients with Kienböck disease stages II to IIIB.

Pankaj Vir Singh ◽  
Gagandeep Singh ◽  
Tejpal Singh ◽  
Abdul Ghani ◽  
Zubair A. Lone

Background: Distal end radius (DER) fractures are most common fractures in upper limb. Intra articular fractures can be managed either by open reduction and internal fixation by volar locking plate or can be managed by closed reduction and external fixator application or by percutaneous pinning. The purpose of our study was to compare the functional outcome of volar locking plate with that of external fixation.Methods: A prospective cohort study was conducted between June 2019 to June 2020 in Government Medical College, Jammu on 46 patients with intra articular distal end radius fractures. Of which 26 were managed by volar locking plate and 20 were managed by external fixator. the results of both groups were compared on the basis of radiological parameter and range of motion achieved post operatively. The functional outcome was evaluated using DASH score and Gartland–Werley scale. Results: Final range of motion, grip strength were better in patients managed with volar locking plate (VLP) as compared to those who were managed with external fixator (EF). Radiographically, volar tilt, radial height were all better in VLP group than EF.Conclusions: We concluded that VLP is superior method to maintain reduction till the union occurs and prevents the fracture collapse in intra articular distal end radius fractures as compared with external fixator. Thus, giving better functional and radiological outcome than the external fixator.

Xuanchi Liu ◽  
Saeed Miramini ◽  
Minoo Patel ◽  
JinJing Liao ◽  
Darpan Shidid ◽  

Prakashappa Thamalehally Hanumanthappa ◽  
Bharath Raja B. S. ◽  
Muthu Kishore Marichamy

<p class="abstract"><strong>Background:</strong> Distal end radius fractures are one of the most common fractures. Compared to younger patients, elderly with distal radius fractures with osteoporosis and higher comminution compromise the treatment outcomes. Anatomic reduction with stable fixation is usually the choice of treatment for displaced intra-articular fractures. While osteoporosis and poor bone quality hamper fracture stabilization, locking compression plates (LCPs) provide enhanced stability and axial loading force as compared to conventional plates. The current study retrospectively analysed the postoperative radiological outcomes in a 2.7 mm volar LCP system used for internal stabilisation of intra articular distal radius fractures.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted in the Sanjay Gandhi institute of trauma and orthopaedics, Bangalore from June 2018 to July 2020. All Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B and C distal radius fractures of patients aged 60 and above who underwent 2.7 mm volar locking plate fixation during that time period were analysed with X-rays at immediate post-operative, six weeks and three months. The radiological outcome was scored based on Sarmiento’s modification of Lindstorm criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean immediate post-operative radial shortening, decrease in radial deviation and loss of palmar tilt were 3.80±1.03, 4.38±1.05 and 3.97±1.02, respectively. The corresponding values at last follow up were 4.31±1.12, 6.19±1.02 and 4.76±0.99, respectively. No statistically significant difference (p=0.949; p=1.0; p=0.996) in radial shortening, loss of radial deviation and decrease in palmar angulation was seen till the final follow up. Sarmiento’s modification of Lindstorm criteria showed a good radiological outcome in 80% and excellent in 20%.</p><p class="abstract"><strong>Conclusions:</strong> Use of 2.7 mm volar LCP showed good to excellent post-operative radiological outcomes in geriatric population. The fracture reduction achieved in the immediate post-operative period is maintained throughout the follow up duration without any significant change.</p>

Hand ◽  
2021 ◽  
pp. 155894472110172
Maximilian A. Meyer ◽  
Kyra A. Benavent ◽  
Stein J. Janssen ◽  
Cassandra M. Chruscielski ◽  
Philip E. Blazar ◽  

Background The purpose of this study was to evaluate the impact of pronator quadratus (PQ) repair on reoperation rates after distal radius open reduction internal fixation (ORIF) using a volar locking plate. Methods A retrospective study of all patients undergoing distal radius ORIF with a volar locking plate between January 2012 and December 2016 at 2 urban, academic level I trauma centers was performed. Patient demographics, fracture and procedure characteristics, surgeon subspecialty, PQ repair, and reoperations were recorded. Descriptive statistics were used to determine whether patient-related or injury-related characteristics were associated with PQ repair. Bivariate and multivariable regression analyses were used to assess the effect of PQ repair on subsequent reoperations. Results In total, 509 patients were included, including 31 patients with bilateral injuries. The average follow-up time was 3.7 ± 2.8 years. Patients undergoing PQ repair were younger (57 ± 17 years vs 61 ± 17 years) and were more likely to have a lower Soong grade (53% vs 44% with Soong grade 0) than patients without PQ repair. Pronator quadratus repair was not found to have a significant impact on hardware removal, reoperations for flexor tendon pathology, or overall reoperations. Conclusions Pronator quadratus repair was more commonly performed in younger patients and in patients with a lower Soong grade. Hand-subspecialized surgeons are more likely to pursue PQ repair than trauma-subspecialized surgeons. This study did not detect statistically significant differences in hardware removal, flexor tendon pathology, or overall reoperations between groups.

2021 ◽  
Xue-yang Gui ◽  
Zhao-hui Cheng ◽  
Hongfei Shi ◽  
Yi-xin Chen ◽  
Jin Xiong ◽  

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.

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