Characteristics of two different locking compression plates in the volar fixation of complex articular distal radius fractures

Recum, Jan von; Matschke, Stefan; Jupiter, Jesse B.; Ring, David; Souer, J. Sebastiaan; Huber, Michael L.; Audigé, Laurent

doi:10.1302/2046-3758.16.2000008

Cited by 23 publications

(17 citation statements)

References 23 publications

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“…Screw-plate failure, i.e. screw push-out, is a known complication following polyaxial VLPO [ 36 , 37 ]. To our best knowledge, no biomechanical study has yet analysed this failure mode.…”

Section: Discussionmentioning

confidence: 99%

The influence of distal screw length on the primary stability of volar plate osteosynthesis—a biomechanical study

et al. 2015

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BackgroundExtensor tendon irritation is one of the most common complications following volar locking plate osteosynthesis (VLPO) for distal radius fractures. It is most likely caused by distal screws protruding the dorsal cortex. Shorter distal screws could avoid this, yet the influence of distal screw length on the primary stability in VLPO is unknown. The aim of this study was to compare 75 to 100 % distal screw lengths in VLPO.MethodsA biomechanical study was conducted on 11 paired fresh-frozen radii. HRpQCT scans were performed to assess bone mineral density (BMD) and bone mineral content (BMC). The specimens were randomized pair-wise into two groups: 100 % (group A) and 75 % (group B) unicortical distal screw lengths. A validated fracture model for extra-articular distal radius fractures (AO-23 A3) was used. Polyaxial volar locking plates were mounted, and distal screws was inserted using a drill guide block. For group A, the distal screw tips were intended to be flush or just short of the dorsal cortex. In group B, a target screw length of 75 % was calculated. The specimens were tested to failure using a displacement-controlled axial compression test. Primary biomechanical stability was assessed by stiffness, elastic limit, and maximum force as well as with residual tilt, which quantified plastic deformation.ResultsNine specimens were tested successfully. BMD and BMC did not differ between the two groups. The mean distal screw length of group A was 21.7 ± 2.6 mm (range: 16 to 26 mm), for group B 16.9 ± 1.9 mm (range: 12 to 20 mm). Distal screws in group B were on average 5.6 ± 0.9 mm (range: 3 to 7 mm) shorter than measured. No significant differences were found for stiffness (706 ± 103 N/mm vs. 660 ± 124 N/mm), elastic limit (177 ± 25 N vs. 167 ± 36 N), maximum force (493 ± 139 N vs. 471 ± 149 N), or residual tilt (7.3° ± 0.7° vs. 7.1° ± 1.3°).ConclusionThe 75 % distal screw length in VLPO provides similar primary stability to 100 % unicortical screw length. This study, for the first time, provides the biomechanical basis to choose distal screws significantly shorter then measured.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-015-0283-8) contains supplementary material, which is available to authorized users.

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“…Screw-plate failure, i.e. screw push-out, is a known complication following polyaxial VLPO [ 36 , 37 ]. To our best knowledge, no biomechanical study has yet analysed this failure mode.…”

Section: Discussionmentioning

confidence: 99%

The influence of distal screw length on the primary stability of volar plate osteosynthesis—a biomechanical study

et al. 2015

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“…Thielke et al 8 treated 49 displaced articular fractures with the overall outcome on Gartland and Werley scales being 85% excellent to good scores. Similarly, Recum et al 9 showed 96% and 86% excellent to good in 2.4 mm and 3.5 mm LCP respectively. We had comparable results of 85% in excellent to good category [ Table 5 ].…”

Section: Discussionmentioning

confidence: 77%

“…According to Knirk and Jupiter, 3 these fractures must always be separated from extra-articular fractures as their response to treatment and the functional outcomes are always quite distinct. Thielke et al 8 used fixed angle plates and von Recum et al 9 used 2.4 and 3.5 mm LCP for fixation of these fractures. Extra-articular comminuted fractures (type A2 and A3) are inherently prone to re-displacement after closed reduction.…”

Section: Discussionmentioning

confidence: 99%

Two peg spade plate for distal radius fractures

Hardikar¹,

Prakash²,

Hardikar³

et al. 2015

IJOO

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Background:The management of distal radius fractures raises considerable debate among orthopedic surgeons. The amount of axial shortening of the radius correlates with the functional disability after the fracture. Furthermore, articular incongruity has been correlated with the development of arthritis at the radiocarpal joint. We used two peg volar spade plate to provide a fixed angle subchondral support in comminuted distal radius fractures with early mobilization of the joint.Materials and Methods:Forty patients (26 males and 14 females) from a period between January 2009 and December 2011 were treated with two peg volar spade plate fixation for distal radius fracture after obtaining reduction using a mini external fixator. Patients were evaluated using the demerit point system of Gartland and Werley and Sarmiento modification of Lindstrom criteria at final followup of 24 months.Results:The average age was 43.55 years (range 23-57 years). Excellent to good results were seen in 85% (n = 34) and in all patients when rated according to the demerit point system of Gartland and Werley and Sarmiento modification of Lindstrom criteria, respectively. Complications observed were wrist stiffness in 5% (n = 2) and reflex sympathetic dystrophy in 2.5% (n = 1).Conclusions:The two peg volar spade plate provides a stable subchondral support in comminuted intraarticular fractures and maintains reduction in osteoporotic fractures of the distal radius. Early mobilization with this implant helps in restoring wrist motion and to prevent development of wrist stiffness.

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“…The range of motion (ROM) and grip strength were used to evaluate the wrist's function. The physician-based Gartland-Werley score [8] and the patient-reported DASH (disabilities of the arm, shoulder, and hand) score system [9]were used to indicate the overall functional outcome. Before the culture results, chemotherapy was administered for 2 weeks with four oral anti-tuberculous agents: isoniazid 5 mg/kg, rifampicin 10 mg/kg, pyrazinamide 20 mg/kg, and ethambutol 15 mg/kg per day.…”

Section: Patients' Datamentioning

confidence: 99%

Wrist Tuberculosis-experience From Eighteen Cases: A Retrospective Study

Zou

tan²,

guo

et al. 2020

Preprint

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Background Wrist tuberculosis is a rare disease, easy to cause misdiagnosis, delay treatment and lead to poor prognosis. In this study, the clinical manifestations, diagnosis, treatment and prognosis of 18 cases of wrist tuberculosis were analyzed retrospectively. Methods We conducted a retrospective study investigating tuberculosis of the wrist, diagnosed in 18 patients from August 2013 to November 2018. Puncture biopsy confirmed the diagnosis. The study includes 11 males and 7 females, and 8 left and 10 right wrists. The average age was 53.5 ± 18.3 years and ranged from 15 to 81 years. The disease course was 1 to 42 months, with an average of 15.1 ± 11.3 months. Eighteen patients were treated with surgery and chemotherapy, 3 patients with severe bone defect were treated with wrist fusion, and 15 patients were treated with focus removal. The Gartland and Werley score, DASH score, the range of motion (ROM), grip strength, and imaging examinations were used to evaluate the postoperative recovery of the patients. Results Eighteen patients were followed up for 15 to 77 months, with an average follow up of 39.7 ± 15.3 months. The ESR and CRP levels were normal for all patients after chemotherapy. No recurrence of tuberculosis was observed in any of the patients. Among the 15 focus removal, the Gartland and Werley scores at admission, two weeks of chemotherapy, 1 month after surgery, and the last follow-up were 21.73 ± 4.33, 18.60 ± 3.16,11.27 ± 2.79, and 5.07 ± 2.28, respectively; and DASH scores were 45.87 ± 5.58, 39.47 ± 4.72,22.67 ± 6.54, and 6.73 ± 2.94, respectively. The wrist range of motion (ROM) and grip strength improved significantly compared to those at admission. Among the three cases of wrist fusion, 2 were fixed with a steel plate and the fixation position of wrist joint was good. One case was fixed with Kirschner wire and resulted in a slightly deformed wrist joint. Conclusion For the patients with wrist tuberculosis, early diagnosis, preoperative and postoperative chemotherapy, thorough focus removal, and appropriate fixation of the affected limb can help restore the function of the affected wrist, reduce the recurrence rate, and improve the quality of life.

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Characteristics of two different locking compression plates in the volar fixation of complex articular distal radius fractures

Cited by 23 publications

References 23 publications

The influence of distal screw length on the primary stability of volar plate osteosynthesis—a biomechanical study

The influence of distal screw length on the primary stability of volar plate osteosynthesis—a biomechanical study

Two peg spade plate for distal radius fractures

Wrist Tuberculosis-experience From Eighteen Cases: A Retrospective Study

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