Combined Volar and Dorsal Plating for Complex Comminuted Distal Radial Fractures

Farhan, Mohd Fadil Muhammad; Wong, Jian Hao; Sechachalam, Sreedharan; Yong, F. C.; Teoh, Lam-Chuan

doi:10.1177/230949901502300105

Cited by 16 publications

(11 citation statements)

References 18 publications

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“…Several reports show that the VLP is related to tendon related complications, even necessitating plate removal and resurgery [ 8 ].However, we did not experience such complications in our patient group, possibly as a result of appropriate patient selection, careful soft tissue dissection and precise screw lengths. Farhan et al reported in their series of patients with AO23C3 distal radius fractures that 16% of the patients required plate removal [ 23 ]. In our series, we had only one patient with an AO23C3 type fracture, and we treated the patient using EF, and the patient had an event-free follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Management of Distal Radius Fractures: Comparison of Three Methods

Ermutlu

Mert

Kovalak

et al. 2020

Cureus

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Introduction Distal radius fractures are the most common type of all extremity fractures. It is generally accepted that fractures with more than 2 mm step-off in the radiocarpal joint and greater than 10 degrees dorsal tilt should be treated surgically. However, the ideal technique for surgical management is still a point of debate. We performed cross-sectional data analysis to compare the results of three treatments methods-volar locking plate (VLP), external fixation (EF), Kirschner wire (K-wire)-in patients with distal radius fractures, and compared the clinical, functional, and radiological results Materials and methods Forty-four patients with distal radius fractures who underwent fixation with VLP, K-wire or EF between 2011 and 2013 were included in the study. All fractures were classified according to the Müller's Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Frykman's classifications. Routine radiographs were taken at the postoperative three weeks, six weeks, and three months. Radial inclination, volar tilt, radial length and ulnar variance were assessed on the follow-up visits and additionally at the follow-up for the study. The patient-based Disabilities of the Arm, Shoulder and Hand (DASH) score system and the physician-based MAYO scale were used to evaluate functional outcomes. Radiological and functional outcomes between three surgical modalities were compared and statistically analyzed. Results The average age at the time of surgery was 52 years (range = 35-69 years). Of a total of 44 patients, 28 were operated with VLP, 11 were with K-wire and five with EF. Satisfactory reduction was achieved in all fractures, and all of the fractures healed. DASH and MAYO scores were similar in all groups. Regarding radiographic parameters, there was no significant difference in radial inclination, volar tilt, radial length and ulnar variance between the treatment modality groups. When evaluated based on fracture geometry, the DASH score was significantly higher in the patients with AO23A type fracture compared to the patients with AO23B and AO23C type fractures. As for MAYO score, all AO23 groups had similar outcomes. Conclusions Surgical treatment options VLP, EF, and K-wire provide adequate fixation, satisfactory radiological, and functional results for the management of distal radius fractures of various 1 2 3 4 5 6

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Section: Discussionmentioning

confidence: 99%

Management of Distal Radius Fractures: Comparison of Three Methods

Ermutlu

Mert

Kovalak

et al. 2020

Cureus

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“…Farhan et al [21] reviewing data of 24 patients with severe comminuted fracture of distal radius treated by double plating, reported complications such as tendon rupture, carpal tunnel syndrome, infection and non-union, in addition to the early removal of dorsal plate among four patients. Besides, they concluded that double plating has the advantages of early motion and good outcome.…”

Section: Discussionmentioning

confidence: 99%

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra-Articular Fractures

Abdel-Ghany¹,

Tohamy²,

Shaaban³

et al. 2017

OJO

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Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular fractures. Patients and Methods: Forty-six patients with distal radius intra-articular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento's radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological outcome and five patients (20.9%) had good radiological outcome according to Sarmiento's radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome; there was no or insignificant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.

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“…Due to less soft tissue on the dorsal side of the wrist, there may be higher likelihood of tendon irritation and need for hardware removal, although new lower profile plates may help mitigate this problem. Farhan et al, in their retrospective series of 24 patients with AO C3 distal radius fractures treated with combined volar and dorsal plating, 4 patients required plate removal [6].…”

Section: Dorsal Monoblock Platingmentioning

confidence: 99%

“…There is a high rate of concomitant scapholunate interosseous ligament injury with high energy distal radius fractures [6]. Diagnosis relies on either radiographic SL distance and SL angle or intraoperative fluoroscopic or arthroscopic assessment.…”

Section: Scapholunate Ligament Injurymentioning

confidence: 99%

Management of High Energy Distal Radius Injuries

Blazar

2019

Curr Rev Musculoskelet Med

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Purpose of Review High energy distal radius are commonly multi-fragmentary with significant comminution and/or bone loss. They can also be associated with ligamentous and soft tissue injury and neurovascular compromise. As such, reconstruction of these injuries can be challenging. This paper will review the relevant anatomy, different methods of fixation, and present techniques for difficult fractures. Recent Findings Volar locked plating is a successful, very common method of treatment for distal radius fractures, but dorsal plating, fragment specific fixation, spanning bridge plating, and external fixation are sometimes necessary, particularly in higher energy injuries characterized by metaphyseal comminution, small volar fragments, intra-articular free fragments or lunate facet subsidence. Extended flexor carpi radialis (FCR), dorsal, and flexor carpi ulnaris (FCU) exposures can assist in visualizing the fracture site. Summary There are many different modes of fixation for distal radius fractures, and successful outcome depends on selection of appropriate fixation based on the fracture pattern and status of the soft tissues. Keywords Distal radius. Hand trauma. Comminuted fracture. Articular fracture. Open reduction internal fixation This article is part of the Topical Collection on Distal Radius and Wrist Fractures

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Combined Volar and Dorsal Plating for Complex Comminuted Distal Radial Fractures

Abstract: Combined volar and dorsal plating enables early mobilisation and good outcome for certain complex comminuted distal radial fractures.

Cited by 16 publications

References 18 publications

Management of Distal Radius Fractures: Comparison of Three Methods

Management of Distal Radius Fractures: Comparison of Three Methods

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra-Articular Fractures

Management of High Energy Distal Radius Injuries

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