Dorsal Wrist Spanning Plate Fixation for Treatment of Radiocarpal Fracture-Dislocations

Wahl, Elizabeth P; Lauder, Alexander; Pidgeon, Tyler S.; Guerrero, Evan M; Ruch, David S.; Richard, Marc J.

doi:10.1177/1558944719893068

Cited by 17 publications

(13 citation statements)

References 21 publications

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“…However, the DASH scores presented suggest that patients can still function well following plate removal. 25,30,32,33,35,38 At final review, DP and ET demonstrated similar radiographic outcomes. Although a meta-analysis has shown lower rates of infection and pain for DP, there is a higher risk of hardware failure, but no differences between DASH scores or additional operative interventions were noted.…”

Section: Discussionmentioning

confidence: 81%

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature

Esworthy,

Shaji,

Duraku

et al. 2023

J Wrist Surg

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Background Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results.There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.

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Section: Discussionmentioning

confidence: 81%

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature

Esworthy,

Shaji,

Duraku

et al. 2023

J Wrist Surg

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“…Compared to intramedullary wires and external fixator placement, bridge plating offers the advantage of maintaining an anatomic reduction throughout the postoperative course given that fixation is more robust and closer to the joint axis. While it has been well studied in biomechanical models of distal radius fractures[ 26 ], there is not enough data exploring its use in the setting of radiocarpal dislocations[ 20 , 21 ]. Biomechanical strength may either be extrapolated from the study by Alluri et al [ 18 ] or may represent an area of future research.…”

Section: Discussionmentioning

confidence: 99%

“…Bridge plate fixation for radiocarpal instability has received some attention recently. Wahl et al [ 20 ] reported good outcomes with the use of this technique in their retrospective review of 13 patients, using fixation to the third metacarpal in all their cases[ 20 ]. Azad et al [ 21 ] recently shared their results of a cadaveric study and suggested that fixation to the third metacarpal may result in more anatomic alignment.…”

Section: Introductionmentioning

confidence: 99%

Bridge plating in the setting of radiocarpal instability: Does distal fixation to the second or third metacarpal matter? A cadaveric study

Tabeayo¹,

Saucedo²,

Srinivasan³

et al. 2023

World J Orthop

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BACKGROUND Radiocarpal dislocations are rare but potentially devastating injuries. Poorer outcomes are associated with inadequate or lost reduction, such as ulnar translocation, but no consensus exists on the ideal fixation technique. Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal, but its application for radiocarpal dislocations has not been established. AIM To determine whether distal fixation to the second or third metacarpal matters. METHODS Using a cadaveric radiocarpal dislocation model, the effect of distal fixation was studied in two stages: (1) A pilot study that investigated the effect of distal fixation alone; and (2) a more refined study that investigated the effect of described techniques for distal and proximal fixation. Radiographs were measured in various parameters to determine the quality of the reduction achieved. RESULTS The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third. The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique. CONCLUSION In a cadaveric radiocarpal dislocation model, anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed. When considering dorsal bridge plate fixation for radiocarpal dislocations, the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.

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“…Some authors have demonstrated that ulnar translation of the carpus is the predictable consequence of an avulsion injury to the volar radiocarpal ligaments, specifically the RSC and RL ligaments. [ 1 , 8 , 9 ] Rayhack et al [ 8 ] sequentially sectioned the radiocarpal ligaments and found that ulnar subluxation of the wrist joint required transection of both the RSC and RL ligaments. Both Dumontier et al [ 1 ] and Yuan et al [ 10 ] concluded that volar radiocarpal ligament repair leads to better outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Rayhack et al [ 8 ] reported that all four patients treated with repair of the palmar ligaments had recurrent ulnar translation, and two required total wrist arthrodesis. Wahl et al [ 9 ] reported there was only 1 case (8%) of ulnar carpal translation after treat the radiocarpal fracture-dislocation using dorsal wrist spanning plate fixation. In our study, this patient showed good clinical results, but the radiological reports showed that the ulnar translation recurred postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Treatment of purely ligamentous dorsoulnar radiocarpal dislocation with ulnar translation of the carpus

et al. 2020

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Rationale: Radiocarpal fracture-dislocations are extremely infrequent injuries caused by high-energy trauma and involve significant osseous and ligamentous injuries. If not treated properly, it can lead to serious complications such as ulnar translation of the carpus, multidirectional instability, loss of motion, and post-traumatic arthritis. Purely ligamentous injuries are rarer than fracture-dislocation injuries. Because previous studies have reported small patient cohorts, there has been no standardized treatment strategy for purely ligamentous radiocarpal dislocation. Patient concerns: A 24-year-old man suffered a left wrist injury in a motorcycle accident. Plain radiographs revealed dorso-ulnar radiocarpal dislocation without radial fracture and Carpal-ulnar distance ratio (CUDR) was 0.16. MRI scans showed the disruption of the dorsal ligaments and capsules and avulsed from the proximal insertion of the volar radiocarpal ligaments. Diagnosis: Dorsoulnar radiocarpal dislocation with purely ligamentous injury. Intervention: We removed the interposing chondral fragment from the radiocarpal joint and repaired the radioscaphocapitate (RSC) and radiolunate (RL) ligaments with the Jugger Knot Soft Anchor Suture (Biomet, Inc, Warsaw, IN) and applied additional radiocarpal K-wires and an external fixator to maintain reduction and optimal ligament tension. Outcomes: The patient showed good clinical results although ulnar translation of the carpus recurred in radiological follow-up. Lessons: Aggressive surgical management is needed earlier in the treatment of purely ligamentous radiocarpal dislocation, especially if the ulnar translation of the carpus was observed in the initial radiographs.

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Dorsal Wrist Spanning Plate Fixation for Treatment of Radiocarpal Fracture-Dislocations

Cited by 17 publications

References 21 publications

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature

Bridge plating in the setting of radiocarpal instability: Does distal fixation to the second or third metacarpal matter? A cadaveric study

Treatment of purely ligamentous dorsoulnar radiocarpal dislocation with ulnar translation of the carpus

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