Failure of a retinacular flap to prevent dorsal wrist pain after titanium Pi plate fixation of distal radius fractures

Chiang, Peter P.; Roach, S.; Baratz, Mark E.

doi:10.1053/jhsu.2002.33703

Cited by 51 publications

(36 citation statements)

References 17 publications

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“…Others recommend a coverage of dorso-ulnar plate by retinacular fl ap (6). Chiang and Roach used this technique with limited success (20). In their review, 9 out of 20 patients (45 %) required a plate removal.…”

Section: Discussionmentioning

confidence: 99%

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Is an implant removal after dorsal plating of distal radius fracture always needed?

Gajdos¹,

Božík²,

Stranak³

2015

BLL

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PURPOSE: The purpose of this study was to evaluate the need for an implant removal and the frequency of hardware related complications in a group of distal radius fractures treated with dorsal double plating. METHODS: This retrospective study analyzed data from 37 patients in whom distal radius fracture surgery was performed through single dorsal approach with two low profi le titanium plates during a period of 5 years. Objective and subjective parameters were evaluated, focusing on detection of potentially harmful complications and the need of hardware removal during the follow up at least 12 months after the surgery. RESULTS: 37 patients with distal radius fracture treated by dorsal double plating were included in this study. 19 patients had their implant removed and 18 patients had their implant retained. There was no statistical difference between these groups in respect to age, fracture type, incidence of associated wrist injury, hand dominance, gender and Mayo wrist score. Only subjective parameters including the average value of the Quick Disabilities of Arm, Hand, and Shoulder Questionnaire and the Visual Analogue Scale were higher in the group of patient requiring implant removal with a statistically signifi cant difference. CONCLUSION: Our results suggested that only symptomatic hardware should be removed. A decreased range of motion and extensor tendon problems are the most frequent complication, that necessitate plate removal. The main indicator of implant related soft tissue problems was the dorsal wrist pain syndrome (Tab. 1, Fig. 3, Ref. 36). Text in PDF www.elis.sk.

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Section: Discussionmentioning

confidence: 99%

“…Tendon rupture has been reported as early as 8 weeks and as late as 7 months after the surgery (20). As a result of these complications, the dorsal implants often have to be removed (21).…”

Section: Introductionmentioning

confidence: 99%

Is an implant removal after dorsal plating of distal radius fracture always needed?

Gajdos¹,

Božík²,

Stranak³

2015

BLL

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“…[2,6] However, complications including soft tissue irritation, extensor tendonitis, extensor tendon rupture, and chronic dorsal irritation requiring plate removal have been documented, particularly with π-type dorsal plates. [4,20,21,24] More recent studies of lower profile dorsal plates have shown a lower rate of dorsal tissue complications, although authors have reported reoperation for extensor pollicis longus tenolysis [9] and hardware removal due to dorsal wrist pain. [26] In an attempt to avoid the complications of dorsal plate placement, volar plating of distal radius fractures has been advocated.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Different Volar Fracture Fixation Plates for Distal Radius Fractures

Sobky

Baldini

Thomas

et al. 2007

Hand (New York, N,Y.)

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The purpose of this study was to compare the biomechanical properties of four volar fixed-angle fracture fixation plate designs in a novel sawbones model as well as in cadavers. Four volar fixed angle plating systems (Hand Innovations DVR-A, Avanta SCS/V, Wright Medical Lo-Con VLS, and Synthes stainless volar locking) were tested on sawbones models using an osteotomy gap model to simulate a distal radius fracture. Based on a power analysis, six plates from each system were tested to failure in axial compression. To simulate loads with physiologic wrist motion, six plates of each type were then tested to failure following 10,000 cycles applying 100N of compression. To compare plate failure behavior, two plates of each type were implanted in cadaver wrists and similar testing applied. All plate constructs were loaded to failure. All failed with in apex volar angulation. The Hand Innovations DVR-A plate demonstrated significantly more strength in peak load to failure and failure after fatigue cycling (p value < 0.001 for single load and fatigue failure). However, there was no significant difference in stiffness among the four plates in synthetic bone. The cadaveric model demonstrated the same mode of failure as the sawbones. None of the volar plates demonstrated screw breakage or pullout, except the tine plate (Avanta SCS/V) with 1 mm of pullout in 2 of 12 plates. This study demonstrates the utility of sawbones in biomechanical testing and indicates that volar fixation of unstable distal radius fractures with a fixed angle device is a reliable means of stabilization.

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“…5 Our case is different from the previous reports because the similar sort of plate had been used for volar fixation of a distal radial fracture. 2,6 We feel its indication should be for dorsal fixation of distal radial fractures, for which it was originally designed. An angled T-plate is ideal for use on the volar aspect of the distal radius.…”

Section: Discussionmentioning

confidence: 99%

Rupture of flexor pollicis longus post reduction radial fracture

2006

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The T-plate is a recently developed low-profile plate for use in the fixation of distal radius fractures. Its design allows contouring to fit the unique surface of the volar surface of the distal radius. This is an angled T-plate well suited for volar fixation of distal radial fractures. There has been a recent report of delayed extensor tendon rupture after volar fixation of a distal radial fracture, 1 but there are no reports of an injury to the flexor tendons after use of the plate on the volar surface. We report a delayed rupture of the flexor pollicis longus tendon after volar fixation of a distal radial fracture using a Tplate. Case reportA 49-year-old right-handed man sustained a comminuted, intra-articular distal radial fracture after a fall onto his outstretched left hand. He was initially treated with closed reduction and immobilization along with referral to physiotherapy. The follow-up visit 10 days later showed that the fracture reduction was lost and open reduction and internal fixation was suggested. So, after 3 weeks of injury, he underwent open reduction and internal fixation with a T-plate placed on the volar surface.The implant was applied through a volar approach to the radius. The flexor carpi radialis subsheath was opened and the tendon was retracted in an ulnar direction along with the flexor tendons and the median nerve. The sheath was released distal to the wrist flexion crease so that it could be mobilized adequately. The pronator quadratus was exposed and elevated off the volar aspect of the radius from a radial to ulnar direction without detaching it form its attachment. Fracture fragments were reduced directly and with fluoroscopy, as there was considerable intra-articular comminution and displacement, so then the brachioradialis and the first dorsal compartment were elevated off the distal radius and the radial shaft was pronated to facilitate exposure. This allowed access through the fracture site to the entire distal radius. Under fluoroscopy, the articular fragments were reduced with a bone clamp using the scaphoid and lunate as a mold. Preliminarily, the fragments were held in place by using K-wires. Once preliminary reduction was achieved, the selected volar plate was positioned and held in place with stabilization wires. Confirmation of preliminary reduction and guide wire placement was obtained with intrasurgical fluoroscopy. It is mandatory that the intra-articular fracture fragments be aligned anatomically before

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Failure of a retinacular flap to prevent dorsal wrist pain after titanium Pi plate fixation of distal radius fractures

Cited by 51 publications

References 17 publications

Is an implant removal after dorsal plating of distal radius fracture always needed?

Is an implant removal after dorsal plating of distal radius fracture always needed?

Biomechanical Comparison of Different Volar Fracture Fixation Plates for Distal Radius Fractures

Rupture of flexor pollicis longus post reduction radial fracture

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