Functional Outcomes in Volar-Displaced Distal Radius Fractures Patients with Marginal Rim Fragment Treated by Volar Distal Locking Plates

Naïto, Kiyohito; Sugiyama, Yoichi; Kinoshita, M.; Obata, Hiroyuki; Goto, Kenji; Nagura, Nana; Iwase, Yoshiyuki; Obayashi, Osamu

doi:10.1055/s-0038-1675245

Cited by 9 publications

(12 citation statements)

References 21 publications

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“…In 2004, Harness et al reported that treatment of DRF with VLFF using an existing volar locking plate is difficult due to its anatomical characteristics [ 20 ]. However, new DVLP applicable to volar-displaced fractures distal to the watershed line have recently been developed, and treatment of volar-displaced DRF with VLFF using DVLP has improved [ 15 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, many cases that were difficult to treat due to postoperative re-displacement were of volar-displaced DRF with VLFF, and re-displacement on the volar side developed after surgery because PVLP was selected for these volar-displaced fractures or DVLP was selected, but the plate placement site was inappropriate [12][13][14]. Based on these reports, we cover VLFF and sufficiently apply buttress fixation as a treatment strategy using DVLP, considering that volar-displaced DRF with VLFF has a high risk for postoperative displacement [15] [15,21]. On the other hand, in dorsal-displaced fractures with VLFF, we consider secondary displacement to be caused by pulling by the short radiolunate ligament attached to VLFF through the dorsal displacement of carpal VLFF.…”

Section: Discussionmentioning

confidence: 99%

“…Among DRFs with VLFF, many with difficulty in treatment due to postoperative re-displacement are of volar-displaced fractures [12][13][14]. Our algorithm for treating distal radius fractures uses proximal volar locking plates (PVLP) for dorsal displaced fractures and DVLP for volar displaced fractures [15]. Therefore, in this study, based on the hypothesis that PVLP can be used to treat dorsally displaced fractures even with VLFF, the clinical outcomes of PVLP fixation for dorsally displaced fractures with and without VLFF were compared.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

Obata

Naïto

Sugiyama

et al. 2021

SICOT-J

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Introduction: Although many clinical studies about distal radius fracture (DRF) accompanied by volar lunate facet fragments (VLFF) have recently been reported, none focus on the direction of displacement of distal fragments. Many previous cases with difficulty in treating DRF with VLFF were volar-displaced fractures. Thus, the postoperative risk for re-displacement is different between volar- and dorsal-displaced fractures with VLFF. The aim of this study is to compare the outcome of dorsal-displaced fractures treated using proximal volar locking plates (PVLP) between those with VLFF and those without, in order to reconsider the indications of distal volar locking plates (DVLP) and investigate the possibility of treating dorsal-displaced DRF with VLFF using PVLP. Methods: The subjects were 122 patients with dorsal-displaced DRFs treated using PVLP (42 males and 80 females, mean age: 59.2 years old). The patients were divided into 13 patients with VLFF group and 109 patients without VLFF group, and the clinical outcomes at 12 months after surgery were compared. Results: No significant difference was noted on any evaluation between the groups. In addition, no postoperative re-displacement of VLFF was observed and bone union was confirmed. Furthermore, no osteoarthritic change was noted in all patients. Conclusions: We confirmed that surgical treatment for dorsal-displaced DRF using PVLP is possible even in cases of DRF with VLFF. In addition, DVLP is an implant with a high complication risk; therefore, it may be necessary to reconsider the use of DVLP for dorsal-displaced DRF with VLFF treatable by PVLP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

Obata

Naïto

Sugiyama

et al. 2021

SICOT-J

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“…Bone suture and hook plate stabilize the soft tissues (capsule, ligaments) in the case of a small bony fragment which includes the attachment of the short radiolunate and volar radioulnar ligaments. Fixation with distally positioned special volar plates can be a valid treatment option [14,15]. These special plates can provide a sufficient buttress effect on small distal fragments.…”

Section: Discussionmentioning

confidence: 99%

Volar plate fixation in intra-articular distal radius fractures with a volar lunate facet fragment

Benis

Vanhove

Hollevoet

2020

Hand Surgery and Rehabilitation

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“…8,9,10 Over the years, several implants and fixation strategies have been described with particular reference to distal radius volar rim fractures-these include hook plates, distal volar locking plates, wire loops, buttress pin clamps and headless screws. [9][10][11][12][13][14][15][16][17][18] However, these implants or fixation strategies have broadly been described for large, volar marginal fragments greater than 4e5 mm in size. There are only a few techniques addressing small, volar marginal fragments and such fractures continue to pose a challenge to orthopedic surgeons.…”

Section: Introductionmentioning

confidence: 99%

The “AIIMS hairpin loop” technique for ‘extreme’ volar rim fractures of distal radius

Garg

Bansal

Mehta

2021

Journal of Clinical Orthopaedics and Trauma

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Background: Treatment of distal radius fractures has seen a paradigm shift since the use of volar locking plates became popular. However, there is a subset of fractures, which includes extreme distal volar rim fractures, that is often not amenable to fixation by volar locking plates as there is insufficient bone mass to put screws. These fractures as such are quite rare but carry a huge morbidity due to frequent lack of anatomical reduction and fixation. A number of different techniques like hook plates, specially designed distal volar locking plates and loop wire techniques have been described for these fractures, but they have been found to be less helpful when the fracture fragments are very small.Methods: Herein, we describe our experience on 6 patients, using a novel surgical technique for fixation of distal radius volar rim fractures which works equally well even when the fragments are quite small (2e3 mm). The technique uses low cost and readily available implants (K wire and conventional volar locking plate) without the need of any special implants.Results: The total of 6 cases of distal radius volar rim fractures (AO/OTA Type B3 ¼ 4, Type C1 ¼ 2) were operated. The mean age was 50.83 years (range: 31e72). The mean follow-up duration was 43.3 months (range: 26e66). The mean size of the volar fragment was 3.66 mm (range: 2e5). The mean pronation and supination were 72.5 (60e80) and 74.2 (60e85). The main flexion and extension were 52.5 (40e75) and 58.3 (50e80) respectively. The mean grip strength was 19.8 kg (4e38) and it was mean 79.3% (40 e130%) compared to uninjured side. The mean PRWE score was 12.3 (2e31). One patient developed symptoms of Complex Regional Pain syndrome 1 (CRPS 1) which resolved with conservative management and no other complications were noted.Conclusion: Our technique offers an indigenous, cost-effective way for fixation of extreme volar rim fracture fragments which can be easily adopted and used by surgeons in developing countries.

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Functional Outcomes in Volar-Displaced Distal Radius Fractures Patients with Marginal Rim Fragment Treated by Volar Distal Locking Plates

Cited by 9 publications

References 21 publications

Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

Volar plate fixation in intra-articular distal radius fractures with a volar lunate facet fragment

The “AIIMS hairpin loop” technique for ‘extreme’ volar rim fractures of distal radius

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