Hardware-Related Complications After Dorsal Plating for Displaced Distal Radius Fractures

Matzon, Jonas L.; Kenniston, Julia A.; Beredjiklian, Pedro K.

doi:10.3928/01477447-20141023-54

Cited by 27 publications

(18 citation statements)

References 22 publications

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“…12 Recent improvements have made the locking plate thinner with a rounder edge, which has led to a lower complication rate. [7][8][9][10] In this study, we showed the excellent results of lowprofile DLP in both two types of fractures. The type 1 fracture causes dorsal shearing accompanied by compression force.…”

Section: Discussionsupporting

confidence: 60%

“…3,5,6 However, a new generation of 1.0-to 1.6-mm, low-profile dorsal locking plates (DLPs) have been designed to minimize tendon irritation. [7][8][9][10] Here, we retrospectively reviewed on patients treated by DLPs. The purpose of this study was to demonstrate our surgical strategy and technique of DLPs for displaced distal radius fractures according to the fracture patterns.…”

mentioning

confidence: 99%

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Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

et al. 2016

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Most fractures of the distal radius can be treated with volar locking plates (VLPs) including the majority (89.6%) of AO C3-type fractures.1 VLP has recently gained widespread acceptance as the primary option for the treatment of this trauma.2 However, dorsally displaced fractures accompanied by the following conditions are not easy to treat using a single VLP 3,4 : when a significant dorsal die-punch is present, which sometimes involves the displacement of the distal radioulnar joint (DRUJ); or when a volar fracture line is distal to the watershed line or associated with dorsal communicated fractures. In these situations, the ulnar corner fragment occasionally cannot be held by a VLP or the distal edge of VLP can impinge on flexor tendons and cause injury. The displaced dorsal wall is involved with an elevated large roof, a rotated rim fragment, or impaction of the articular surface, which may cause arthritis of the wrist, or irritation of extensor tendon. These displacements seemed to be difficult to correct by a single volar approach. Keywords► dorsally displaced distal radius fractures ► low-profile dorsal locking plates ► surgical strategy and technique ► fracture type ► indication and clinical results AbstractBackground The low-profile dorsal locking plating (DLP) technique is useful for treating dorsally comminuted intra-articular distal radius fractures; however, due to the complications associated with DLP, the technique is not widely used.Methods A retrospective review of 24 consecutive cases treated with DLP were done. Results All cases were classified into two types by surgical strategy according to the fracture pattern. In type 1, there is a volar fracture line distal to the watershed line in the dorsally displaced fragment, and this type is treated by H-framed DLP. In type 2, the displaced dorsal die-punch fragment is associated with a minimally displaced styloid shearing fracture or a transverse volar fracture line. We found that the die-punch fragment was reduced by the buttress effect of small L-shaped DLP after stabilization of the styloid shearing for the volar segment by cannulated screws from radial styloid processes. At 6 months after surgery, outcomes were good or excellent based on the modified Mayo wrist scores with no serious complications except one case. The mean range of motion of each type was as follows: the palmar flexion was 50, 65 degrees, dorsiflexion was 70, 75 degrees, supination was 85, 85 degrees, and pronation was 80, 80 degrees; in type 1 and 2, respectively. Conclusion DLP is a useful technique for the treatment of selected cases of dorsally displaced, comminuted intra-articular fractures of the distal radius with careful soft tissue coverage.

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Section: Discussionsupporting

confidence: 60%

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confidence: 99%

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

et al. 2016

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“…Our results are very similar to a recent study evaluating patients with distal radius fractures treated with titanium low-profile dorsal plates. 11 They reviewed 125 patients with displaced distal radius fractures treated with a low-profile titanium dorsal plating system. Though their follow-up period was only 1 year and most of our plates were volar while theirs were all dorsal, the percentage of patients requiring plate removal was 8% while we removed 11%.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, the difficulty in removing the plates has been attributed to bony integration as well as mechanical binding between the titanium screw and plate. 10,11 Furthermore, the interaction between the plates and the overlying tendons has been implicated in a greater number of inflammatory responses and attrition ruptures. These have been compared in vivo to stainless-steel plates and found to be more problematic.…”

Section: Introductionmentioning

confidence: 99%

Titanium versus Stainless-Steel Plating in the Surgical Treatment of Distal Radius Fractures: A Randomized Trial

et al. 2016

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Our purpose was to compare postoperative complications and rate of plate removal in titanium and stainless-steel plating of distal radius fractures (DRF). Patients following DRF were randomly fixed with titanium or stainless-steel plates using the same plating system. Complications, second surgeries, and plate prominence were documented. A total of 41 patients were treated with stainless-steel and 22 with titanium plates. Average follow-up was 60???5.6 months. There was no difference in demographics, fracture characteristics, or follow-up between the groups. Plate prominence was found in 50% of radiographs (mean distance: 1.4 mm). Four titanium plates and three stainless-steel plates were removed (11%). Mean time to plate removal was 18.4???4.6 months. There was no difference in removal rates between the groups. Plate material and prominence, age, fracture comminution and smoking status were not associated with plate removal. Our results support using volar and dorsal plates regardless of the plate material.

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“…Dorsal locking plates have the advantage of acting as a buttress to posterior comminution and the locking plates may also allow increased periosteal blood supply [ 38 ]. Dorsal plating fixation is an accepted treatment for unstable, dorsally displaced DRFs with many benefits, including the ease of exposure, visualization of the articular surface, and biomechanical advantage of plate placement as a dorsal buttress [ 39 ]. Previous studies showed that dorsal locking plating was associated with extensor tendon complications, consequently volar locking plating gained more acceptance.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments

et al. 2015

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BackgroundTo compare risk of carpal tunnel syndrome (CTS) in distal radius fracture (DRF) patients after 7 treatments using bridging external fixation (BrEF), non-bridging external fixation (non-BrEF), plaster fixation, K-wire fixation, dorsal plating fixation, volar plating fixation, and dorsal and volar plating by performing a network meta-analysis.Material/MethodsAn exhaustive search of electronic databases identified randomized controlled trails (RCTs) closely related to our study topic. The published articles were screened, based on predefined inclusion and exclusion criteria, to select high-quality studies for the present network meta-analysis. Data extracted from the selected studies were analyzed using STATA version 12.0 software.ResultsThe literature search and selection process identified 12 eligible RCTs that contained a total of 1370 DRF patients (394 patients with BrEF, 377 patients with non-BrEF, 89 patients with K-wire fixation, 192 patients with plaster fixation, 42 patients with dorsal plating fixation, 152 patients with volar plating fixation, and 124 patients with dorsal and volar plating fixation). Our network meta-analysis results demonstrated no significant differences in CTS risk among the 7 treatments (P>0.05). The value of surface under the cumulative ranking curve (SUCRA), however, suggested that dorsal plating fixation is the optimal treatment, with the lowest risk of CTS in DRF patients (dorsal plating fixation: 89.2%; dorsal and volar plating: 57.8%; plaster fixation: 50.9%; non-BrEF: 50.6%; volar plating fixation: 39.6%; BrEF: 38.4%; K-wire fixation: 23.6%).ConclusionsOur network meta-analysis provides evidence that dorsal plating fixation significantly decreases the risk of CTS and could be the method of choice in DRF patients.

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Hardware-Related Complications After Dorsal Plating for Displaced Distal Radius Fractures

Cited by 27 publications

References 22 publications

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

Titanium versus Stainless-Steel Plating in the Surgical Treatment of Distal Radius Fractures: A Randomized Trial

Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments

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