Minimally Invasive Plate Osteosynthesis for Extra-articular Distal Radius Fracture in Postmenopausal Women: Longitudinal versus Transverse Incision

Abstract

Background This work aimed to compare two mini-invasive palmar approaches (longitudinal and transverse) to osteosynthesize fractures of the distal radius. The main hypothesis was that the longitudinal technique gave smaller incisions. The secondary hypothesis was that the longitudinal technique would be better for the recovery of pain, functional scores, strength, and mobility. Materials and Methods The series included 30 extra-articular distal radius fractures in 30 patients (average age: 74 years) fixed with volar locking plate using a mini-invasive technique. Fifteen of these patients had a single longitudinal surgical approach (Group I), and 15 had a transverse approach that was completed with a longitudinal incision for the proximal screws (Group II). Results The combined average incision size was 14.73 mm in Group I and 19.8 mm in Group II. After 6 months, the pain was on average 1.4/10 (Group I) and 0.46/10 (Group II), the quick Disability of the Arm, Shoulder, and Hand was 13.63/100 (Group I) and 2.8/100 (Group II), Patient-Related Wrist Evaluation was 11.8/100 (Group I) and 5.97/100 (Group II), grip strength was 81.06% (Group I) and 72.13% (Group II), flexion was 88.13% (Group I) and 75% (Group II), extension was 86% (Group I) and 64.6% (Group II), ulnar inclination was 89% (Group I) and 78.67% (Group II), radial inclination was 89.73% (Group I) and 79.93% (Group II), pronation was 96.67% (Group I) and 81.46% (Group II), and supination was 91.93% (Group I) and 79.87% (Group II). Clinical Relevance The longitudinal technique gave smaller incisions than the transverse technique. Among the secondary hypotheses, all the variables were better with the longitudinal technique, except the pain, although without any significant difference.

A systematic review and meta-analysis of the pronator quadratus repair following volar plating of distal radius fractures

“…The pronator quadratus (PQ) muscle resides in the fracture zone and implant placement site. Several published studies have addressed methods of preservation or repair of the PQ muscle [ 2 – 4 ]. A previous study surveyed all active members of the American Society for Surgery of the Hand in the USA, and 83% (608/753) responded that they attempted to repair the PQ muscle [ 5 ].…”

Mini-Invasive Surgery for Distal Radius Fractures: A Double Incision under 12 mm

“…In general, they overlap previous papers relying on MIPO technique 9 and are, in fact, located above the ones that were reported using transverse incision. 20 At final follow-up, radiological parameters are all within the normal ranges. In summary, from our data, MIPO technique with smaller incisions and using a specific plate allowed good clinical and radiological results, in agreement with current literature.…”

“…Scores for quickDASH are also located between the lowest reported values in current literature. 4,9,20 All the ROM parameters and grip strength, with exception of ulnar deviation (87 AE 20% of the contralateral side), were above the 95% barrier of the contralateral side (►Fig. 5A-D).…”

“…Previous literature in MIPO techniques reports an incision sized between 10 and 15 mm when using longitudinal approach, 4,7 but some papers still describe incisions within 25 and 40 mm. 9,20 For transverse approach, mean size of 19.8 mm (ranged from 17 to 26 mm) has been reported. 20 In our study, both mean size of the distal transverse incision and the sum of the sizes of both incisions (►Table 2, ►Fig.…”

“…9,20 For transverse approach, mean size of 19.8 mm (ranged from 17 to 26 mm) has been reported. 20 In our study, both mean size of the distal transverse incision and the sum of the sizes of both incisions (►Table 2, ►Fig. 4A, B) were indeed smaller than previously reported using the same kind of approach.…”