The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Wall, Lindley B.; Brodt, Michael D.; Silva, Matthew J.

doi:10.1016/s0363-5023(12)60017-3

Cited by 20 publications

(44 citation statements)

References 33 publications

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“…Repeat measurement and confirmation using the pronation view and the dorsal horizon view is needed if a longer screw (than screws in other quadrants) is used. When in doubt, a shorter screw is recommended, as the construct stiffness of locked unicortical fixation of >75% length is similar to locked bicortical fixation, 15 whereas dorsal cortex penetration of even 1 mm may produce tendon or nerve complications.…”

Section: Discussionmentioning

confidence: 99%

Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures

Yuen

Yee

Fang

et al. 2015

J Orthop Surg (Hong Kong)

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Purpose. To develop a reference for the distal screw length in volar locking plate fixation for distal radial fractures in an East Asian population. Methods. 12 pairs of forearm specimens from 11 male and one female East Asian cadavers were scanned using computed tomography. On sagittal images of the distal radius, the mean cortex-to-cortex distance of 8 quadrants was measured as a reference for the distal screw length. In addition, intra-operative 3-dimensional fluoroscopy of 10 male and 10 female patients who underwent volar locking plate fixation for distal radial fractures was used to validate the distal screw length in the cadaveric reference. 76 distal locking screws were applied in the 8 quadrants; their cortex-to-cortex distances were measured. Results. The mean cortex-to-cortex distances at quadrants A, B, C, D, E, F, G, and H were 15.4 mm, 19.6 mm, 20.8 mm, 20.0 mm, 13.3 mm, 18.0 mm, 18.8 mm, and 17.4 mm, respectively. In 45% of the specimens, the 2 screws inserted at quadrants C and D were longest. Distal screws (quadrants A to

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Section: Discussionmentioning

confidence: 99%

Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures

Yuen

Yee

Fang

et al. 2015

J Orthop Surg (Hong Kong)

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“…Unfortunately, the cancellous metaphyseal bone of the distal radius does not allow standard non-locked screws to obtain adequate purchase. In addition, bicortical screws are inadvisable in the distal portion of the distal radius since prominent dorsal screw tips can result in extensor tendon irritation or rupture [2,9].…”

Section: Discussionmentioning

confidence: 99%

“…With locking screws, the threads on the screw heads lock directly into the plate, so compression of the plate to the underlying bone is not needed and unicortical screws can provide adequate stability [3,9]. By virtue of the screws threading into the plate, locking plates provide stability by creating a fixed angle construct.…”

Section: Discussionmentioning

confidence: 99%

Routine use of Locking Shaft Screws is not Necessary in Volar Plate Fixation of Distal Radius Fractures

Lutsky

Hoffler

Kim

et al. 2015

Hand (New York, N,Y.)

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Hypothesis Volar locking plate fixation is a common treatment method for distal radius fractures. Recently, implants have been designed with an option to use locking screws in the shaft portion of the plate. While there is a high incidence of low bone mineral density in patients who sustain fragility fractures of the distal radius, the need for locking shaft screws is not well defined. Our hypothesis is that the routine use of locking screws in the shaft portion of volar plates is not required to maintain reduction or to prevent hardware failure. Methods A retrospective review was performed in all patients over age 50 years who underwent volar plate fixation using an implant with non-locking shaft screws for a distal radius fracture during a 2-year period. Patients were permitted to perform early range of motion exercises. Radiographs were examined and measurements were obtained to assess maintenance of reduction and incidence of hardware failure. Patients were followed at least until fracture healing. Patients were excluded from analysis if locking shaft screws were utilized or if follow-up was inadequate. Results Forty-one patients met the inclusion criteria. The average age was 62 years (range 50-79). There were 12 men and 29 women. The implant used incorporated 3.5-mm shaft screws in 26 patients and 2.4-mm shaft screws in 15 patients. All patients healed within acceptable radiographic parameters (mean volar tilt=4.9°, mean radial inclination=21.7°, mean radial height=11.6 mm). There were not any instances of hardware failure. Discussion Distal radius fractures frequently occur in patients with low bone mineral density. Non-locking, bicortically placed shaft screws provide adequate stability to allow for early range of motion without loss of reduction or hardware failure. The routine use of locking screws in the shaft portion of volar plates does not appear justified.

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“…4 This suggests that the greater the proportion of distal metaphysis thickness covered by a screw, the greater the biomechanic stability of the construct. In our study, neither group had screw lengths that were <75% of the thickness of the distal metaphysis, and so it was not known whether a few millimeters of extra screw penetration achieve any clinical advantage.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The length of the distal-row screws in relation to the volar-dorsal metaphyseal width affects the construct stiffness. 4 Variable angle or polyaxial locking plates can achieve better biomechanics and versatility. The variable angle plates have greater flexibility in screw angle insertion, particularly for peri-articular fragments (Fig.…”

Section: Introductionmentioning

confidence: 99%

Polyaxial versus Uniaxial Volar Locking Plate for Distal Radial Fractures

Al-Mouazzen

Chou²,

Kyriakopoulos³

et al. 2014

J Orthop Surg (Hong Kong)

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Purpose.To compare the penetration of the distal screws in relation to the thickness of the distal metaphysis in the polyaxial versus uniaxial volar locking plates. Methods. Records of 78 patients aged 16 to 79 years who underwent open reduction and internal fixation for distal radial fractures (n=81) were reviewed. All fracture subtypes were included. 20 men and 22 women aged 18 to 79 (mean, 50) years were treated with the uniaxial locking plate, whereas 15 men and 21 women aged 16 to 79 (mean, 51) years were treated with the polyaxial locking plate. The choice of plate was determined by the operating surgeon based on familiarity and perceived advantages of the 2 plates. Penetration of the distal locking screws in relation to the volar-dorsal thickness of the distal radial metaphysis was measured, and the percentage of subchondral bone unsupported by the screws calculated. of Orthopaedic Surgery 2014;22(1):9-12 subchondral bone was significantly lower in the polyaxial than uniaxial volar locking plate group (12% vs. 23%, p<0.001). No patient had screw overpenetration. Conclusion. The polyaxial volar locking plate system enabled deeper insertion of distal screws into the subchondral bone, and thus providing better buttress for the fracture fragments.

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The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Cited by 20 publications

References 33 publications

Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures

Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures

Routine use of Locking Shaft Screws is not Necessary in Volar Plate Fixation of Distal Radius Fractures

Polyaxial versus Uniaxial Volar Locking Plate for Distal Radial Fractures

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