The maximum distal and ulnar position of a fixed-angle volar plate to avoid intra-articular penetration

Abstract

In cases of recalcitrant carpal tunnel syndrome, many surgical procedures have been described to provide a healthy tissue bed to the median nerve, including hypothenar fat pad flaps (Strickland et al., 1996), reverse radial artery adipofascial flaps (Braun et al., 1995), pronator quadratus muscle flaps (Dautel and Merle, 1993) and abductor digiti minimi flaps (Reismann and Dellon, 1983). We report a case of the successful treatment of recalcitrant carpal tunnel syndrome by an adipofascial flap based on an ulnar artery perforator, when the intended radial artery perforator was unavailable.A 55-year old right-hand dominant woman presented with carpal tunnel syndrome in the right hand with an associated palmar wrist ganglion. Nerve conduction studies confirmed median nerve compression at the carpal tunnel on the right side. She underwent an open carpal tunnel decompression and excision of the ganglion. She then developed similar symptoms of carpal tunnel syndrome on the left hand that was treated by open decompression a few months later. After successful resolution of her symptoms, she was discharged at the 3-month follow-up.She re-presented 6 months later with recurrence of left sided carpal tunnel syndrome and an extremely hypersensitive scar .She underwent a further decompression along with an adipofascial forearm flap based on a radial artery perforator, preserving the radial artery (Braun et al., 1995). The patient had complete resolution of symptoms on the left side, but she complained of a persistent tender scar and recurrence of median nerve symptoms on the right side. It was planned to carry out a similar adipofascial flap based

Treatment of extra-articular and simple articular distal radial fractures with intramedullary nail versus volar locking plate

“…Nine patients had postoperative complications, three requiring plate removal for extensor tendonitis. Soong et al (2011), Gavaskar et al (2012 and Dy et al (2012) stated that flexor tendon injury is one of the most common complications of volar plate fixation of distal radial fractures. Other drawbacks of volar plate osteosynthesis include an extensive surgical approach, interruption of periosteal blood supply and risk of refracture at the end of the plate (Macintyre et al, 2009).…”

Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures

“…Using the skyline view (the wrist is flexed at 75° and forearm held 20° dorsally from the vertical axis), dorsal cortical screw penetration can be detected more sensitively and accurately than from lateral or oblique views (Riddick et al, 2012). Dy et al (2012) described in a cadaveric study that a fixed-angle volar plate could be placed distally to the watershed line without intra-articular screw penetration when using four fluoroscopic views (posteroanterior, posteroanterior with a tilt of 10°, lateral, and lateral with a tilt of 20°). On the other hand, Takemoto et al (2011) reported in their cadaveric study that using CT is superior to plain radiographs regarding screw penetration of the subchondral plate of the distal radial articular surface.…”