The Treatment of Unstable Distal Radius Fractures With Volar Fixation

Orbay, Jorge L.

doi:10.1142/s0218810400000223

Cited by 221 publications

(153 citation statements)

References 13 publications

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“…With the development of anatomic plate designs for joint fractures, different approaches with a high amount of subchondral metalwork are proposed, for example, for the proximal tibia fracture: four small fragment screws with a 3.5-mm diameter or two 4.5-mm locking screws in the less invasive stabilization system (LISS, De Puy Synthes Inc., Brüttisellen, Switzerland). Similar examples exist for distal radius [37] and proximal humerus [15] fractures. Therefore a large volume of the subchondral bone needs to be removed and is replaced by metalwork.…”

Section: Discussionmentioning

confidence: 52%

Subchondral screw abutment: does it harm the joint cartilage? An in vivo study on sheep tibiae

Goetzen

Hofmann‐Fliri

Arens

et al. 2017

International Orthopaedics (SICOT)

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Purpose Subchondral screw abutment in osteosynthesis of joint fractures is an effective method to achieve sufficient screw grip. In this study we investigated if subchondral screw placement is possible without harming the overlying subchondral plate and joint cartilage iatrogenic. Materials and Methods A 3.5-mm conventional steel screw was placed in the tibia of ten sheep in distances between 1 and 7 mm beneath the joint cartilage. After a follow up of two and four months, evaluation of the subchondral bone and joint cartilage was performed by means of a histological osteoarthritis score, HRpQCT imaging and determination of the glycosaminoglycan content in the cartilage. The control group was the contralateral knee of the same animal. Results Histomorphometric evaluation of the Mankin osteoarthritis score revealed no significant difference compared to the control after two (p = 0.102) and four months (p = 0.429).No correlation between distance of the screw to the cartilage and histological scoring was found (p = 0.658, R2 = 0.04 after two months and p = 0.171, R2 = 0.18 after four months). HRpQCT measurements of the subchondral thickness between screw and cartilage after two (p = 0.05) and four months (p = 0.424) showed no significant difference. Mean glycosaminoglycan content in the treatment group compared to the control after two months (p = 0.25) and four months (p = 0.523) was not significant different. Conclusion In conclusion subchondral screw abutment did not damage the joint cartilage after a two-and four-month follow up in this sheep model.

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Section: Discussionmentioning

confidence: 52%

Subchondral screw abutment: does it harm the joint cartilage? An in vivo study on sheep tibiae

Goetzen

Hofmann‐Fliri

Arens

et al. 2017

International Orthopaedics (SICOT)

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“…The dorsal FCR sheath is then incised, and a superficial blunt retainer is used between the incised FCR tendon sheaths. The radial 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) FCR sheath protects the radial artery, whereas the ulnar FCR sheath protects the median nerve. Once this is done, blunt dissection is carried down to the pronator quadratus muscle.…”

Section: Surgical Techniquementioning

confidence: 99%

“Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar and Dorsal Metaphyseal Comminution

Day

Kamath

Makhni

et al. 2007

Hand (New York, N,Y.)

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Introduction Intra-articular distal radius fractures with volar and dorsal comminution present a special challenge to the hand surgeon. Methods Ten patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared to the uninjured side were recorded. Functional outcome was evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Gartland and Werley scoring system. Results Median age at surgery was 58 years (range, 24 to 86). Mean follow-up was 17 months (range, 12 to 28). According to the AO classification system, there were three type C2 and seven type C3 fractures. Median preoperative dorsal angulation was 24 deg; median postoperative dorsal angulation was 3 deg. Eighty percent (8) of the fractures also had an intra-articular step-off or gap, all of which were corrected to neutral by the procedure. Compared with the contralateral side, mean extension and flexion were 73 and 75%, respectively, pronation and supination were 95 and 88%, respectively, and grip strength and thumb pinch were 72 and 87%, respectively. Mean postoperative DASH score was 16 points, and 70% (7) of the patients had Gartland and Werley scores of good or excellent. None of the patients needed to have their plates removed, and no extensor tendon rupture was reported. Conclusions The "sandwich" plating technique is an effective method of regaining near-anatomic reconstruction of intra-articular, volarly and dorsally comminuted distal radius fractures. Results from this study demonstrate that patients can expect to regain about 80% of their range of motion and strength. Moreover, 70% of the patients will have good to excellent functional outcomes. This is the first study to examine range of motion and functional outcome of low-profile "sandwich" plating without plate removal.

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“…Others suggest that a worse radiographic outcome in conservatively treated patients does not limit functional recovery at one year [11]. After the introduction of the volar plate in the early 1990s locking plates are currently gaining popularity because of their high stability and improved fixation in osteoporotic bone [12,13]. In 2008, there were already more than 30 different volar plating systems [14].…”

Section: Introductionmentioning

confidence: 99%

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

Twigt

Bemelman

Lansink

et al. 2013

International Orthopaedics (SICOT)

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Purpose C-type distal radial fractures remain challenging fractures. Currently locking plates are very popular because of their length preserving, stability. A considerable drawback is the high cost. Since 2003 we have been using mini AO plates (2.7 mm) as an alternative. We analysed our results and performed a cost analysis. Methods Retrospective analysis was performed of all patients operated upon between 2003 and 2008 for C type distal radius fractures. Reduction was achieved with mini AO plates, applied in a buttress fashion, with ligamentotaxis. Rehabilitation consisted of immediate mobilisation. Pre-and postoperative X-rays, operative results and patient charts were reviewed. Furthermore, we prospectively evaluated the functional results using VAS, DASH and Mayo wrist scores. Lastly, we assessed the implant costs and compared them to locking plates. Results Thirty-four patients were treated with a mean age of 49 years. Mean radial shortening improved 2 mm; dorsal and radial angulation improved 23 and 4°, respectively. At consolidation (eight weeks) the average radial shortening was 0.75 mm, a volar angulation of 3°, and 21°of radial angulation. Functional results were excellent, demonstrated by a mean VAS score less than 1, a DASH score of 12 and a Mayo wrist score of 87. Compared to locking plates, there was an overall reduction in material costs of 15,300 Euro.Conclusions Our technique has excellent biomechanical stability, enabling immediate functional rehabilitation, good anatomical and functional outcome with significantly lower costs.

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The Treatment of Unstable Distal Radius Fractures With Volar Fixation

Cited by 221 publications

References 13 publications

Subchondral screw abutment: does it harm the joint cartilage? An in vivo study on sheep tibiae

Subchondral screw abutment: does it harm the joint cartilage? An in vivo study on sheep tibiae

“Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar and Dorsal Metaphyseal Comminution

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

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