Volar Plate Osteosynthesis of Distal Radius Fractures With Concurrent Prophylactic Carpal Tunnel Release Using a Hybrid Flexor Carpi Radialis Approach

Gwathmey, F. Winston; Brunton, Lance M.; Pensy, Raymond A.; Chhabra, Arvind

doi:10.1016/j.jhsa.2010.03.043

Cited by 34 publications

(22 citation statements)

References 25 publications

(37 reference statements)

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“…They similarly had no cases of flexor tendon injury or rupture. 30 Presently, we are unaware of any cases in which a flexor tendon rupture occurred after the e-FCR approach at our institution or in the literature.…”

Section: Discussionmentioning

confidence: 89%

Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches

et al. 2019

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Background Flexor tendon irritation or rupture following open reduction and volar plate fixation of distal radius fractures can cause significant morbidity and necessitate additional surgical intervention. Objectives To compare the impact of the extended flexor carpi radialis (e-FCR) and standard flexor carpi radialis (FCR) approaches on contact pressures between the flexor tendons and volar distal radius plates. Methods Eight matched pairs of fresh frozen cadavers had each limb randomized to undergo either the e-FCR or standard FCR approach. After the approach, a locking plate was applied to the volar distal radius more distally than ideally to create a worst-case scenario for the digital flexor tendons. Electronic pressure sensors were secured to the volar aspect of each locking plate. Each wrist was pinned in 20 degrees of extension during testing. Using a computer-controlled stepper motor system attached to the digital flexor and extensor tendons, the digits were taken through 4,000 cycles simulating 12 weeks of active flexion and extension. Results There were no statistically or clinically significant differences when comparing the contact pressures of the e-FCR approach with the standard FCR approach at any time intervals. The e-FCR had statistically significantly higher radial-sided contact pressures than ulnar-sided contact pressures during early-to-intermediate testing intervals. These differences resolved at late and final testing intervals. Conclusions When comparing the standard FCR approach with the e-FCR approach, with the wrist in 20 degrees of extension, there is no significant difference in contact pressures that occur between the digital flexor tendons and volar distal radius plates. Clinical Relevance Further study and technique modifications may eventually lead to better methods of avoiding flexor tendon rupture during the volar plating of distal radius fractures.

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Section: Discussionmentioning

confidence: 89%

Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches

et al. 2019

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“…16,17 Further clinical study demonstrated that in the authors' hands, this hybrid approach was clinically safe with no iatrogenic injury noted to any critical structures. 9,18 However, the degree of visualization of the distal TCL is somewhat unclear from the authors' description. In addition, Weber and Sanders themselves acknowledged that the recurrent motor branch of the median nerve is not well visualized in the FCR approach to the carpal tunnel.…”

Section: Discussionmentioning

confidence: 95%

Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study

et al. 2016

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Distal radius fractures (DRF) are common injuries, comprising nearly one sixth of all fractures presenting to the emergency room, while accounting for a noteworthy proportion of health care costs.1-3 Operative treatment of DRF is on the rise, likely as the result of their increasing overall incidence as well as continually evolving implant technologies and fixation techniques.3,4 Unfortunately, as the incidence of these fractures increases, the risk of complications due to the injury or its Keywords ► extended flexor carpi radialis approach ► distal radius volar plating ► acute carpal tunnel release ► palmar cutaneous branch median nerve ► motor recurrent AbstractBackground The safety of surgical approaches for single-versus double-incision carpal tunnel release in association with distal radius open reduction and internal fixation remains controversial. Purpose The purpose of this study was to identify critical structures to determine if a single-incision extension of the standard flexor carpi radialis (FCR) approach can be performed safely. Methods Nine cadaveric arms with were dissected under loupe magnification, utilizing a standard FCR approach. After the distal radius exposure was complete, the distal portion of the FCR incision was extended to allow release of the carpal tunnel. Dissection of critical structures was performed, including the recurrent thenar motor branch of the median nerve, the palmar cutaneous branch of the median nerve (PCBm), the palmar carpal and superficial palmar branches of the radial artery, and proximally the median nerve proper. The anatomic relationship of these structures relative to the surgical approach was recorded. Results Extension of the standard FCR approach as described in this study did not damage any critical structure in the specimens dissected. The PCBm was noted to arise from the radial side of the median nerve an average of 6.01cm proximal to the proximal edge of the transverse carpal ligament. The PCBm became enveloped in the layers of the antebrachial fascia and the transverse carpal ligament at the incision site, protecting it from injury. The recurrent motor branch of the median nerve, branches of the radial artery and the median nerve proper were not at risk during extension of the FCR approach to release the carpal tunnel. Conclusions Extension of the standard FCR approach to include carpal tunnel release can be performed with minimal risk to the underlying structures. This exposure may offer benefits in both visualization and extent of carpal tunnel release.

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“…No neurovascular or tendon injuries were noted, affirming the safety of this approach as also noted in previous studies when the RCTR was used alone 5 or in conjunction with CMC arthroplasty or open reduction of distal radius fractures. [18][19][20] In the studies of Reale et al and Kluge wherein they reported superficial wound infection, rates were 5.3% and 5% respectively. 6 , 21 In our current study, superficial wound infection rate was lower in the two-incision group at 3.1% but was slightly higher at 7.7% in the RCTR group than those previous studies.…”

Section: Discussionmentioning

confidence: 99%

Carpal Tunnel Release Using the Radial Sided Approach Compared With the Two-Incision Approach

2014

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We compared carpal tunnel release using a radial sided approach (RCTR) with a two-incision approach with regards to complications, grip strength, and functional outcomes. Retrospective chart review was done and data was collected pre-operatively, and post-operatively at six weeks and three months. A total of 32 and 26 patients were included in the two-incision and RCTR groups respectively. At six weeks, the RCTR group showed an increased grip strength (+32.24%) while the two-incision group was weaker (-6.75%). Both groups showed an increased strength at three months, RCTR at 98.4% while the two-incision group was significantly lower at 38.6% increase. Both techniques provided improvement in outcome scores, with no statistical difference. RCTR was associated with a significantly earlier return of grip strength and had better grip strength at six weeks and three months post-operatively. Both techniques provided symptom relief and good functional outcome.

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Volar Plate Osteosynthesis of Distal Radius Fractures With Concurrent Prophylactic Carpal Tunnel Release Using a Hybrid Flexor Carpi Radialis Approach

Cited by 34 publications

References 25 publications

Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches

Contact Pressure between Digital Flexors and Plates for Distal Radius Approaches

Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study

Carpal Tunnel Release Using the Radial Sided Approach Compared With the Two-Incision Approach

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