"Sandwich" plating for intra-articular distal radius fractures with volar and dorsal metaphyseal comminution.
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SUBMITTER: Day CS
PROVIDER: S-EPMC2528974 | biostudies-other | 2008 Mar
REPOSITORIES: biostudies-other
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Project description:Background: Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on optimal management. Our purpose is to describe our method of dorsal plating and report postoperative outcomes. Methods: This study is a retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes. Results: Patient age averaged 38.2 years (range, 23-56 years), and 80% were male. Sporting injuries were the most common mechanism (80%). Time to surgery averaged 7 days, and postoperative follow-up duration averaged 19.6 months (median 8 months). All fractures were intra-articular at the proximal interphalangeal joint with volar instability. There were no complications and no patients required secondary surgery. Grip strength was maintained and range of motion was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick Disability of the Arm, Shoulder and Hand was 0.5 (range, 0-2.3), 100% of patients were satisfied, and average visual analog pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union at an average of 6.6 weeks (range, 6-7 weeks) in all fractures. Conclusions: Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability. This fixation method allows for early range of motion without complications in this case series. All fractures united, and patients had minimal functional deficits and were able to maintain good range of motion.
| S-EPMC6759971 | biostudies-literature
Project description:Background ?We evaluated the detection for screw penetration on the dorsal cortex of the radius in serial oblique, dorsal tangential, and radial groove radiographic views in volar plating fixation. Materials and Methods ?Eight screw positions were set in each of the four cadaveric radii. Screw 1 was placed in the styloid subregion, whereas screws 2 and 3 were placed just proximal to the styloid and were defined for the radial region of the radius. Screws 4 (distal to the extensor pollicis longus [EPL] groove), 5 (the distal half of the groove), and 6 (the proximal half of the groove) were placed in the central region of the radius. Screws 7 (just medial to the groove) and 8 (sigmoid notch subregion) were positioned in the ulnar region of the radius. The screws were overlengthened by 1 and 2?mm and were evaluated in three radiographic views. Results ?Penetrations in the radial region were fully visible in supinated oblique views with 1- and 2-mm overlengthened screws. The penetration of screw 4 was clearly observable over a considerable range of views. However, the 1-mm penetration of screw 5 was not detectable at any angle of projection. Detection of the ulnar region screw was the most difficult among the three regions with oblique views. In the dorsal tangential view, the 1-mm penetration of screw 4 was not observed in any of the four radii, but the penetration of screw 5 was detectable in all the radii. The screws 2, 3, 5, 7, and 8 were readily detectable. The screw 4 was barely seen in the radial groove view, while the screws 5 and 6 were readily detectable. Conclusion/Clinical Relevance ?Appropriate combinations of these well-known radiological views are essential for the overall detection of penetrated screws during plating in distal radius fractures.
| S-EPMC5658214 | biostudies-literature
Project description:This article is a systematic review of the recent published literature on the biomechanics of volar locking plate fixation of distal radius fractures. PUBMED/MEDLINE and EMBASE databases were searched on 13th Sep 2018. Biomechanical papers on volar locking plate fixation of distal radius fractures since 2010 were included. Papers were analysed and included studies were appraised by the author using the validated quality assessment GRADE tool. The search revealed 456 papers between January 2010 and the present day whose abstracts were reviewed for relevance and 21 papers were included for full paper review. The aim of this systematic review was to evaluate the evidence to determine the surgical techniques and strategies that are associated with the best biomechanical outcomes of volar plating for distal radius fractures. Review of the literature revealed that it was not necessary to fill all available distal locking screws, there was little evidence to support the use of 2 rows of screws distally over 1 row. Screws of 75% length of the distal cortex are sufficient to withstand standard postoperative regimes in extrarticular fractures. The was a paucity of evidence to conclude multidirectional locking plates were superior to fixed angle plates or that one brand of plate was superior to another.
| S-EPMC6739430 | biostudies-literature
Project description:BackgroundThe most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails.AimThe objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures.MethodsSeventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated.ResultsAll patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant.ConclusionThe modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.
| S-EPMC9245216 | biostudies-literature
Project description:The dorsal tangential (DT) view has been shown to improve the detection of dorsal screw perforation during volar distal radius fracture fixation. Here we performed a cadaveric imaging survey study to evaluate if the DT view was uniformly beneficial for all screws.Standardized placement of fixed-angle volar distal radius plates was performed on two cadavers. Fluoroscopic images depicting variable screw perforation of each of the four screw holes on the plate were generated. A 46-image survey was distributed at a large academic medical center. Respondents were asked to answer if the screw was perforating through the dorsal cortex in each image. Statistical analysis was performed using Fisher's exact test. A p value < .05 was considered significant.The DT view offered a significantly more reliable determination of dorsal screw penetration than traditional lateral imaging for the radial-most screw at all degrees of perforation and the middle two screws at 2 mm of perforation. Residents and attendings had more accurate screw readings overall using the DT view.The DT view is superior to traditional lateral imaging in the detection of small amounts of dorsal perforation of the radial-most three screws of a fixed-angle volar plate.
| S-EPMC5555008 | biostudies-other
Project description:BACKGROUND:Distal radius fracture (DRF) is the most common upper extremity fracture that requires surgery. Operative treatment with a volar locking plate has proved to be the treatment of choice for unstable fractures. However, no consensus has been reached about the benefits of pronator quadratus (PQ) repair after volar plate fixation of DRF in terms of patient-reported outcome measures, pronation strength, and wrist mobility. METHODS:We searched the PubMed, Embase, Cochrane Central, and China National Knowledge Infrastructure (CNKI) databases up to March 13, 2020, and included randomized-controlled, non-randomized controlled, or case-control cohort studies that compared cases with and without PQ repair after volar plate fixation of DRF. We used a random-effects model to pool effect sizes, which were expressed as standardized mean differences (SMDs) and 95% confidence intervals. The primary outcomes included Disabilities of the Arm, Shoulder, and Hand scores and pronation strength. The secondary outcomes included the SMDs in pain scale score, wrist mobility, and grip strength. The outcomes measured were assessed for publication bias by using a funnel plot and the Egger regression test. RESULTS:Five randomized controlled studies and six retrospective case-control studies were included in the meta-analysis. We found no significant difference in primary and secondary outcomes at a minimum of 6-month follow-up. In a subgroup analysis, the pronation strength in the PQ repair group for AO type B DRFs (SMD = - 0.94; 95% CI, - 1.54 to - 0.34; p < 0.01) favored PQ repair, whereas that in the PQ repair group for non-AO type B DRFs (SMD = 0.39; 95% CI, 0.07-0.70; p = 0.02) favored no PQ repair. DISCUSSION:We found no functional benefit of PQ repair after volar plate fixation of DRF on the basis of the present evidence. However, PQ muscle repair showed different effects on pronation strength in different groups of DRFs. Future studies are needed to confirm the relationship between PQ repair and pronation strength among different patterns of DRF. REGISTRATION:This study was registered in the PROSPERO registry under registration ID No. CRD42020188343 . LEVEL OF EVIDENCE:Therapeutic III.
| S-EPMC7493143 | biostudies-literature
Project description:BackgroundThe purpose of the present study was to investigate the influence of the pronator quadratus (PQ) muscle repair following volar plate fixation of distal radius fractures with special regards to the forearm pronation strength. During the early recovery period of 3 months, an improvement of pronation strength and functional scorings was hypothesized for the PQ repair when compared to no repair.MethodsThe inclusion criteria were (1) men or women between 18 and 80 years, (2) isolated, closed fractures of the distal radius, (3) A2 to B2 types of fracture according to the AO fracture classification system, (4) primary volar locking plate osteosynthesis. Patients were randomized to group A = PQ repair and group B = no repair. Follow-up examinations after 6 and 12 weeks included bilateral isometric pronation strength measurement, range of motion, the QuickDASH and the Mayo-Wrist-Score, and a visual analog scale (VAS).Results60 patients (n = 31 in group A and n = 29 in group B) with an average age of 54 years (range 22-77 years) returned for both follow-up visits. The pronation strength measurements showed no significant differences between groups (PQ repair vs. no repair) neither at 6 weeks nor at 12 weeks. Additionally, no statistical significant differences were noted for ROM, QuickDASH-Score or Mayo-Wrist-Score. The VAS scoring revealed a significant decreased pain level after PQ repair at 6 weeks postoperatively (p = 0.017).ConclusionAn improved pronation strength after PQ repair in the early rehabilitation period could not be confirmed. However, the PQ repair might reduce pain in the early postoperative period.Trial registration numberNCT02595229 (ClinicalTrials.gov, registered 02 November 2015).
| S-EPMC4660810 | biostudies-literature
Project description:INTRODUCTION: Extensor tendon irritation and attritional tendon ruptures are potentially serious complications after open reduction and internal fixation of distal radius fractures. These complications are well recognized after dorsal plating of distal radii; and these are now being reported after errant screw placement during volar fixed-angle plating. Intraoperative detection of improper screw placement is critical, as corrective action can be taken before completion of the operative procedure. The purpose of this study was to define the extensor tendon compartments at risk secondary to dorsal screw penetration and to compare pronation and supination fluoroscopic images with standard lateral images in demonstrating dorsal screw prominence during volar locked plating. METHODS: Eight fresh-frozen human cadaveric upper extremities underwent fixation with a volar, fixed-angle distal radius locked plate (Wright Medical Technology, Arlington, TN). Three fluoroscopic views (lateral, supinated, and pronated) followed by dorsal wrist dissections were compared to determine accuracy in detecting dorsal screw prominence and extensor tendon compartment violation. Subsequently, screws measuring 2, 4, 6, 8, and 10(mm longer than the measured depths were sequentially inserted into each distal locking screw, with each image deemed either "in" (completely inside the bone) or "out" (prominent screw tip dorsally-would typically be exchanged for a shorter screw intraoperatively). RESULTS: The radial most distal locking screw (position 1) violated either the first (25%) or second (75%) extensor tendon compartments. The average screw prominence required for radiographic detection was: 6.5(mm for lateral views and 2(mm for supinated views. Pronated views did not identify prominent screws. Screws occupying plate position 2 consistently entered Lister's tubercle, with 5/8 exiting the apex and 3/8 exiting the radial base. The average screw prominences for radiographic detection were: 2.75(mm-lateral views and 3.0(mm-supinated views. Although the screws entered the second dorsal compartment, they did not encroach upon either of the tendons. Screws occupying plate position 3 violated the third extensor tendon compartment in 7/8 specimens with 1/8 exiting the Ulan base of Lister's tubercle. The average screw prominences for radiographic detection were: 3.5(mm-lateral views and 2.5(mm-pronated views. Supinated views did not identify prominent hardware. Screws occupying plate position 4 all violated the IV dorsal extensor compartment-2/8 screws were noted to tent the posterior interosseous nerve. The average screw prominences required for radiographic detection were: 4.0(mm-lateral views and 2.5(mm-pronated views. The supinated views did not identify prominent screws. CONCLUSIONS: Volar fixed-angle plating has shown great promise in the advancement of distal radius fracture management. We have seen in our referral practices and in the literature an increase in the number of extensor tendon complications arising from unrecognized dorsally prominent screws, pegs, or tines. Standard PA and lateral radiographs cannot adequately visualize screw position and length secondary to the complex geometry of the dorsal cortex. We believe this study supports the routine application of intraoperative, oblique pronosupination fluoroscopic imaging for enhanced confirmation of distal locking screw position and length.
| S-EPMC2527147 | biostudies-other
Project description:INTRODUCTION: We retrospectively compared the outcomes of open reduction and internal fixation (ORIF) with volar locking plate versus standard external fixation and percutaneous pinning in treating similar unstable distal radius fractures with a minimum 2-year follow-up. METHODS: The ORIF group included 41 patients with an average follow-up of 29 months. The external fixation group comprised 14 patients with an average follow-up of 33 months. Average age at presentation was 45 years in the external fixation group and 48 years in the ORIF group. The male/female ratios were 16:25 among the ORIF group and 6:8 in the external fixation group. The two groups were compared for clinical and functional outcomes measured by the disabilities of the arm, shoulder, and hand (DASH) score. Pain scores were similar. Radiographic measurements were also evaluated between groups. RESULTS: Final ranges of motion and grip strengths were similar between the two groups. The mean DASH score of the locked volar plate group was 9 compared to 23 for the external fixation group. Radiographically, volar tilt and radial length were significantly better in the patients treated with ORIF. The ORIF group required less therapy visits. No complications occurred in the locked volar plate group whereas two patients had pin tract infections and one had prolonged finger stiffness in the external fixation group. CONCLUSION: Locked volar plating compares favorably to external fixation and pinning for amenable fracture patterns. Whereas grip and range-of-motion data were similar, DASH scores, frequency of rehabilitation, and some radiographic parameters were superior in patients treated with ORIF.
| S-EPMC2529138 | biostudies-other
Project description:PURPOSE: Fixed-angle devices have been a major advancement in orthopedic fracture care and have become an attractive option for fixation of distal radius fractures. Several volar locking plates exist, but there is insufficient literature comparing the strengths of these plates. This study compares the biomechanical strength of two popular volar locking plate systems (Synthes LCP and Hand Innovations DVR-A) along with a nonlocking volar T-plate (Synthes). METHODS: Twenty-three formalin-fixed cadaveric forearms were divided into three groups with similar ages and bone densities. An unstable extra-articular fracture was created using a standardized osteotomy. Each group was fixed with one of the three plates. Each specimen was loaded in axial compression for 2000 cycles at a force of 400 N. Each specimen that completed cyclic testing was loaded to failure. Stiffness, yield point, and ultimate strength were recorded for each construct. RESULTS: Each fixed-angle construct completed all 2000 cycles. The nonlocking plates failed at an average of 560 cycles. The mean stiffness of the DVR-A, LCP, and the volar T-plates were 277.00, 343.17, and 175.67 N/mm, respectively. There was a statistically significant difference between both fixed-angle plates and the nonlocking plate (p < 0.05). The difference between each fixed-angle construct did not reach significance. Yield point and ultimate strength could only be determined for the two fixed-angle devices. There was no statistically significant difference between the constructs for both yield point (DVR-A = 855.56 N, LCP = 894.15 N) and ultimate strength (DVR-A = 1,021.97 N, LCP = 1,114.87 N). CONCLUSIONS: Given our data, fixed-angle constructs withstand cyclical loading representing normal physiologic forces encountered during post-operative rehabilitation. There was no significant biomechanical difference between the two fixed-angle constructs. Our results support that volar fixed-angle locking plates are an effective treatment for unstable extra-articular distal radius fractures, allowing early postoperative rehabilitation to safely be initiated.
| S-EPMC2528971 | biostudies-other