Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates

PURPOSE: To determine whether volar fixed-angle plate fixation with a new plate system could be used to treat dorsally unstable distal radius fractures. We hypothesized that volar fixed-angle plate fixation with or without radial styloid fixed-angle plate fixation would provide sufficient rigidity to allow early active range of motion without compromising fracture reduction. The initiation of early active motion may improve functional outcomes. METHODS: A retrospective review was conducted of one institution's initial experience using a new volar fixed-angle plate system to treat dorsally displaced intra-articular and extra-articular distal radius fractures. Thirty-two fractures in 32 patients with dorsally displaced distal radius fractures were treated with a volar fixed-angle plate with or without a radial styloid fixed-angle plate. Fractures were classified using the AO classification. Radiographic parameters on preoperative, postoperative, and final follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up ranges of motion and complications were reported. Finally, comparisons were made between the 23 fractures treated with a volar plate alone and the 9 fractures treated with a volar plate and a radial styloid plate. RESULTS: The average follow-up period was 13 months. Two thirds of the fractures were intra-articular. Average loss of reduction from initial postoperative to final follow-up radiographs was 0 degrees of volar tilt, 1 degrees of radial inclination, and 0 mm of radial length. Active wrist and forearm ranges of motion were initiated at an average of 11 days after surgery. The final follow-up flexion-extension and pronation-supination arcs averaged 112 degrees and 151 degrees , respectively. The 9 fractures treated with the combination of a fixed-angle volar plate with a fixed-angle radial styloid plate had greater initial displacement than did the 23 fractures treated with a volar plate alone. Otherwise, differences between the 2 groups were not significant. Only 1 radial styloid plate became symptomatic. CONCLUSIONS: Volar plate fixation using a new fixed-angle plate system successfully can stabilize dorsally unstable distal radius fractures. Early active range of motion was facilitated without compromising fracture reduction.     

掌侧锁定钢板治疗桡骨远端不稳定骨折

目的探讨掌侧锁定钢板治疗桡骨远端不稳定骨折的治疗效果。方法对56例桡骨远端不稳定骨折患者采用切开复位掌侧锁定钢板内固定治疗,其中13例复位后骨缺损严重者行人工骨植骨。结果 56例均获随访,时间13~24个月。X线片显示骨折全部愈合。按Gadand-Werley评分标准:优12例,良33例,可10例,差1例。发生腕管综合征4例,拇伸肌腱激惹3例,局部疼痛1例。结论掌侧锁定钢板能有效维持桡骨远端不稳定骨折的复位,但存在各种并发症,处理得当基本能获得满意的腕关节功能。     

Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius

PURPOSE: To review the results of condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius. METHODS: Twenty-four patients in whom a minicondylar blade plate was used to repair an unstable fracture of the distal ulna associated with a fracture of the distal radius were reviewed retrospectively an average of 26 months (range, 12-50 months) after injury. According to the Q modifier of the Comprehensive Classification of Fractures, there were 1 simple fracture of the ulnar neck (Q2), 20 comminuted fractures of the ulnar neck (Q3), and 3 fractures of the head and neck (Q5). Subsequent surgeries included repeat fixation and autogenous cancellous bone grafting in 2 patients with nonunion of the distal radius and 1 with nonunion of the distal ulna. Seven patients had a second operation to remove the ulnar plate secondary to discomfort from plate prominence. RESULTS: The final average motion was as follows: degrees of flexion (range, 30 degrees-80 degrees), 52 degrees of extension (range, 40 degrees-90 degrees), 76 degrees of pronation (range, 45 degrees-90 degrees), and 70 degrees of supination (range, 45 degrees-90 degrees). Grip strength averaged 64% of the contralateral, uninjured extremity (range, 35%-100%). Final radiographic measurements included an average palmar tilt of the distal articular surface of the radius of 8 degrees (range, 0 degrees-20 degrees of palmar tilt), ulnar inclination of 21 degrees (range, 15 degrees-25 degrees), and ulnar positive variance of 1 mm (range, 0-4 mm). There were no problems related to the distal radioulnar joint. According to the system of Gartland and Werley as modified by Sarmiento, there were 6 excellent, 15 good, and 4 fair results at final evaluation. CONCLUSION: For unstable fractures of the distal ulna associated with fracture of the distal radius, condylar blade plate fixation can achieve healing with good alignment, satisfactory function, and an acceptable rate of secondary surgery.     

Rupture of the flexor pollicis longus tendon after volar fixed-angle plating of a distal radius fracture: a case report

We report a case of complete rupture of the flexor pollicis longus tendon 13 months after volar fixed-angle plating of a distal radius fracture. Tendon disruption was associated with a prominent distal volar lip of the plate. The plate was placed at the volar distal lip of the radius, at the location recommended by the manufacturer. Most previous reports of flexor tendon ruptures after volar plating of distal radius fractures have been in improperly placed plates, custom-made plates that were later taken off the market, or in physiologically abnormal tendons. This may be a unique case of flexor pollicis longus rupture with a currently commercially available volar fixed-angle plate, placed at the site recommended by the manufacturer, in a patient without other predisposition to tendon rupture.     

Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?

Introduction

The results and complications using a palmar plate system with the possibility of multidirectional fixed-angle screw fixation (Aptus^® Radius 2.5 mm by Medartis^®) for the treatment of unstable distal radius fractures were evaluated in a single cohort study including 62 patients.

Patients

Patients with extra- and intraarticular fractures were evaluated separately. The mean follow-up was 14.7 months. Active wrist motion averaged 60.1° extension, 52.0° flexion, 86.3° pronation, and 84.6° supination. Grip strength averaged 89% of the contralateral wrist.

Results

There was no loss of the initial reduction with bony union in all cases. The mean DASH-score was 12.6 points. Postoperative complications included two extensor pollicis longus tendon ruptures, two median nerve compression syndromes, one complex regional pain syndrome, and one postoperative haematoma. In our series the results of the intraarticular fracture group were similar to the extraarticular fracture group. The complication rate, however, was substantially higher in the intraarticular fracture group.

Conclusion

We conclude that palmar plating with multidirectional fixed-angle screw insertion is an effective and useful treatment option, especially for complex intraarticular distal radius fractures.     

Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient

PURPOSE: Increased incidence of falls and osteoporosis combine to make distal radius fractures a major cause of morbidity for the elderly patient. This report presents our experience treating distal radius fractures in the elderly population using a volar fixed-angle internal fixation plate. METHODS: We reviewed retrospectively all patients older than 75 years treated during a period of 4 years and 7 months at our centers for unstable distal radius fractures using a volar fixed-angle plate. Postoperative management included immediate finger motion, early functional use of the hand, and a wrist splint used for an average of 3 weeks. Standard radiographic fracture parameters were measured and final functional results where assessed by measuring finger motion, wrist motion, and grip strength. RESULTS: Of 26 patients that fit the inclusion criteria, we were able to evaluate 23 patients with 24 unstable distal radius fractures for an average of 63 weeks. Final volar tilt averaged 6 degrees and radial tilt 20 degrees, and radial shortening averaged less than 1 mm. The average final dorsiflexion was 58 degrees, volar flexion 55 degrees, pronation 80 degrees, and supination 76 degrees. Grip strength was 77% of the contralateral side. There were no plate failures or significant loss of reduction, although there was settling of the distal fragment in 3 patients (1-3 mm). CONCLUSIONS: The treatment of unstable distal radius fractures in the elderly patient with a volar fixed-angle plate provided stable internal fixation and allowed early function. This technique minimized morbidity in the elderly population by successfully handling osteopenic bone, allowed early return to function, provided good final results, and was associated with a low complication rate.     

Flexor carpi radialis tendon rupture as a complication of a closed distal radius fracture: a case report

Although extensor pollicis longus tendon ruptures have been noted as a complication of distal radius fractures, flexor tendon ruptures in association with acute fractures of the distal radius are rare. We report a rupture of the flexor carpi radialis tendon as a complication of an acute distal radius fracture that was discovered during operative management of the fracture.     

Beugesehnenrupturen nach palmarer Osteosynthese mit einer multidirektional winkelstabilen Platte

Six months after the internal fixation of a distal intra-articular fracture of the radius with a fixed-angle plate (APTUS by Medartis), a 79 year old woman sustained chronic tears in flexor digitorum profundus tendons II, III and the flexor pollicis longus tendon.     

Complications of volar plating of distal radius fractures

Open reduction and internal fixation has been shown to be effective in the treatment of unstable distal radius fractures. When a dorsal approach is used, extensor tendons rupture or irritation are frequent and well known complications. Complications associated with volar plate fixation have not been studied to the same extent. In this study a homogenous series of 90 patients treated by volar plate fixation were retrospectively evaluated, focusing on the complications observed. The overall rate of complications was 8% (7 cases). Tendon rupture or irritation of extensor (3 cases) and flexor tendons (2 cases) were the complications most frequently seen. All but one were clearly related to direct attritional damage of the tendon caused by the prominent edge of the plate or by protruding screw tips. Loss of reduction requiring repeat internal fixation was observed in one marginal shear fracture involving the lunate facet fragment. One patient had a carpal tunnel release owing to median nerve irritation. In this study, volar plate fixation appeared as a safe procedure in the management of unstable distal radius fractures, with a low rate of complications. Accurate placement of the plate and exact measurement of the screws may further minimize the incidence of complications. When radiographs reveal conditions that may predispose to tendon attritional lesions (prominent edge of the plate, dorsal protrusion of the screw tips) we strongly recommend early removal of the fixation device.     

Ultrasound changes in the extensor pollicis longus tendon following fractures of the distal radius--a preliminary report

Extensor pollicis longus tendon rupture occurs in 0.2% to 3% of fractures of the distal radius. The underlying mechanism, or mechanisms, of rupture are unknown. This study evaluated this tendon and its surrounding structures using high-resolution ultrasound in 62 patients with distal radius fracture at 6 weeks after injury. The uninjured wrist was examined as a control. The ultrasound measurements at 6 weeks were then correlated with the patients' presenting X-rays. Significant findings included a reduced peak velocity of tendon movement and an increased thickness of both the extensor retinaculum and the tendon sheath on the fractured side. In respect of tendon sheath thickness, these changes were particularly associated with intraarticular fractures. We postulate that the increased thickness of the EPL tendon sheath may further impair an already tenuous blood supply and/or affect the diffusion of nutrients to the tendon within the third extensor compartment, leading to tendon attrition and rupture.