The use of a single volar locking plate for AO C3-type distal radius fractures

Background

A single volar locking plate (VLP) is now frequently used for open reduction and internal fixation (ORIF) of many types of distal radius fractures. Comminuted intra-articular distal radius fractures (AO C3-type) are typically the most challenging to surgically treat. No studies directly address the adequacy of a VLP alone for maintaining reduction of AO C-type fractures. We hypothesized that a single VLP provides an effective method for maintaining reduction for these fractures.

Methods

We retrospectively evaluated radiographs of a series of AO C-type fractures. Seventy-seven patients with 77 AO C3-type fractures were identified from billing records and were eligible for the study. All patients were treated by fellowship-trained hand surgeons. Radiographs at the time of union were compared to those from immediately postoperatively.

Results

Sixty-nine of 77 (89.6 %) fractures treated with VLP fixation alone for AO C3-type distal radius fractures united without loss of reduction. Eight of 77 (10.4 %) patients treated with VLP for AO C3 fractures lost reduction. The most common fracture fragment to lose reduction was the lunate fossa (5 of 8); loss of reduction of the scaphoid fossa die-punch fragment (2 of 8) and the radial styloid (1 of 8) were also seen.

Conclusions

The majority (89.6 %) of AO C3-type fractures treated with a single volar locking plate come to union without loss of reduction.Level of evidence: Level IV.     

Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in addition to volar-locked plating

Background

The volar lunate facet fragment of a distal radius fracture may not be stabilized with volar-locked plating alone due to the small size and distal location of the fragment. Identification and stabilization of this small fragment is critical as unstable fixation may result in radiocarpal and radioulnar joint subluxation. The addition of spring wire fixation with volar plating can provide stable internal fixation of this critical fracture fragment.

Methods

A retrospective review (2006–2011) identified nine patients with distal radius fractures with an associated volar lunate facet fragment that were treated with volar-locked plating and spring wire fixation of the volar lunate facet fragment. Radiographic indices, range of motion, grip strength, and postoperative Patient-related wrist evaluation (PRWE) scores were obtained to assess pain and function.

Results

All distal radius fractures healed, and the volar lunate facet fragment reduction was maintained. The mean follow-up was 54 weeks. Mean active range of motion was 46° wrist flexion, 51° wrist extension, 80° pronation, and 68° supination. The mean grip strength was 21 Kg, achieving 66 % of the uninjured limb. The average PRWE score was 17. No patient required removal of hardware or had evidence of tendon irritation.

Conclusions

The addition of spring wire fixation to volar-locked plating provided stable fixation of the volar lunate facet fragment of distal radius fractures without complication. This technique addresses a limitation of volar-locked plating to control the small volar lunate facet fragment in distal radius fractures otherwise amenable to volar plating.

Level of Evidence

A retrospective case series, Level IV.     

Volar hook plate stabilization of volar marginal fragments in intra-articular distal radius fractures

BackgroundIn the setting of intra-articular distal radius fractures, the volar lunate facet (VLF) is the only articular segment that resists volar carpal subluxation. So, it is important to achieve a stable fixation of this key fragment. The VLF, when small (also called as volar marginal fragment, VMF) is located distal to the watershed line making fixation with the conventional volar locking plates difficult or impossible.Methods18 patients with either an AO: 2R3B3 or a C3 fracture consisting of a VMF underwent surgical repair through a volar approach. The VMF was stabilised using a anatomical volar hook plate. Remaining fracture components were stabilised using 2.4/ 2.0 mm locked plates. Fracture healing, ability of the hook plate to maintain reduction of the VMF and complications were assessed during follow up. Functional outcome was evaluated using Mayo score and patient rated wrist evaluation questionnaires.ResultsAll fractures united at follow up. Reduction of the VMF was maintained through healing with a stable radiocarpal and distal radioulnar joint. The mean flexion - extension wrist arc was 105° ± 10.2° The mean grip strength reached 74.6 ± 6% of the opposite side. The mean Mayo wrist score was 75 ± 5.3 and the mean patient rated wrist evaluation (PRWE) score was 15.2 ± 4.3 indicating recovery of wrist function.ConclusionIt is important to identify VMFs in intra-articular distal radius fractures. Anatomically designed volar hook plate achieves excellent low-profile stable fixation of this key fragment to allow early mobilisation without fearing loss of reduction and volar carpal subluxation.     

Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius

BACKGROUND: The purpose of the present study is to report on a cohort of patients with a volar shearing fracture of the distal end of the radius in whom the unique anatomy of the distal cortical rim of the radius led to failure of support of a volar ulnar lunate facet fracture fragment. METHODS: Seven patients with a volar shearing fracture of the distal part of the radius who lost fixation of a volar lunate facet fragment with subsequent carpal displacement after open reduction and internal fixation were evaluated at an average of twenty-four months after surgery. One fracture was classified as B3.2 and six were classified as B3.3 according to the AO comprehensive classification system. All seven fractures initially were deemed to have an adequate reduction and internal fixation. Four patients required repeat open reduction and internal fixation, and one underwent a radiocarpal arthrodesis. At the time of the final follow-up, all patients were assessed with regard to their self-reported level of functioning and with use of Sarmiento's modification of the system of Gartland and Werley. RESULTS: At a mean of two years after the injury, six patients had returned to their previous level of function. The result was considered to be excellent for one patient, good for four, and fair for two. The average wrist extension was 48 degrees, or 75% of that of the uninjured extremity. The average wrist flexion was 37 degrees, or 64% of that of the uninjured extremity. The one patient who underwent radiocarpal arthrodesis had achievement of a solid union. The four patients who underwent repeat internal fixation had maintenance of reduction of the lunate facet fragment. The two patients who declined additional operative intervention had persistent dislocation of the carpus with the volar lunate facet fragment. CONCLUSIONS: The stability of comminuted fractures of the distal part of the radius with volar fragmentation is determined not only by the reduction of the major fragments but also by the reduction of the small volar lunate fragment. The unique anatomy of this region may prevent standard fixation devices for distal radial fractures from supporting the entire volar surface effectively. It is preferable to recognize the complexity of the injury prior to the initial surgical intervention and to plan accordingly.     

Can we safely place the distal volar locking plate screws into the subchondral zone of a distal radius fracture using a 45° supination oblique view under fluoroscopic guidance?

IntroductionCareful distal locking screw insertion into the subchondral zone is necessary to obtain proper mechanical strength of unstable distal radius fractures using volar locking plating. However, subchondral zone screw insertion increases the risk of intra-articular screw penetration, which may remain unrecognized during surgery due to complex distal radial anatomy. The purpose of this study was to evaluate the role of fluoroscopic guidance with a 45° supination oblique view technique for placing distal screws into the subchondral zone during volar locking plating for unstable distal radius fractures and to explore the factors associated with poor screw placement.MethodsWe retrospectively analyzed 171 wrists of 169 patients treated with variable-angle volar locking plates for unstable radius fractures. The subchondral zone was defined as the metaphyseal area within 4 mm of the articular margin of the distal radius. The location of the distal locking screws and radiographic parameters, including the teardrop angle, were measured using computed tomography scans and X-rays. Clinical and radiographic factors were examined to determine their possible associations with screw placement failure.ResultsOf 581 distal screws inserted, 559 screws (96.2%) were inserted into the subchondral zone and 17 screws into the metaphyseal zone (2.9%). Five screws (0.7%) in three wrists showed intra-articular placement: four screws were placed into the lunate fossa and one into the scaphoid fossa. These three wrists also exhibited significantly reduced teardrop angles. The distal screws were significantly closer to the joint line in the lunate fossa than the scaphoid fossa (1.9 ± 0.9 mm vs. 2.8 ± 1 mm, P < 0.000).ConclusionThe 45° supination oblique view technique is a useful fluoroscopic guiding technique for accurate and safe distal screw placement in the subchondral zone in volar locking plate fixation for distal radial fractures. However, a decreased teardrop angle or extended lunate fossa should be corrected before distal screw insertion to avoid intra-articular screw placement.     

The effects of a displaced dorsal rim fracture on outcomes after volar plate fixation of a distal radius fracture

IntroductionThe purpose of this study was to determine whether a displaced dorsal rim fracture has an adverse effect on wrist function after volar plate fixation of a dorsally displaced distal radius fracture (DRF).Materials and methodsTwo matched cohorts of 23 matched patients, one with a displaced dorsal rim fracture >2 mm (group 1), and the other without a dorsal rim fracture (group 2) were analysed in this study of volar locking plate fixation for dorsally unstable DRFs. The two cohorts were analysed for differences in wrist function and wrist pain, radiographic parameters and arthritic grades of radiocarpal joints. Displacement of dorsal rim fragments and diameters of the retained articular portions of dorsal rims in group 1 were measured.ResultsNo significant difference was found between the two groups in overall wrist function or wrist pain. Mean displacement of dorsal rims in group 1 was 3.0 mm and the mean diameter of the retained articular portion of dorsal articular wall was 2.0 mm. No significant difference was found between the two groups in terms of any radiographic parameters or the arthritic grading of radiocarpal joints.ConclusionA displaced dorsal rim fracture does not appear to affect outcomes adversely after volar locking plate fixation of dorsally displaced DRFs.     

Intraoperative evaluation of DRUJ instability through dorsal stress radiography in distal radius fractures

IntroductionCertain type of injury of the triangular fibrocartilage complex associated with distal radius fracture can result in distal radioulnar joint instability (DRUJ). Untreated DRUJ instability may lead to poor result in the treatment of acute distal radius fractures. The aim of this study was to evaluate DRUJ instability in distal radius fractures through dorsal stress radiography comparing the affected and unaffected wrists intraoperatively.Materials and methods49 patients with a distal radius fracture who were operatively treated with a volar locking plate were included. Dorsal stress radiography was used to evaluate both affected and unaffected wrists peri-operatively to detect DRUJ instability. Under general anesthesia, a dorsal stress test was performed on the unaffected wrist. Additionally, after fixation of the affected wrist, a dorsal stress test was performed. The ulnar translation ratio (UTR) was measured through the dorsal stress radiograph. Arthroscopic examination was performed on all affected wrists according to Palmer's and Atzei classification.ResultsThe UTR of the affected wrist and the TFCC injury Palmer-type IB tendency were positively correlated (odds ratio: 1.18, p-value: 0.002). Additionally, as the UTR difference between the affected and unaffected wrists enlarged, it revealed a significant DRUJ instability tendency due to Palmer-type IB TFCC injury (p-value: 0.000006, Wilcoxon rank-sum test).ConclusionsDorsal stress radiography is a reliable, simple procedure to evaluate DRUJ instability intraoperatively. UTR value from dorsal stress radiography could be useful for evaluating DRUJ instability associated with distal radius fracture.     

单轴与多轴锁定接骨板治疗桡骨远端骨折的疗效比较

背景:切开复位锁定接骨板内固定是桡骨远端骨折的常用治疗方法。根据锁定方式的不同,锁定接骨板分为单轴与多轴两类,二者各有其特点。目的:比较单轴掌侧锁定接骨板(MA-VLP)与多轴掌侧锁定接骨板(PA-VLP)内固定治疗桡骨远端骨折的疗效。方法:回顾分析2014年1月至2018年6月接受手术治疗的77例桡骨远端骨折患者资料。采用MA-VLP固定37例(MA组),PA-VLP固定40例(PA组)。记录手术时间、骨折愈合时间、并发症,测量术后影像学参数,采用DASH评分和Mayo评分评估患肢功能。结果:两组患者均获得良好骨折复位、稳定内固定及骨折愈合。PA组手术时间显著短于MA组(P<0.05)。两组均未出现伤口深部感染、骨折不愈合或畸形愈合、内固定失效等并发症。两组患者骨折愈合时间、术后并发症、影像学参数比较,差异均无统计学意义(P>0.05)。术后6周、12周,PA组DASH评分显著低于MA组(P<0.05);术后6个月及末次随访,两组DASH及Mayo评分差异均无统计学意义(P>0.05)。结论:MA-VLP与PA-VLP内固定用于桡骨远端骨折,均可获得满意的临床疗效,但后者手术时间更短,更利于早期功能恢复。     

Biomechanical comparison of fixed-angle volar plate versus fixed-angle volar plate plus fragment-specific fixation in a cadaveric distal radius fracture model

PURPOSE: To test the hypothesis that combining orthogonal fragment-specific fixation with volar fixed-angle fixation provides markedly higher interfragment stability and construct strength compared with volar fixed-angle fixation alone. METHODS: Eight matched pairs of fresh cadaveric hand and forearm specimens were potted upright in cement. Flexor and extensor tendons were isolated at insertion sites and sutured into a looped bundle for loading in flexion and extension, respectively (up to 61 N). Osteotomies to simulate an AO type C2, 3-part fracture pattern were created with a saw. One randomized specimen from each pair received a locking volar plate and a radial pin plate (VP+PP), and the other received a locking volar plate only (VP). The relative angular displacements between the radial, ulnar, and proximal fragments were obtained with a motion analysis system. After stability tests, specimens were compressed to failure in a wrist-extended position on a material testing machine. Paired t tests were used to compare the interfragment displacement, construct stiffness, and strength between the 2 groups. RESULTS: Comparing fragment displacement in the VP+PP and VP groups showed that with flexion-extension and radial-ulnar deviation, distal fragment displacement was reduced to a statistically significant degree. The VP+PP group also showed higher failure strength and construct rigidity than the VP group. CONCLUSIONS: In a simulated cadaveric model of the distal radius intra-articular fracture, the combined technique of fragment-specific plating with volar fixed-angle fixation alone provides superior biomechanical strength and stability over the volar fixed-angle fixation alone.     

Three‐Dimensional In Vivo Analysis of Malunited Distal Radius Fractures With Restricted Forearm Rotation

Malunited distal radius fractures (DRFs) occasionally restrict forearm rotation, but the underlying pathology remains unclear. We aimed to elucidate the mechanism of rotational restriction by retrospective analysis of 23 patients with unilateral malunited DRFs who presented restricted forearm rotation. We conducted computed tomography during forearm rotation on both sides. Three‐dimensional (3D) bone surface models of the forearm were created, and 3D deformity of the distal radius, translation of the distal radius relative to the ulna, distal radioulnar joint (DRUJ) contact area, and estimated path length (EPL) of distal radioulnar ligaments (DRUL) during forearm rotation were evaluated. In total, 18 patients had dorsal angular deformities (DA group) and five had volar angular deformities (VA group). In the DA group, the closest point between the distal radius and ulna on DRUJ was displaced to the volar side during supination and pronation (p < 0.001); DRUJ contact area was not significantly different between the DA and normal groups. In bone–ligament model simulation, the EPL of dorsal DRUL was longer in the DA group than in the normal group (p < 0.001); opposite phenomena were observed in the VA group. In the DA group, translation of the distal radius in a volar direction relative to the ulna during pronation was impaired presumably due to dorsal DRUL tightness. Anatomical normal reduction of the distal radius by corrective osteotomy may improve forearm rotation by improving triangular fibrocartilage complex tightness and normalizing translation of the distal radius relative to the ulna. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1881–1891, 2019     

Distal radioulnar joint instability in distal radius fractures: the role of sigmoid notch and triangular fibrocartilage complex revisited

The stabilising effects of various structures of the distal radioulnar joint (DRUJ) have been heavily debated. This biomechanical cadaveric study examined the effects of the volar and dorsal lips of the sigmoid notch and the volar and dorsal aspects of the triangular fibrocartilage complex (TFCC) on DRUJ stability. Sequential fractures of the distal radius and sectioning of the TFCC were performed followed by measurements of ulnar translation with the forearm in pronation, neutral and supination. A dorsal lunate facet fracture created instability in pronation. Lunate facet fractures alone did not create instability in other forearm positions. Sectioning of the volar TFCC after loss of the dorsal TFCC by a dorsal lunate facet fracture caused DRUJ instability with the forearm in neutral position. Sectioning of the dorsal TFCC after loss of the volar TFCC due to a volar lunate facet fracture created instability in neutral and pronated positions.     

锁定加压接骨板治疗不稳定型桡骨远端粉碎性骨折

目的探讨不稳定型桡骨远端粉碎性骨折的治疗方法及效果。方法2007年2月-2011年1月根据桡骨远端骨折的类型分别采用掌侧入路、背侧入路及桡侧缘入路行切开复位加压锁定接骨板内固定或加植骨治疗不稳定型桡骨远端粉碎性骨折46例59侧,按照AO分型A2型4侧,A3型7侧,B1型3侧,B2型5侧,B3型10侧,C1型8侧,C2型13侧,C3型9侧。术中行植骨17侧。结果46例患者中41例49侧获5～28个月随访（平均14个月）,全部骨性愈合。腕关节功能按照改良McBride评分标准,优34侧,腕关节背伸750,掌曲-75°;良12侧,背伸70°,掌曲-54°;可3侧,腕关节屈伸有轻微痛,优良率92％。并发症包括背侧入路形成腱鞘炎4例,掌侧入路并发腕管综合征1例,均于拆除内固定后消失。结论复杂的不稳定型桡骨远端粉碎性骨折根据不同骨折类型采用不同的手术入路及支撑板内固定治疗可获得良好的腕关节功能恢复。     

手法间接复位掌侧锁定板固定治疗桡骨远端C3型骨折

目的 ：探讨手法间接复位后AO 2.4 mm桡骨远端锁定板联合经皮穿针固定治疗C3型（AO/OTA分型）桡骨远端骨折的临床疗效及操作技巧。方法：自2009年5月至2012年3月采用手法间接复位AO 2.4 mm桡骨远端掌侧锁定板联合经皮穿针固定治疗桡骨远端骨折AO/OTA分型C3型患者19例21腕（双侧2例）。年龄31~66岁,平均（45.3±17.4）岁;并发尺骨茎突骨折14腕,下尺桡关节不稳6腕;均为闭合性骨折;发病时间4.5~9 d,平均（6.7±3.5）d。采用Henry切口显露骨折部位,保留关节囊、韧带连续性,手法间接复位,C形臂X线透视关节面复位情况,仍存在塌陷者予以撬拨复位后桡骨远端掌侧锁定板固定。下尺桡关节发现不稳定和并发尺骨茎突骨折者均予前臂旋后位石膏托固定6周。结果：19例（21腕）获得随访,时间7~17个月,平均10.5个月。X线示患者桡骨远端骨折均达到骨性愈合,尺骨茎突骨折未愈合3例,下尺桡关节不稳0例,1例出现背侧伸肌腱激惹,内固定取出后激惹消除。术后随访观测患者掌倾角、尺偏角、桡骨茎突高度、关节面和下尺桡关节情况,按照Batra和Gupta评分标准行影像学评定：70分以下3腕,70~79分5腕,80分以上13腕。同时对患者进行主观和客观疗效评定,观测残留畸形和腕关节活动度、并发症情况等,根据Sarmiento改良的Gartland-Werley评分系统评定术后疗效：优17腕,良3腕,可1腕。结论：AO/OTA分型C3型桡骨远端骨折手法间接复位可获得良好复位效果,应用锁定板联合穿针可为其提供内固定架支撑式固定以满足早期功能锻炼要求,患腕功能预后良好。     

Scaphoid nonunion and distal fragment resection: analysis with three-dimensional rigid body spring model

Background  Distal fragment resection is one of the salvage procedures for scaphoid nonunion with osteoarthritis. Despite being reported as a simple procedure with favorable midterm outcomes, further arthritic changes remain a concern in the long term. Scaphoid waist fracture is classified into volar or dorsal types according to the displacement pattern, but the indications for distal fragment resection have never been discussed for these fracture types. Method  We reconstructed a normal wrist model from computed tomography images and performed theoretical analysis utilizing a three-dimensional rigid body spring model. Two types of scaphoid fracture nonunion followed by distal fragment resection were simulated. Results  With volar-type nonunion, the force transmission ratio of the radiolunate joint increased, and the pressure concentration was observed in the dorsal part of the scaphoid fossa and volar part of the lunate fossa of the radius; no deterioration was seen in the midcarpal joint. In the distal fragment resection simulation for volar-type nonunion, pressure concentrations of the radiocarpal joint resolved. With dorsal-type nonunion, force transmission ratio in the radiocarpal joint resembled that of the normal joint model. Pressure concentrations were observed in the dorsoulnar part of the scaphoid fossa and radial styloid. The pressure concentration in the dorsoulnar part of the scaphoid fossa disappeared in the resection model, whereas the concentration in the radial styloid remained. In the midcarpal joint, pressure was concentrated around the capitate head in the nonunion model and became aggravated in the resection model. Conclusions  With volar-type scaphoid nonunion, distal fragment resection seems to represent a reasonable treatment option. With dorsal-type nonunion, however, pressure concentration around the capitate head was aggravated with the simulated distal fragment resection, indicating a potential risk of worsening any preexisting lunocapitate arthritis.     

Effectiveness of Percutaneous Pinning of Acute Partial Scapholunate Injury during Volar Locking Plating for Distal Radius Fractures: A Comparative Study of Pinning and Conservative Treatment

BackgroudWe hypothesized that concurrent temporary fixation of scapholunate ligament (SL) injury during volar locking plate (VLP) fixation of distal radius fractures (DRFs) would improve restoration outcomes based on both radiological and clinical results. Here, we performed a prospective, comparative study investigating the effectiveness of temporary percutaneous reduction/pinning during VLP fixation in DRFs.MethodsThe first 43 consecutive SL injuries were treated concurrently after VLP fixation by closed pinning (group 1); the next 36 consecutive injuries were treated nonoperatively (group 2). Patients were followed up for at least 5 years after treatment. Basic demographic data, radiological measurements, arthroscopic findings of SL injury, and other clinical outcomes were evaluated.ResultsThe mean follow-up period was 7.2 years. No significant differences in basic demographic data were evident between groups. Fracture patterns were not distinctively different between groups. The initial scapholunate angle measured immediately after surgery was 23° ± 3° in group 1 and 38° ± 13° in group 2, indicating a significantly hyperextended scaphoid position in group 1. The final scapholunate angles were also significantly different between groups although the final angle in group 2 (58° ± 11°) was within normal limits. Final visual analog scale scores, Disabilities of the Arm, Shoulder and Hand scores, Gartland and Werley system scores, and wrist motions were not different between groups; however, grip strength at the time of final follow-up was closer to that of the contralateral uninjured wrist in group 1. Arthrosis was less advanced in group 1.ConclusionsTemporary fixation for SL injury with a DRF can be an effective option for the maintenance of scapholunate angle. The non-fixed group exhibited a more pronounced collapse of the scapholunate angle although the angle was still within normal limits, and clinical outcomes were similar between groups regardless of the fixation status.     

The “AIIMS hairpin loop” technique for ‘extreme’ volar rim fractures of distal radius

Background: Treatment of distal radius fractures has seen a paradigm shift since the use of volar locking plates became popular. However, there is a subset of fractures, which includes extreme distal volar rim fractures, that is often not amenable to fixation by volar locking plates as there is insufficient bone mass to put screws. These fractures as such are quite rare but carry a huge morbidity due to frequent lack of anatomical reduction and fixation. A number of different techniques like hook plates, specially designed distal volar locking plates and loop wire techniques have been described for these fractures, but they have been found to be less helpful when the fracture fragments are very small.Methods: Herein, we describe our experience on 6 patients, using a novel surgical technique for fixation of distal radius volar rim fractures which works equally well even when the fragments are quite small (2–3 mm). The technique uses low cost and readily available implants (K wire and conventional volar locking plate) without the need of any special implants.Results: The total of 6 cases of distal radius volar rim fractures (AO/OTA Type B3 = 4, Type C1 = 2) were operated. The mean age was 50.83 years (range: 31–72). The mean follow-up duration was 43.3 months (range: 26–66). The mean size of the volar fragment was 3.66 mm (range: 2–5). The mean pronation and supination were 72.5° (60–80) and 74.2° (60–85). The main flexion and extension were 52.5° (40–75) and 58.3° (50–80) respectively. The mean grip strength was 19.8 kg (4–38) and it was mean 79.3% (40–130%) compared to uninjured side. The mean PRWE score was 12.3 (2–31). One patient developed symptoms of Complex Regional Pain syndrome 1 (CRPS 1) which resolved with conservative management and no other complications were noted.Conclusion: Our technique offers an indigenous, cost-effective way for fixation of extreme volar rim fracture fragments which can be easily adopted and used by surgeons in developing countries.     

Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability

BACKGROUND: Volar plate fixation with use of either a locking plate or a neutralization plate has become increasingly popular among surgeons for the treatment of dorsally comminuted extra-articular distal radial fractures. The purpose of the present study was to compare the relative stability of five distal radial plates (four volar and one dorsal), all of which are commonly used for the treatment of dorsally comminuted extra-articular distal radial fractures, under loading conditions simulating the physiologic forces that are experienced during early active rehabilitation. METHODS: With use of a previously validated Sawbones fracture model, a dorsally comminuted extra-articular distal radial fracture was created. The fracture fixation stability of four volar plates (an AO T-plate, an AO 3.5-mm small-fragment plate, an AO 3.5-mm small-fragment locking plate, and the Hand Innovations DVR locking plate) were compared under axial compression loading and dorsal and volar bending simulating the in vivo stresses that are generated at the fracture site during early unopposed active motion of the wrist and digits. A single dorsal plate (an AO pi plate) was used for comparison, with and without simulated volar cortical comminution. The construct stiffness was measured to assess the resistance to fracture gap motion, and comparisons were made among the implants. RESULTS: The volar AO locking and DVR plates had greater resistance to fracture gap motion (greater stiffness) compared with the volar AO nonlocking and AO T-plates under axial and dorsal loading conditions (p < 0.01), with no significant difference between the AO volar locking and DVR plates. The volar AO locking plate had greater resistance to fracture gap motion than did the volar AO nonlocking plate under axial loading and dorsal bending forces (p < 0.01). The dorsal pi plate had the greatest resistance to fracture gap motion under axial loading and volar and dorsal bending forces (p < 0.01). However, the pi plate was significantly less stable to axial load and dorsal bending forces when the volar cortex was comminuted (p < 0.01). CONCLUSIONS: In this model of dorsally comminuted extra-articular distal radial fractures, dorsal pi-plate fixation demonstrated better resistance to fracture gap motion than did the four types of volar plate fixation. The AO volar locking and DVR plates conferred the greatest resistance to fracture gap motion among the four volar plates tested. Volar locking technology conferred a significant increase in resistance to fracture gap motion as compared with nonlocking plate technology.     

Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis

Study DesignSystematic review and meta-analysis.IntroductionThe use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF).Purpose of the StudyTo compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP.MethodsWe searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group.ResultsSeven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = –0.48, 95% CI –0.73 to –0.22, P < .001; SMD = –0.69, 95% CI –0.97 to –0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups.ConclusionThis systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses.     

两种内固定治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效比较

目的 比较采用桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定和单纯桡骨远端掌侧锁定钢板治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效.方法 将73例桡骨远端骨折伴尺骨茎突基底部骨折患者按治疗方法的不同分为观察组(采用桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定治疗,38例)和对照组(采用单纯桡骨远端掌侧锁定钢板治疗,35...