Volar long locking compression plate fixation for distal radius fractures with metaphyseal and diaphyseal extension

Minimally invasive approach in radio distal end fractures, three different types of incisions

Two techniques are described to treat distal radius fractures: conventional (Henry approach) and minimally invasive plate osteosynthesis. The latter technique has been described by different authors such as Imatani et al. and Zenke et al.

This was a descriptive retrospective study, analyzing 26 adult patients with unstable distal radius fracture, extra-articular type A or partially intra-articular type B according to AO. The approaches used were: (i) single longitudinal palmar incision; (ii) double T-incision (horizontal and vertical) and (iii) double position II.

Ages were between 21 and 78 years. Most affected hand was the right. Most common fracture was 23B2 (AO classification). In total, 84.6% of the patients did not present complications. According to the functional evaluation of the wrist by the Mayo Clinic, 31% showed excellent results, 42% showed good results, 27% showed fair results.

The techniques had satisfactory results for the osteosynthesis with more aesthetic and less invasive approach.

Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly

BACKGROUND

Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients.

METHODS

One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared.

RESULTS

Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group.

CONCLUSION

The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients.

LEVEL OF EVIDENCE

III Therapeutic study.

Minimally invasive percutaneous plate osteosynthesis for distal radius fractures with long-segment metadiaphyseal comminution

INTRODUCTION

Distal radius fractures with both metaphyseal and diaphyseal comminution are commonly encountered injuries due to high-energy trauma. However, effectively treating patients with this disease remains challenging for the surgeon.

HYPOTHESIS

The goal of this study was to evaluate the outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique for distal radius fractures with long-segment metadiaphyseal comminution.

MATERIAL AND METHODS

Nine patients with distal radius fractures involving long-segment metadiaphyseal comminution were treated with MIPPO from June 2011 to May 2012. Radiograph index, the range of motion of the wrist and forearm, grip strength, the Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed at final follow-up. Additionally, time to bone healing, time to return to work or activity, and postoperative complications were also recorded.

RESULTS

All nine fractures healed by 13±1.3 weeks postoperatively. At an average follow-up of 15.9±3.6 months, the radiographs revealed a mean radial inclination of 18.2±2.7°, a mean volar tilt of 10.7±3.2°, and a radial shortening of 2.3±1.0mm. Nine patients had excellent wrist function according to the DASH score, range of motion, and grip strength. Except one patient experienced delayed healing of the distal incision, no complications occurred. All patients resumed work or activity within 16.2±1.9 weeks.

DISCUSSION

Volar MIPPO is a safe and effective surgical treatment method for distal radius fractures with long-segment metadiaphyseal comminution, with few potential complications.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Minimally invasive plate osteosynthesis in distal radius fractures with metaphyseal extension: A series of 13 cases

To evaluate objective and subjective outcomes after minimally invasive volar locked plate fixation of distal radius fractures with metaphyseal extension, we retrospectively evaluated 13 patients with unstable distal radius fractures with metaphyseal extension, treated by minimally invasive volar locked plating. Patients' average age was 41 years. Two volar incisions, 2 to 3cm long, were made; indirect reduction was performed and a volar locked T-plate was placed submuscularly under fluoroscopy guidance. Twelve fractures healed after an average of 2.46 months; one patient needed revision due to a new injury. The plate had to be removed in one patient. On X-rays, radial height averaged 12.78mm, radial inclination averaged 21.34° and volar tilt averaged 8.22°. Flexion averaged 75°, extension 71.5°, pronation 82.08° and supination 83.08°. Grip strength averaged 83.75% of the contralateral wrist. The DASH score averaged 13.91 points and pain assessed on VAS averaged 0.92 points. In unstable distal radius fractures with metaphyseal extension, minimally invasive plate osteosynthesis using volar locked plates led to good reduction and stable fixation, with low pain levels, and good functional and esthetic results. Indirect reduction techniques, fluoroscopy, and restoration of radial length, rotation and alignment, are necessary to achieve these outcomes.

LEVEL OF EVIDENCE

IV.