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Eda Y, Asai R, Kohyama S, Ikumi A, Totoki Y, Yoshii Y. Three-Dimensional Morphometric Analysis of the Volar Cortical Shape of the Lunate Facet of the Distal Radius. Diagnostics (Basel) 2024; 14:1802. [PMID: 39202290 PMCID: PMC11353463 DOI: 10.3390/diagnostics14161802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.
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Affiliation(s)
- Yusuke Eda
- Department of Orthopaedic Surgery, Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba 305-8576, Japan
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan;
| | - Reo Asai
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan;
| | - Sho Kohyama
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan (Y.T.)
| | - Yasukazu Totoki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan (Y.T.)
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan;
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Bharadwaj A, Yogarajah N, Wignadasan W, Davy A, Hunter AR. Low Rates of Hardware Removal and Tendon Rupture for the Acu-Loc 2 Volar Distal Radius Plate: A Minimum One-Year Follow-Up Study. Cureus 2024; 16:e62165. [PMID: 38993466 PMCID: PMC11238753 DOI: 10.7759/cureus.62165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
AIM Volar locking plates designed for far distal radius fracture fixation can have a significant hardware removal rate and risk of tendon rupture. Plate design has a role in the rate of complications. This study assessed the hardware removal and tendon rupture rate of the Acu-Loc 2 volar distal radius (VDR) plate often used in the treatment of far distal radial fractures. METHOD We searched our electronic healthcare records system for all patients who had undergone fixation with an Acu-Loc 2 VDR plate (Acumed, Hillsboro, OR, USA) at a tertiary center between January 2017 and December 2021. Patients were excluded if their follow-up time was less than one year or if they could not be contacted by telephone follow-up. Pre-operative radiographs were examined for fracture classification. Follow-up time was defined as the last contact in the clinic or by telephone. RESULTS A total of 92 patients underwent an open reduction and internal fixation (ORIF) with an Acu-Loc 2 VDR plate. A total of 85 patients met the inclusion criteria for this study. Our cohort included 33 males (38.8%) and 52 females (61.2%). The mean age was 50 years. Twenty-seven fractures (31.0%) were extra-articular, and 60 fractures (69.0%) were intra-articular. The mean follow-up time for the patients was 593.3 days (range 369 to 1185 days). Four patients (4.7%) had their hardware removed. Three (3.5%) patients underwent removal due to tendon irritation and one patient (1.2%) due to a peri-prosthetic fracture around the plate. There were no tendon ruptures recorded. CONCLUSION The Acu-Loc 2 VDR plate had a low medium-term hardware removal rate and no tendon ruptures. These rates are lower than would be expected when compared with other far distal plate designs.
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Affiliation(s)
- Aniket Bharadwaj
- Trauma and Orthopaedics, University College London Hospital, London, GBR
| | - Nimalesh Yogarajah
- Trauma and Orthopaedics, University College London Hospital, London, GBR
| | | | - Anthea Davy
- Trauma and Orthopaedics, University College London Hospital, London, GBR
| | - Alistair R Hunter
- Trauma and Orthopaedics, University College London Hospital, London, GBR
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Sochol KM, Gluck M, McGough J, Hausman M. Optimizing Volar Tilt Restoration and Plate Position in Distal Radius Fractures. J Hand Surg Am 2024; 49:64.e1-64.e7. [PMID: 35843762 DOI: 10.1016/j.jhsa.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 03/31/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius fractures are common and often treated surgically with a volar plate. A complication of volar plating includes tendonitis or rupture of the flexor pollicis longus (FPL) tendon. We hypothesize that failure to restore the volar tilt of the distal radius results in increased pressure on the FPL tendon. METHODS Ten fresh-frozen cadaveric wrists were assessed for this study. During testing, weights were suspended from the FPL tendon to stimulate muscle contraction. Reproducible fractures were created and fixed via volar plating. The contact force between FPL and the bone or plate edge was measured with a force transducer in 5 surgical conditions. These were assessed to evaluate whether failure to restore the volar tilt increases the pressure with a plate proximal or distal to the watershed line. RESULTS Significant increases in contact forces were observed between the control and both conditions in which volar tilt was not restored, with mean increases of 1.9 N and 3.0 N. A significant increase in the contact force was found when placing the plate distal to the watershed line with a mean increase of 2.03 N comparing the failure to restore volar tilt and after restoring the volar tilt. Significant increases in contact force were also observed between the dorsal plate condition, which failed to restore the volar tilt, and both plate conditions with placement distal to the watershed line, with mean differences of 0.94 N and 1.09 N, respectively. CONCLUSIONS Failure to restore the volar tilt in surgically treated distal radius fractures causes increased pressure on the FPL tendon. Plate placement distal to the watershed line also causes increased FPL tendon pressure over the plate edge. CLINICAL RELEVANCE This study demonstrates the importance of restoring the volar tilt of the distal radius in surgically treated distal radius fractures and confirms that plate placement distal to the watershed line will increase pressure on the FPL tendon.
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Affiliation(s)
- Kristen M Sochol
- Icahn School of Medicine at Mount Sinai, New York, NY; Department of Orthopedic Surgery, Zucker School of Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, NY.
| | - Matthew Gluck
- Icahn School of Medicine at Mount Sinai, New York, NY
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Holc F, Bronenberg Victorica P, Avanzi R, Huespe IA, De Carli P, Boretto JG. Risk of Volar Locking Plate Removal After Distal Radius Fractures: Time-to-Event Analysis. J Hand Surg Am 2023; 48:1011-1017. [PMID: 37578402 DOI: 10.1016/j.jhsa.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The primary purpose of this study was to describe the rate of volar locking plate (VLP) removal after distal radius fracture and how long it takes for the risk of VLP removal to stabilize. The secondary purpose was to describe the reasons for VLP removal and analyze the relationship between it and the Soong index. METHODS This was a single-center retrospective cohort study. Patients aged >18 years with distal radius fracture who underwent VLP fixation were included. Hardware removal, time until VLP removal, and the primary reason for removal were recorded. The implant prominence was measured as described by Soong. We used Kaplan-Meier curves and risk tables to describe the risk of VLP removal and variation over time. Multivariable logistic regression was used to assess the relationship between Soong grade and VLP removal. RESULTS A total of 313 wrists were included. There were 35 cases of VLP removal, with an overall incidence of 11.2% at 15 years of follow-up. The incidence rate was 1.2 per 100 individuals per year for the entire cohort. The risk of VLP removal decreased from 6.2% in the first postoperative year to 1.7% in the second year and 1.4% in the third year. Beyond that, the rate remained <1% per year throughout the follow-up period. The median hardware removal time was 11 months. The main reasons for VLP removal were tenosynovitis, implant-associated pain, and screw protrusion. We found no association between Soong grade and VLP removal. CONCLUSIONS Volar locking plate removal after distal radius fracture was more common in the first year after surgery and remained notable until the third year. Regular monitoring and patient education to assess possible complications related to hardware are important during this period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Fernando Holc
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Pedro Bronenberg Victorica
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocio Avanzi
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan A Huespe
- Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo De Carli
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge G Boretto
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abstract
There are several options for plate fixation of distal radius fractures. Volar plating has broad applicability and consistent outcomes, and thus is the most commonly used plate type. Dorsal plates are advantageous for specific fracture patterns, and can provide direct fracture reduction and buttressing, but may be prominent and can cause tendon irritation. Bridge plates offer an alternative to external fixation while avoiding the complications with prominent hardware, because they span highly comminuted fractures and can be used for immediate weight bearing; however, they require plate removal. Choice of plate fixation should depend on fracture type, patient factors, and surgeon experience.
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Flexor tendon complications in distal radius fractures treated with volar rim locking plates. HAND SURGERY & REHABILITATION 2020; 39:511-515. [DOI: 10.1016/j.hansur.2020.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023]
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Asmar G, Bellity J, Falcone MO. Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:481-490. [PMID: 32955698 DOI: 10.1007/s00590-020-02791-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs) with minimally invasive plate osteosynthesis (MIPO), but surgery learning curves could be long. The purpose of this study was to assess a new extra-short plate with two locking diaphyseal divergent screws, specifically designed for MIPO, preserving the pronator quadratus muscle. MATERIALS AND METHODS This retrospective study consisted of three phases: (i) the evaluation of surgical comfort with the incision size and the duration of 59 consecutive surgeries using the extra-short plate in DRFs; (ii) the verification of the implant ability to maintain radiographic indices compared immediately postoperatively and at consolidation. They included radial inclination (RI), volar tilt (VT) and ulnar variance (UV); (iii) the assessment of clinical outcomes at last follow-up through: pain measured on the visual analogue scale (VAS), QuickDASH score, patient-rated wrist evaluation (PRWE) score, grip strength, range of motion and complications. RESULTS In the first phase: mean incision size was 32 mm, and mean operative time was 28.5 min. In the second phase, there was no statistical difference between the two measures of the indices studied. In the third phase, mean follow-up time was 14.2 months, VAS score was 1.1, QuickDASH score was 11.4/100, and PRWE score was 9.5/100. Flexion was 91%, extension was 94%, and grip strength was 86% compared to the contralateral side. CONCLUSION The surgical comfort may be related to short operative time and incision. The implant allowed maintaining the radiographic indices without secondary displacement. Functional clinical outcomes were satisfactory. This extra-short plate design belongs to a novel generation of VLPs.
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Affiliation(s)
- Ghada Asmar
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Jonathan Bellity
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France
| | - Marc-Olivier Falcone
- Ramsay Générale de Santé - Capio - Hôpital Privé Paul d'Egine, 4 avenue Marx Dormoy, 94500, Champigny-Sur-Marne, France. .,Clinique Internationale du Parc Monceau, 21 rue de Chazelles, 75017, Paris, France.
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Volar plate for intra-articular distal radius fracture. A prospective comparative study between elderly and young patients. Orthop Traumatol Surg Res 2020; 106:319-323. [PMID: 32044260 DOI: 10.1016/j.otsr.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/18/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of the distal radius fracture in elderly remains controversial. The objective was to assess the outcomes of volar locking plate for displaced complete intra-articular distal radius fractures in elderly as compared to younger patients. HYPOTHESIS The outcomes in elderly patients would be comparable with those in younger patients with a low rate of complications. MATERIAL AND METHODS Non-randomised prospective comparative study between 70 patients older than 65 years and 46 younger patients with AO type-C fractures. The main outcome was Disabilities Arm, Shoulder and Hand (DASH) score. Secondary variables were Patient-Rated Wrist Evaluation (PRWE) score, range of motion, Visual Analogue Scale (VAS) for pain, and grip strength. Radiological measurements were also performed. RESULTS The mean follow-up was 30.9 (range, 24-53) months. There were no significant differences in mean DASH, PRWE, VAS-pain, wrist motion or radiological parameters at final follow-up. Multivariate analysis showed that the functional outcomes were significantly influenced by baseline ulnar positivity greater than 3mm at baseline but not by age. DISCUSSION The study hypothesis was confirmed. Surgical treatment with volar locking plate for displaced complete intra-articular fractures of the distal radius in elderly patients represents a safe and effective treatment alternative with similar early complication rate than in younger. LEVEL OF EVIDENCE III, cohort study.
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Hammerle D, Osterhoff G, Allemann F, Werner CML. Comparison of intraoperative 2D vs. 3D imaging in open reduction and fixation of distal radius fractures. Eur J Trauma Emerg Surg 2018; 46:557-563. [PMID: 30350005 DOI: 10.1007/s00068-018-1036-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In the volar plating of distal radius fractures, intraoperative three-dimensional (3D) imaging is designed to allow better judgment regarding screw and implant positioning compared with conventional intraoperative two-dimensional (2D) imaging. We evaluated the impact of these two imaging modalities on the rates of intraoperative revision and secondary surgery, as well as the need for implant removal during follow-up. METHODS A retrospective analysis of consecutive patients who underwent volar plate osteosynthesis for isolated distal radius fractures between January 2008 and April 2016 was performed. Patient files were evaluated for intraoperative imaging findings, intraoperative and postoperative revision rates, and implant removal during follow-up. Additional analyses of radiation exposure, operation time, and hospitalization time were performed. RESULTS A total of 314 patients were analyzed (mean age: 54 ± 19 years; 210 females). For 246 patients, only 2D imaging was performed, while the remaining 68 patients underwent both 2D and 3D imaging (O-Arm, Medtronic). The intraoperative revision rate was significantly (p < 0.001) higher with 3D imaging (32.4%) compared with 2D imaging (2.0%). The postoperative revision rates were similar between both the groups (2.9% vs. 2.0%; p = 0.674). Compared with 2D imaging, the use of the Medtronic O-Arm resulted in a significantly lower implant removal rate (8.8% vs. 18.7%; p = 0.036) during follow-up. CONCLUSION Compared with conventional 2D imaging, the use of intraoperative 3D imaging significantly increased the intraoperative revision rate and has the potential for positive long-term effects for lowering the risk of requiring an implant removal.
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Affiliation(s)
- Diego Hammerle
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St.Gallen, Rorschacher Strasse 95, 9007, St.gallen, Switzerland.
| | - Georg Osterhoff
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Florin Allemann
- Klinik für Traumatologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
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