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McCarty JC, Cross RE, Laane CLE, Hoftiezer YAJ, Gavagnin A, Regazzoni P, Fernandez Dell'Oca A, Jupiter JB, Bhashyam AR. Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments. Hand (N Y) 2024:15589447241233762. [PMID: 38439630 DOI: 10.1177/15589447241233762] [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] [Indexed: 03/06/2024]
Abstract
BACKGROUND We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. METHODS Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. RESULTS Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. CONCLUSIONS The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.
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Affiliation(s)
- Justin C McCarty
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA
| | - Rachel E Cross
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Charlotte L E Laane
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yannick Albert J Hoftiezer
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aquiles Gavagnin
- Department of Orthopedics, Hospital Britanico Montevideo, Uruguay
| | | | | | - Jesse B Jupiter
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Abhiram R Bhashyam
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
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Berger L, Pahr D, Synek A. Articular contact vs. embedding: Effect of simplified boundary conditions on the stress distribution in the distal radius and volar plate implant loading. J Biomech 2022; 143:111279. [DOI: 10.1016/j.jbiomech.2022.111279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
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Hadzhinikolova M, Zderic I, Ciric D, Barcik JP, Enchev D, Baltov A, Rusimov L, Varga P, Stoffel K, Richards G, Gueorguiev B, Rashkov M. Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment - a biomechanical study. BMC Musculoskelet Disord 2022; 23:35. [PMID: 34986819 PMCID: PMC8734044 DOI: 10.1186/s12891-021-04989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.
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Affiliation(s)
- Mariya Hadzhinikolova
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Daniel Ciric
- AO Research Institute Davos, Davos, Switzerland.,Flinders University, Tonsley, South Australia
| | | | - Dian Enchev
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Lyubomir Rusimov
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | | | - Mihail Rashkov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
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Towards optimization of volar plate fixations of distal radius fractures: Using finite element analyses to reduce the number of screws. Clin Biomech (Bristol, Avon) 2021; 82:105272. [PMID: 33493739 DOI: 10.1016/j.clinbiomech.2021.105272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Using fewer distal screws in volar plate fixation of distal radius fractures could reduce treatment costs and complications. However, there is currently no consensus on the ideal screw configuration, likely due to experimental limitations and its subject-specific nature. In this study, finite element analysis was used to investigate (1) if reducing the number of screws is biomechanically feasible and (2) if an optimal screw configuration is subject-specific. METHODS Validated subject-specific finite element models of 16 human radii with extra articular distal radius fractures and volar plate fixation with six distal screws were used as a baseline. 41 additional configurations with three to six distal screws were simulated for each subject. Axial stiffness and peri-implant strains around the distal screws were evaluated. Subject-specific optimum configurations were determined using a lower bound for the axial stiffness and minimizing peri-implant strains. FINDINGS Even using three distal screws led to only minor deterioration of the biomechanical properties in the best configuration (axial stiffness: -11.2%, peri-implant strains: -35.0%), but a considerable deterioration in the worst configuration (axial stiffness: -46.2%, peri-implant strains: +112.4%). The optimization showed that the ideal screw configuration is subject-specific and on average 1.9 screws could be saved based on the herein used optimization criterion. INTERPRETATION This study highlights that not only how many, but which screws are used in volar plate fixation of distal radius fractures is critical. Using a patient-specific selection of distal screws bears potential to save costs and reduce complications.
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5
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Oh GH, Kim HS, Lee JI. Biomechanical evaluation of the stability of extra-articular distal radius fractures fixed with volar locking plates according to the length of the distal locking screw. Comput Methods Biomech Biomed Engin 2020; 24:922-932. [PMID: 33347357 DOI: 10.1080/10255842.2020.1861254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Surgeons usually used short screws to avoid extensor tendon problems during volar locking plate fixation in distal radius fracture. However, the stability according to the length of distal locking screws have not been fully understood. We investigated this issue through finite element analysis and compression test using synthetic radius. Our results demonstrated that the bi-cortical full-length fixation does not contribute to the stiffness increase in the axial compression direction, and a reduction in length of up to more than 50% length can still provide similar stability to full-length screws. Our data can support that surgeon should undersize the distal screw.
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Affiliation(s)
- Gyung-Hwan Oh
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea
| | - Hak-Sung Kim
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea.,Institute of Nano Science and Technology, Hanyang University, Seoul, Korea
| | - Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri hospital, Guri, Korea
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Jung HS, Jung HS, Baek SH, Lee JS. How Many Screws Are Needed for Reliable Stability of Extra-articular Nonosteoporotic Distal Radius Fractures Fixed with Volar Locking Plates? Clin Orthop Surg 2020; 12:22-28. [PMID: 32117534 PMCID: PMC7031436 DOI: 10.4055/cios.2020.12.1.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/01/2019] [Indexed: 11/06/2022] Open
Abstract
Background We hypothesized that volar locking pate fixation using a minimum number of screws-four in the distal row and two in the shaft of the plate-will provide sufficient stability for unstable extra-articular fractures of the distal radius. We aimed to compare the biomechanical properties of different numbers and locations of screws in volar locking plate fixation and describe the clinical and radiological outcome of plate fixation using a minimum number of screws for distal radius fractures. Methods We divided 48 artificial radius fracture bones into four groups (group A-D) based on the number and location of screws used for fixation with volar locking plates. The artificial bone models were subjected to axial compression and volar bending load with a force of 250 N and 80 N, respectively, for 1,000 cycles at a frequency of 1 Hz. We also retrospectively reviewed 42 patients with unstable, extra-articular, distal radius fractures who were treated with volar locking plate fixation using a minimum number of screws. Results Group A (seven distal screws and three proximal screws) had the highest mean stiffness: 303.7 N/mm under axial compression and 61.1 N/mm under volar bending. Compared with group A, group D (four screws in the distal part and two screws in the shaft) showed significantly lower stiffness; therefore, group D was considered inferior in terms of stability. However, in the fatigue test, neither deformation of the metal plate nor detachment or breakage of the metal screws was observed in all groups. In the clinical study, all fractures united without displacement and satisfactory clinical outcome was obtained. Conclusions In the dorsally comminuted, extra-articular, nonosteoporotic distal radius fractures, the minimum number of screws-four in the distal row and two in the shaft-in volar locking plate fixation can provide sufficient stability. Further biomechanical studies involving osteoporotic bone will be necessary to confirm the results because volar plate fixation is most commonly used in patients with osteoporosis.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Han Sol Jung
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Suk-Ho Baek
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Sung Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
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Martin DP, Park AG, Jamison D, Jones CM, Ilyas AM. Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius. J Hand Surg Am 2019; 44:1093.e1-1093.e8. [PMID: 30898463 DOI: 10.1016/j.jhsa.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This biomechanical study compared the stability of volar locking plates (VLPs) and locking fragment-specific (LFS) dorsal and radial styloid plates for the fixation of dorsal (AO 23-B2) and radial styloid (AO 23-B1) shear fractures of the distal radius, respectively. METHODS Two groups of 6 composite radii were fixed with a VLP or an LFS dorsal plate over a simulated dorsal shear fracture. Two additional groups of 6 radii received the same VLP or an LFS radial plate to fix a radial styloid fracture. Each plated radius was tested under cyclic axial compression by a servohydraulic testing machine that recorded axial displacement per cycle. Construct stiffness was calculated from the slope of the force-displacement curve. RESULTS In the dorsal shear fracture model, the dorsal LFS plate exhibited less displacement than the VLP (0.32 ± 0.04 vs 0.43 ± 0.07 mm, respectively) and showed greater average stiffness (645 ± 64 vs 433 ± 88 N/mm, respectively). Plate type was responsible for 53.1% of the variation in displacement and 68.6% of the variation in stiffness. In the radial styloid fracture model, variations due to number of cycles elapsed and plate type were similar for displacement and stiffness in both groups. The average stiffness during cyclical nondestructive testing was 566 ± 45 and 573 ± 60 N/mm for VLP and LFS radial plating groups, respectively. CONCLUSIONS For AO 23-B2 (dorsal rim) fractures, the dorsal LFS plates exhibited significantly less displacement and greater stiffness in axial loading than VLPs. For AO 23-B1 (radial styloid) fractures, the VLP displayed similar displacement and stiffness to the radial LFS plates. CLINICAL RELEVANCE All constructs tested could be expected to withstand axial compressive forces typical of early postoperative rehabilitation.
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Affiliation(s)
- Dennis P Martin
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Andrew G Park
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - David Jamison
- Mechanical Engineering Department, Villanova University, Villanova, PA
| | - Christopher M Jones
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- The Rothman Institute, Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Ramavath A, Howard N, Lipscombe S. Biomechanical considerations for strategies to improve outcomes following volar plating of distal radius fractures. J Orthop 2019; 16:445-450. [PMID: 31528050 DOI: 10.1016/j.jor.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/15/2019] [Indexed: 01/30/2023] Open
Abstract
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.
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Affiliation(s)
- A Ramavath
- Department of Trauma and Orthopaedics, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - N Howard
- Department of Trauma and Orthopaedics, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - S Lipscombe
- Department of Trauma and Orthopaedics, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
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Drobetz H, Black A, Davies J, Buttner P, Heal C. Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates. World J Orthop 2018; 9:203-209. [PMID: 30364833 PMCID: PMC6198296 DOI: 10.5312/wjo.v9.i10.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.
METHODS A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.
RESULTS Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.
CONCLUSION Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.
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Affiliation(s)
- Herwig Drobetz
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Alyce Black
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
| | - Jonathan Davies
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
| | - Petra Buttner
- Tropical Health Solutions PTY Ltd, Townsville 4810, Queensland, Australia
- Centre for Chronic Disease Prevention, James Cook University, Cairns 4878, Queensland, Australia
| | - Clare Heal
- James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
- Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, Townsville 4810, Queensland, Australia
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Tsutsui S, Kawasaki K, Yamakoshi KI, Uchiyama E, Aoki M, Inagaki K. Impact of double-tiered subchondral support procedure with a polyaxial locking plate on the stability of distal radius fractures using fresh cadaveric forearms: Biomechanical and radiographic analyses. J Orthop Sci 2016; 21:603-8. [PMID: 27523260 DOI: 10.1016/j.jos.2016.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 04/27/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The present study compared the changes in biomechanical and radiographic properties under cyclic axial loadings between the 'double-tiered subchondral support' (DSS) group (wherein two rows of screws were used) and the 'non-DSS' (NDSS) group (wherein only one row of distal screws was used) using cadaveric forearm models of radius fractures fixed with a polyaxial locking plate. MATERIAL AND METHODS Fifteen fresh cadaveric forearms were surgically operated to generate an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 23-C2 fracture model with the fixation of polyaxial volar locking plates. The model specimens were randomized into two groups: DSS (n = 7) and NDSS (n = 8). Both the groups received 4 locking screws in the most distal row, as is usually applied, whereas the DSS group received 2 additional screws in the second row inserted at an inclination of about 15° to support the dorsal aspect of the dorsal subchondral bone. Cyclic axial compression test was performed (3000 cycles; 0-250 N; 60 mm/min) to measure absolute rigidity and displacement, after 1, 1000, 2000 and 3000 cycles, and values were normalized relative to cycle 1. These absolute and normalized values were compared between those two groups. Radiographic images were taken before and after the cyclic loading to measure changes in volar tilt (ΔVT) and radial inclination (ΔRI). RESULTS The DSS group maintained significantly higher rigidity and lower displacement values than the NDSS group during the entire loading period. Radiographic analysis indicated that the ΔVT values of the DSS group were lower than those of the NDSS group. In contrast, the fixation design did not influence the impact of loading on the ΔRI values. CONCLUSIONS Biomechanical and radiographic analyses demonstrated that two rows of distal locking screws in the DSS procedure conferred higher stability than one row of distal locking screws.
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Affiliation(s)
- Sadaaki Tsutsui
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Keikichi Kawasaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Ken-Ichi Yamakoshi
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan; College of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Eiichi Uchiyama
- Department of School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Mitsuhiro Aoki
- Health Sciences University of Hokkaido, School of Rehabilitation Science, Sapporo, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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11
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Im JH, Lee JY. Pearls and Pitfalls of the Volar Locking Plating for Distal Radius Fractures. J Hand Surg Asian Pac Vol 2016; 21:125-32. [PMID: 27454625 DOI: 10.1142/s242483551640004x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Volar locking plate fixation has been widely accepted method for the treatment of unstable distal radius fractures. Although the results of volar locking plate fixation are encouraging, it may cause implant-related complications such as flexor or extensor tendon injuries. In depth understanding of anatomy of the distal radius is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid these complications. This article will review the anatomic characteristics of the distal radius because selecting proper implant and positioning of the plate is closely related to the volar surface anatomy of the distal radius. The number and the length of distal locking screws are also important to provide adequate fixation strength to maintain fracture fixation. We will discuss the pros and cons of the variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation. Finally, we will discuss about correcting radial length and volar tilt by using eccentric drill holes and distal locking first technique.
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Affiliation(s)
- Jin-Hyung Im
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
| | - Joo-Yup Lee
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea
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12
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Vosbikian MM, Ketonis C, Huang R, Ilyas AM. Optimal Positioning for Volar Plate Fixation of a Distal Radius Fracture: Determining the Distal Dorsal Cortical Distance. Orthop Clin North Am 2016; 47:235-44. [PMID: 26614937 DOI: 10.1016/j.ocl.2015.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are currently among the most common fractures of the musculoskeletal system. With a population that is living longer, being more active, and the increasing incidence of osteoporosis, these injuries will continue to become increasingly prevalent. When operative fixation is indicated, the volar locking plate has recently become the treatment of choice. However, despite its success, suboptimal position of the volar locking plate can still result in radiographic loss of reduction. The distal dorsal cortical distance is being introduced as an intraoperative radiographic tool to help optimize plate position and minimize late loss of fracture reduction.
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Affiliation(s)
- Michael M Vosbikian
- Hand and Microvascular Surgery, Harvard-Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman Building-10th Floor, Boston, MA 02215, USA.
| | - Constantinos Ketonis
- Orthopaedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, College Building-Room 516, Philadelphia, PA 19107, USA
| | - Ronald Huang
- Orthopaedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, College Building-Room 516, Philadelphia, PA 19107, USA
| | - Asif M Ilyas
- The Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
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Dong CL, Liu HZ, Zhang ZC, Zhao HL, Zhao H, Huang Y, Yao JH, Sun TS. The influence of MicroRNA-150 in Osteoblast Matrix Mineralization. J Cell Biochem 2015. [PMID: 26212040 DOI: 10.1002/jcb.25245] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Chun-Ling Dong
- Department of Nursing; Linyi People's Hospital; Linyi 276003 P.R. China
| | - Hao-Zhi Liu
- Department of Pharmacology; Linyi Health School; Linyi 276000 P.R. China
| | - Zhen-Chun Zhang
- Department of Rheumatism Immunity; Linyi People's Hospital; Linyi 276003 P.R. China
| | - Huan-Li Zhao
- Department of Orthopedics; Linyi People's Hospital; Linyi 276003 P.R. China
| | - Hui Zhao
- Department of Rheumatism Immunity; Linyi People's Hospital; Linyi 276003 P.R. China
| | - Yan Huang
- Department of Nursing; Linyi People's Hospital; Linyi 276003 P.R. China
| | - Jian-Hua Yao
- Department of Nursing; Linyi People's Hospital; Linyi 276003 P.R. China
| | - Tian-Sheng Sun
- Department of Nursing; Linyi People's Hospital; Linyi 276003 P.R. China
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Baumbach SF, Synek A, Traxler H, Mutschler W, Pahr D, Chevalier Y. The influence of distal screw length on the primary stability of volar plate osteosynthesis--a biomechanical study. J Orthop Surg Res 2015; 10:139. [PMID: 26351239 PMCID: PMC4563846 DOI: 10.1186/s13018-015-0283-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Extensor tendon irritation is one of the most common complications following volar locking plate osteosynthesis (VLPO) for distal radius fractures. It is most likely caused by distal screws protruding the dorsal cortex. Shorter distal screws could avoid this, yet the influence of distal screw length on the primary stability in VLPO is unknown. The aim of this study was to compare 75 to 100 % distal screw lengths in VLPO. Methods A biomechanical study was conducted on 11 paired fresh-frozen radii. HRpQCT scans were performed to assess bone mineral density (BMD) and bone mineral content (BMC). The specimens were randomized pair-wise into two groups: 100 % (group A) and 75 % (group B) unicortical distal screw lengths. A validated fracture model for extra-articular distal radius fractures (AO-23 A3) was used. Polyaxial volar locking plates were mounted, and distal screws was inserted using a drill guide block. For group A, the distal screw tips were intended to be flush or just short of the dorsal cortex. In group B, a target screw length of 75 % was calculated. The specimens were tested to failure using a displacement-controlled axial compression test. Primary biomechanical stability was assessed by stiffness, elastic limit, and maximum force as well as with residual tilt, which quantified plastic deformation. Results Nine specimens were tested successfully. BMD and BMC did not differ between the two groups. The mean distal screw length of group A was 21.7 ± 2.6 mm (range: 16 to 26 mm), for group B 16.9 ± 1.9 mm (range: 12 to 20 mm). Distal screws in group B were on average 5.6 ± 0.9 mm (range: 3 to 7 mm) shorter than measured. No significant differences were found for stiffness (706 ± 103 N/mm vs. 660 ± 124 N/mm), elastic limit (177 ± 25 N vs. 167 ± 36 N), maximum force (493 ± 139 N vs. 471 ± 149 N), or residual tilt (7.3° ± 0.7° vs. 7.1° ± 1.3°). Conclusion The 75 % distal screw length in VLPO provides similar primary stability to 100 % unicortical screw length. This study, for the first time, provides the biomechanical basis to choose distal screws significantly shorter then measured. Electronic supplementary material The online version of this article (doi:10.1186/s13018-015-0283-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian F Baumbach
- Department of Trauma Surgery, University Hospital of Munich (LMU), Campus Innenstadt, Nußbaumstrasse 20, 80336, Munich, Germany.
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria
| | - Hannes Traxler
- Center of Anatomy and Cell Biology, Department of Systematic Anatomy, Medical University Vienna, Währinger Straße 13, 1090, Vienna, Austria
| | - Wolf Mutschler
- Department of Trauma Surgery, University Hospital of Munich (LMU), Campus Innenstadt, Nußbaumstrasse 20, 80336, Munich, Germany
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, 1060, Vienna, Austria
| | - Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 15, 81377, Munich, Germany
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Distal radius: anatomical morphometric gender characteristics. Do anatomical pre-shaped plates pay attention on it? Arch Orthop Trauma Surg 2015; 135:133-9. [PMID: 25388864 DOI: 10.1007/s00402-014-2112-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of the study was to investigate differences in the osseous structure anatomy of male and female distal radii. METHODS Morphometric data were obtained of 49 distal human cadaveric radii. An imprint of the distal edge was attained using silicone mass and the palmar cortical angle (PCA) of the lateral and intermediate column, here declared as medial, according to the concept of Rikli and Rigazzoni. The lateral and medial length and five widths were digitally measured by three observers. In order to compare the measurements an unpaired t test was used. To prove the reliability of the measurements an intraclass correlation analyses was done. RESULTS Overall mean medial PCA was 148.25° (SD ± 6.83) and mean lateral PCA 156.07° (SD ± 7.00). In male specimens, the mean medial PCA was 147.38° (SD ± 6.01) and mean lateral PCA was 153.6° (SD ± 6.20) whereas in female specimens, the mean medial PCA was 149.41° (SD ± 7.79) and the mean lateral PCA 159.37° (SD ± 6.78), with statistical significance for the female lateral PCA. No gender significant difference for the medial PCA and no significant side difference for the PCA's could be found. The ICC of the observers was r = 0.936 and 0.976 for the medial and for lateral PCA 0.957-0.984. The palmar cortical length of the distal radius was significantly longer in male specimens. For all widths, larger values for male radii were measured, being statistically significant in all cases. CONCLUSION Male dimensions concerning the wide were significantly larger when compared with females. Regarding the PCA at the medial and lateral column, we found significant difference for lateral PCA concerning the gender. Overall, study results demonstrated an angle of 148.25° ± 6.83 for the medial PCA and 156.07° ± 7.00 for the lateral PCA.
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Can the use of variable-angle volar locking plates compensate for suboptimal plate positioning in unstable distal radius fractures? A biomechanical study. J Orthop Trauma 2015; 29:e1-6. [PMID: 24786734 DOI: 10.1097/bot.0000000000000146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the biomechanical stability under load-to-failure conditions of optimally placed fixed-angle volar locking plates versus suboptimally placed variable-angle volar locking plates in unstable, intraarticular distal radius fractures. METHODS A Melone type 1 (AO 23-C3) fracture was created in 25 sawbone radii and plated with either a fixed-angle or variable-angle Synthes plate with identical profile. Four plate positions were tested: distal ulnar (DU, positioned distally to obtain subchondral support and ulnar to hold the lunate facet fragments), distal radial (DR, 3 mm radial to DU), proximal ulnar (PU, 3 mm proximal to DU), and proximal radial (PR, 3 mm proximal and 3 mm radial to DU). The specimens were loaded until failure as defined by a 2-mm displacement of any fracture fragment. The fixed-angle plates were tested in the DU position, whereas the variable-angle plates were tested in all 4 positions. RESULTS The dorsal lunate fragment was the first to fail in every group followed by the radial styloid and volar lunate fragments, respectively. Load-to-failure, from greatest to least, occurred at the DR (278 ± 56 N), PR (277 ± 68 N), DU fixed-angle (277 ± 68 N), DU variable-angle (236 ± 31 N), and PU (202 ± 75 N) positions, respectively. Rigidity was calculated using the slope of the dorsal lunate force-displacement curve before failure (at loads 100-150 N). Rigidity was greatest at the PU position (126 ± 60 N/mm) followed by PR (125 ± 30 N/mm), DU fixed-angle (125 ± 25 N/mm), DR (122 ± 66 N/mm), and DU variable-angle (101 ± 35) positions, respectively. Univariate analysis of rigidity and load-to-failure was not significantly different between groups. CONCLUSIONS In this experimental model, variable-angle screws provided a leeway of 3 mm in both the sagittal and coronal directions without sacrificing construct strength, which may considerably facilitate fixation of these difficult fractures.
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Oppermann J, Wacker M, Stein G, Springorum HP, Neiss WF, Burkhart KJ, Eysel P, Dargel J. Anatomical fit of seven different palmar distal radius plates. Arch Orthop Trauma Surg 2014; 134:1483-9. [PMID: 25108754 DOI: 10.1007/s00402-014-2072-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the anatomical fit of different, precontoured palmar distal radius plates. METHODS The anatomical fit of seven different types of palmar distal radius plates [Königsee variable fixed-angle radius plate 7/3-hole, Königsee variable fixed-angle radius plate 5/3-hole (Allendorf, Germany), Medartis 2.5 Adaptive TriLock, Medartis 2.5 TriLock, Medartis 2.5 TriLock extraarticular, (Basel, Switzerland), Synthes VA-LCP distal two-column-radius, Synthes LCP extraarticular (Bettlach, Switzerland)] were investigated in 25 embalmed human cadaveric radii. An imprint of the space between the well-positioned plate and the distal radius was attained using a silicone mass and the maximum height of the silicone imprint was digitally measured. The mean maximum imprint height was compared between the seven plates using an analysis of variance with repeated measures and Bonferroni correction for multiple comparisons. RESULTS The mean maximum distance between the plates and the radial cortex was <2 mm for all plates. The greatest difference was found with the Medartis Adaptive (1.99 ± 0.45 mm) and the least difference with the Synthes two-column (1.56 ± 0.76 mm), this difference being statistically significant (p = 0.005). CONCLUSION Although there was no complete congruency between the plates and the radial cortex, all distal palmar radius plates investigated in this study presented a reasonable anatomical shape. The Synthes VA-LCP distal two-column-radius plate palmar showed the best anatomical fit. A low profile and optimized anatomical precontouring minimizes irritation of the surrounding soft tissues and should be considered with plate design and implant choice.
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Affiliation(s)
- Johannes Oppermann
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany,
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Distal radial fractures. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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