Dorsal locked plate fixation of distal radius fractures

Intraoperative assessment of the dorso-ulnar fragment stability with stress fluoroscopy: An observational study

This study aims to investigate the effectiveness of intraoperative stress radiographs in evaluating the stability and fixation adequacy of the dorso-ulnar fragment (DUF) after volar plate application. Sixty-four patients who underwent open reduction and internal fixation due to comminuted distal radius fracture accompanied by DUF between May 2020 and February 2022 were reviewed retrospectively. Two groups were compared, with and without stress radiographs used in addition to routine fluoroscopic imaging during the surgical treatment of distal radius fractures. DUF sizes and fracture classifications were made according to preoperative computed tomography. Displacement of the DUF, dorsal cortex screw penetration, and the number of screws inserted into the DUF were evaluated on immediate postoperative CT scans and direct radiographs. DUF displacement at the patients' last follow-up was significantly higher in the control group (1.62 mm) than in the additional stress fluoroscopy applied group (0.53 mm). It was observed that the amount of displacement increased as the dorso-volar size of the DUF decreased. No significant difference was observed in dorsal cortex screw penetrations between the 2 groups. In the additional stress fluoroscopy applied group, stabilization rates with at least 1 screw over volar-locking plate for DUF were significantly higher (P < .001). Compared to the stress fluoroscopy group, the change in ulnar variance (P < .001) and volar tilt (P < .001) was significantly higher in the control group in the last follow-up radiography. No significant difference was observed between the implant removal rates of both groups. Evaluation of the stability of the DUF with stress radiographs after fixation is an effective method to reveal the need for additional fixation. Dorsal stress radiographs allow dynamic evaluation of fixation strength.

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature

Background  Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes  This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods  Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results  Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results. There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion  DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.

The Pitfalls of Difficult Distal Radius Fractures and Provisional Reduction

Distal radius fractures are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate treatment options. These fractures can be difficult injuries to treat surgically based on a large variability of fracture patterns, bone quality, and anatomy. It is important to understand the potential pitfalls associated with the treatment of difficult distal radius fractures to prevent avoidable complications. Some of these pitfalls include but are not limited to appropriate surgical exposure and soft tissue handling, provisional reduction, fixation type, and augmentation of fracture fixation.

Postoperative early and proactive grip strength training program for distal radius fractures promotes earlier recovery of grip strength: A retrospective study

The use of volar locking plates (VLPs) for distal radius fractures has remarkably improved clinical outcomes; however, there are some reports of delayed recovery of grip strength. Since January 2019, we have been conducting an early and proactive grip strength training program (EGTP). In this program, 20 minutes of grip strength training-using a gripper with a load of 0.7 kg-was initiated from 2 weeks after surgery; the load was then gradually increased. From 6 weeks postsurgery, daily home grip strength training was performed using a gripper with a load of 5 kg, provided to the patient.We investigated whether the introduction of the EGTP could lead to earlier recovery of grip strength. We also examined whether the EGTP caused postoperative correction loss at the fractured site, or contributed to the early improvement of wrist function.Thirty-nine patients who underwent surgery using VLPs for distal radius fractures were included in this study; 20 followed the EGTP (EGTP group) and 19 patients did not (NGTP group). For these patients, grip strength and range of motion of the wrist joint were evaluated both 3 and 6 months postoperatively. The Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were also evaluated 6 months postoperatively. Additionally, corrective losses of radial inclination (RI), palmar tilt (PT), and ulnar variance (UV)-occurring from immediately postsurgery to 6 months after surgery-were evaluated.At both 3 and 6 months postoperatively, the grip strength of the EGTP group was significantly higher than that of the NGTP group. Regarding range of motion, only palmar flexion was significantly improved in the EGTP group at 3 months postoperatively. Conversely, no differences in corrective losses of RI, PT, and UV, or in qDASH scores, were observed between the two groups.The results of this study suggest that the EGTP can provide early recovery of grip strength and palmar flexion of the wrist without causing corrective loss at the fracture site.

The Die Punch Fragment: Analysis of Fragment Geometry and Need for Fixation

Introduction  Die punch (DP) fragments are among the most common fracture fragments to lose reduction after volar locked plating of articular distal radius fractures (DRFs). We aimed to report the number of patients in our institution who had a computed tomography (CT)-confirmed DP fragment and who had open reduction and internal fixation (ORIF) through a dorsal approach; to report the length of the radioulnar portion of the DP fragment relative to the total distal radioulnar joint (DRUJ) length; and to identify if an association exists between this length and the choice for a volar versus a dorsal operative approach to the DP fragment. Materials and Methods  We performed measurements on the preoperative CT scans of 94 skeletally mature patients with a DP fragment. We also collected data related to their demographics, injury, and treatment. Of the 94 patients in this study, 84 (89%) had AO type C fractures. Results  Thirteen out of 94 patients (14%) who had ORIF of their DRF with a DP fragment had a separate dorsal incision. The mean proportion of the DP fragment length relative to the total DRUJ length was 0.51 ± 0.19. There was no association between the length of the DP fragment and volar versus dorsal approach. Conclusion  DP fragment size is not an indicator of the need for or use of a dorsal approach in DRF fixation. Level of Evidence  This is a Level IV,-retrospective study.

Radiological, Clinical and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures

PURPOSE

The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures.

METHODS

We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires.

RESULTS

Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients.

CONCLUSION

The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent.

LEVEL OF EVIDENCE

Therapeutic IV.

Combined Approach for Intra-articular Distal Radius Fracture: A Case Series and Literature Review

Background

The purpose of this study was to classify the possible indications for a combined approach to distal radius fractures (DRFs) by investigating surgical outcomes of patients treated according to our treatment algorithm.

Methods

A combined approach was performed in 32 patients. Patients who were thought to need a combined approach were classified into three types according to the combined injuries associated with loss of volar cortical buttresses in DRFs. The classifications included the following: type 1, free intra-articular fragments; type 2, distally migrated dorsal fragments located beyond the wrist joint; and type 3, centrally impacted articular fragments and displaced dorsal fragments, not reduced by indirect methods.

Results

Seven patients had type 1 fractures treated with volar plates and excision of the intra-articular fragments. Fourteen patients had type 2 fractures: 12 were treated with volar plates and excision of dorsal fragments, and 2 with relatively large unstable dorsal fragments were treated with combined volar and dorsal plates. The remaining 11 patients had type 3 fractures treated with combined volar and dorsal plates. At the latest follow-up, the radiographs revealed an average of 16.9° of radial inclination, an average of 4.2° of volar tilt, and an average of 7.5 mm of radial height. According to the Garland and Werley scores, the functional results were excellent for 3 patients, good for 25, and fair for 4.

Conclusions

The classification system indicated when an additional dorsal approach was needed in unstable DRFs, and it may establish useful guidelines for appropriate surgical decision-making.

Mechanical Comparison of a Novel Hybrid and Commercial Dorsal Double Plating for Distal Radius Fracture: In Vitro Fatigue Four-Point Bending and Biomechanical Testing

This study compares the absolute and relative stabilities of a novel hybrid dorsal double plating (HDDP) to the often-used dorsal double plating (DDP) under distal radius fracture. The “Y” shape profile with 1.6 mm HDDP thickness was obtained by combining weighted topology optimization and finite element (FE) analysis and fabricated using Ti6Al4V alloy to perform the experimental tests. Static and fatigue four-point bending testing for HDDP and straight L-plate DDP was carried out to obtain the corresponding proof load, strength, and stiffness and the endurance limit (passed at 1 × 10⁶ load cycles) based on the ASTM F382 testing protocol. Biomechanical fatigue tests were performed for HDDP and commercial DDP systems fixed on the composite Sawbone under physiological loads with axial loading, bending, and torsion to understand the relative stability in a standardized AO OTA 2R3A3.1 fracture model. The static four-point bending results showed that the corresponding average proof load values for HDDP and DDPs were 109.22 N and 47.36 N, that the bending strengths were 1911.29 N/mm and 1183.93 N/mm, and that the bending stiffnesses were 42.85 N/mm and 4.85 N/mm, respectively. The proof load, bending strength and bending stiffness of the HDDPs were all significantly higher than those of DDPs. The HDDP failure patterns were found around the fourth locking screw hole from the proximal site, while slight plate bending deformations without breaks were found for DDP. The endurance limit was 76.50 N (equal to torque 1338.75 N/mm) for HDDP and 37.89 N (equal to torque 947.20 N/mm) for DDP. The biomechanical fatigue test indicated that displacements under axial load, bending, and torsion showed no significant differences between the HDDP and DDP groups. This study concluded that the mechanical strength and endurance limit of the HDDP was superior to a commercial DDP straight plate in the four-point bending test. The stabilities on the artificial radius fractured system were equivalent for novel HDDP and commercial DDP under physiological loads in biomechanical fatigue tests.

Interpretations of the Term "Watershed Line" Used as Reference for Volar Plating

Objective  The objective of this systematic review is to provide an overview of all interpretations of the definition of the watershed line used in literature. Methods  The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed for this review. A comprehensive search was performed for definitions of the watershed line given in literature. A total of 32 studies giving an explicit interpretation of the definition of the watershed line or anatomical reference for plate positioning in writing and/or imaging were included. Results  In 32 studies, we found eight different landmarks used to refer to the watershed line or correct plate positioning. Five studies used two different soft tissue landmarks. Six different bony landmarks were described in 24 studies. These could further be subdivided into three anatomical interpretations, described in seven studies, in which the term "watershed line" is explained as a distinguishable anatomical line, and two surgical interpretations, described in 15 studies, which are purely reflecting the optimal location of the volar plate. One interpretation of the watershed line described in two studies combined both anatomical and surgical landmarks. Conclusion  The (mis)interpretation of the definition of the term "watershed line" as described by Orbay is subject to the type of landmarks and purpose used: soft tissue or bony landmarks and an anatomical or a surgical purpose. A clear distinction can be made between interpretations using bony landmarks, as the true watershed line is defined and definitions using soft tissue landmarks, which might represent the reference points surgeons use in clinical practice.

Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius

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.

Intercarpal Ligament Injuries Associated With Distal Radius Fractures

Injuries to the scapholunate (SL) and lunotriquetral (LT) interosseous ligaments occur in approximately one third of distal radius fractures. The diagnosis of these injuries is challenging because plain radiographs are not reliably diagnostic. Wrist arthroscopy may be the most accurate way to examine and diagnose soft-tissue injuries of the carpus adjacent to a distal radius fracture. Treatment options for SL and LT ligament injuries include open repair and/or percutaneous pinning. Because the natural history of these injuries is unclear, the necessity of diagnosing and treating these SL and LT interosseous ligament defects remains speculative.

Distal Radius Volar Plate Design and Volar Prominence to the Watershed Line in Clinical Practice: Comparison of Soong Grading of 2 Common Plates in 400 Patients

PURPOSE

To compare plate positioning in clinical practice of 2 commonly used volar locking plate designs with respect to the watershed line as classified by the Soong grading system.

METHODS

For this retrospective study, we included a total of 400 patients who underwent open reduction and internal fixation between May 2013 and February 2018. Cohort 1 was defined as patients treated with distal volar radius (DVR) plates during this period. Cohort 2 comprised 200 patients who had volar plate fixation with variable angle locking compression plates (LCP) during the same period. Standardized lateral wrist radiographs were categorized into Soong grade 0, 1, or 2.

RESULTS

In cohort 1, 87 plates (43.5%) were not prominent volar to the watershed line, grade 0; 95 plates (47.5%) demonstrated grade 1 prominence; and 18 plates (9.0%) demonstrated grade 2 prominence. In cohort 2, 63 plates (31.5%) were grade 0; 103 plates (51.5%) were grade 1; and 34 plates (17%) had grade 2 prominence on, and volar to, the watershed line. These radiographic results show a greater incidence of volar plate prominence with respect to the watershed line, as defined as Soong grading, in cohort 2.

CONCLUSION

This study shows that the use of the variable angle LCP plate is associated with more prominent volar positioning with respect to the watershed line compared with the DVR plate.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.

Management of High Energy Distal Radius Injuries

PURPOSE OF REVIEW

High energy distal radius are commonly multi-fragmentary with significant comminution and/or bone loss. They can also be associated with ligamentous and soft tissue injury and neurovascular compromise. As such, reconstruction of these injuries can be challenging. This paper will review the relevant anatomy, different methods of fixation, and present techniques for difficult fractures.

RECENT FINDINGS

Volar locked plating is a successful, very common method of treatment for distal radius fractures, but dorsal plating, fragment specific fixation, spanning bridge plating, and external fixation are sometimes necessary, particularly in higher energy injuries characterized by metaphyseal comminution, small volar fragments, intra-articular free fragments or lunate facet subsidence. Extended flexor carpi radialis (FCR), dorsal, and flexor carpi ulnaris (FCU) exposures can assist in visualizing the fracture site. There are many different modes of fixation for distal radius fractures, and successful outcome depends on selection of appropriate fixation based on the fracture pattern and status of the soft tissues.

Wrist Fractures and Osteoporosis

Distal radial fractures account for up to 18% of all fractures in patients over 65 years of age, and osteoporosis is a predominant factor in these fractures. Fracture treatment may include closed reduction and casting/splinting, external fixation, and open reduction and internal fixation.

Volar plating in distal radius fractures: A prospective clinical study on efficacy of dorsal tangential views to avoid screw penetration

PURPOSE

The purpose of this prospective cohort study of patients treated with volar plating for distal radius fractures is to evaluate the efficacy (defined as detection rate, or the ability to detect dorsally protruding screws) of additional dorsal tangential views (DTV) after obtaining standard anteroposterior (AP) and elevated lateral views by evaluating the change in intraoperative strategy in 100 patients.

MATERIALS AND METHODS

100 patients aged 18 years and older undergoing volar plating for acute extra- or intra- articular distal radius fractures were prospectively enrolled. Intraoperative fluoroscopy views, including AP, elevated lateral and DTV were obtained. Intraoperative -screw- revision frequency for dorsal screw protrusion, screw position relative to volar plate and to dorsal compartment, and screw lengths were evaluated.

RESULTS

Additional DTV led to a change of intraoperative management in 31 of 100 (31%) of patients. A total of 35 out of 504 screws (6.9%) were changed. Screws in the two most radial screws in the plate were at the highest risk of being revised; 16 (46%) screws in most radial position and nine (26%) screws in the 2nd from radial position were revised. Furthermore, five (14%) screws in both the 2nd from ulnar and most ulnar screw holes were revised after DTV. No screws were revised in the central hole. The median length of revised protruding screws was 22 mm (range, 12-26 mm), and these were changed to a mean length of 20  mm (range, 10-22 mm).

CONCLUSION

In this prospective series of 100 patients, obtaining additional DTV is found to be efficacious as it led to change in intraoperative strategy in one-third of patients. We concur with previous pilot studies that DTV, after obtaining conventional AP and elevated lateral views, is advised to avoid dorsally protruding screws, which could minimise the potential for iatrogenic extensor tendon rupture after volar plating for distal radius fractures. Diagnostic accuracy of DTV is subject of a subsequent prospective cohort study with post-operative CT to serve as the reference standard.

LEVEL OF EVIDENCE

.Prognostic I.

The Retinaculum Flap for Dorsal Fixation of Distal Radius Fractures

In spite of the more popular volar approach for plating of distal radius fractures (DRFs), there are still indications for dorsal plating and even combined dorsovolar plating in complex DRFs. Dorsal plating carries a concern for complications such as tenosynovitis, extensor tendon adhesions, and delayed extensor tendon ruptures. These risks can be minimized by use of modern low-profile plates and the use of an extensor retinaculum flap to cover the distal plate and screws. We describe the technique of the dorsal retinaculum flap for dorsal plating of DRFs.

Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications?

BACKGROUND

The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use.

METHODS

Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky's plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures.

RESULTS

Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures.

CONCLUSIONS

The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.

Use of Volar Plate for Indirect Coronal Plane Reduction in an Intraarticular Distal Radius Fracture

Management of intraarticular distal radius fractures requires precise reconstruction of the articular surface to optimize outcomes. Treatment goals also include restoration of alignment, rotation, and angulation in both the coronal and sagittal planes of the metaphyseal component of these fractures. Surgical management with open reduction and internal fixation with a volar plate is often the preferred method of open treatment. However, a variety of different techniques have been described, and the preferred technique may be determined on an individual basis by the fracture characteristics, patient-dependent factors, or surgeon experience.

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

Background The low-profile dorsal locking plating (DLP) technique is useful for treating dorsally comminuted intra-articular distal radius fractures; however, due to the complications associated with DLP, the technique is not widely used. Methods A retrospective review of 24 consecutive cases treated with DLP were done. Results All cases were classified into two types by surgical strategy according to the fracture pattern. In type 1, there is a volar fracture line distal to the watershed line in the dorsally displaced fragment, and this type is treated by H-framed DLP. In type 2, the displaced dorsal die-punch fragment is associated with a minimally displaced styloid shearing fracture or a transverse volar fracture line. We found that the die-punch fragment was reduced by the buttress effect of small l-shaped DLP after stabilization of the styloid shearing for the volar segment by cannulated screws from radial styloid processes. At 6 months after surgery, outcomes were good or excellent based on the modified Mayo wrist scores with no serious complications except one case. The mean range of motion of each type was as follows: the palmar flexion was 50, 65 degrees, dorsiflexion was 70, 75 degrees, supination was 85, 85 degrees, and pronation was 80, 80 degrees; in type 1 and 2, respectively. Conclusion DLP is a useful technique for the treatment of selected cases of dorsally displaced, comminuted intra-articular fractures of the distal radius with careful soft tissue coverage.

Distal Radius Fractures: Approaches, Indications, and Techniques

Distal radius fractures remain among the most common fractures of the upper extremity. The indications for operative management continue to evolve based on outcomes from the most recent clinical studies. Advancements over the past decade have expanded the variety of fixation options available; however, the clinical superiority of a particular treatment modality remains without consensus. Each approach requires the use of unique surgical techniques, and the choice of a particular implant system should be based on the surgeon's familiarity with the implant design and its limitations. As our understanding of the management of distal radius fractures improves, so will our indications for each specific treatment modality.

Management of Severely Comminuted Distal Radius Fractures

Distal radius fractures are among the most common fractures of the upper extremity. Indications for operative and nonsurgical management have evolved over time, as have fixation techniques. Volar locking plates are commonly used in the treatment of selected distal radius fractures such as low-energy or relatively uncomplicated fractures. They have limitations, however, in the management of highly comminuted fracture patterns and in polytrauma patients. In these patients, other methods ranging from spanning fixation to fragment-specific fixation have emerged as useful alternatives in the surgeon's armamentarium for treatment of these challenging fractures.

Hardware-related complications after dorsal plating for displaced distal radius fractures

There has been a trend away from dorsal fixation of distal radius fractures secondary to a historically higher complication rate. However, the literature on low-profile dorsal plates and titanium implants for the treatment of these fractures is limited. The goal of the current study was to evaluate hardware-related complications and removal rates after open reduction and internal fixation of unstable, displaced distal radius fractures using a dorsal approach with a low-profile titanium plate. A single surgeon treated 125 patients with isolated, unstable, dorsally displaced distal radius fractures by open reduction and internal fixation using a low-profile titanium dorsal plating system. A total of 110 patients were followed for a minimum of 1 year, and mean follow-up was 27 months (range, 12-74). Outcomes were assessed radiographically and clinically. Satisfactory alignment was achieved in all cases, and no fracture went on to nonunion. Nine patients (8%) required removal of hardware at an average of 12 months (range, 6-34). Six patients (5%) had evidence of extensor tenosynovitis intraoperatively, but no extensor tendon ruptures were identified. Overall, using the Gartland and Werley score, results were excellent in 82 patients, good in 22 patients, fair in 5 patients, and poor in 1 patient. Six complications accounted for the fair and poor results. The average Disabilities of the Arm, Shoulder and Hand (DASH) score at latest follow-up was 6 (range, 0-25). This series showed that the technique of dorsal plating with a low-profile titanium plate is safe and effective.

Anatomical fit of seven different palmar distal radius plates

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.