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

Comparative Biomechanical Study of Fragment-Specific Plates and Headless Screws for Radial Styloid and Lunate Facet Fixation in Distal Radius Fracture Evaluated in a Synthetic Composite

PURPOSE

To evaluate the compressive stiffness (ability to resist compression under an applied load) of fragment-specific plate and headless screw fixation for radial styloid and volar lunate facet fractures in a synthetic composite distal radius.

METHODS

A simulated radial styloid fracture (AO type B1.1) and simulated volar lunate facet fracture (AO type B3.3) were created in synthetic composite distal radii and fixed with a fragment-specific plate (FSP) using a radial styloid or lunate facet plate or with two- or three-headless screws (2HS, 3HS), creating 6 fixation models: B1.1/FSP, B1.1/2HS, B1.1/3HS, B3.3/FSP, B3.3/2HS, and B3.3/3HS. Compressive stiffness of fixation constructs under initial static load, cyclic load, and final static load was investigated. Nonaxial loadings, including shearing and rotation, were not evaluated.

RESULTS

Regarding AO type B1.1, the mean stiffness of the B1.1/FSP construct was not significantly different from the intact radius, and the mean stiffness was greatest in the B1.1/3HS and lowest in the B1.1/2HS construct. For AO type B3.3, the mean stiffness of the B3.3/3HS construct was not significantly different from the intact radius, and the mean stiffness of the B3.3/FSP and B3.3/2HS construct was greatest and lowest, respectively. Minimal differences in stiffness between initial and final static loads confirmed that there was no evidence of failure implant under cyclic compressive loads.

CONCLUSIONS

Fragment-specific plates and two- or three-headless screw fixation maintained mechanical stability through compressive cyclic loading for radial styloid and volar lunate facet fractures. The FSPs and three-headless screws fixations provided superior stiffness over the two-headless screws fixation. There was no articular fracture failure in all fixation constructs with initial static compression, cyclic loading, and final compression.

CLINICAL RELEVANCE

Fragment-specific plates and headless screws can both be considered as adequate fixation for radial styloid and volar lunate facet fractures.

Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür?

Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared. Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation. Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively. Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.

[Research progress in the treatment of distal radius fractures assisted by wrist arthroscopy]

OBJECTIVE

To review the research progress of wrist arthroscopy assisted treatment of distal radius fractures.

METHODS

To summarize and describe the anatomical characteristics and fracture classification of the distal radius, indications and contraindications of wrist arthroscopy-assisted treatment, surgical methods, and associated soft tissue injuries, and summarize the advantages and disadvantages of the operation through a large number of literature at home and abroad on the treatment of distal radius fractures assisted by wrist arthroscopy.

RESULTS

Wrist arthroscopy as a minimally invasive technique for the treatment of distal radius fractures, compared with traditional surgery, can accurately observe intra-articular damage and perform operations under the microscope to avoid secondary damage to blood vessels, nerve, and tendon, etc., and can achieve one-stage repair and reconstruction by repairing the ligament, trigonal fibrocartilage complex, and carpal dislocation. It has the advantages of less trauma, fast postoperative recovery, extensive indications, fewer complications, and satisfactory effectiveness.

CONCLUSION

Wrist arthroscopy has advantages that traditional X-ray film, CT, MRI, and arthrography examinations do not have. Moreover, wrist arthroscopy has achieved satisfactory effectiveness in the adjuvant treatment of intra-articular distal radius fractures.