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Jain N, Hernandez E, Medina Y, Gottlich C, MacKay BJ. Intramedullary Plate Fixation and Viable Bone Allografting in a Complex Intra-articular Distal Radius Fracture Nonunion: A Case Report. Cureus 2024; 16:e57308. [PMID: 38690450 PMCID: PMC11059219 DOI: 10.7759/cureus.57308] [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: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
In this report, we detail a 69-year-old female who sustained a comminuted intra-articular left distal radius fracture that failed to heal with bridge plate fixation. Given the patient's poor subchondral bone stock and refusal of bone autograft, we designed a construct using a dorsal spanning plate and an intramedullary fragment-specific plate as a volarly placed strut in combination with viable bone allograft and cancellous bone chips to treat this nonunion. This case demonstrates an option for distal radius non-union treatment and highlights the importance of ingenuity that orthopedic surgeons should demonstrate when trying to accommodate patients' wishes.
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Affiliation(s)
- Neil Jain
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Evan Hernandez
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Yasier Medina
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Caleb Gottlich
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Brendan J MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
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Fones L, O'Mara LC, Gallant G, Kwok M, Abboudi J, Beredjiklian P. Distal Radius Fracture Therapy Utilization Following Traditional Open Reduction and Internal Fixation and Dorsal Bridge Plate Fixation. Cureus 2024; 16:e54875. [PMID: 38533157 PMCID: PMC10964216 DOI: 10.7759/cureus.54875] [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: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Background Many distal radius fractures are treated with a volar locking plate, but a minority undergo dorsal bridge plate fixation. This study's primary purpose was to compare therapy utilization following distal radius fractures treated with traditional open reduction and internal fixation (ORIF) versus dorsal bridge plate fixation. Secondary outcomes were time to first and last therapy visits and therapy costs. Methods Patients over 18 years old who underwent distal radius ORIF between January 2021 and August 2022 at a single regional orthopedic practice were identified. Patients who underwent post-operative hardware removal were retrospectively reviewed to identify dorsal bridge plate fixation patients. This resulted in "traditional ORIF" and "dorsal bridge plate" groups. Therapy visit number, cost, and payor (insurance type including Medicare, private insurance, worker's compensation, automobile policy, and private pay) were collected. Results In total, 1,376 patients met the inclusion criteria. Of these, 713 of the 1,283 (55.6%) patients in the traditional ORIF group and 25 of the 44 patients (56.8%) in the dorsal bridge plate group attended therapy at our institution. Traditional ORIF and dorsal bridge plate patients averaged 12.6(±10) and 24(±18.7) therapy visits in the one-year following ORIF, respectively. Time to last therapy visit was 90.9(±60) and 175.2(±72.1) days in the traditional ORIF and dorsal bridge plate groups, respectively. Total therapy cost was $1,219(±$1,314) and $2,015(±$1,828) in the traditional ORIF and dorsal bridge plate groups with similar out-of-pocket costs. Conclusions Dorsal bridge plate fixation patients attended a greater number of therapy sessions, had a longer time from surgery until therapy end, and had a higher therapy total cost relative to traditional ORIF, but both groups had similar patient out-of-pocket therapy costs.
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Affiliation(s)
- Lilah Fones
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Lauren C O'Mara
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Gregory Gallant
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Moody Kwok
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jack Abboudi
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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Komura S, Hirakawa A, Hirose H, Yamamoto K, Matsushita Y, Matsumoto K, Akiyama H. Reconstruction of a severe comminuted distal radius fracture with a large segmental bone defect by dorsal bridge plating combined with a vascularized fibular graft: A case report. J Orthop Sci 2023; 28:1508-1512. [PMID: 34507872 DOI: 10.1016/j.jos.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hitoshi Hirose
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kyosuke Yamamoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Bradley H, Rodriguez J, Ahn J, Sammer D, Golden A, Koehler D. Evaluation of Radiographic Parameters Following Dorsal Wrist-Spanning Plate Fixation of Distal Radius Fractures to the Second Versus Third Metacarpal. J Hand Surg Am 2023; 48:1061.e1-1061.e6. [PMID: 35534327 DOI: 10.1016/j.jhsa.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 01/26/2022] [Accepted: 03/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Dorsal wrist-spanning plate fixation for comminuted, intra-articular distal radius fractures involves the indirect reduction of intra-articular fractures via ligamentotaxis. The reduction is maintained by application of a bridge plate from the radial diaphysis to either the second or third metacarpal. The objective of this study was to retrospectively compare radiographic outcomes between distal radius fractures managed with bridge plate fixation to the second versus third metacarpal. METHODS A single-institution retrospective review identified 50 cases of distal radius fractures that underwent dorsal wrist-spanning plate fixation, with 9 and 41 fractures undergoing fixation to the second and third metacarpals, respectively. Radiographic parameters, such as radial height, radial inclination, volar tilt, and ulnar variance, were measured at 3 time points: immediately after surgery, immediately prior to elective plate removal, and at the final follow-up. Radiographic measurements of the 2 cohorts were compared at the 3 time points. RESULTS Final radiographs showed an average radial height of 8.9 mm versus 9.4 mm for the second versus third metacarpal cohorts, respectively; average radial inclination of 17.4° for both the second and third metacarpal cohorts; average volar tilt of 1.9° versus 1.7° for the second versus third metacarpal cohorts, respectively; and an average ulnar variance of +0.6 mm versus +0.1 mm for the second versus third metacarpal cohorts, respectively. Radiographic parameters of the second and third metacarpal cohorts were similar across all the time points. Additionally, evaluation of the radiographic parameters across the 3 time points (immediately after surgery, immediately prior to elective plate removal, and at the final follow-up) demonstrated little to no loss of radiographic alignment. CONCLUSIONS Radiographic outcomes for distal radius fractures managed with bridge plate fixation to the second versus third metacarpal appear similar. The distal plate fixation site can likely be determined on the basis of fracture anatomy and patient-specific features. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Hallie Bradley
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joel Rodriguez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Douglas Sammer
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ann Golden
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel Koehler
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Fleifel D, Pytiak AV, Jin X, Cizmic Z, Vaidya R. Biomechanics of Subcutaneous Locked Plating Versus Burke Plate and External Fixator for Comminuted Distal Radius Fractures. Cureus 2023; 15:e39142. [PMID: 37332475 PMCID: PMC10275508 DOI: 10.7759/cureus.39142] [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: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Background External fixators that span the wrist have been the historical norm in treating distal radius fractures. We have modified a dorsal distraction approach by using a subcutaneously applied locked bridge plate through two small incisions superficial to the extensor tendons and outside the extensor compartment. The purpose of this study was to biomechanically evaluate this modified method of fixation for comminuted distal radius fractures in comparison with two established constructs. Methods Matched cadaver specimens were used to model an AO Type 23-C3 distal radius fracture. Biochemical testing for stiffness during axial compressive loading was done on three constructs: a conventional Burke distraction plate, the subcutaneous internal fixation plating technique, and an external fixator. All specimens were cyclically loaded for 3000 cycles and then retested. Results The modified construct was found to be stiffer than the external fixator (p=0.013). When compared to the Burke plate, the modified construct was significantly less stiff before axial cycling (p=0.025). However, the difference was not maintained after cycling, and the post-axial loading stiffness difference was non-significant (p=0.456). Conclusion Our data demonstrate the biomechanical integrity of the subcutaneous plating technique for the fixation of comminuted distal radius fractures. It is stiffer than an external fixator and has the theoretical advantage of avoiding pin-tract infections. In addition, it is subcutaneous and not a cumbersome external construct. Our construct is minimally invasive, and it does not violate the dorsal extensor compartments. This allows for finger movement even while the construct is in place.
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Affiliation(s)
- Dominik Fleifel
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
| | - Andrew V Pytiak
- Department of Pediatric Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, USA
| | - Xin Jin
- Department of Biomedical Engineering, Wayne State University School of Medicine, Detroit, USA
| | - Zlatan Cizmic
- Department of Orthopaedic Surgery, St. John Providence Hospital, Southfield, USA
| | - Rahul Vaidya
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, USA
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, USA
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Tabeayo E, Saucedo JM, Srinivasan RC, Shah AR, Karamanos E, Rockwood J, Rodriguez-Merchan EC. Bridge plating in the setting of radiocarpal instability: Does distal fixation to the second or third metacarpal matter? A cadaveric study. World J Orthop 2023; 14:207-217. [PMID: 37155513 PMCID: PMC10122777 DOI: 10.5312/wjo.v14.i4.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Radiocarpal dislocations are rare but potentially devastating injuries. Poorer outcomes are associated with inadequate or lost reduction, such as ulnar translocation, but no consensus exists on the ideal fixation technique. Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal, but its application for radiocarpal dislocations has not been established.
AIM To determine whether distal fixation to the second or third metacarpal matters.
METHODS Using a cadaveric radiocarpal dislocation model, the effect of distal fixation was studied in two stages: (1) A pilot study that investigated the effect of distal fixation alone; and (2) a more refined study that investigated the effect of described techniques for distal and proximal fixation. Radiographs were measured in various parameters to determine the quality of the reduction achieved.
RESULTS The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third. The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique.
CONCLUSION In a cadaveric radiocarpal dislocation model, anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed. When considering dorsal bridge plate fixation for radiocarpal dislocations, the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.
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Affiliation(s)
- Eloy Tabeayo
- Department of Orthopedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY 10461, United States
| | - James M Saucedo
- Houston Methodist Institute for Academic Medicine, Houston Methodist Orthopedics and Sports Medicine, Houston, TX 77479, United States
| | - Ramesh C Srinivasan
- Hand Center of San Antonio and the Department of Orthopedic Surgery, University of Texas Health Science Center, The Hand Center of San Antonio, San Antonio, TX 78240, United States
| | - Amita R Shah
- University of Texas Health Science Center at San Antonio, University of North Carolina at Chapel Hill, San Antonio, TX 78229, United States
| | - Efstathios Karamanos
- Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, UT Health San Antonio, San Antonio, TX 78229, United States
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Modest JM, Raducha JE, Schilkowsky RM, Molino J, Got CJ, Katarincic JA, Gil JA. Supplementary Fixation Improves Stability of Intra-Articular Distal Radius Fractures Managed With a Spanning Plate. J Hand Surg Am 2023:S0363-5023(23)00021-7. [PMID: 36792395 DOI: 10.1016/j.jhsa.2023.01.002] [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: 08/11/2022] [Revised: 12/11/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Previous studies evaluating weight bearing of distal radius fractures treated through dorsal spanning bridge plates used extra-articular fracture models, and have not evaluated the role of supplementary fixation. We hypothesized that supplementary fixation with a spanning dorsal bridge plate for an intra-articular wrist fracture would decrease the displacement of individual articular pieces with cyclic axial loading and allow for walker or crutch weight bearing. METHODS Thirty cadaveric forearms were matched into 3 cohorts, controlling for age, sex, and bone mineral density. An intra-articular fracture model was fixed with the following 3 techniques: (1) cohort A with a dorsal bridge plate, (2) cohort B with a dorsal bridge plate and two 1.6-mm k-wires, and (3) cohort C with a dorsal bridge plate and a radial pin plate. Specimens were axially loaded cyclically with escalating weights consistent with walker and crutch weight-bearing with failure defined as 2-mm displacement. RESULTS No specimens failed at 2- or 5-kg weights, but cohort A had significantly more displacement at these weights compared with cohort B. Cohort A had significantly more failure than cohort C. Both cohort A and cohort B had significantly more displacement at crutch weight bearing compared with cohort C. The supplementary fixation group had significantly lower displacement at crutch weight-bearing compared with cohort A in all gaps. Survival curves demonstrated the fixation cohort to survive higher loads than the nonfixation group. CONCLUSION There was significantly less displacement and less failure of intra-articular distal radius fractures treated with a spanning dorsal bridge plate and supplementary fixation. Our model showed that either type of fixation was superior to the nonfixation group. CLINICAL SIGNIFICANCE When considering early weight-bearing for intra-articular distal radius fractures treated with a spanning dorsal bridge plate, supplementary fixation may be considered as an augmentation to prevent fracture displacement.
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Affiliation(s)
- Jacob M Modest
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI.
| | - Jeremy E Raducha
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Rachel M Schilkowsky
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Janine Molino
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Christopher J Got
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Julia A Katarincic
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Joseph A Gil
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI
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Izawa Y, Murakami H, Shirakawa T, Sato K, Yoshino T, Tsuchida Y. Distraction plating for bilaterally severely comminuted distal radius fracture: a case report. Case Reports Plast Surg Hand Surg 2023; 10:2165497. [PMID: 36685805 PMCID: PMC9848338 DOI: 10.1080/23320885.2023.2165497] [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] [Indexed: 01/13/2023]
Abstract
We report a case in which distraction plating was performed for bilateral highly comminuted distal radius fractures. The upper extremities' range of motion and function was acceptable. Thus, distraction plating can be a good option for relatively young patients with severe comminution of the radius and soft tissue damage.
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Affiliation(s)
- Yuta Izawa
- Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan,CONTACT Yuta Izawa Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Kita 33 jou Higashi 14 chome 3-1, Higashiku, Sapporo, Hokkaido, Japan
| | - Hiroko Murakami
- Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Tetsuya Shirakawa
- Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuo Sato
- Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toshiki Yoshino
- Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yoshihiko Tsuchida
- Department of Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Roberts T, Kocialcowski C, Cowey A. Dorsal bridging plates for the treatment of high and low energy distal radius fractures. J Clin Orthop Trauma 2022; 35:102048. [PMID: 36340961 PMCID: PMC9634010 DOI: 10.1016/j.jcot.2022.102048] [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: 05/03/2022] [Revised: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Distal radius fractures are common and treatment of complex fracture pattens can be challenging. We assessed functional outcomes, radiographic analysis, and complications of 26 distal radius fractures treated with dorsal bridging plate (DBP) at a mean of 14 months post plate removal (6-34 months). Radiographic parameters were measured pre- and post-operatively and patient reported wrist evaluation scores, patient reported wrist range of movement and satisfaction scores. Mean post-operative total PRWE was 26 (range 0-76) and mean wrist mobility 52° flexion (range 10°-85°) and 50° extension (range 10°-85°). Mean post-operative patient satisfaction score was 89% (range 50-100%). Four patients developed complications (one EPL rupture and three developed CRPS). DBP can reliably restore distal radius anatomy and is associated with good functional outcome scores, return of functional range of wrist movement and high levels of patient satisfaction. Level of Evidence III.
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Affiliation(s)
- Tobias Roberts
- Corresponding author. Trauma & Orthopaedic Department, St. George's Hospital, London, SW17 0QT, UK.
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Biz C, Cerchiaro M, Belluzzi E, Bortolato E, Rossin A, Berizzi A, Ruggieri P. Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern? J Pers Med 2022; 12:jpm12091532. [PMID: 36143316 PMCID: PMC9503670 DOI: 10.3390/jpm12091532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-3348
| | - Elena Bortolato
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Alessandro Rossin
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Antonio Berizzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
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Raducha JE, Hresko A, Molino J, Got CJ, Katarincic J, Gil JA. Weight-Bearing Restrictions With Distal Radius Wrist-Spanning Dorsal Bridge Plates. J Hand Surg Am 2022; 47:188.e1-188.e8. [PMID: 34023193 DOI: 10.1016/j.jhsa.2021.04.008] [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: 04/02/2020] [Revised: 01/29/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The fixation of comminuted distal radius fractures using wrist-spanning dorsal bridge plates has been shown to have good postoperative results. We hypothesized that using a stiffer bridge plate construct results in less fracture deformation with loads required for immediate crutch weight bearing. METHODS We created a comminuted, extra-articular fracture in 7 cadaveric radii, which were fixed using dorsal bridge plates. The specimens were positioned to simulate crutch/walker weight bearing and axially loaded to failure. The axial load and mode of failure were measured using 2- and 5-mm osteotomy deformations as cutoffs. Bearing 50% and 22% of the body weight was representative of the force transmitted through crutch and walker weight bearing, respectively. RESULTS The load to failure at 2-mm deformation was greater than 22% body weight for 2 of 7 specimens and greater than 50% for 1 of 7 specimens. The load to failure at 5-mm deformation was greater than 22% body weight for 6 of 7 specimens and greater than 50% for 4 of 7 specimens. The mean load to failure at 2-mm gap deformation was significantly lower than 50% body weight (110.4 N vs 339.2 N). The mean load to failure at 5-mm deformation was significantly greater than 22% body weight (351.8 N vs 149.2 N). All constructs ultimately failed through plate bending. CONCLUSIONS All constructs failed by plate bending at forces not significantly greater than the 50% body weight force required for full crutch weight bearing. The bridge plates supported forces significantly greater than the 22% body weight required for walker weight bearing 6 of 7 times when 5 mm of deformation was used as the failure cutoff. CLINICAL RELEVANCE Elderly, walker-dependent patients may be able to use their walker as tolerated immediately after dorsal bridge plate fixation for extra-articular fractures. However, patients should not be allowed to bear full weight using crutches immediately after bridge plating.
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Affiliation(s)
- Jeremy E Raducha
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
| | | | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Christopher J Got
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI; University Orthopedics Incorporated, Providence, RI
| | - Julia Katarincic
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI; University Orthopedics Incorporated, Providence, RI
| | - Joseph A Gil
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI; University Orthopedics Incorporated, Providence, RI
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12
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Labrum JT, Ilyas AM. Bridge Plate Fixation of Distal Radius Fractures: Indications, Techniques, and Outcomes. Orthopedics 2021; 44:e620-e625. [PMID: 34292828 DOI: 10.3928/01477447-20210618-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal radius fractures are among the most commonly encountered injuries treated by orthopedic surgeons. The incidence of distal radius fractures appears to be on the rise. Although this injury is usually treated nonoperatively, surgical management is often indicated and involves several options, including percutaneous pinning, fragment-specific fixation, volar/dorsal/radial locked plating, intramedullary fixation, and external fixation. More recently, dorsal spanning bridge plating has been introduced for certain fracture patterns and patient circumstances. This article reviews the indications, surgical techniques, outcomes, and potential complications associated with bridge plating of distal radius fractures. The authors believe that this article will familiarize surgeons with an additional surgical technique that can be used to treat complex presentations of a common orthopedic injury. [Orthopedics. 2021;44(4):e620-e625.].
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Distal Radius Fractures and the Dorsal Spanning Plate in the Management of the Polytraumatized Patient. J Orthop Trauma 2021; 35:s6-s10. [PMID: 34415875 DOI: 10.1097/bot.0000000000002204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are some of the most common fractures treated by the orthopaedic surgeon. There are a variety of methods of fixation to treat these fractures; however, in patients with polytrauma and in high-energy fracture patterns, fixation options can be limited. In the past, these fractures were treated with plaster, Kirschner wires, or external fixators that were fraught with complications. The dorsal spanning plate is an excellent option in the treatment of high-energy fractures and patients with polytrauma, fractures with dorsal or volar comminution, fracture dislocations, and shear injuries, and in geriatric patients with poor bone quality. The dorsal spanning plate not only allows for fixation of these complex fractures but also allows for weight-bearing through the wrist, an advantage for patients with concomitant lower extremity fractures and geriatric patients who need mobility aides. Understanding the risks and benefits of dorsal spanning plates and their use for the treatment of polytraumatized patient is a vital base of knowledge for the orthopaedic traumatologist.
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Fares AB, Childs BR, Polmear MM, Clark DM, Nesti LJ, Dunn JC. Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review. J Hand Surg Am 2021; 46:627.e1-627.e8. [PMID: 33573844 DOI: 10.1016/j.jhsa.2020.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal radius fractures. METHODS A literature search performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 206 articles, 12 of which met inclusion criteria, accounting for 310 patients. Included articles contained the results of DBP for treatment of distal radius fractures with reported outcomes between 1988 and 2018. Data were pooled and analyzed focusing on patient demographics, as well as 3 primary outcomes of complications, range of motion (ROM), and Disabilities of the Arm, Shoulder, and Hand (DASH) and QuickDASH scores. RESULTS Average age was 55 years, median follow-up was 24 months, and the most common use was in comminuted (92%) intra-articular (92%) distal radius fracture caused by fall (58%), or motor vehicle collision or motorcycle collision (27%). A minority of patients had open fractures (16%) and most were cases of polytrauma (65%). Median time from placement to DBP removal was 17 weeks (mean, 119 days). At final follow-up, mean wrist ROM was 45° flexion, 50° extension, 75° pronation, and 73° supination. Mean DASH score was 26.1, and mean QuickDASH score was 19.8. The overall rate for any complication was 13%; the most common was hardware failure (3%) followed by symptomatic malunion or nonunion (3%), and persistent pain after hardware removal (2%). CONCLUSIONS Dorsal bridge plating was found to be used most commonly in intra-articular, comminuted distal radius fractures with overall functional wrist ROM, moderate patient-reported disability, and a 13% complication rate at follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Austin B Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX.
| | - Benjamin R Childs
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - Michael M Polmear
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
| | - DesRaj M Clark
- Department of Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Leon J Nesti
- Department of Clinical and Experimental Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX
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The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study. Eur J Trauma Emerg Surg 2021; 48:2369-2377. [PMID: 34185106 DOI: 10.1007/s00068-021-01738-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. METHODS Indication for SP fixation include DRFs with severe metaphyseal comminution, radiocarpal fracture dislocations with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. For functional and patient-rated outcome analysis only patients who completed the 12 month follow-up were included. RESULTS In the mentioned timeframe, a total of 562 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). Twenty-five patients completed the 12 month follow-up (mean 14.5 months, range 12-24). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced asymptomatic non-union. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Complications included two patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8.3 (range 4-10) and mean visual analogue scale for resting pain was 0.8 (range 0-5). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23 kg (range 4-74 kg) amounting to 68% of the opposite side. Range of motion regarding the extension/flexion, radial/ulnar abduction and pronation/supination arc reached 72%, 77% and 95% compared to the unaffected side, respectively. CONCLUSIONS The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.
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Henry TW, Tulipan JE, McEntee RM, Beredjiklian PK. Early Retrieval of Spanning Plates Used for Fixation of Complex Fractures of the Distal Radius. J Wrist Surg 2021; 10:229-233. [PMID: 34109066 PMCID: PMC8169165 DOI: 10.1055/s-0040-1722573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Background Spanning plates are being increasingly used for the treatment of complex fractures of the distal radius. The traditional recommendation is to leave the hardware in place for at least 12 weeks. Questions/Purpose This study assesses the comparative outcomes of spanning plates removed at or before 10 weeks. We hypothesized that acceptable healing and functional outcomes can be achieved with earlier hardware removal to allow for earlier range of motion, rehabilitation, and return to function. Patients and Methods All patients treated for a comminuted, intra-articular distal radius fracture with a temporary spanning plate were identified. Outcomes of bridge plates removed before 10 weeks were compared with plates removed after 12 weeks. Twenty patients in the short duration cohort were compared with 40 patients in the long duration cohort. Results All fractures healed and there were 10 complications (4 short duration, 6 long duration) and 2 reoperations (1 short duration, 1 long duration) in the study population. There were no significant differences in final Quick-DASH scores (27.4 short duration, 20.9 long duration) or radiographic alignment. Mean values for wrist extension and ulnar deviation were significantly worse in the long duration cohort, although these differences are of unclear clinical significance. Conclusion It may be safe to remove spanning bridge plates earlier than what is traditionally recommended. Plate removal at or before 10 weeks did not detract from healing or radiographic alignment. Prospective investigations assessing the optimal duration of fixation for this technique are needed. Level of Evidence This is a Level IV study.
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Affiliation(s)
- Tyler W. Henry
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jacob E. Tulipan
- Department of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Richard M. McEntee
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pedro K. Beredjiklian
- Department of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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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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Temporary spanning plate wrist fixation of complex distal radius fractures: a systematic review of 353 patients. Eur J Trauma Emerg Surg 2021; 48:1649-1662. [PMID: 33900417 DOI: 10.1007/s00068-021-01656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Temporary spanning plate fixation of the wrist has been described as an alternative treatment method for complex distal radius fractures (DRfs). This systematic review aims to gain insight on clinical and radiological outcomes of this technique currently published in literature. METHODS A comprehensive literature search of Pubmed, Embase, CENTRAL and CINAHL databases was conducted on November 5th 2020. All studies reporting on complications, functional, patient-rated and radiological outcomes of temporary spanning plate wrist fixation of DRFs in adult patients were included. RESULTS Two prospective and eight retrospective cohort studies were included encompassing 353 patients with of 357 DRFs. The overall mean age was 53 years (range 19-95 years). Overall mean follow-up ranged from 6 months to 8.8 years. The union rate was 99.4%. Plate removal was performed on average 4.5 months after initial operation (range 1.1-28.9 months). The most frequently reported complication was implant failure with an incidence of 3.1%. Mean flexion/extension, pronation/supination and radial/ulnar inclination arc averaged 96.6°, 151.5° and 36.5°, respectively. Grip strength averaged 79.7% of the contralateral side. Mean DASH and PRWE scores were 22.9 and 16 points, respectively. Radiological indices were all within the acceptable limits. CONCLUSIONS Temporary spanning plate wrist fixation is a safe method for the treatment of complex DRFs. This technique can exploit the advantages of temporary wrist immobilization without the disadvantages of external fixation. With these aspects in mind, the spanning plate can serve as a valuable tool in the treatment of complex intra-articular DRFs.
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van Leeuwen RJH, van de Wall BJM, van Veleen NM, Hodel S, Link BC, Knobe M, Babst R, Beeres FJP. Temporary external fixation versus direct ORIF in complete displaced intra-articular radius fractures: a prospective comparative study. Eur J Trauma Emerg Surg 2021; 48:4349-4356. [PMID: 33630119 DOI: 10.1007/s00068-021-01611-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In complex distal radius fractures (DRF), both direct osteosynthesis (one-stage approach) and temporary external fixation as a bridge to definitive osteosynthesis (two-stage approach) are used. Studies directly comparing these two management options are lacking. This study aims to compare the two procedures with regard to complications, and radiological and functional outcomes. MATERIAL This prospective observational study included all patients presenting with AO OTA C2 or C3 DRF (1) between January 2011 and January 2018. All patients were categorised into two groups according to received treatment: patients who underwent direct definitive osteosynthesis (Group One Stage) and patients who received an external fixator followed by definitive fixation (Group Two Stage). Primary outcome was the Patient-Rated Wrist Evaluation score (PRWE) measured at 1 year follow-up. Secondary outcomes included complications, range of motion (ROM), and radiologic parameters (ulnar variance, radial inclination and volar tilt). RESULTS A total of 187 patients were included in Group One Stage with a mean age of 55.6 years (SD 17.2), of which 67 had a C2 and 120 a C3 fracture. Group Two Stage consisted of 66 patients with a mean age of 53.7 years (SD 20.4 years), of which 6 patients having a C2 and 60 a C3 fracture. There was no significant difference in complications and median PRWE between Group One Stage (12.0, IQR 2.0-20.0) and Group Two Stage (12.2, IQR 5.5-23.4) (p = 0.189), even after correction for differences in baseline characteristics. The ROM and radiologic parameters did not show any significant differences as well. CONCLUSION No differences were found in clinical, functional, and radiological outcome between one- and two-staged surgical techniques. It may be concluded that a two-stage approach is a viable and safe alternative.
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Affiliation(s)
| | | | - Nicole M van Veleen
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Sandro Hodel
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Matthias Knobe
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Reto Babst
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
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Mirarchi AJ, Nazir OF. Minimally Invasive Surgery: Is There a Role in Distal Radius Fracture Management? Curr Rev Musculoskelet Med 2021; 14:95-100. [PMID: 33443658 PMCID: PMC7930151 DOI: 10.1007/s12178-020-09689-x] [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] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This review explores minimally invasive surgical techniques for distal radius fractures and guides their use in conjunction with, or as an alternative to, volar locked plating. RECENT FINDINGS Fractures of the lunate facet, die-punch fractures, and marginal articular shear injuries present challenges that cannot be easily addressed with volar plating. The use of external fixation, Kirschner wires, and dorsal bridge plating should all be considered. These techniques, in combination and in addition to volar locked plating, continue to play an important role in fracture management. Arthroscopically assisted surgery with minimally invasive fixation allows for detailed inspection of the radiocarpal joint. Closed treatment and casting continue to play an important role in distal radius fracture care. The role of minimally invasive surgery for distal radius fractures is still being defined. While fixation using a volar locking plate is by far the most common treatment method, other techniques should be considered to improve outcomes and decrease complications.
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Affiliation(s)
- Adam J. Mirarchi
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, USA
| | - Omar F. Nazir
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, USA
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21
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Ilyas AM, Hayward GM, Harris JA, Wang W, Bucklen BS. Bridge Plate Design Effects on Yield and Fatigue in Distal Radius Fracture Model. J Wrist Surg 2020; 9:475-480. [PMID: 33282532 PMCID: PMC7708032 DOI: 10.1055/s-0040-1713419] [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: 06/13/2019] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
Background Bridge plating for distal radius fractures is indicated for complex fractures with comminution, extensive articular involvement, and/or cases requiring immediate weight bearing. Bridge plate fixation of distal radius fractures is a well-documented treatment method; however, failures have been reported with repetitive loading through the bridged distal radius fracture. Plate design is implicated as a cause of plate fracture in select clinical studies but few mechanical tests comparing bridge plate designs have been reported. This study sought to determine the impact of plate design on bridge plates intended to allow for immediate weight-bearing. Methods Axial static ( n = 3) and dynamic testing ( n = 3) was performed on three distraction plates designs: bridge plate 1 (BP1) with central holes, bridge plate 2 (BP2) without central holes, and locking compression plate (BP3). Plates were loaded in axial compression with a simulated 10-mm fracture gap. Results Significant static load differences were noted between all groups. Static load to failure for BP1, BP3, and BP2 were 240 ± 5 N, 398 ± 9 N, and 420 ± 3 N, respectively ( p < 0.05). BP1 was the only plate series that failed during dynamic testing; all other plates achieved 100,000 cycles. Failure mode was a fracture occurring through the central screw hole of BP1. Finite element analysis demonstrated the effects of central screw holes on stress, strain, and plastic deformation under loading. Conclusion Unused screw holes are the mechanical weak points; plates designed without these central screw holes are expected to survive greater load values. The threshold for clinical importance will need to be determined by future studies.
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Affiliation(s)
- Asif M. Ilyas
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gerald M. Hayward
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical Inc., Audubon, Pennsylvania
| | - Jonathan A. Harris
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical Inc., Audubon, Pennsylvania
| | - Wenhai Wang
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical Inc., Audubon, Pennsylvania
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical Inc., Audubon, Pennsylvania
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Role of a spanning plate as an internal fixator in complex distal radius fractures. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 33:77-88. [PMID: 33245372 DOI: 10.1007/s00064-020-00686-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/11/2019] [Accepted: 07/19/2019] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Minimally invasive temporary internal wrist arthrodesis as an alternative treatment method in complex distal radius fractures. INDICATIONS Complex distal radius fractures with dorsal and/or palmar comminution and little to no reconstruction possibilities, radiocarpal ligamentous injury, need for early weight bearing through the affected wrist (walking aids). CONTRAINDICATIONS Complex hand injuries limiting the possibility to safely secure the plate at either the metacarpal or the radial shaft. SURGICAL TECHNIQUE Percutaneous or open reduction and fixation of the distal radius fracture. Determine the location for the two stab incisions under fluoroscopy; one over the distal radial diaphysis and one over the second or third metacarpal. A third incision over Lister's tubercle allows transposition of the extensor pollicis longus (EPL) tendon, excision of the posterior interosseous nerve and dorsal arthrotomy. Retrograde insertion of the spanning plate. Placement of a first nonlocking screw through the glide hole into the metacarpal shaft. Under traction, a proximal screw hole is filled with a nonlocking screw into the radial diaphysis. Tightening of the cortical screws under lateral fluoroscopic view. The remaining screw holes at both the distal and proximal ends of the plate are filled with locking screws. Layered wound closure. POSTOPERATIVE MANAGEMENT A removable wrist splint is worn during 2 weeks. Weight bearing through the injured wrist is immediately allowed. Removal of the spanning plate is scheduled at 3 months after radiographic evidence of fracture consolidation. RESULTS In total, twelve distal radius fractures were treated by dorsal spanning plate fixation between January 2018 and January 2019. Average age was 53.3 ± 24.5 years (range 22-95 years). Both 3.5 mm and 2.4/2.7 mm plates were used. All twelve fractures were healed after 3 months. The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 36.4 (range 8.3-70.0). There was one EPL tendon rupture, one case with extensor tendon adhesions, one periosteosynthetic fracture of the radial shaft and one complex regional pain syndrome. There was no implant failure and no infection.
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Wang WL, Ilyas AM. Dorsal Bridge Plating versus External Fixation for Distal Radius Fractures. J Wrist Surg 2020; 9:177-184. [PMID: 32257622 PMCID: PMC7113002 DOI: 10.1055/s-0039-1694063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
Background External fixation and dorsal bridge plating are wrist spanning fixation options for distal radius fractures; however, their comparative effectiveness is not well understood. A meta-analysis was conducted to compare the clinical outcomes between these two techniques. Materials and Methods A PubMed database query of all distal radius fracture cases managed with spanning external fixation or dorsal bridge plating was performed. A total of 28 articles met inclusion criteria, yielding 895 patients for data extraction and comparative analysis. Results Dorsal bridge plating demonstrated lower rates of infection (2 vs. 10%, p = 0.05) and complex regional pain syndrome (1 vs. 4%, p = 0.04) but higher rates of hardware failure (4 vs. 1%, p = 0.026). Bridge plating also demonstrated higher rates of excellent/good ratings under the Gartland and Werley outcome score (91 vs. 83%, p = 0.016). There was no significant difference in DASH (Disability of the Arm, Shoulder, and Wrist) scores, radiographic parameters, or unplanned reoperations between the two spanning fixation options. Conclusion Bridge plating and external fixation both appear to be comparable for spanning fixation constructs for distal radius fractures, but with bridge plating having a potentially lower complication profile.
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Affiliation(s)
- William L. Wang
- Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pennsylvania
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Vakhshori V, Rounds AD, Heckmann N, Azad A, Intravia JM, Rosario S, Stevanovic M, Ghiassi A. The Declining Use of Wrist-Spanning External Fixators. Hand (N Y) 2020; 15:255-263. [PMID: 30084266 PMCID: PMC7076625 DOI: 10.1177/1558944718791185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: External fixation has been traditionally used to treat comminuted or open distal radius fractures that are not amenable to open reduction internal fixation. This procedure is associated with a relatively high complication rate and has been used with decreasing frequency in recent years. However, trends in external fixation utilization for the treatment of distal radius fractures have not been described. Methods: Using the Nationwide Inpatient Sample, patients with a distal radius fracture treated with external fixation from 2003 to 2014 were identified. The annual incidence was reported, and hospital and demographic variables associated with external fixation use were determined. Results: During the study period, 593 929 patients with a distal radius fracture were identified, of which 51 766 (8.7%) were treated with a wrist-spanning external fixator. Wrist external fixation for the treatment of distal radius fractures declined steadily from 2003 to 2014. In 2003, external fixation use was highest, accounting for 17.4% of distal radius fractures. By 2014, only 4.9% of distal radius fracture were treated with external fixation. During this period, the incidence of distal radius fractures declined by 6.9% while external fixator utilization decreased by 73.7%. Patients receiving an external fixator were more likely to be male, low-income, and treated in a rural, nonteaching, privately owned hospital. Conclusions: External fixator use for the treatment of distal radius fractures steadily declined during the study period. Males and those with lower incomes treated in rural, nonteaching, and privately owned hospitals are more likely to receive external fixation.
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Affiliation(s)
- Venus Vakhshori
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Alexis D. Rounds
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Ali Azad
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Jessica M. Intravia
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Santano Rosario
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, USA
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Vakhshori V, Alluri RK, Stevanovic M, Ghiassi A. Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation. Hand (N Y) 2020; 15:116-124. [PMID: 30003802 PMCID: PMC6966280 DOI: 10.1177/1558944718787877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Internal radiocarpal distraction plating is a versatile tool in the treatment of distal radius fractures that are not amenable to nonoperative treatment or operative fixation with standard volar or dorsal implants. Internal distraction plates may also be indicated in the setting of polytrauma or osteopenic bone. The plate functions as an internal fixator, using ligamentotaxis to restore length and alignment while providing relative stability for bony healing. The plate can be fixed to either the second or the third metacarpal, and anatomic and biomechanical studies have assessed the strengths and weaknesses of each strategy. This operative fixation technique leads to acceptable radiographic results and functional outcomes. Following fracture union, the plate is removed, and wrist range of motion is resumed.
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Affiliation(s)
- Venus Vakhshori
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
| | - Ram Kiran Alluri
- Keck Medical Center at the University of
Southern California, Los Angeles, USA,Ram Kiran Alluri, Department of Orthopaedic
Surgery, Keck Medical Center at the University of Southern California, 1520 San
Pablo Street, #2000, Los Angeles, CA 90033, USA.
| | - Milan Stevanovic
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
| | - Alidad Ghiassi
- Keck Medical Center at the University of
Southern California, Los Angeles, USA
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Sharareh B, Mitchell S. Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019; 2:94-101. [PMID: 35415482 PMCID: PMC8991644 DOI: 10.1016/j.jhsg.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/03/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Multifragmentary fractures of the distal radius with articular and metaphyseal comminution (AO 23-C3) represent challenging injuries to manage. Distal fracture lines, articular comminution, and limited distal bone stock may preclude stable fixation with a volar locking plate. The use of a dorsal spanning plate (DSP) offers an alternative treatment option in this setting. We examined the radiographic outcomes of a consecutive series of patients with comminuted intra-articular distal radius fractures not amenable to volar locked plating, who were treated with a DSP. Methods We reviewed all distal radius fractures treated with a dorsal spanning plate at our institution between October, 2014 and March, 2018. Patients with AO 23-C3 fractures treated with dorsal spanning plate fixation were included in this study. Demographic data, time from plate placement to removal, and postoperative radiographic outcomes were examined. Results We identified 24 patients, mean age 41 years (range, 19-62 years). Mean follow-up was 19.5 weeks (range, 12-35 weeks) from the time of plate placement. Plates were removed at a mean of 87 days (range, 40-215 days) after surgery. All patients achieved radiographic union. Mean radial height at the time of union was 11.1 mm (SD, ±3.7 mm; range, 6-18 mm), radial inclination was 19.7° (SD, ±5.4°; range, 9° to 30°), ulnar variance was 1.0 mm (SD, ±2.4 mm; range, -3 to 6 mm), and volar tilt was 1.4° (SD, ±5.2°; range, -10° to 14°). Mean articular displacement was 1.7 mm (SD, ±1.7 mm; range, 0-6 mm). Malalignment of at least one of these radiographic parameters was identified in 16 of 24 patients at the time of union. Conclusions Dorsal spanning plate fixation offers an alternative treatment option for comminuted intra-articular distal radius fractures (AO 23-C3). Although this technique presents a straightforward means for fixation of complex distal radius fractures, radiographic outcomes may be inferior relative to less complex fractures treated with standard volar plating techniques. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Behnam Sharareh
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - Scott Mitchell
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
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Hyatt BT, Hanel DP, Saucedo JM. Bridge Plating for Distal Radius Fractures in Low-Demand Patients With Assist Devices. J Hand Surg Am 2019; 44:507-513. [PMID: 30366732 DOI: 10.1016/j.jhsa.2018.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
Bridge plate fixation has traditionally been described for the treatment of high-energy distal radius fractures with extensive comminution, associated instability, and polytrauma with the need for immediate upper extremity assisted weight bearing. Certain patient populations who may similarly benefit from such effective and expedient stabilization include patients with multiple comorbidities who may have lower-energy fractures, poor bone quality, and a baseline reliance on ambulatory assist devices. This article reviews treatment considerations for distal radius fractures in low-demand patients and explores the rationale and technique of bridge plate fixation in this population.
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Affiliation(s)
- Brad T Hyatt
- Department of Orthopaedics, Wright-Patterson Medical Center, Dayton, OH
| | - Douglas P Hanel
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
| | - James M Saucedo
- The Hand Center of San Antonio, UT Health San Antonio Department of Orthopaedics, San Antonio, TX.
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Perlus R, Doyon J, Henry P. The use of dorsal distraction plating for severely comminuted distal radius fractures: A review and comparison to volar plate fixation. Injury 2019; 50 Suppl 1:S50-S55. [PMID: 31040029 DOI: 10.1016/j.injury.2019.03.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Optimal fixation for highly comminuted distal radius fractures remains a major treatment challenge for orthopaedic surgeons. Dorsal distraction plating can serve as an improved fixation technique by allowing reduction under ligamentotaxis, providing a dorsal buttress, addressing proximal comminution, and allowing for early weightbearing in polytrauma patients. The aim of this study was to review current literature regarding treatment of distal radius fractures treated with dorsal distraction plating. METHODS We performed a literature search in Pubmed and EMBASE databases to identify all studies analyzing use of dorsal distraction plating. Case reports, biomechanical and anatomic cadaver studies were excluded from analysis. Primary outcome measures were range of motion (ROM) at final follow up, grip strength, and radiographic parameters. RESULTS Eight studies were included in the final analysis. Pooled mean ROM after dorsal distraction plating was found to be 47.6° of flexion, 50.5° of extension, 76.0° of pronation, and 74.2° of supination. Pooled mean grip strength was 79.1% compared to the uninjured contralateral limb. Pooled mean volar tilt was 3.6°. Overall radial height was maintained at an average of 10.5 mm with a pooled mean loss of only 3.8 mm in length. Mean radial inclination was found to be 19.4 mm with patients having a mean ulnar variance of 0.5 mm. DISCUSSION & CONCLUSION Treatment of comminuted intra-articular distal radius fractures with dorsal distraction plating yielded excellent outcomes with very low complication rates, and has several advantages over volar plating and/or external fixation for these fractures. Necessity of plate removal remains a negative feature of this technique.
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Affiliation(s)
- R Perlus
- University of Toronto, Department of Orthopaedic Surgery, Toronto, ON, Canada.
| | - J Doyon
- University of Toronto, Department of Orthopaedic Surgery, Toronto, ON, Canada
| | - P Henry
- Sunnybrook Health Sciences Center, Holland Orthopaedic and Arthritic Center, Toronto, ON, Canada
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Azad A, Intravia JM, Hill JR, Leland H, Vakhshori V, Stevanovic M, Ghiassi A. Carpal Translocation Following Dorsal Bridge Plate Fixation of Distal Radius Fractures: A Cadaveric Study. J Wrist Surg 2019; 8:234-239. [PMID: 31192046 PMCID: PMC6546489 DOI: 10.1055/s-0039-1683434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/28/2019] [Indexed: 01/26/2023]
Abstract
Background Dorsal bridge plate fixation is an effective technique for stabilization of highly comminuted, complex distal radius fractures. However, it is unknown whether fixation to the second or third metacarpal is optimal. Given dorsal bridge plating spans the radiocarpal joint, it is unclear if the dorsal spanning plate affects carpal position. This study investigates differences in carpal translocation resulting from bridge plate distal fixation to either the second or third metacarpal. Methods Ten paired cadaveric upper extremities without evidence of gross deformity or prior surgery distal to the elbow were evaluated with three-view wrist fluoroscopic images for baseline radiographic measurements. An unstable distal radius fracture model was created via a volar approach using a 1-cm osteotomy. Following fracture creation, a dorsal bridge plate was applied with random to the second metacarpal on one limb, and the third metacarpal on the contralateral limb. Laterality for distal fixation was chosen randomly. Fluoroscopic images were repeated and radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, radial rotation index, and carpal translocation were measured. Results Radial inclination, radial height, radiocarpal angle, volar tilt, ulnar variance, radiolunate angle, and radioscaphoid angle were not statistically different before and after fixation, or when comparing the second or third metacarpal fixation. Additionally, there was no difference in Taleisnik's ulnar translocation index, Chamay's ulnar translation index, or McMurtry's carpal translation index based on which metacarpal was used for distal fixation. Conclusions Dorsal bridge plate fixation of distal radius fractures restores preoperative physiologic measures of the radius, ulna, and carpus. Carpal translocation was similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a bridge plate. Level of Evidence This is a Level V, therapeutic study.
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Affiliation(s)
- Ali Azad
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Jessica M. Intravia
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - J. Ryan Hill
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Hyuma Leland
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Venus Vakhshori
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
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[An Experience of Using a Distraction Plate for an Elderly Patient with a Highly Communited Intraarticular Distal Radius Fracture]. J UOEH 2019; 41:57-61. [PMID: 30867401 DOI: 10.7888/juoeh.41.57] [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: 11/21/2022]
Abstract
We performed open reduction and internal fixation using a distraction plate in two cases of elderly patients with highly communited intraarticular open distal radius fractures. There was no corrective loss of intraarticular fracture fragment in either case. The implant was removed in one case because bone union was achieved. The plate was retained in the other case, without the hope of implant removal. Neither case complained of any marked disturbance of activities of daily living (ADL), and there was no pain at the time of the final follow up period. However, there is a high possibility of limitation of the range of motion (ROM) of the wrist after implant removal, therefore we need to judge the indications carefully.
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Lauder A, Hanel DP. Spanning Bridge Plate Fixation of Distal Radial Fractures. JBJS Rev 2019; 5:01874474-201702000-00002. [PMID: 28248738 DOI: 10.2106/jbjs.rvw.16.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander Lauder
- Department of Orthopaedics, University of Washington, Seattle, Washington
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32
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Huish EG, Coury JG, Ibrahim MA, Trzeciak MA. Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction. Hand (N Y) 2018; 13:346-349. [PMID: 28403633 PMCID: PMC5987982 DOI: 10.1177/1558944717704514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results with prior publications for both external fixation and internal fixation with volar locked plates. Methods: Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (M.A.T. and M.A.I.) from May 30, 2013, to December 29, 2015, were identified and included in the study. Retrospective chart and radiograph review was performed on 19 patients, 11 male and 8 female, with mean age of 47.83 years (22-82). No patients were excluded from the study. Results: All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49-129). Follow-up radiographs showed average radial inclination of 20.5° (13.2°-25.5°), radial height of 10.7 mm (7.5-14 mm), ulnar variance of -0.3 mm (-2.1 to 3.1 mm), and volar tilt of 7.9° (-3° to 15°). One patient had intra-articular step-off greater than 2 mm. Conclusions: Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt.
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Affiliation(s)
- Eric G. Huish
- Valley Orthopedic Surgery Residency, Modesto, CA, USA
- Eric G. Huish Jr, Valley Orthopedic Surgery Residency, 1441 Florida Avenue, Modesto, CA 95350, USA.
| | - John G. Coury
- Valley Orthopedic Surgery Residency, Modesto, CA, USA
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Huang JI, Peterson B, Bellevue K, Lee N, Smith S, Herfat S. Biomechanical Assessment of the Dorsal Spanning Bridge Plate in Distal Radius Fracture Fixation: Implications for Immediate Weight-Bearing. Hand (N Y) 2018; 13:336-340. [PMID: 28387161 PMCID: PMC5987984 DOI: 10.1177/1558944717701235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The goal of this study was to compare the biomechanical stability of a 2.4-mm dorsal spanning bridge plate with a volar locking plate (VLP) in a distal radius fracture model, during simulated crutch weight-bearing. METHODS Five paired cadaveric forearms were tested. A 1-cm dorsal wedge osteotomy was created to simulate an unstable distal radius fracture with dorsal comminution. Fractures were fixed with a VLP or a dorsal bridge plate (DBP). Specimens were mounted to a crutch handle, and optical motion-tracking sensors were attached to the proximal and distal segments. Specimens were loaded in compression at 1 mm/s on a servohydraulic test frame until failure, defined as 2 mm of gap site displacement. RESULTS The VLP construct was significantly more stable to axial load in a crutch weight-bearing model compared with the DBP plate (VLP: 493 N vs DBP: 332 N). Stiffness was higher in the VLP constructs, but this was not statistically significant (VLP: 51.4 N/mm vs DBP: 32.4 N/mm). With the crutch weight-bearing model, DBP failed consistently with wrist flexion and plate bending, whereas VLP failed with axial compression at the fracture site and dorsal collapse. CONCLUSIONS Dorsal spanning bridge plating is effective as an internal spanning fixator in treating highly comminuted intra-articular distal radius fracture and prevents axial collapse at the radiocarpal joint. However, bridge plating may not offer advantages in early weight-bearing or transfer in polytrauma patients, with less axial stability in our crutch weight-bearing model compared with volar plating. A stiffer 3.5-mm DBP or use of a DBP construct without the central holes may be considered for distal radius fractures if the goal is early crutch weight-bearing through the injured extremity.
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Affiliation(s)
- Jerry I. Huang
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, USA,Jerry I. Huang, Associate Professor, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105, USA.
| | - Bret Peterson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, USA
| | - Kate Bellevue
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, USA
| | - Nicolas Lee
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Sean Smith
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Safa Herfat
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
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Tinsley BA, Ilyas AM. Distal Radius Fractures in a Functional Quadruped: Spanning Bridge Plate Fixation of the Wrist. Hand Clin 2018; 34:113-120. [PMID: 29169592 DOI: 10.1016/j.hcl.2017.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients who require assistive devices with their hands for mobilization are called functional quadrupeds. These patients pose a unique challenge after they have a distal radius fracture, as their injury not only limits the wrist but also compromises ambulation. The authors propose a different treatment strategy for functional quadrupeds to improve mobilization and weight-bearing with the injured limb after a distal radius fracture. In this article, the authors define the functional quadruped and describe their technique of spanning bridge plate fixation with a retrospective review of patient outcomes.
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Affiliation(s)
- Brian A Tinsley
- Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Asif M Ilyas
- Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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35
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Alluri RK, Bougioukli S, Stevanovic M, Ghiassi A. A Biomechanical Comparison of Distal Fixation for Bridge Plating in a Distal Radius Fracture Model. J Hand Surg Am 2017; 42:748.e1-748.e8. [PMID: 28601513 DOI: 10.1016/j.jhsa.2017.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/04/2017] [Accepted: 05/12/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of second versus third metacarpal distal fixation when using a radiocarpal spanning distraction plate in an unstable distal radius fracture model. METHODS Biomechanical evaluation of the radiocarpal spanning distraction plate comparing second versus third metacarpal distal fixation was performed using a standardized model of an unstable wrist fracture in 10 matched-pair cadaveric specimens. Each fixation construct underwent a controlled cyclic loading protocol in flexion and extension. The resultant displacement and stiffness were calculated at the fracture site. After cyclic loading, each specimen was loaded to failure. The stiffness, maximum displacement, and load to failure were compared between the 2 groups. RESULTS Cyclic loading in flexion demonstrated that distal fixation to the third metacarpal resulted in greater stiffness compared with the second metacarpal. There was no significant difference between the 2 groups with regards to maximum displacement at the fracture site in flexion. Cyclic loading in extension demonstrated no significant difference in stiffness or maximum displacement between the 2 groups. The average load to failure was similar for both groups. CONCLUSIONS Fixation to the third metacarpal resulted in greater stiffness in flexion. All other biomechanical parameters were similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a spanning internal distraction plate. CLINICAL RELEVANCE The treating surgeon should choose distal metacarpal fixation primarily based on fracture pattern, alignment, and soft tissue integrity. If a stiffer construct is desired, placement of the radiocarpal spanning plate at the third metacarpal is preferred.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
| | - Sofia Bougioukli
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
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36
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Wigton MD, Nazir OF, Graves BR, Apel PJ, Li Z. Dorsal Distraction Plating and Lunate Decortication for Stage III Kienböck Disease: A Novel Technique. Tech Hand Up Extrem Surg 2017; 21:13-17. [PMID: 27984361 DOI: 10.1097/bth.0000000000000146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Kienböck disease (KD) is a progressive condition and difficult to manage. A number of treatment algorithms exist but there is no clear consensus as to which method produces the best outcome, particularly for Lichtman stage III disease. The majority of the current treatment options for KD emphasize lunate unloading and restoration of biology with bone graft. However, less attention has been given to the protection of the lunate during revascularization process. We report a novel technique of lunate decompression and bone grafting, combined with wrist distraction with or without radial shortening osteotomy via dorsal wrist bridge plating for the treatment of stage II-IIIa/b KD. This technique provides the advantages of distraction of the carpus unloading the lunate after bone grafting and during revascularization without the issues inherent to external fixation. In addition, this technique allows compression through a radial osteotomy site when performed. Our approach to the treatment of KD has incorporated this technique for patients with stage II or IIIa/b disease.
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Affiliation(s)
- Michael D Wigton
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
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Childs S, Mann T, Dahl J, Ketz J, Hammert WC, Murray PM, Elfar J. Differences in the Treatment of Distal Radius Fractures by Hand Fellowship Trained Surgeons: A Study of ABOS Candidate Data. J Hand Surg Am 2017; 42:e91-e97. [PMID: 28027845 PMCID: PMC5292287 DOI: 10.1016/j.jhsa.2016.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The management of distal radius fractures differs based on the nature of the fracture and the experience of the surgeon. We hypothesized that patients requiring surgical intervention would undergo different procedures when in the care of a surgeon with subspecialty training in hand surgery as compared with surgeons with no subspecialty training in hand surgery. METHODS We queried the ABOS database for case log information submitted for part II of the ABOS examination. Queries for all codes involved with distal radius fracture management were combined with associated codes for the management of median nerve neuropathy, triangular fibrocartilage complex tears, ulnar shaft, and styloid fractures. Hand fellowship trained orthopedic surgeons were compared with those completing other fellowships and non-fellowship trained orthopedic surgeons during their board collection period. RESULTS During the study period, 2,317 orthopedic surgeons reported treatment of 15,433 distal radius fractures. Of these surgeons, 411 had hand fellowship training. On a per surgeon basis, fellowship trained hand surgeons operatively treated more multifragment intra-articular distal radius fractures than their non-hand fellowship trained counterparts (5.3 vs 1.2). Additional procedures associated with the management of distal radius fractures were also associated with the fellowship training of the treating surgeon. CONCLUSIONS Among orthopedic surgeons taking part II of the ABOS certifying examination, differences exist in the type, management, and reporting of distal radius fractures among surgeons with different areas of fellowship training. CLINICAL RELEVANCE This study describes the association of hand surgery fellowship training on the choice of intervention for distal radius fractures and associated conditions.
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Affiliation(s)
- Sean Childs
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Tobias Mann
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Jason Dahl
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - John Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Warren C Hammert
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Peter M Murray
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL
| | - John Elfar
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY.
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Mann T, Lee DJ, Dahl J, Elfar JC. Can Radiocarpal-Spanning Fixation Be Made More Functional by Placing the Wrist in Extension? A Biomechanical Study Under Physiologic Loads. Geriatr Orthop Surg Rehabil 2016; 7:23-9. [PMID: 26929853 PMCID: PMC4748161 DOI: 10.1177/2151458515621109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigate whether applying an internal radiocarpal-spanning plate with the wrist in slight extension affects the biomechanical stability of the construct. An unstable distal radius fracture was simulated in 10 cadaveric specimens and immobilized with a radiocarpal-spanning plate holding the wrist in a neutral position. This construct was then physiologically loaded through the wrist flexor and extensor tendons. The resulting motion at the fracture was captured with a displacement sensor. The plate was then extended using an in situ bending technique, placing the wrist in extension, and the experiment was repeated. No statistically significant difference in the biomechanical stability afforded by the radiocarpal-spanning plate was detected with the wrist in extension compared to that in the traditional neutral position. The radiocarpal-spanning plate fixation was more stable when loaded through the extensor tendons. We conclude that immobilizing a distal radius fracture with an internal radiocarpal-spanning plate that holds the wrist in extension does not compromise biomechanical stability.
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Affiliation(s)
- Tobias Mann
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel J Lee
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jason Dahl
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - John C Elfar
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Abstract
BACKGROUND Two separate approaches have been described for radiocarpal spanning internal fixation for high-energy distal radius fractures with metaphyseal extension. To our knowledge, relevant anatomic relationships and structures at risk for iatrogenic injury have not been identified in the literature. METHODS Twelve fresh frozen cadaver arms were randomized to fixation with a dorsal radiocarpal spanning plate using one of two techniques: (1) index finger metacarpal fixation (index group) or (2) middle finger metacarpal fixation (middle group). Cadaveric dissection and relevant anatomic relationships were assessed in relation to the plate. RESULTS Superficial branches of the radial sensory nerve were in contact with the index group plate in all specimens, while no contact occurred in the middle group specimens. No extensor digitorum comminus (EDC) middle extensor tendons contacted the plate in the index group; an average of 10 cm of plate contact was seen in the middle group. The extensor pollicis longus (EPL) tendon contacted the plate in both the index and middle groups for an average distance of 12.4 and 25.5 mm, respectively. One complication [EPL and extensor indicis proprius (EIP) entrapment] was observed in the middle finger metacarpal group. CONCLUSION Mounting the dorsal bridge plate to the index finger metacarpal places the superficial branches of the radial sensory nerve at risk during dissection, while mounting the plate to the middle finger metacarpal leads to a greater degree of tendon-plate contact.
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Affiliation(s)
- Jason Dahl
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA USA
| | - Daniel J. Lee
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642 USA
| | - John C. Elfar
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642 USA
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40
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Brogan DM, Richard MJ, Ruch D, Kakar S. Management of Severely Comminuted Distal Radius Fractures. J Hand Surg Am 2015; 40:1905-14. [PMID: 26243322 DOI: 10.1016/j.jhsa.2015.03.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- David M Brogan
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - David Ruch
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - Sanjeev Kakar
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg Am 2015; 40:1554-62. [PMID: 26143028 DOI: 10.1016/j.jhsa.2015.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the functional outcomes of patients treated with dorsal spanning distraction bridge plate fixation for distal radius fractures. METHODS All adult patients at our institution who underwent treatment of a unilateral distal radius fracture using a dorsal bridge plate from 2008 to 2012 were identified retrospectively. Patients were enrolled in clinical follow-up to assess function. Wrist range of motion, grip strength, and extension torque were measured systematically and compared with the contralateral, uninjured wrist. Patients also completed Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation outcomes questionnaires. RESULTS Eighteen of 100 eligible patients, with a minimum of 1 year from the time of implant removal, were available for follow-up (mean, 2.7 y). All fracture patterns were comminuted and intra-articular (AO 23.C3). There were significant decreases in wrist flexion (43° vs 58°), extension (46° vs 56°), and ulnar deviation (23° vs 29°) compared with the contralateral uninjured wrist. Grip strength was 86% and extension torque was 78% of the contralateral wrist. Comparison of dominant and nondominant wrist injuries identified nearly complete recovery of grip (95%) and extension (96%) strength of dominant-sided wrist injuries, compared with grip (79%) and extension (65%) strength in those with an injured nondominant wrist. Mean Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 16 and 14, respectively. There were 2 cases of postoperative surgical site pain and no cases of infection, tendonitis, or tendon rupture. CONCLUSIONS Distraction bridge plate fixation for distal radius fractures is safe with minimal complications. Functional outcomes are similar to those published for other treatment methods. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Alexander Lauder
- Department of Orthopaedics, University of Washington, Seattle, WA.
| | - Sonya Agnew
- Division of Plastic Surgery, Northwestern University, Jesse Brown VAMC, Chicago, IL
| | - Karim Bakri
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
| | | | - Douglas P Hanel
- Department of Orthopaedics, University of Washington, Seattle, WA
| | - Jerry I Huang
- Department of Orthopaedics, University of Washington, Seattle, WA
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42
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Abstract
BACKGROUND The surgical treatment of metadiaphyseal distal radius fractures may be difficult due to the associated articular or periarticular extension that limits standard fixation techniques. Longer distal radius volar locking plates allow stable fixation of the distal fragments while providing standard plate fixation in the proximal radius. We hypothesize that this plating technique allows adequate fixation to both the distal radius and metadiaphyseal fragments. The purpose of the study is to describe the outcomes, radiographic parameters, secondary surgeries, and complication rate with this device. METHODS A retrospective chart review was conducted on adult patients with a distal radius fracture and metadiaphyseal involvement treated with a volar, distally locked plate. All patients were followed up for radiographic union, with a mean time of 219 days (range 38-575). Fracture patterns, outcomes of range of motion, grip strength, and complications, as well as injury, post open reduction and internal fixation (ORIF), and finally, healed radiographic parameters were recorded. RESULTS Twenty patients with 21 fractures were included. At union, mean radiographic parameters were the following: volar tilt of 8°, radial inclination of 27°, radial height of 14 mm, and ulnar variance of -1 mm. The mean final range of motion was 52° flexion, 50° extension, 68° pronation, and 66° supination. Complications included one infection and one plate removal. Four patients developed a nonunion requiring secondary procedures. There were no incidents of hardware failure or adhesions requiring tenolysis. CONCLUSION Distally locked long volar plating for metadiaphyseal distal radius fractures is a safe and effective treatment option for these complex fracture patterns allowing anatomic restoration of the radial shaft and distal radius.
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43
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Lewis S, Mostofi A, Stevanovic M, Ghiassi A. Risk of tendon entrapment under a dorsal bridge plate in a distal radius fracture model. J Hand Surg Am 2015; 40:500-4. [PMID: 25624263 DOI: 10.1016/j.jhsa.2014.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the risk of iatrogenic damage to the extensor tendons and sensory nerves under a bridge plate along the second versus third metacarpal. METHODS Using 6 paired (left-right) cadaver forearms-wrists and via a volar approach, we created a distal radius fracture with metaphyseal comminution. We then applied a dorsal distraction plate to either the second or third metacarpal. We next performed dorsal dissection of the hand and wrist over the zone of injury to determine the position of the plate relative to the extensor tendons and sensory nerves. RESULTS The bridge plate on the third metacarpal entrapped tendons of the first and third compartment in all 6 specimens. When the plate was applied to the second metacarpal there were no cases of tendon entrapment. There were no instances of nerve entrapment in plating to either the second or third metacarpal. CONCLUSIONS Distraction plating has been proposed for use in the second and third metacarpals for unstable comminuted distal radius fractures. We recommend formal exposure of the extensor tendons over the zone of injury when applying a distraction bridge plate to the third metacarpal. CLINICAL RELEVANCE Plating to the second metacarpal decreases the risk of entrapment of extensor tendons compared with plating to the third metacarpal.
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Affiliation(s)
- Sarah Lewis
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA.
| | - Amir Mostofi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA
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44
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Dorsal distraction plating for highly comminuted distal radius fractures. J Hand Surg Am 2015; 40:355-7. [PMID: 25459381 PMCID: PMC4306644 DOI: 10.1016/j.jhsa.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/04/2014] [Indexed: 02/02/2023]
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45
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Abstract
Fractures of the distal radius are common injuries in both athletes and nonathletes. Management is dictated by the nature of the fracture and the patient's level of competition, age, and sport-specific demands. Treatment strategies range from nonoperative treatment for stable injuries to primarily operative treatment for unstable fractures, particularly in active athletes. Once the decision has been made to treat a distal radius fracture operatively, a wide variety of fixation options are available. However, no technique has proven superior to all others, and no single method of fixation will lead to acceptable results in all types of distal radius fractures. This study will highlight important considerations when treating distal radius fractures in athletes, describe the various fixation options available, and discuss our method for determining the fixation needs of each fracture.
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46
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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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47
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Abstract
In polytrauma patients, the presence of a multifragmentary distal radius fracture poses a challenge with respect to early mobilization. Dorsal spanning plate fixation is an alternative choice for these patients for providing definitive operative fixation of the distal radius fracture and for providing a construct to allow weight-bearing through the injured wrist for rehabilitative purposes. In this article, we describe the operative technique to place a dorsal spanning plate and provide a retrospective review of outcomes in polytrauma patients.
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Affiliation(s)
- Seth D Dodds
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT
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48
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Lee SK, Seo DW, Kim KJ, Yang DS, Choy WS. Volar long locking compression plate fixation for distal radius fractures with metaphyseal and diaphyseal extension. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23:407-15. [PMID: 23412298 DOI: 10.1007/s00590-012-0994-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/03/2012] [Indexed: 11/24/2022]
Abstract
Comminuted distal radial fractures with metaphyseal and diaphyseal extension are uncommon and remain a challenge to treat. The purpose of this study was to assess the radiographic and functional outcomes of treatment with the volar long locking compression plate (LCP) system for distal radius fractures with metaphyseal and diaphyseal extension. This retrospective study was performed on 22 consecutive patients who were treated with open reduction and internal fixation with the application of a 2.4-mm-extra-long LCP volar distal radius plate. Patients were evaluated based on clinical signs and radiography studies. The average time to fracture union was 16 weeks. The volar tilt was restored to a mean of 10.1°. The radial length and radial inclination were restored to a mean of 12.8 mm and 23.6° at final follow-up, respectively. The mean loss of radial length was -1.0 mm at final follow-up as compared with the contralateral extremity. The average ulnar variance was positive 0.1 mm at final follow-up with a congruent distal radioulnar joint. The degree of collapse after fixation between immediate postoperative and final follow-up visit was -0.1 mm. Using the demerit-point system of the Gartland and Werley rating system, 14 results were rated as excellent, 5 as good and 1 as fair. DASH scores averaged 10.1 points. Based on our experience, the volar long LCP is useful in the management of comminuted fractures of the distal radius, in which there is proximal extension into the diaphysis and can avoid or minimize the complications of external fixation or dorsal bridging distraction plate.
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Affiliation(s)
- Sang Ki Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 302-799, Korea.
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Abstract
Complex distal radius fractures are high-energy injuries of the wrist with articular disruption, ligamentous instability, significant comminution, soft tissue injury, and/or neurovascular impairment. The management of these injuries requires a thorough understanding of wrist functional anatomy and familiarity with a wide selection of approach and fixation options. This article reviews an approach that involves structured evaluation, aggressive soft tissue management, early reduction and skeletal stabilization, and a columnar approach to definitive care. Outcome is determined by multiple factors and depends greatly on the soft tissue injury, patient factors, and management and the adequacy of restoration of osseous and ligamentous relationships.
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Affiliation(s)
- Stephen A Kennedy
- Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine, University of Washington-Roosevelt II, Seattle, WA 98105, USA
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50
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Abstract
No area of fracture management has had such a recent explosion of new treatment modalities as distal radius plating. This explosion has largely been implant- and industry-driven, with little evidence-based research guiding the way. A perceived difficulty with commonly used modalities by the orthopedic community has been enough to drive an entire new set of options for distal radius fixation. A drift from dorsal to volar plating has occurred that has been unexamined by randomized research. Segment specific fixation has been a new mindset that has resulted in a novel plate line and has caused other manufacturers to redesign their product lines. Other novel approaches for proposed problems include locking plates, nail-plate combinations, and others. This article outlines some of these options with a literature opinion and a clarification from the authors. A treatment plan for common fractures of the distal radius is also outlined.
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