Biomechanical considerations for strategies to improve outcomes following volar plating of distal radius fractures

Ramavath, A.L.; N, Howard; Lipscombe, S.

doi:10.1016/j.jor.2019.04.006

Cited by 7 publications

(9 citation statements)

References 36 publications

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“…An appropriate length of the distal row of locking screws was proven crucial for the single volar plating construct [ 26 ]. However, the risk of extensor tendon irritation would increase with longer distal radius screws [ 29 ]. Multi-row of volar locking screws was considered more stable than the single row screw construct.…”

Section: Discussionmentioning

confidence: 99%

“…Multi-row of volar locking screws was considered more stable than the single row screw construct. However, little evidence was provided to support the use of two rows of distal screws over one row in the fixation of distal radius fractures [ 29 ]. Besides, the combined usage of volar and dorsal plating was recommended to provide extra buttress for the dorsal fragment [ 4 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED ARTICLE: Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution

Gui

Cheng

et al. 2021

J Orthop Surg Res

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Background Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. Materials and methods Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. Results A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. Conclusions The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. Trial registration This study has been registered on the ClinicalTrials.gov.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution

Gui

Cheng

et al. 2021

J Orthop Surg Res

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show abstract

“…An appropriate length of the distal row of locking screws was proven crucial for the single volar plating construct [24]. However, the risk of extensor tendon irritation would increase with longer distal radius screws [27]. Multi-row of volar locking screws was considered more stable than the single row screw construct.…”

Section: Resultsmentioning

confidence: 99%

“…Multi-row of volar locking screws was considered more stable than the single row screw construct. However, little evidence was provided to support the use of two rows of distal screws over one row in the xation of distal radius fractures [27]. Besides, the combined usage of volar and dorsal plating was recommended to provide extra buttress for the dorsal fragment [9,28,29].…”

Section: Resultsmentioning

confidence: 99%

Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

Gui

Cheng

Shi

et al. 2021

Preprint

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Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

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“…67,68 Similarly, plates with multiple distal screw holes have not been shown to provide superior fracture stability over those with single-row locked screw holes. 69 The use of screws has been reported to have better torsional and compressive stability over pegs by the biomechanical studies. 55,70 Plate failure and other complications following volar plating are not uncommon.…”

Section: Volar Approachmentioning

confidence: 99%

Distal radius fractures: current concepts

et al. 2021

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Distal radius fractures (DRFs) are commonly encountered in the elderly population, secondary to low-energy injury mechanisms. In the younger population, DRFs are mainly secondary to high-energy trauma. Stable DRFs can be treated conservatively. However, in the elderly population group, DRFs are often unstable and are likely to benefit from surgical intervention. They are often compounded by comorbid medical conditions requiring optimisation. When treating the elderly group, one should be aware of sarcopaenia, as this may have a bearing on return to function. Recent literature reports an increasing trend in the surgical management of these fractures. Current classification systems fail to consistently guide the management of these fractures. Although evidence is still limited in guiding decision-making in the treatment of these fractures, one should consider the economic implications of prolonged immobilisation in young patients in addition to defined indications for surgery. Improvement in implants allows safe dorsal fixation in patients with dorsal comminution, with low complication rates reported. This narrative review summarises current trends and the body of evidence. Level of evidence: Level 5 Keywords: distal radius, fracture management, osteoporosis

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Biomechanical considerations for strategies to improve outcomes following volar plating of distal radius fractures

Cited by 7 publications

References 36 publications

RETRACTED ARTICLE: Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution

RETRACTED ARTICLE: Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution

Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

Distal radius fractures: current concepts

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