Biomechanical Stability of Volar Plate Only Versus Addition of Dorsal Ulnar Pin Plate: A Dorsal Ulnar Fragment, C-3–Type, Distal Radius, Cadaver Fracture Model

Patrick, Nathan; Lewis, Gregory S.; Roush, Evan P.; Black, Sarah S; Henderson, Stacy R.; Taylor, Kenneth F.

doi:10.1097/bot.0000000000001776

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…The polyvinyl chloride tube, encompassing the tibia and fibula, was fastened to the vertical actuator of a servohydraulic test frame (FlexTest 40; MTS), as performed in previous work. 5 - 7 , 24 , 37 The braided line, whipstitched through the Achilles, was attached to a pulley mechanism of a pneumatic actuator to apply a tensile force. 24 The foot rested on a plate supported by bearings that allowed translation and rotation in the horizontal plane perpendicular to the applied force.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

et al. 2022

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Background: The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. Purpose: To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal–medial cuneiform joint). Results: There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. Conclusion: The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. Clinical Relevance: Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.

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Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

et al. 2022

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“…Preventive Measures of Extensor Tendon Irritation Oka et al reported that six out of nine patients experienced tendon problems after corrective osteotomy combined with dorsal fixation 13 . Our study found that two out of 17 patients experienced postoperative pain due to extensor tendon irritation, which indicated that this approach might have fewer side effects, which may be attributed to the following reasons.…”

Section: Advantages Of the Combination Of Dorsal And Volar Fixation F...mentioning

confidence: 99%

“…Martinez-Mendez et al speculated that insufficient volar tilt correction might result from the poor healing of dorsal bone or insufficient screw fixation in poor bone quality 12 . Indeed, no consensus has been reached on whether dorsal fixation combined with volar fixation may improve the recovery of volar tilt 13 .…”

Section: Introductionmentioning

confidence: 99%

Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra‐Articular Fracture of the Distal Radius: A Retrospective Study

Zhang

Zhu

et al. 2022

Orthopaedic Surgery

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Objectives Although corrective osteotomy with volar or dorsal plate fixation can treat malunion of distal radius fractures, each has its own disadvantages. Little is currently known on whether dorsal fixation combined with volar fixation may further improve recovery. This study aimed to evaluate the clinical value of corrective osteotomy combined with volar and dorsal plate fixation in patients with malunion of intra‐articular fractures of the distal radius. Methods Seventeen patients with malunion of intra‐articular fractures of the distal radius treated with corrective osteotomy with volar and dorsal plate fixation from 1 January 2016 to 31 November 2018 were retrospectively analyzed. The enrolled patients included seven males and 10 females with an average age of 54.9 years (range: 36–70 years). The radiographic parameters, including the radial length, the radial inclination angle, the ulnar variance, and the volar tilt, as well as clinical outcomes, including wrist and forearm range of motion (ROM), grip strength, the Mayo Modified Wrist Score (MMWS), and the disabilities of the Arm, Shoulder, and Hand (DASH) score, were examined at 3 months and 18 months after operation and compared with the preoperative state. The paired t ‐test was used for statistical analysis. Results After corrective osteotomy combined with volar and dorsal plate fixation, all included patients were followed up for 18 months, and there was no surgical site infection. Patients reported postoperative pain due to the irritation of extensor tendon (two cases) and wrist arthritis (two cases). The radial length increased from 1.34 ± 2.34 mm to 9.25 ± 2.65 mm and 9.03 ± 2.47 mm at 3 months and 18 months postoperatively ( t = 8.257, 7.954, all p < 0.05). The radial inclination angle increased from 6.45° ± 0.76° to 19.35° ± 3.43° and 19.03° ± 3.63° at 3 and 18 months ( t = 12.517, 12.122, all p < 0.05). The ulnar variance decreased from 5.11 ± 0.23 mm to 1.32 ± 0.31 mm and 1.54 ± 0.62 mm at 3 and 18 months ( t = 4.214, 4.895, all p < 0.05). The volar tilt was corrected from 4.47° ± 3.46° to 15.51° ± 2.72° and 14.12° ± 2.41°, respectively ( t = 11.247, 10.432, all p < 0.05). Moreover, wrist ROM increased from 42.53° ± 8.99° to 98.70° ± 7.61° and 101.24° ± 7.66° ( t = 41.433, 46.627, all p < 0.05), while forearm ROM was increased from 94.82° ± 6.54° to 134.47° ± 5.06° and 137.24° ± 5.52°, respectively ( t = 31.507, 32.584, all p < 0.05). Similarly, grip strength, MMWS, and DASH were also remarkably improved. There were no significant differences in the wrist and forearm ROM, grip strength, MMWS, and DASH scores between follow‐u...

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“…4,8 Surgeons have attempted to overcome this issue with a variety of techniques and prostheses that both provide resolute fixation of DUC fragments and are low profile, aiming to mitigate the risk of tendon complications. [9][10][11][12][13][14][15][16] We describe, here, an arthroscopic-assisted approach to distal radius fracture fixation that utilizes the successes of volar plating, provides a low profile, simple method of reducing and stabilizing DUC fragments and overcomes the issues of visualization of fractures in this region of the joint and their safe reduction with ultra-low-profile fixation.…”

mentioning

confidence: 99%

“…4 8 Surgeons have attempted to overcome this issue with a variety of techniques and prostheses that both provide resolute fixation of DUC fragments and are low profile, aiming to mitigate the risk of tendon complications. 9 10 11 12 13 14 15 16…”

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confidence: 99%

Arthroscopic-assisted Distal Radius Fracture Fixation for Dorsoulnar Corner Fragments Using a Locked, Hooked Kirschner-Wire Technique

Ross,

White,

Smith

2023

J Wrist Surg

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Background: Distal radius fractures with dorso-ulnar corner fragments (DUC) pose a surgical challenge due to limited visualization and the risk of hardware prominence. Traditional approaches often result in inadequate reduction and fixation, leading to suboptimal clinical outcomes. Description of Technique: In this study, we introduce an arthroscopic-assisted approach for the fixation of distal radius fractures with DUC fragments. The technique utilizes locked, hooked K-wires to provide a low-profile dorsal capturing mechanism. We outline the step-by-step procedure, which includes pre-operative planning, volar plate application, and arthroscopic reduction of DUC fragments. Patients and Methods: We applied this technique to a 60-year-old female patient with an unstable intra-articular distal radius fracture and a DUC fragment. Closed reduction was initially attempted, followed by arthroscopic-assisted reduction and internal fixation using the locked, hooked K-wire technique. Results: Our technique has demonstrated its ability to withstand early movement rehabilitation protocols without fixation loss, enabling early mobilization. A custom thermoplastic splint was worn for 6 weeks, with favorable supination/pronation and wrist flexion/extension outcomes at clinical review. Conclusions: Arthroscopic-assisted fixation with locked, hooked K-wires offers a reliable solution for accurately reducing challenging DUC fragments in distal radius fractures. This approach complements standard distal radius fixation systems, providing a low-profile dorsal capturing mechanism and addressing the issue of hardware prominence, ultimately improving clinical outcomes.

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Biomechanical Stability of Volar Plate Only Versus Addition of Dorsal Ulnar Pin Plate: A Dorsal Ulnar Fragment, C-3–Type, Distal Radius, Cadaver Fracture Model

Cited by 5 publications

References 29 publications

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra‐Articular Fracture of the Distal Radius: A Retrospective Study

Arthroscopic-assisted Distal Radius Fracture Fixation for Dorsoulnar Corner Fragments Using a Locked, Hooked Kirschner-Wire Technique

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