Complications following dorsal versus volar plate fixation of distal radius fracture: A meta-analysis

Wei, Jie; Yang, Tubao; Luo, Wei; Qin, Jiabi; Kong, Fan-jing

doi:10.1177/0300060513476438

Cited by 73 publications

(68 citation statements)

References 24 publications

(62 reference statements)

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“…However, patients who were treated with dorsal plate fixation had higher risk of tendon problems. 49 In our study, no significant differences were reported in complication rates between dorsal and volar plate fixation. In our opinion, the decision for the type of fixation should be based on the type of malunion and the surgeon's experience with the specific approach and technique.…”

Section: Discussioncontrasting

confidence: 49%

“…48 Recently, a meta-analysis was published that evaluates complications in distal radius fractures treated with dorsal or volar plate fixation. 49 No significant differences were observed in the overall complication risk. 49 Patients with volar plate fixation showed a higher rate of neuropathy and carpal All data are expressed in percentages.…”

Section: Discussionmentioning

confidence: 92%

“…49 No significant differences were observed in the overall complication risk. 49 Patients with volar plate fixation showed a higher rate of neuropathy and carpal All data are expressed in percentages. Bone union was considered complete when the osteotomy gap was filled with bone formation, judged on radiographs in two directions.…”

Section: Discussionmentioning

confidence: 92%

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Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

et al. 2015

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Background?Open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. However, bone grafts are also associated with donor site morbidity, delayed union at bone?graft interfaces, size mismatch between graft and osteotomy defect, and additional operation time. Purpose?The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Methods?Between January 1993 and December 2013, 132 corrective osteotomies and plate fixations without bone grafting were performed for malunited distal radius fractures. The minimum follow-up time was 12 months. Primary study outcomes were time to complete bone healing and secondary fracture displacement. Preoperative and postoperative radiographs during follow-up were compared with each other, as well as with radiographs of the uninjured side. Results?All 132 osteotomies healed. In two cases (1.5%), healing took more than 4 months, but reinterventions were not necessary. No cases of secondary fracture displacement or hardware failure were observed. Significant improvements in all radiographic parameters were shown after corrective osteotomy and plate fixation. Conclusion?This study shows that bone grafts are not required for bone healing and prevention of secondary fracture displacement after corrective osteotomy and plate fixation of malunited distal radius fractures. Level of evidence?Therapeutic, level IV, case series with no comparison group

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 92%

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Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

et al. 2015

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“…Despite the development of new low profi le implants, tendon irritation or rupture remains one of the most frequent complication after dorsal plating (19). Tendon rupture has been reported as early as 8 weeks and as late as 7 months after the surgery (20).…”

Section: Introductionmentioning

confidence: 99%

Is an implant removal after dorsal plating of distal radius fracture always needed?

Gajdos¹,

Božík²,

Stranak³

2015

BLL

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PURPOSE: The purpose of this study was to evaluate the need for an implant removal and the frequency of hardware related complications in a group of distal radius fractures treated with dorsal double plating. METHODS: This retrospective study analyzed data from 37 patients in whom distal radius fracture surgery was performed through single dorsal approach with two low profi le titanium plates during a period of 5 years. Objective and subjective parameters were evaluated, focusing on detection of potentially harmful complications and the need of hardware removal during the follow up at least 12 months after the surgery. RESULTS: 37 patients with distal radius fracture treated by dorsal double plating were included in this study. 19 patients had their implant removed and 18 patients had their implant retained. There was no statistical difference between these groups in respect to age, fracture type, incidence of associated wrist injury, hand dominance, gender and Mayo wrist score. Only subjective parameters including the average value of the Quick Disabilities of Arm, Hand, and Shoulder Questionnaire and the Visual Analogue Scale were higher in the group of patient requiring implant removal with a statistically signifi cant difference. CONCLUSION: Our results suggested that only symptomatic hardware should be removed. A decreased range of motion and extensor tendon problems are the most frequent complication, that necessitate plate removal. The main indicator of implant related soft tissue problems was the dorsal wrist pain syndrome (Tab. 1, Fig. 3, Ref. 36). Text in PDF www.elis.sk.

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“…5,6,20,21) The palmar cutaneous branch of the median nerve lies close to the FCR sheath and various anatomical variations in its origin and course render it vulnerable to injury during surgical approaches in this area. 5,10,11,13,14,[22][23][24][25] The most common manifestations of a PCBMN injury in our series were parasthesiae, hypoaesthesia or anaesthesia in the distribution of the nerve coupled with pain on extension of the wrist.…”

Section: )mentioning

confidence: 99%

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

Samson

Power

2017

J Hand Surg Asian-Pac Vol

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Background: Our aims were to identify iatrogenous injuries to the palmar branch of the median nerve sustained during volar plate fixation of the distal radius, make the clinician aware of this relatively uncommon complication of distal radius fixation, to emphasise common threads in symptomatology and to propose an algorithm for evaluation and management. Methods: Retrospectively interrogating our database over a 5 year period, the case records, neurophysiology records, operative records, therapy records were reviewed. The data was analysed with regard to the grade of surgeon performing the procedure, the site of injury, complexity of the fracture, delay to surgery, implant choice and outcome of the treatment. Variations in nerve anatomy were documented during revision surgery and common themes in symptomatology and clinical presentation were identified. Results: Seven patients with an iatrogenic injury involving the palmar branch of the median nerve associated with volar plate fixation of the distal radius were assessed. The male: female ratio was 1:6 and the mean age of patients was 47.8 years (33-74 years). The initial operative fixation was undertaken by a consultant orthopaedic surgeon at a mean of 7.8 (1-17) days from injury. The mean time from fracture fixation surgery to referral to the peripheral nerve injury service was 8.9 (2-36) months. Six patients presented with pain on attempted wrist extension. Five patients had parasthesia, hyperaesthesia or dysaesthesia in the distribution of the PCBMN. Anaesthesia or hypoaesthesia was present in three patients. Two patients presented with symptoms of complex regional pain syndrome (CRPS) Type 2. Conclusions: Revising relevant anatomy and possible variations as well as careful placements of retractors in the region of the median nerve could bring down these injuries. We propose an algorithm for their management.

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Complications following dorsal versus volar plate fixation of distal radius fracture: A meta-analysis

Abstract: Dorsal fixation offers a lower risk of neuropathy and carpal tunnel syndrome than the volar approach, but a higher risk of tendon irritation. Patients with a distal radius fracture can expect similar outcomes after volar or dorsal surgery.

Cited by 73 publications

References 24 publications

Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

Is an implant removal after dorsal plating of distal radius fracture always needed?

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

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