Management of Severely Comminuted Distal Radius Fractures

Brogan, David M.; Richard, Marc J.; Ruch, David S.; Kakar, Sanjeev

doi:10.1016/j.jhsa.2015.03.014

Cited by 48 publications

(55 citation statements)

References 72 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Higher complication rates with volar plate fixation have been noted in more complex fractures (AO 23-C3), including loss of reduction and inferior radiographic outcomes. 3 Traditionally, external fixation has been considered for highly comminuted fractures to restore overall length and stability. 4,5 More recently, wrist dorsal wrist spanning plate (DSP) fixation,…”

mentioning

confidence: 99%

Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients

Sharareh

Mitchell

2020

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

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, 19e62 years). Mean follow-up was 19.5 weeks (range, 12e35 weeks) from the time of plate placement. Plates were removed at a mean of 87 days (range, 40e215 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, 6e18 mm), radial inclination was 19.7 (SD, ±5.4 ; range, 9 to 30 ), ulnar variance was 1.0 mm (SD, ±2.4 mm; range, e3 to 6 mm), and volar tilt was 1.4 (SD, ±5.2 ; range, e10 to 14 ). Mean articular displacement was 1.7 mm (SD, ±1.7 mm; range, 0e6 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 intraarticular 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. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Treatment of intra-articular distal radius fractures centers on restoring length and alignment and obtaining congruency of the articular surface. A variety of techniques are available, from closed reduction to percutaneous, external, and internal fixation. Although comparative studies have not unequivocally demonstrated superiority of one of these techniques, volar locked plating has become a preferred means of internal fixation of intra-articular distal radius fractures. Despite the popularity of this technique, certain fractures may not be well-suited to volar locked plating alone, including dorsal shearing fractures 1 and complex articular fracture patterns. 2 Highly comminuted articular fractures provide a challenge in that standard volar plating options may not capture key articular fragments or provide sufficient stability to maintain alignment during healing. Higher complication rates with vo...

show abstract

mentioning

confidence: 99%

Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients

Sharareh

Mitchell

2020

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

show abstract

“…A study by Rozental et al reported complications in 75% of the patients treated with pi-plates; these findings confirm reports by Ring et al 45,46 In conclusion, volar plate fixation has become the standard treatment of intra-articular fracture fragments with good clinical outcomes. [47][48][49] Adding a bone forceps to the surgical technique will allow adequate reduction of the dorsal lunate facet fragment without additional morbidity. Further comparisons in outcomes between our proposed technique and other fixation approaches are required, emphasizing the need of fixation of the dorsal lunate facet fragment, along with the safety and efficacy to do so with a full-length screw.…”

Section: Discussionmentioning

confidence: 99%

Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps

et al. 2018

View full text Add to dashboard Cite

Background The dorsal lunate facet fragment represents part of a complex articular injury of the distal radius and is challenging to reduce through a standard volar approach. We propose reduction through a standard volar approach and intraoperative dorsal lunate facet reduction using a bone forceps. To evaluate the postoperative reduction, we used computed tomography (CT) scan. Methods We retrospectively included 60 patients with a median follow-up of 44 weeks. Fracture reduction was evaluated using pre- and direct postoperative CT scans of the wrist, measuring the articular gap and step of the sigmoid notch. The range of motion was evaluated clinically by the treating physician. Bivariate analysis was performed to compare pre- and postoperative radiographic measurements and to compare wrist range of motion. Results When comparing the injured with the uninjured wrist, there was a significant difference in flexion, extension, pronation, and supination. In 87% of the patients, there was complete radiographic reduction of the fracture. Conclusion This study shows that dorsal ulnar lunate facet fracture fragments in distal radius fractures can be reduced through a standard volar approach with the help of an intraoperative bone reduction forceps. Using wrist CT, we showed that 87% of the patients with a dorsal ulnar lunate facet fragment had a postoperative articular step or gap of <1 mm. Level of Evidence: This is a level IV, therapeutic study.

show abstract

“…An epidemiological review showed a biphasic age at onset of distal radius fractures. 23 The patients treated by DLP in this study included those in the younger male generation compared with the patients who received VLP. Higher energy shearing fractures of the end of the distal radius occur most commonly in young people, affecting males more than females, and are more likely to result in greater articular involvement and comminution.…”

Section: Discussionmentioning

confidence: 99%

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

et al. 2016

View full text Add to dashboard Cite

Most fractures of the distal radius can be treated with volar locking plates (VLPs) including the majority (89.6%) of AO C3-type fractures.1 VLP has recently gained widespread acceptance as the primary option for the treatment of this trauma.2 However, dorsally displaced fractures accompanied by the following conditions are not easy to treat using a single VLP 3,4 : when a significant dorsal die-punch is present, which sometimes involves the displacement of the distal radioulnar joint (DRUJ); or when a volar fracture line is distal to the watershed line or associated with dorsal communicated fractures. In these situations, the ulnar corner fragment occasionally cannot be held by a VLP or the distal edge of VLP can impinge on flexor tendons and cause injury. The displaced dorsal wall is involved with an elevated large roof, a rotated rim fragment, or impaction of the articular surface, which may cause arthritis of the wrist, or irritation of extensor tendon. These displacements seemed to be difficult to correct by a single volar approach. Keywords► dorsally displaced distal radius fractures ► low-profile dorsal locking plates ► surgical strategy and technique ► fracture type ► indication and clinical results AbstractBackground The low-profile dorsal locking plating (DLP) technique is useful for treating dorsally comminuted intra-articular distal radius fractures; however, due to the complications associated with DLP, the technique is not widely used.Methods A retrospective review of 24 consecutive cases treated with DLP were done. Results All cases were classified into two types by surgical strategy according to the fracture pattern. In type 1, there is a volar fracture line distal to the watershed line in the dorsally displaced fragment, and this type is treated by H-framed DLP. In type 2, the displaced dorsal die-punch fragment is associated with a minimally displaced styloid shearing fracture or a transverse volar fracture line. We found that the die-punch fragment was reduced by the buttress effect of small L-shaped DLP after stabilization of the styloid shearing for the volar segment by cannulated screws from radial styloid processes. At 6 months after surgery, outcomes were good or excellent based on the modified Mayo wrist scores with no serious complications except one case. The mean range of motion of each type was as follows: the palmar flexion was 50, 65 degrees, dorsiflexion was 70, 75 degrees, supination was 85, 85 degrees, and pronation was 80, 80 degrees; in type 1 and 2, respectively. Conclusion DLP is a useful technique for the treatment of selected cases of dorsally displaced, comminuted intra-articular fractures of the distal radius with careful soft tissue coverage.

show abstract

Management of Severely Comminuted Distal Radius Fractures

Cited by 48 publications

References 72 publications

Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients

Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients

Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps

Surgical Strategy and Techniques for Low-Profile Dorsal Plating in Treating Dorsally Displaced Unstable Distal Radius Fractures

Contact Info

Product

Resources

About