What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Kilian, Miroslav; Simkovic, P; Zamborský, Radoslav; Skoda, A; Labas, P

doi:10.4149/bll_2019_080

Cited by 4 publications

(11 citation statements)

References 28 publications

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“…The fractures of distal radius are frequent, and the incidence of concomitant lesions of SL and LT ligaments is evidently higher than it was originally thought to be. The operative treatment of instable dislocated extra-articular and intra-articular fractures of the distal radius by means of angle-stable plates is currently regarded as part of the standard procedure while we can expect other techniques in the future (10,11). The concomitant injuries of SL and LT intervals are standardly diagnosed by a combination of clinical, radiological, and CT/MR arthrography examinations, but arthroscopy has currently become the best option.…”

Section: Discussionmentioning

confidence: 99%

How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture

Kilian¹,

Heger²,

Simkovic³

et al. 2021

BLL

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PURPOSE OF THE STUDY: Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fl uoroscopic identifi cation. PATIENTS AND METHODS: We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal fi ndings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score. RESULTS: The intra-operative examination identifi ed 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was signifi cant three months after the surgery. After six and twelve months, the difference became negligible. CONCLUSION: The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab.

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Section: Discussionmentioning

confidence: 99%

How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture

Kilian¹,

Heger²,

Simkovic³

et al. 2021

BLL

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“…Weak evidence exists to define optimal VLPO screw lengths in each radial column 10,22 . Kilian et al 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Significant dorsal comminution can make predicting the distance from plate to dorsal cortex nearly impossible, preventing the estimation of appropriate screw length 22 . Under‐estimation of screw length in certain fractures (such as shear‐type injuries) may allow for unstable dorsal ulnar fragments, resulting in an unstable carpus 22 . Further, imaging challenges persist during and after surgery, with the complex anatomy of the Lister's tubercle limiting the identification of penetrating screws using traditional fluoroscopic views 23 …”

Section: Introductionmentioning

confidence: 99%

“…Firstly, there is currently no known technique to accurately predict appropriate screw length based on pre‐operative imaging 21 . Significant dorsal comminution can make predicting the distance from plate to dorsal cortex nearly impossible, preventing the estimation of appropriate screw length 22 . Under‐estimation of screw length in certain fractures (such as shear‐type injuries) may allow for unstable dorsal ulnar fragments, resulting in an unstable carpus 22 .…”

Section: Introductionmentioning

confidence: 99%

“…22 Under-estimation of screw length in certain fractures (such as shear-type injuries) may allow for unstable dorsal ulnar fragments, resulting in an unstable carpus. 22 Further, imaging challenges persist during and after surgery, with the complex anatomy of the Lister's tubercle limiting the identification of penetrating screws using traditional fluoroscopic views. 23 Given the opportunities presented by unicortical locking fixation, this study aimed to systematically review the existing literature to determine whether the current data favours unicortical locking over bicortical fixation in terms of stability, reduction quality and complication rates.…”

Section: Introductionmentioning

confidence: 99%

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Optimal screw length in volar locking plate osteosynthesis for distal radius fractures: a systematic review

Gunaratne

Nazifi

D’Souza

et al. 2021

ANZ Journal of Surgery

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Background Fractures of the distal radius represent the most common fracture of the upper limb, and can be managed surgically with volar locking plate osteosynthesis (VLPO). Uncertainty remains regarding the optimal length of the distal locking screws. The aim of this study was to determine the optimal VLPO screw length which provided adequate stability while minimizing complications. Methods A systematic review of relevant literature published within Cochrane, PubMed, MEDLINE and Embase, including studies up to April 2020, was performed using the Preferred Reporting Items for Systemic Reviews and Meta‐analysis (PRISMA) guidelines. Studies were included if they investigated distal radius fracture fixation with VLPO, screw lengths, complications, and associated imaging. Results Search results identified 664 relevant studies, of which 14 studies examining 926 radii were included for review. Synthesis revealed that unicortical locking fixation with screws ~75% the depth of the radius, or 2 mm short of the dorsal cortex, provided equivalent stability to bicortical fixation. The lunate may be used as a proxy to determine radial depth at each quartile column. Inadvertent screw protrusion can be assessed by taking four images intra‐operatively; anteroposterior (AP), lateral, 45° supinated and dorsal tangential views (DTVs). Radial shaft screws can have up to 2 mm prominence with no clinical significance. Conclusion Unicortical locking fixation at least 75% the depth of the distal radius provides equivalent stability to bicortical fixation in extra‐articular fractures with lower complication rates. Imaging should be used to confirm that penetration of the dorsal cortex has not occurred.

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Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study

Hadzhinikolova

Ciric

Barcik

et al. 2022

BMC Musculoskelet Disord

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Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.

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What are the ideal screw lengths in volar locking plate fixation for distal radius fractures?

Cited by 4 publications

References 28 publications

How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture

How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture

Optimal screw length in volar locking plate osteosynthesis for distal radius fractures: a systematic review

Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study

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