Volar locking plate ﬁxation of unstable distal radius fractures

Objective & Hypothesis:Objectives: We evaluated radiographic and functional results of volar locking plate ﬁxation of unstable distal radius fractures.

📊

Key Findings & Data:Methods: The study included 27 patients (15 males, 12 females; mean age 45 years; range 18 to 77 years) who were treated with volar locking plate ﬁxation for unstable distal radius fractures.

💡

Conclusion & Impact:Conclusion: Volar locking plate ﬁxation is an effective treatment in the anatomical and functional restoration of unstable distal radius fractures.

🔬Design:Survey & Empirical Study

📍Scope:Comprehensive Sample

⚙️Variables:Donanım tasarımı · Kırıklar · açık

Abstract

Objectives: We evaluated radiographic and functional results of volar locking plate ﬁxation of unstable distal radius fractures. Methods: The study included 27 patients (15 males, 12 females; mean age 45 years; range 18 to 77 years) who were treated with volar locking plate ﬁxation for unstable distal radius fractures. Twenty-two patients (81.5%) had AO type C and ﬁve (18.5%) had type B fractures. Two patients (7.4%) had type I open fractures. Dorsal and volar angulation were present in 21 (77.8%) and six (22.2%) fractures, respectively. Four patients (14.8%) also had elbow dislocation and/or fracture and nine patients (33.3%) had disruption of the distal radioulnar joint. Autologous iliac crest graft was used in 10 patients (37%). Postoperative assessments included range of movement and grip strength measurements, and radiographic parameters using the Stewart criteria. Functional results were assessed using the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire and the Gartland-Werley scale. The mean follow-up was 18 months (range 12 to 34 months). Results: All fractures united without a problem within a mean of 6.5 weeks (range 6 to 8 weeks). The following parameters became equal to the unaffected side: ulnar variance (n=21, 77.8%), radial inclination angle (n=13, 48.2%), radial tilt angle (n=8, 29.6%), and radial height (n=11, 40.7%). The mean radiographic Stewart score was 0.5 (range 0 to 3). The mean grip strength of the operated side was 72.4% (18 kg) of the normal side. The mean Q-DASH and Gartland-Werley scores were 8.3 (range 0 to 70.5) and 4.7 (range 0 to 16), respectively. According to the Gartland-Werley scale, the results were excellent in 12 patients (44.4%), good in 12 patients, and moderate in three patients (11.1%). Three complications (11.1%) occurred, including loss of alignment in two patients, and screw-related discomfort in one patient. Conclusion: Volar locking plate ﬁxation is an effective treatment in the anatomical and functional restoration of unstable distal radius fractures.

Özet

Amaç: Volar yerleşimli kilitli plak vida tespitleri ile tedavi edilen instabil radius alt uç kırıklarının radyograﬁk ve işlevsel sonuçları değerlendirildi. Çalışma planı: Radius alt uç instabil kırığı nedeniyle volar yerleşimli kilitli plak tespiti uygulanan 27 hasta (15 erkek, 12 kadın, ort. yaş 45; dağılım 18-77) incelendi. AO sınıﬂamasına göre kırıkların 22’si (%81.5) tip C, beşi (%18.5) tip B idi. İki hastada (%7.4) tip I açık kırık vardı. Kırıkların 21’inde (%77.8) dorsal, altısında (%22.2) volar açılanma vardı. Dört hastada (%14.8) kırığa dirsek çıkığı ve/veya kırık eşlik etmekteydi. Dokuz hastada (%33.3) distal radioulnar eklem sorunları vardı. On hastada (%37) kırık tespitine ek olarak otolog krista iliyka grefti kullanıldı. Hastaların hareket açıklıkları, kavrama kuvvetleri ölçüldü, Stewart ölçütlerine göre radyograﬁk değerlendirmeleri yapıldı. Fonksiyonel değerlendirmede Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Türkçe) sorgulaması ve Gartland-Werley değerlendirme formu kullanıldı. Ortalama takip süresi 18 ay (dağılım 12-34 ay) idi. Sonuçlar: Kırıkların tümü ortalama 6.5 haftada (dağılım 6-8 hafta) sorunsuz kaynadı. Yirmi bir hastada (%77.8) ulnar varyans, 13 hastada (%48.2) radial inklinasyon açısı, sekiz hastada (%29.6) radial tilt açısı, 11 hastada (%40.7) radial yükseklik sağlam taraﬂa eşitlendi. Stewart ölçütlerine göre ortalama radyograﬁ puanı 0.5 (dağılım 0-3) bulundu. Tedavi edilen tarafta kavrama gücü, sağlam tarafın ortalama %72.4’ü (18 kg) idi. Quick-DASH-T skoru ortalaması 8.3 (dağılım 0-70.5), Gartland-Werley puanı ortalaması 4.7 (dağılım 0-16) bulundu. Gartland-Werley değerlendirmesine göre, 12 hastada (%44.4) mükemmel, 12 hastada iyi, üç hastada (%11.1) ise orta sonuç alındı. İki hastada dizilim kaybı ve bir hastada çevre dokularda uyumsuzluk olmak üzere üç (%11.1) hastada komplikasyon görüldü. Çıkarımlar: Volar yerleşimli kilitli plak uygulamaları radius alt uç anatomisinin düzeltilmesinde ve korunmasında etkilidir.

Keywords

Donanım tasarımı Kırıklar açık Ortopedik fiksasyon araçları El bileği eklemi Hareket açıklığı eklem Radius kırıkları Nakil otolog Equipment Design Fractures Open Orthopedic Fixation Devices Wrist Joint Range of Motion Articular Radius Fractures Transplantation Autologous

🔖

Cite This Article

KILIÇ, A., KABUKÇUOĞLU, Y., ÖZKAYA, U., GÜL, M., SÖKÜCÜ, S., ÖZDOĞAN, Ü. (2009). Volar locking plate ﬁxation of unstable distal radius fractures. Acta Orthopaedica et Traumatologica Turcica, Cilt: 43 - Sayı: 4, 303–308. https://ajindex.com/articles/354077

References (14)

Arora R, Lutz M, Fritz D, Zimmermann R, Oberladstätter J, Gabl M. Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures. Arch Orthop Trauma Surg 2005;125:399-404
Ay Ş, Akıncı M, Bektaş U. Distal radius kırıklarının cerrahi tedavisinde plak ve vida uygulamalarında güncel yaklaşımlar. TOTBİD Dergisi 2005;4:15-23
Hove LM, Nilsen PT, Furnes O, Oulie HE, Solheim E, Mölster AO. Open reduction and internal fixation of displaced intraarticular fractures of the distal radius. 31 patients followed for 3-7 years. Acta Orthop Scand 1997;68:59-63
Rizzo M, Katt BA, Carothers JT. Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intraarticular distal radius fractures.Hand 2008;3:111-7
Simic PM, Weiland AJ. Fractures of the distal aspect of the radius: changes in treatment over the past two decades. J Bone Joint Surg [Am] 2003;85:552-64
Trumble TE, Culp R, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. J Bone Joint Surg [Am] 1998;80:582-600
Khanduja V, Ng L, Dannawi Z, Heras L. Complications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate. Acta Orthop Belg 2005;71:672-7
Willis AA, Kutsumi K, Zobitz ME, Cooney WP 3rd. Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg [Am] 2006;88:2411-7
Sobky K, Baldini T, Thomas K, Bach J, Williams A, Wolf JM. Biomechanical comparison of different volar fracture fixation plates for distal radius fractures. Hand 2008;3:96-101
Levin SM, Nelson CO, Botts JD, Teplitz GA, Kwon Y, Serra-Hsu F. Biomechanical evaluation of volar locking plates for distal radius fractures. Hand 2008;3:55-60
Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res 2006;445:58-67
Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg [Am] 2005;30:743-9
Schmelzer-Schmied N, Martini AK, Jung M. The palmar fixed angle plate in distal radius fractures-advantages and disadvantages. [Article in German] Obere Extremität 2007;2:150-5
Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fracture