Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates

PURPOSE: To determine whether volar fixed-angle plate fixation with a new plate system could be used to treat dorsally unstable distal radius fractures. We hypothesized that volar fixed-angle plate fixation with or without radial styloid fixed-angle plate fixation would provide sufficient rigidity to allow early active range of motion without compromising fracture reduction. The initiation of early active motion may improve functional outcomes. METHODS: A retrospective review was conducted of one institution's initial experience using a new volar fixed-angle plate system to treat dorsally displaced intra-articular and extra-articular distal radius fractures. Thirty-two fractures in 32 patients with dorsally displaced distal radius fractures were treated with a volar fixed-angle plate with or without a radial styloid fixed-angle plate. Fractures were classified using the AO classification. Radiographic parameters on preoperative, postoperative, and final follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up ranges of motion and complications were reported. Finally, comparisons were made between the 23 fractures treated with a volar plate alone and the 9 fractures treated with a volar plate and a radial styloid plate. RESULTS: The average follow-up period was 13 months. Two thirds of the fractures were intra-articular. Average loss of reduction from initial postoperative to final follow-up radiographs was 0 degrees of volar tilt, 1 degrees of radial inclination, and 0 mm of radial length. Active wrist and forearm ranges of motion were initiated at an average of 11 days after surgery. The final follow-up flexion-extension and pronation-supination arcs averaged 112 degrees and 151 degrees , respectively. The 9 fractures treated with the combination of a fixed-angle volar plate with a fixed-angle radial styloid plate had greater initial displacement than did the 23 fractures treated with a volar plate alone. Otherwise, differences between the 2 groups were not significant. Only 1 radial styloid plate became symptomatic. CONCLUSIONS: Volar plate fixation using a new fixed-angle plate system successfully can stabilize dorsally unstable distal radius fractures. Early active range of motion was facilitated without compromising fracture reduction.     

Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation

PURPOSE: The purpose of this study was to compare the outcomes of 2 treatments for unstable distal radius fractures: open reduction internal fixation (ORIF) through a volar approach with a fixed-angle implant and a standard external fixation (EF) method. METHODS: This study included patients with comminuted unstable intra-articular and extra-articular distal radius fractures treated by a single surgeon. Data were gathered retrospectively on 11 patients treated with EF who had been followed up for an average of 47 months (range, 12-84 mo). Prospective data were gathered on 21 patients who were treated with ORIF through a volar approach with a fixed-angle implant. Follow-up evaluation for this group averaged 17 months (range, 12-24 mo). The 2 groups were compared for range of motion (ROM), strength, and functional outcome as measured by the Patient Rated Wrist Evaluation (PRWE) and the Disability of the Arm, Shoulder, and Hand Questionnaire (DASH). Fracture reduction was evaluated from radiographs taken at the last follow-up visit and compared between groups. RESULTS: The mean passive wrist ROM at the final follow-up evaluation in EF patients was 59 degrees extension and 57 degrees flexion, compared with 63 degrees extension and 64 degrees flexion in patients treated with ORIF. Passive pronation/supination arc of motion was similar for the 2 groups, as were the DASH and PRWE scores. Grip strength as a percentage of the opposite wrist was significantly greater in the external fixation group, a possible consequence of longer follow-up evaluation. Final radiographic measurements for the EF group averaged 5 degrees volar tilt and 25 degrees radial inclination, with 2.2-mm ulnar-positive variance. The ORIF with volar plating group averaged 10 degrees volar tilt and 22 degrees radial inclination, with .5-mm ulnar-negative variance. Radial length and volar tilt were significantly greater for the ORIF group. The average final intra-articular step-off was significantly different, with 1.4-mm step-off in the EF group and .4 mm in the ORIF group. CONCLUSIONS: The use of ORIF with a volar fixed-angle implant resulted in stable fixation of the distal articular fragments, allowing early postsurgical wrist motion. The PRWE and DASH scores for the groups were equivalent, whereas intra-articular step-off, volar tilt, and radial length were better in the ORIF group. There were few complications, implant removal was not necessary, and early postsurgical wrist ROM was initiated without loss of reduction.     

固定角度掌侧接骨板结合克氏针治疗不稳定桡骨远端骨折

目的 探讨固定角度掌侧接骨板结合克氏针治疗不稳定桡骨远端骨折的临床效果.方法 2005年1月至2007年12月对19例不稳定桡骨远端骨折采用切开复位固定角度掌侧接骨板结合克氏针固定治疗,随访临床效果.结果所有患者随访5-14个月,平均11个月,所有患者均骨性愈合,愈合时间5-16周,平均愈合时间9.6周.掌倾角5°～12°,平均9.4°;尺偏角18°～24°,平均21°.6例轻度疼痛,4例活动受限,平均屈伸角度121°,平均握力为健侧的84.2%,桡骨长度得到恢复,关节面台阶＜1 mm.Cooney腕关节评分:优4例,良13例,可2例,优良率89.5%.结论 固定角度掌侧接骨板结合克氏针固定治疗不稳定桡骨远端骨折,可以获得满意的临床效果.     

Surgical treatment of unstable distal radius fractures with volar locking plates

BACKGROUND: Surgical treatment of unstable distal radius fractures does not always yield a satisfactory outcome. The several surgical strategies available have problems associated with them. This study was undertaken to determine if volar locking plate fixation could be useful for treating unstable distal radius fractures. METHODS: This retrospective follow-up study assessed 24 fractures in 24 patients with unstable distal radius fractures surgically treated with one of three volar locking plate systems. According to the AO classification system, 7 patients had type A3 fractures, 5 patients had type C2 fractures, and the remaining 12 patients had type C3 fractures. Radiographic measurements included volar tilt, radial inclination, and ulnar variance. Clinical outcomes were evaluated by active range of motion of the wrist and forearm, grip strength, Saito's wrist score, and the Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (JSSH version of the DASH). RESULTS: At the time of final follow-up (5 months minimum) the mean volar tilt was 8.1 degrees , radial inclination was 20 degrees, and ulnar variance was 0.4 mm. Mean wrist extension measured 61 degrees, wrist flexion 55 degrees, radial deviation 23 degrees, ulnar deviation 35 degrees, pronation 87 degrees, and supination 87 degrees. Grip strength recovered to a mean of 84% of the grip strength in the contralateral limb for patients who had injured their dominant hand and to a mean of 73% for patients who had injured their nondominant hand. Saito's wrist score calculations revealed 20 excellent and 4 good results. The mean DASH disability/symptom score was 9.9 points, and the mean DASH work module score was 8.2 points. CONCLUSIONS: The present study demonstrated that unstable distal radius fractures could be successfully treated with volar locking plate systems.     

Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report

Using a volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 29 patients with 31 dorsally displaced, unstable distal radial fractures with a new fixed-angle internal fixation device. At a minimal follow-up time of 12 months the fractures had healed with highly satisfactory radiographic and functional results. The final volar tilt averaged 5 degrees; radial inclination, 21 degrees; radial shortening, 1 mm; and articular incongruity, 0 mm. Wrist motion at final follow-up examination averaged 59 degrees extension, 57 degrees flexion, 27 degrees ulnar deviation, 17 degrees radial deviation, 80 degrees pronation, and 78 degrees supination. Grip strength was 79% of the contralateral side. The overall outcome according to the Gartland and Werley scales showed 19 excellent and 12 good results. Our experience indicates that most dorsally displaced distal radius fractures can be anatomically reduced and fixed through a volar approach. The combination of stable internal fixation with the preservation of the dorsal soft tissues resulted in rapid fracture healing, reduced need for bone grafting, and low incidence of tendon problems in our study.     

Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results

Background  With an incidence of about 2–4 per 1,000 residents per year, the distal radial fracture is the most common fracture in the human skeleton. The introduction of fixed-angle plate systems for extension fractures at the radius was evaluated in a prospective study performed at our hospital after selection and acquisition of a new system. The focus of our interest was whether a secondary loss of reduction can be avoided by this plating system. Methods  We reviewed 80 patients treated for unstable distal radius fractures using a volar fixed-angle plate. Postoperative management included immediate finger motion, early functional use of the hand, a wrist splint used for 4 weeks and physiotherapy. Standard radiographic and clinical fracture parameters after 12 months (range 12–14 months) were measured and final functional results where assessed. Results  Bone healing had occurred in all patients at the time of follow-up after 1 year. On X-rays taken at the time of follow-up 60 patients (75%) had no radial shortening, 20 patients (25%) had a mean radial shortening of only 1.8 mm (range 1–3 mm) compared to the contralateral side. The radial tilt was on average 22° (range 14°–36°); the volar tilt was on average 6° (range 0°–18°). Comparing the first postoperative X-rays with those taken at final evaluation showed no measureable loss of reduction in the volar or radial tilt. Castaing’s score, which includes the radiographic results, yielded a perfect outcome in 30 cases, a good outcome in 49 cases and an adequate outcome in one case. The range of motion was on average reduced by 21% during extension/flexion, by 11% during radial/ulnardeviation and by 7% in pronation and supination compared to the contralateral side. Grip strength was 65% that of the contralateral side. The mean DASH score was 25 points. Conclusion  Fixed-angle plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist. The technically simple palmar access, with a low rate of complications, allows exact anatomical reduction of the fracture. The multidirectional fixed-angle system we used provides solid support for the joint surface even in osteoporotic bone and allows simple subchondral placement of screws with sustained retention of the outcome of reduction. Secondary correction loss can be avoided by this procedure. Early mobilisation can be achieved and is recommended.     

Dorsal plating for comminuted intra-articular fractures of the distal end of the radius.

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23 degrees, volar tilt 7 degrees, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5 degrees during follow-up in ten patients. Use of dorsal Symmetry plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.     

Fixed-Angle Volar Plate Fixation for Distal Radius Fractures in Immunosuppressed Patients

The aim of this study was to define the outcome and complications following open reduction and internal fixed-angle plating of distal radius fractures for patients on chronic immunosuppression medications. A retrospective study identified 11 patients with distal radius fractures that had been on chronic immunosuppressive medication. The mean patient age was 59.9 years (40–82 years). According to the Orthopedic Trauma Association classification, there was one 23A3, one 23B3, and nine 23C type fractures. There were two open fractures. All patients received preoperative antibiotics and underwent reduction and fixation with a volar, fixed-angle plate. Postoperative measurements included postoperative and final radiographic indices, wrist flexion and extension, forearm rotation, and grip strength. Clinical follow-up averaged 13 months, and radiographic follow-up averaged 14.9 months. Statistical analysis was performed comparing means of various parameters with a two-sided t test with an alpha value ≤0.05. All fractures healed, and there were no infections. The final mean ulnar variance, volar tilt, and radial inclination were −0.1 mm (ulnar negative; −2.0 to +2.5 mm), 13° (5–23°), and 21° (15–27°), respectively. The mean articular gap or step was 0.4 mm. There was a small but significant decrease between the final and postoperative mean ulnar variance (p = 0.03). Mean wrist flexion was 47°, extension 47°, pronation 77°, and supination was 76°. Grip strength averaged 16.3 kg versus 25.1 kg for the opposite extremity. The one major complication included a postoperative carpal tunnel syndrome. Fixed-angle volar plate fixation for distal radius fractures in patients with chronic immunosuppression was associated with union (with acceptable radiographic alignment), no wound-healing problems or infections, and with functional wrist and forearm motion and grip strength.     

Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture

PURPOSE: To evaluate the results following locking plate fixation of unstable distal ulna fractures with concomitant distal radius fracture. METHODS: A retrospective review was conducted to identify patients who had been treated with a locking plate for unstable displaced fractures of the distal ulna in which a concomitant ipsilateral distal radius fracture was also treated operatively. Medical records and radiographs were reviewed, and 5 patients were identified with an average age of 52 years (range, 47-61 years) and with follow-up averaging 11.6 months (range, 6-17 months). There were 2 open and 3 closed fractures. Included was 1 simple neck, 1 comminuted neck, 1 head, and 2 head and neck fractures of the distal ulna. All distal radius fracture implants were locked volar plates. RESULTS: All distal ulna and distal radius fractures united, and the average motion was: flexion 59 degrees ; extension 59 degrees ; pronation 67 degrees ; and supination 72 degrees . Average grip strength was 97% of the opposite extremity. Final ulnar variance averaged -0.4 mm (ulnar negative), radial inclination was 20 degrees , and volar tilt was 8 degrees . All distal radioulnar joints were stable. Two patients had mild, transient paresthesias of the dorsal sensory branch of the ulnar nerve, and both patients recovered completely within 3 months. There were no subsequent surgeries or hardware failures. There were no infections and no wound problems. Based upon the Sarmiento modification of the Gartland and Werley rating score, there were 4 excellent results and 1 good result. CONCLUSIONS: Locked plating of unstable distal ulna fractures, in the setting of an associated distal radius fracture, resulted in union, good to excellent alignment and motion, nearly symmetric grip strength, and minimal transient morbidity.     

Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius

PURPOSE: Despite the recent popularity of volar plating for dorsally displaced distal radius fractures there is a paucity of data documenting the results of this treatment method. The purpose of this study was to determine the functional outcome of patients treated with volar fixed-angle plating for dorsally displaced, unstable distal radius fractures. METHODS: We reviewed the records of all patients treated at our institution with internal fixation using volar plates for dorsally displaced, comminuted distal radius fractures. Patients with follow-up periods shorter than 12 months were excluded from the study. Outcomes were evaluated at the latest follow-up examination with the Disabilities of the Arm, Shoulder, and Hand and the Gartland and Werley scoring systems. RESULTS: We studied 41 patients with a mean age of 53 years. The average follow-up period was 17 months. All fractures were stabilized with volar locking plates. Radiographs in the immediate postoperative period showed a mean radial height of 11 mm, mean radial inclination of 21 degrees , and mean volar tilt of 4 degrees. At fracture healing the mean radial height was 11 mm, mean radial inclination was 21 degrees, and mean volar tilt was 5 degrees. The average score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 14 and all patients achieved excellent and good results on the Gartland and Werley scoring system, indicating minimal impairment in activities of daily living. Nine patients experienced postoperative complications. There were 4 instances of loss of reduction with fracture collapse, 3 patients required hardware removal for tendon irritation, 1 patient developed a wound dehiscence, and 1 patient had metacarpophalangeal joint stiffness. CONCLUSIONS: Patients with unstable, dorsally displaced fractures of the distal radius treated with volar fixed-angle devices have good or excellent functional outcomes despite a high complication rate. When compared with previous reports on dorsal plating volar plates appear to have a higher incidence of fracture collapse but a lower rate of hardware-related complications. Complex fracture patterns thus mandate a careful and individualized approach. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.     

两种内固定治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效比较

目的比较采用桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定和单纯桡骨远端掌侧锁定钢板治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效。方法将73例桡骨远端骨折伴尺骨茎突基底部骨折患者按治疗方法的不同分为观察组(采用桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定治疗,38例)和对照组(采用单纯桡骨远端掌侧锁定钢板治疗,35例)。测量桡骨远端掌倾角、尺偏角、桡骨高度。术后4个月采用Dienst功能评分标准评价临床疗效。末次随访时采用腕关节活动度评价腕关节功能恢复情况。结果患者均获得随访,时间9~16个月。术后掌倾角、尺偏角、桡骨高度两组比较差异均无统计学意义(P>0.05)。术后4个月采用Dienst功能评分标准评价临床疗效的优良率,观察组明显高于对照组(P<0.05)。末次随访时两组腕关节功能均已恢复。结论与采用单纯桡骨远端掌侧锁定钢板治疗相比,桡骨远端掌侧锁定钢板+尺骨茎突单皮质骨螺钉固定治疗桡骨远端骨折伴尺骨茎突基底部骨折更利于改善患者临床症状,更利于恢复腕关节的稳定性。     

Volar fixation of distal radial fracture using compression plate: clinical and radiographic evaluation of 20 patients

Distal radius fractures can be treated with different methods, depending on the type of fracture and, on our experience, according to the Fernandez algorithm. The report presents our experience treating distal radius fractures using a volar plate. We reviewed retrospectively 20 patients treated, during a period of 3 years (May 2008–May 2011) at our center, for unstable distal radius fractures using a volar plate. All patients were reviewed by thorough clinical examination and standard radiographs of the operated wrist. For the clinical evaluation, we used Mayo Wrist Score and DASH Score. At review, the injured wrist had recovered an average range of motion in flexion–extension of 120°, and the grip strength was an average of 50 % compared to contralateral side. Overall, results at Mayo Wrist Score were good to excellent in 30 %, satisfactory in 55 %, and poor in 15 %; results at DASH Score were good to excellent in 90 %, satisfactory in 10 % with no poor case. The majority of patients were fully satisfied with the results (65 %), 20 % of patients were partially satisfied, 5 % were poorly satisfied, and 10 % were not satisfied. At review, 4 patients reported the presence of transient paresthesia localized to the first three rays of the hand. At radiographic evaluation, the majority of patients had a radial tilt between 20 and 23, ulnar variance between 0 and 3, and dorsal tilt between 9 and 14. The treatment of unstable distal radius fractures with a volar plate provided stable internal fixation and allowed early function and was associated with a low complication rate.     

Winkelstabile, volare Plattenosteosynthese komplexer artikulärer Frakturen am distalen Radius

Fractures of the distal radius represent one of the most common fractures and have high socioeconomic relevance. Using the volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 49 displaced intra-articular distal radius fractures with a new fixed-angle internal fixation device. According to the AO classification, there were 21 C1, 19 C2, and nine C3 fractures. A retrospective study was carried out to obtain the functional results after open reduction and plate osteosynthesis. Loss of correction between postoperative and follow-up radiography was 1 degrees in volar tilt and radial inclination. The radial shortening was 1 mm. Wrist motion at final follow-up examination had recovered to an average of 80% of that at the normal, contralateral site. Overall outcome according to the Gartland and Werley scales showed 35% excellent, 50% good, and 15% fair results. Using the Martini score, we obtained 85% excellent and good results. The DASH score represented high subjective satisfaction.     

Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study

PURPOSE: To evaluate and compare the biomechanic rigidity and strength of 3 fixed-angle plates used to treat extra-articular distal radius fractures that are dorsally unstable. Volar fixed-angle plates were compared with a dorsal fixed-angle nail plate. METHODS: Three plate constructs were tested: the dorsal nail plate (DNP), distal volar radius (DVR) plate, and locking compression plate (LCP) volar distal radius plate. With anatomic, third-generation, artificial composite radii, dorsally unstable extra-articular distal radius fracture models were made by cutting a wedge osteotomy with an 8-mm dorsal gap 1 cm from the articular surface. These models were then fixed with the 3 implants by the method recommended by the manufacturer. The proximal radii of each specimen were attached to the base of a materials testing machine with a probe centered at the radial side of the lunate fossa. The specimens were loaded at a constant rate to failure under axial compression. Load and displacement were plotted graphically, and the resulting rigidities and strengths of each plate were assessed statistically. RESULTS: The DVR group had significantly greater stiffness than the LCP group. The DVR group had significantly higher maximum loads than both the DNP and LCP groups. There were no significant differences in yield loads. Both the DNP and DVR groups had significantly less displacement at yield than the LCP group. CONCLUSIONS: These 3 groups had similar yield loads. However, the LCP was less stiff than the DVR and had more displacement at yield than both the DVR and DNP. The yield load of all 3 implants was much higher than previously described loads for active wrist and finger motion.     

Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate

OBJECTIVES: The increasing number of fixed-angle plate systems used to treat distal radius fractures carries with it the problem of determining the optimal fixation for unstable fractures. Our goal was to analyze the clinical and radiological outcomes of patients with displaced, unstable distal radius fractures treated with a palmar fixed-angle plate. DESIGN: Prospective protocol; multicenter clinical study; retrospective analysis. SETTING: Level 1 university trauma centers. PATIENTS: Over a mean 15-month period (range, 12 to 27 months), 141 consecutive patients were treated for an unstable dorsally displaced distal radius fracture of which 114 or 81% were followed for 1 year or longer. INTERVENTION: Open reduction and palmar internal fixation with a fixed-angle plate (2.4 mm LCP Distal Radius Plates; Synthes, Salzburg, Austria). Indication for surgical treatment was the inability to obtain or maintain fracture or articular alignment after initial closed reduction. MAIN OUTCOME MEASURES: In a follow-up period, which had to be longer than 12 months, objective and subjective functional results (active range of motion; strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS); Green and O'Brien Score) and radiographic assessment (palmar tilt, radial inclination, ulnar variance, fracture union) were assessed. Potentials for complications were given special attention. RESULTS: In the 114 patients followed for a minimum of 12 months, there were 21 men and 93 women with a mean age of 57 years (17 to 79 years). Fractures were classified according to the AO/ASIF classification system as type A2 (n = 39), A3 (n = 16), C1 (n = 24), C2 (n = 30), or C3 (n = 5). The modified Green and O'Brien Score revealed 31 excellent, 54 good, 23 fair, and 6 poor results. Active wrist motion averaged 54 degrees extension (82% as compared with the uninjured side) and 46 degrees flexion (72% as compared with the uninjured side). The average pronation was 81 degrees (95% as compared with the uninjured side), and the average supination was 82 degrees (95% as compared with the uninjured side). Mean grip strength at final follow-up was 70% of the uninjured side. Low residual pain values in the wrist were demonstrated: 81 patients (71%) were pain free, 17 patients (15%) had mild pain, 10 patients (9%) had moderate pain, and 6 patients (5%) had severe pain. The DASH score averaged 13 points (range, 0 to 39 points). Fracture union was achieved in all patients. A mean loss of palmar tilt of 3.4 degrees (range, 0 to 8 degrees), radial inclination of 0.4 degrees (range 0 to 2 degrees), and of the ulnar variance of 1.2 mm (range, 0 to 6 mm) was measured. The overall complication rate was 27% (31/114). The most frequent problems were flexor and extensor tendon irritation (57% of the total number of complications), including 2 ruptures of the flexor pollicis longus tendon, 2 ruptures of the extensor pollicis longus tendon, 4 cases of extensor tendon tenosynovitis, and 9 cases of flexor tendon tenosynovitis. Carpal tunnel syndrome was observed in 3 patients, and complex regional pain syndrome occurred in 5 patients. In 2 cases, loosening of a single screw was seen. Delayed fracture union occurred in 3 patients, and intraoperative intraarticular screw displacement was recognized in 1 patient. Neither clinical outcome nor complication rate were dependent on fracture type (intraarticular versus extraarticular). CONCLUSION: Fixation of unstable dorsally displaced distal radius fractures with a fixed angle plate provides sufficient stability with minimal loss of reduction. Nevertheless, very distal palmar plate position can interfere with the flexor tendon system, too long screws can penetrate the extensor compartments, and distal screws in comminuted fracture patterns can cut through the subchondral bone and penetrate into the radiocarpal joint. Mindful of these problems, we consider that the complex fracture pattern of an unstable distal radius fracture cannot be treated by a single plate system and approach.     

DVR解剖型桡骨掌侧锁定接骨板治疗桡骨远端骨折

目的探讨开放复位DVR解剖型桡骨掌侧锁定接骨板治疗桡骨远端骨折的疗效。方法回顾性分析自2010年12月。2012年4月用DVR解剖型桡骨掌侧锁定接骨板治疗的不稳定桡骨远端骨折15例。结果15例获随访8～24个月,平均14个月,所有骨折均于术后3个月内愈合。术后平均掌倾角、尺偏角、尺骨变异分别为（7．9±2．3）°、（21．5±3．4）。、（-0．20±1．21）mm,末次随访时平均掌倾角、尺偏角、尺骨变异分别为（7．80±2．24）°、（21．3±3。4）°、（-0．07±1．22）mm,二者差异无统计学意义。按照改良的Green—O＇Bfien功能评分,腕关节功能：优11例,良2例,可1例,差1例。结论开放复位DVR解剖型桡骨掌侧锁定接骨板治疗桡骨远端骨折具有操作简单、骨折复位好、固定牢固、可早期功能锻炼、腕关节功能恢复满意的优点。是治疗桡骨远端比较理想的方法。     

Volar fixed-angle plating of the distal radius

The treatment of unstable distal radius fractures continues to improve as better methods of skeletal fixation and soft-tissue management are developed. Apart from closed reduction and percutaneous pinning of simpler fracture patterns, the three main methods of management are external fixation, dorsal plating, and volar fixed-angle plating. Specific advantages of volar fixed-angle plating include stable fixed-angle support that permits early active wrist rehabilitation, direct fracture reduction, and fewer soft-tissue and tendon problems. Volar fixed-angle plating also avoids the complications often associated with external fixation and dorsal plating. Biomechanical data indicate that, when loaded to failure, volar fixed-angle plates have significant strength advantages over dorsal plating. Volar fixed-angle plating is advantageous in elderly osteopenic patients and for high-energy comminuted fractures and malunions requiring osteotomy.     

Failure of a retinacular flap to prevent dorsal wrist pain after titanium Pi plate fixation of distal radius fractures

Patients with distal radius fractures that had been treated with a dorsal Pi plate and retinacular flap covering the transverse limb of the Pi plate were evaluated clinically and radiographically. Nine of 20 patients (45%) required plate removal for dorsal wrist pain. Three of the remaining 11 who retained the plate had dorsal tenderness over the wrist extensors. There were no differences evident between the 2 groups in plate size, position, or number of screws used. In addition there were no significant differences between the groups in either radial height or inclination. The palmar tilt did show a trend toward statistical significance: those patients who required plate removal had an average of 4.1 degrees of dorsal tilt, patients whose plate was not removed averaged 2.8 degrees of palmar tilt. Our results show that the retinacular flap covering the distal transverse limb of the Pi plate did not prevent the occurrence of dorsal wrist pain. Dorsal wrist pain remained a problem with dorsal plating of distal radius fractures.     

Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution

BACKGROUND: Distal radial fractures with extensive comminution involving the metaphyseal-diaphyseal junction present a major treatment dilemma. Of particular difficulty are those fractures involving the articular surface. One approach is to apply a dorsal 3.5-mm plate extra-articularly from the radius to the third metacarpal, stabilizing the diaphysis and maintaining distraction across the radiocarpal joint. METHODS: Twenty-two patients treated with a distraction plate for a comminuted distal radial fracture were included in the study. With use of three limited incisions, a 3.5-mm ASIF plate was applied in distraction dorsally from the radial diaphysis, bypassing the comminuted segment, to the long-finger metacarpal, where it was fixed distally. The articular surface was anatomically reduced and was secured with Kirschner wires or screws. Eleven of the twenty-two fractures were treated with bone-grafting. The plate was removed after fracture consolidation (at an average of 124 days), and wrist motion was initiated. All patients were followed prospectively with use of radiographs, physical examination, and DASH (Disabilities of the Arm, Shoulder and Hand) scores. RESULTS: All fractures united by an average of 110 days. Radiographs showed an average palmar tilt of 4.6 degrees and an average ulnar variance of neutral (0 degrees), whereas loss of radial length averaged 2 mm. Flexion and extension averaged 57 degrees and 65 degrees, respectively, and pronation and supination averaged 77 degrees and 76 degrees , respectively. The average DASH scores were 34 points at six months, 15 points at one year, and 11.5 points at the time of final follow-up (at an average of 24.8 months). According to the Gartland-Werley rating system, fourteen patients had an excellent result, six had a good result, and two had a fair result. Grip strength and the range of motion of the wrist at one year correlated inversely with the proximal extent of fracture comminution into the diaphysis. The duration of plate immobilization did not correlate with the range of motion of the wrist or with the DASH score at one year. CONCLUSIONS: The use of a distraction plate combined with reduction of the articular surface and bone-grafting when needed can be an effective technique for treatment of fractures of the distal end of the radius with extensive metaphyseal and diaphyseal comminution. A functional range of motion with minimal disability can be achieved despite a prolonged period of fixation with a distraction plate across the wrist joint.     

新型锁定加压钢板治疗老年桡骨远端C型骨折

目的 探讨新型2.4 mm锁定加压钢板(LCP)治疗老年桡骨远端C型骨折的初期疗效.方法 回顾性分析2006年10月至2008年11月采用新型2.4 mm LCP治疗21例老年桡骨远端C型骨折患者,男7例,女14例;年龄71～85岁,平均76岁.骨折按AO分型:C1型6例,C2型13例,C3型2例,均为闭合性骨折.所有患者均经掌侧入路复位固定,术中不显露背侧组织,骨缺损严重行置入人工骨.结果 所有患者获平均10.6个月(8～27个月)随访.X线片示骨折全部一期愈合,平均愈合时间为8周.2例骨缺损严重者,术中植入人工骨.所有患者均无感染、骨不连、钢板松动、腕管综合征等并发症发生.术后功能康复时间4～36周,平均11周.腕关节活动度:背伸23°～84°,平均71.3°;掌屈33°～86°,平均72.0°;尺偏19°～29°,平均26.3°;桡偏12°～30°,平均19.9°;前臂旋前60°～87°,平均79.5°;旋后52°～80°,平均76.4°.与健侧对比,握力减弱3例,活动后疼痛3例.按改良的Mcbride腕关节功能评价标准:优14例,良5例,可2例,优良率为90.5%.结论 新型2.4 mm LCP治疗老年骨质疏松引起的桡骨远端C型骨折,内固定坚强,可以早期功能锻炼,疗效佳.