Top PDF Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

A 40-year-old, right hand dominant, unemployed, female presented to the emergency department with right wrist pain following a fall onto her right out- stretched hand. She had a past medical history of smok- ing (30 pack/years), hypertension, adult obstructive sleep apnea, depression, bipolar disorder, and anxiety. Her body mass index (BMI) at that time was 39. Initial eva- luations revealed a swollen wrist, no ecchymosis and a 2+ radial pulse. Radiographs demonstrated a right intra- articular distal radius fracture (AO, type 23-A3) in AP and lateral views. Following reduction, patient was placed in a sugar tong splint and was instructed to return for follow-up in one week. At 7 days, radiographs showed -20 degree of dorsal tilt (Figure 1). At that point, she chose to undergo surgery.
Show more

6 Read more

Original Article Volar locking plate fixation versus Kirschner wire fixation in distal radius fractures: a meta-analysis

Original Article Volar locking plate fixation versus Kirschner wire fixation in distal radius fractures: a meta-analysis

ficiency of surgeons and different types of dis- tal radius fractures. Since the sample size of some RCTs was small, patient age was con- sidered as another source of heterogeneity. Previous study indicated that in patients sixty- five years of age or older, surgery could not give any improvement in terms of the range of motion, PRWE and DASH scores [19]. We are unable to perform a subgroup analysis for dif- ferent age to identify possible source of hetero- geneity, because none of the included study reported outcomes of volar locking plate fixa- tion and K-wire fixation according to different age group.
Show more

10 Read more

Comparison of radiographic and functional results of die-punch fracture of distal radius between volar locking plating (VLP) and external fixation (EF)

Comparison of radiographic and functional results of die-punch fracture of distal radius between volar locking plating (VLP) and external fixation (EF)

Due to the unstable status, almost all the die-punch fractures necessitate the open reduction and locking plate/screws fixation via volar or dorsal approach. In addition, in some cases, percutaneous fixation with K- wires, mini-external fixator, non-locking plate/screws, wrist arthroscopy, intramedullary fixation, or combined use of two or more were used [7, 12, 13]. However, to our best knowledge, there is no consensus on the treat- ment of die-punch fractures, leading to the more diffi- culty in understanding of the functional results among the different surgical interventions for this type of injury. This study aimed to compare the external fixator and the traditional VLP fixation for treatment of die-punch fractures, with regard to radiological parameters (volar tilt, radial inclination, articular step-off, ulnar variance), functional outcomes (wrist mobility, grip strength), and the overall functional assessment using disabilities of the arm, shoulder, and hand (DASH) and Gartland–Werley scoring systems.
Show more

7 Read more

UK DRAFFT: A randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

UK DRAFFT: A randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

Of note, 430 patients with intra-articular fractures were excluded on the basis that the ‘ surgeon needed to open the fracture to achieve reduction of the joint surface ’ . Inevitably these fractures would be fixed with a plate, since the incision required to reduce the joint surface is essentially the same as that required for the insertion of the plate. There were 639 patients who fulfilled the eligibility criteria – some of whom did not wish to take part in the trial for the reasons described – so the majority of the patients who met the other eligibility criteria were considered by the surgeons to be eligible. Nonetheless, the number of patients excluded from the analysis on the basis of the ‘ surgeon needed to open the fracture to achieve reduction of the joint surface ’ eligibility criterion was perhaps greater than might have been expected given the proportion of complex intra-articular fractures, that is those who might be expected to fulfil this criteria, reported in the literature. Some surgeons may have taken a ‘ cautious ’ approach to the decision to include a patient in the trial, that is they excluded the patient if there was any doubt about their ability to subsequently reduce the joint surface without opening the joint. There was also some variability by trial centre in the number of patients excluded for this reason, but this was not unexpected and reflects variation in clinical practice and in particular the variation in surgeons ’ willingness to open the joint surface. To some degree, variation in the surgeons ’ preoperative assessment of their ability to reduce the fracture reflects such variation in clinical practice across the NHS.
Show more

154 Read more

Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate

Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate

Donor site morbidity, especially at the iliac crest, has been well described and minor complications such as persistent pain at the harvest site, superficial sensory nerve injury, superficial hematoma or seroma and superficial infection have been reported [15]. Moreover, a volar approach is easier than a dorsal approach and the reduction of the volar cortex is simple because of less comminution and the advantage of direct vision [16]. The present study showed that a corrective osteotomy using a volar locking plate without the use of bone grafting could effectively produce a significant improvement in wrist function in patients treated for extra-articular distal radius malunion. We obtained an excellent correction of deformity based on radiographic parameters, with low morbidity and no non- unions, hardware failure or need for hardware removal. Our results are in line with those reported by Mahmoud et al. [17], who treated 30 malunited dorsally-angulated radii using fixed-angle volar locking plates without bone graft- ing, obtaining at a mean 18-month follow-up radiological evidence of union, correction of the deformity, and clinical and functional improvement in all cases. In particular, the improvement in the DASH and Mayo scores obtained in the present study was 28.5 and 42.8 points, respectively, compared with the 21.6 and 22.7 points reported by Mahmoud et al. [17]. These differences in functional out- come can probably be explained by the longer follow-up period of the present research. Favorable results have also been reported in numerous studies following volar locking plates with additional bone graft [18, 19]. The volar approach and the use of locking plates is an extremely effective and safe technique; in fact, the use of fixed-angle locking plates reduces the risk of postoperative bone dis- placement, and requires a shorter immobilization time [20, 21]. Moreover, the mechanical strength provided by this construct does not necessarily require the use of bone grafting. We therefore believe that the volar approach and locking plate, without necessarily the use of bone grafting, is an effective technique for addressing symptomatic and even severe deformities of the distal radius, and should be preferred especially in elderly patients with poor bone
Show more

6 Read more

External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

External fixation versus volar locking plate for displaced intra-articular distal radius fractures: a prospective randomized comparative study of the functional outcomes

was checked in the C-arm in antero-posterior and lateral views (Fig. 1). Reduction was achieved via manual traction and closed reduction method in all cases. Sterile betadine dressing of the pin tract site was performed. A below- elbow plaster of Paris slab was applied in all patients for 1 week. The external fixator was removed in all patients after 8 weeks. No extra wire was used in any patient since we were able to achieve reduction in fracture by use of pins only.

6 Read more

Original Article Efficacy of volar locking plate fixation for unstable distal radius fractures in elderly patients

Original Article Efficacy of volar locking plate fixation for unstable distal radius fractures in elderly patients

by one case of postoperative re-displacement occurred in this study. 2) A good exposure is needed to avoid repeated fluoroscopic exami- nation and prolonged operative time. The pro- nator muscle should be protected during the operation. Dos Remedios et al. [22] pointed out pronator muscle played an important role in the wrist function, including forearm rotation and distal ulnar joint stability. Above all, minimally invasive was advocated to avoid pronator mus- cle damage. 3) As to patients with type C2 frac- tures, especially who had crushing volar corti- cal bone, loss of the distal radius would occur even though Kirschner wire fixation was per- formed after reduction. Thus, it would be better to fix distal end of fracture firstly, then loosen oval foramen of the plate and draw again, and finally tight the screws after distal radius restor- ing to normal height. 4) Palmar approach might be associated with tendon rupture or other complications. Tarallo et al. [23] conducted a retrospective study to investigate the complica- tion incidence s of volar locking plate fixation for unstable DRFs. The result showed that 18 of 303 (5.9%) DRFs patients suffered from complications after volar locking plate fixation and extensor tendon injury accounted for 50% of all complications due to technical defect of the internal fixation. In our study, we also found that the complications of volar locking plate fixation of DRFs were related to technic- al defects during internal fixation. Fortunately, this complication could be avoided by careful operative procedure. 5) For unstable DRFs, distal radioulnar join dislocation should be noticed and corrected timely. In our study, one patient obtained not well rotation function dur- ing follow-up because his dislocation was not observed in time. 6) The protection for soft tis- sue should be considered during the surgery because of the poor flexibility of the skin and soft tissues were relatively poor in elderly patients; the affected limbs should be elevated postoperatively to lessen edema.
Show more

7 Read more

Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

Short term comparative study of external fixation versus volar locking compression plate in the treatment of unstable distal radius fractures

In this study, we found that the external fixator is equally Effective in maitaining length when compared to volar locking plate in Type I and Type III Fernandaz . But in communited fractures external fixation had given good alignment of fracture than volar locking plate. However radiological outcome such asLength maintainence and union are equal in both groups, although in one case of external fixator group, there was minimal dorsal tilt .In Type II Fernandaz fractures external fixation is not much effective , volar plating had been done .
Show more

72 Read more

UK DRAFFT   A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

UK DRAFFT A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

The secondary outcome measures in this trial are: the Disabilities of Arm, Shoulder and Hand score ; The DASH Outcome Measure is a 30-item, self-report ques- tionnaire designed to provide a more general measure of physical function and symptoms in people with muscu- loskeletal disorders of the upper limb [10], EQ-5D; The EQ-5D is a validated, generalised, quality of life ques- tionnaire consisting of 5 domains related to daily activ- ities with a 3-level answer possibility. The combination of answers leads to the QoL score [11], Complications; all complications will be recorded. Radiographic eva- luation; Standard posterior-anterior and lateral radio- graphs will be taken at baseline, 6-weeks and 12 months after the injury, Resource use will be monitored for the economic analysis. Unit cost data will be obtained from national databases such as NHS Reference costs, the BNF and PSSRU Costs of Health and Social Care [12]. Where these are not available the unit cost will be esti- mated in consultation with the finance department at the lead hospital. The cost consequences following dis- charge, including NHS costs and patients’ out-of-pocket expenses will be recorded via a short questionnaire which will be administered at 3, 6 and 12 months post surgery. Patient self-reported information on service use has been shown to be accurate in terms of the intensity of use of different services [13].
Show more

6 Read more

Volar Locking Plate Breakage after Nonunion of a Distal Radius Osteotomy

Volar Locking Plate Breakage after Nonunion of a Distal Radius Osteotomy

All these previous studies reported on cases of DR plate breakage that were fabricated from grade II titanium [1–4]. The titanium plates are more likely to fail than stainless steel plates [9]. The plates used in the current case were fabricated from 3.5 mm thick stainless steel. The anatomic design allows contouring to fit the volar surface of the distal radius. There are seven distal screw holes (2.4 mm) with threads that can accept either a locking or nonlocking screw and five proximal screw (3.5 mm) holes in the first plate and seven proximal screw holes in the second plate. We usually use plates longer than three proximal screw holes and fill all the distal row screw holes to fix distal radius osteotomies, because of the length of the plate and the distribution of the screws, both of which have been shown to be important factors determining the stability of fixation [9–11]. Biomechanical studies suggest that, for fractures of the radius, 3 or 4 screws should be used on each side of the fracture, because the forces acting on these bones are predominantly rotational [9–11].
Show more

6 Read more

Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study

Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study

With respect to complications, we did not find a sig- nificant difference in the incidence rate, 34.5% in the EF group and 28.2% in the VLP group, both of which was in range of the reported figures [10, 18, 19, 26, 33]. Cao et al. [33] retrospectively reviewed 226 type C3 distal radius fractures treated by external fixator in the elderly patients, and reported a rate of 18.6% (42/226) for over- all complications, 10% for loss of reduction, 6.2% for joint stiffness, 2.2% for traumatic arthritis, and 0.5% for pin-tract infection. Richard et al. [10] reported a signifi- cantly higher overall rate of complications in the EF group (52.5%, 31/59) than that in the VLP group (25%, 14/56). In a meta-analysis of 9 RCTs, Esposito et al. [34] concluded the significantly higher incidence of overall complications or infection in EF over VLP, but non-significant for re-operation, osteoarthritis, malu- nion, nerve deficit, complex regional pain syndrome, painful retained hardware requiring removal, carpal tunnel syndrome, stiffness, tendon rupture, or tendon- itis. It is often difficult to compare these reported varied figures due to differences in study design, patient characteristics, data collection, and follow-up period. On the other hand, complications from physician re- ports and patient reports are different, with the former emphasizing check-up related complications while the latter often take symptoms as the major concern. McKay et al. [35] suggested not all suboptimal results should be considered as complications, unless it is at- tributable to a specifically diagnosed complication; the authors proposed a complication checklist to improve prospective data collection.
Show more

8 Read more

UK DRAFFT : a randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

UK DRAFFT : a randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

management remains controversial. In general, fractures of the distal radius are treated non-operatively if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic. However, if this is not possible, then operative fixation is required. There are several operative options but the two most common in the UK, are Kirschner-wire fixation (K-wires) and volar plate fixation using fixed-angle screws (locking-plates). The primary aim of this trial is to determine if there is a difference in the Patient-Reported Wrist Evaluation one year following K-wire fixation versus locking-plate fixation for adult patients with a dorsally-displaced fracture of the distal radius. Methods/design: All adult patients with an acute, dorsally-displaced fracture of the distal radius, requiring operative fixation are potentially eligible to take part in this study. A total of 390 consenting patients will be randomly allocated to either K-wire fixation or locking-plate fixation. The surgery will be performed in trauma units across the UK using the preferred technique of the treating surgeon. Data regarding wrist function, quality of life, complications and costs will be collected at six weeks and three, six and twelve months following the injury. The primary outcome measure will be wrist function with a parallel economic analysis.
Show more

7 Read more

Distal radius fractures with diaphyseal involvement: fixation with fixed angle volar plate

Distal radius fractures with diaphyseal involvement: fixation with fixed angle volar plate

Volar plate fixation has been recognized to be an effective and safe treatment in unstable distal radius fractures [1, 2]. Long volar plates are available in most surgical instrumen- tation boxes to manage distal radial fractures that extend to the diaphysis. The reasoning behind this treatment is that long volar plates can reduce the distal radius, stabilize the metadiaphyseal junction, and fix the diaphysis firmly, restoring the articular congruity and relationship, as well as the radial length and alignment. Wrist immobilization is limited to 3 or 4 weeks, allowing early functional recovery. We report the results of 21 cases treated with this technique using an extended Henry’s volar approach. M. Rampoldi ( & ) D. Palombi
Show more

7 Read more

Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires

Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires

Pooling the data from four RCTs [9–11, 13], our meta- analysis found that grip strength was significantly better in patients with VLP fixation at 3 and 6 months postop- eratively, with no significant difference at 12 months postoperatively. We found range of wrist flexion and su- pination to be significantly better in patients with VLP fixation at 3 and 6 months, again with no significant dif- ference, compared to patients with K-wire fixation, at 12 months. There were no differences for other ROMs of the wrist between the two patient groups. In our ana- lysis, we presumed that patient-reported function and satisfaction, as recorded by the DASH, was partially re- lated to objective assessments of wrist and hand function (i.e. ROM and grip strength) following DDDRF, which could explain statistical differences in grip strength be- tween the two patient groups over the early postopera- tive period. But the ROMs of the wrist and grip strength between the two patient groups are also similar at 1 year. Even extension and pronation do not show any difference
Show more

12 Read more

Mid-term functional outcome after the internal fixation of distal radius fractures

Mid-term functional outcome after the internal fixation of distal radius fractures

Surgery was performed under general or regional anaes- thesia with use of an arm tourniquet and administration of antibiotics according to local policy. A standard volar approach through the bed of Flexor Carpi Radialis was performed. The Stryker Matrix Smartlock volar locking plate (Stryker Leibinger GmbH & Co. Germany) was used in all cases. This is a low profile, titanium plate incorporating 20 degree variable angle locking for all screws. Skin closure and postoperative immobilisation was according to the operating surgeon ’ s preference. Bone grafting and carpal tunnel decompression were not routinely performed, although carpal tunnel decom- pression was done at the time of internal fixation in 10 patients at the discretion of the operating surgeon. Rea- sons for decompression included pre-existing carpal Table 1 Outcome grading for Quick DASH and MAYO wrist scores
Show more

8 Read more

Incidence of complications and secondary procedure following distal radius fractures treated by volar locking plate (VLP)

Incidence of complications and secondary procedure following distal radius fractures treated by volar locking plate (VLP)

In our study, we found that the significant collapse of the lunate fossa (5 mm or more) were independent factors associated with the increased risk of overall complications and the need of a secondary procedure. According to anatomical and imaging studies, the lunate fossa accounted for 52 to 53% of the articular surface of the distal radius, which is the central axis of the loading on the wrist joint surface. Therefore, lunate fovea col- lapse or poor reduction will seriously affect the move- ment of the wrist joint [22, 23]. On the other hand, the lunate fossa collapse fracture is often caused by high-en- ergy impact injury, known as die-punch fracture, which is difficult to reduce and also a challenge to maintain the stability after its reduction. We previously studied 93 type B distal radius fractures fixed by VLP, with a signifi- cant lunate fossa collapse in 21 cases and non-significant in 72 cases, and found the significantly different rate of “ articular step-off ” (19% vs 4%). Similarly, Beck et al. [24] demonstrated the significant collapse of the lunate fossa (5 mm or more) and the volar cortex length avail- able for fixation less than 15 mm were independent pre- dictors for postoperative reduction loss.
Show more

9 Read more

Distal radius fracture   outcome with volar locking compression plate

Distal radius fracture outcome with volar locking compression plate

Use of this plate enables early joint mobilization with stable fixation construct owing to its close forming near articular margin and availability of different screw directions; proving its biomechanical superiorities. As well, the use of volar approach poses minimal soft tissue trauma and good space for implant placement, avoiding the pitfalls of the dorsal approach like irritation of extensor tendon e and possibly late tendon ruptures (Schnur and Change, With volar approach the large volar fragment, small fragment near the lunate fossa, the radial styloid and the ulnar fragment of the distal radius should be fixed with buttressing itself and with the use of spatially oriented small threaded screws as and when necessary. Separate screws, k- wires or tension band should be utilized to fix the radial or ulnar styloid fractures and unstable DRUJ. The very absence of fracture fragment displacement and shortening in our case is related to the proper plate placement within 2mm of the articular margin and securing each fragment with accurate placement of fixation screws.
Show more

5 Read more

Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

The volar variable angle locking plate is not a panacea for distal end radius fractures. The inability to decipher the articular anatomy of the distal end radius and the poor re- duction of the fracture will lead to poor results with this newer implant. Complications such as hardware promi- nence, loss of reduction, and tendon irritation are similar to those found with other volar plates. The overall com- plication rate in our study was 21.7%, which is comparable to that reported by Jagodzinski et al. in a bicentric study on distal radius variable angle locking plates (28). They re- ported a complication rate of 19.6%, although the major- ity had screw misplacement, while Kawasaki et al. had no reported cases of screw misplacement (29). In our study, there was only one case of screw misplacement because extra care was taken to prevent this complication since it could have resulted in longer fluoroscopy time. However, no effort was made to calculate the resultant extra fluo- roscopy exposure. The smaller sample size in our study could also be the reason for only a single case of such a com- plication.
Show more

8 Read more

Volar locking distal radius plates show better short-term results than other treatment options: a prospective randomised controlled trial

Volar locking distal radius plates show better short-term results than other treatment options: a prospective randomised controlled trial

The treatment of distal radius fractures with VLDRPs has been an area of increased research interest in the last ten years. Recently, many authors have focused on the fact that outcomes when compared with non-operative treatment are similar after 12 to 24 mo. There have also been recent publications showing that volar plating is significantly more expensive when compared to other treatment modalities. There are, however only very limited data on return to work and function in the short term. Earlier return of function and ability to work, which is potentially possible with volar locking plates could mean significant overall cost savings when compared to other treatment options which necessitate 6 wk of immobilisation.
Show more

9 Read more

Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

provided stronger stability than the LPSG and LPDP methods, except for shear loads under Nor conditions. This can be attributed to the medial and lateral mechan- ical pathway and multi-planar fixation provided by the LPMP (Fig. 10). The fracture regional stability was assessed by evaluating the amplitude of distance and angle of the fracture gap. The LPMP provided the great- est antirotational stability under both bone conditions and provided anticompression/shear stability under Nor conditions due to direct dual-column support and center symmetrical fixation. The LPMP, LPSG, and LPDP methods all showed similar anticompression/shear ability under Ost conditions; this may be due to the weak holding force between the screws and the osteoporotic bone. In general, the LPMP provided strong construct stability. Strong fixation using the LPMP is beneficial for fracture healing, and patients can perform postoperative exercise earlier to recover shoulder joint function, except for motions that induce shear load.
Show more

10 Read more

Show all 10000 documents...

Related subjects