Operative treatment and outcome of unstable distal radial fractures using a palmar T-miniplate at a non-specialized institution

E Skouras, Y Hosseini, V Berger, K Wegmann, T C Koslowsky, E Skouras, Y Hosseini, V Berger, K Wegmann, T C Koslowsky

Abstract

Treatment options for displaced distal radial fractures are still a controversial topic of discussion. Although good results for the palmar plating of high-volume centers have been published, evidence of its successful use in smaller institutions is still lacking. We report the clinical and radiological results of the treatment for 84 distal radial fractures with a single 2.4-mm T-miniplate in an institution performing <30 procedures per year. According to the AO classification system, there were 30 A, 5 B, and 49 C fractures with a patients mean age of 64 years. After a minimum of 12-month follow-up, we found very good and good results according to the Gardland and Sarmiento scores and a DASH of 5.6. Only five patients were classified as having a moderate outcome. A remaining intra-articular step-off of more than 1 mm was seen in 15 patients. In a comparison of grip strength between the injured and uninjured hands, we saw a difference of 6.8 % less on the injured side. We saw two instances of tendon rupture and one of tendon irritation due to prominent dorsal screws and necessitating revision surgery. Flexor tendon irritation was noted in one patient, requiring a second operation. Modern treatment for distal radial fractures can be performed successfully and with good clinical outcome in smaller institutions. Based on the high and increasing incidence of distal radial fractures, there is no need to transfer these patients into high-volume centers. Level of evidence Case study, Level IV.

Figures

Fig. 1
Fig. 1
A fluoroscopy of the dimensions of the palmar miniplate on a sawbone model. The right side of the picture shows the self-cutting 3.5-mm screws for the long bar of the plate. Six smaller 2.2-mm locked angle miniscrews have been placed at the distal part of the plate, each addressing as many fracture fragments as possible
Fig. 2
Fig. 2
A complex AO C2 distal radial fracture and its reconstruction with a locked angle miniplate. The clinical result shows a free and unlimited function of the wrist. The patient only complains a prominent ulnar head without pain due to the nonunion of the ulnar styloid and minimal ulnar plus. The increased radial inclination was asymptomatic

References

    1. O’Neil TW, Cooper C, Fin JD, et al. Incidence of distal forearm fractures in British men and women. Osteoporos Int. 2001;12:555–558. doi: 10.1007/s001980170076.
    1. Rueger M, Linhardt W, Sommerfeld DW (1998) Differenzialindikation zur Behandlung der distalen Radiusfraktur Trauma und Berufskrankheit 1:6–14
    1. Handoll HH, Madhock R (2003) Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev, CD003209
    1. Abramo A, Kopylov P, Geijer M, Tugil M. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients. Acta Orthop. 2009;80(4):478–485. doi: 10.3109/17453670903171875.
    1. Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am. 2009;91(7):1568–1577. doi: 10.2106/JBJS.H.00722.
    1. Gofton W, Liew A. Distal radius fractures: nonoperative and percutaneous pinning treatment options. Hand Clin. 2010;26(1):43–53. doi: 10.1016/j.hcl.2009.08.012.
    1. Rosental TD, Beredjikian PK, Bozentka GJ. Function outcome and complications following two types of plating fort he distal part of the radius. J Bone Joint Surg Am. 2003;85:1956–1965.
    1. Knight D, Hajducka C, Will E, McQueen M. Locked volar plating for unstable distal radial fractures: clinical and radiological outcomes. Injury. 2010;41(2):184–189. doi: 10.1016/j.injury.2009.08.024.
    1. Jupiter JB, Marent-Huber M, LCP Study Group Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am. 2009;91(1):55–65. doi: 10.2106/JBJS.G.01498.
    1. Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M. Unstable distal radius fractures in the elderly patient–volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma. 2010;68(4):992–998.
    1. Jupiter JB, Marent-Huber M, LCP Study Group Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl):1.
    1. Smith DW, Henry MH. Volar fixed angle plating of distal radial fractures. JAAOS. 2005;13:28–36.
    1. Knirk JL. Jupiter JB Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68(5):647–659.
    1. Melone CP. Articular fractures of the distal radius. Orthop Clin North Am. 1984;15:215–236.
    1. McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius, randomized comparison of four treatment methods. J Bone Joint Surg Br. 1988;70:649–651.
    1. Sarmiento A, Pratt GW, Berry NC, et al. Colles fractures. Functional bracing in supination. JBJS (Am) 1975;57(3):311–317.
    1. Gardland JJ, Jr, Werley CW. Evaluation of healde ‘Colles’ fractures. J Bone Joint Surg. 1951;33:895–907.
    1. Hudak Pl, Amadino PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disability of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG) Am J Ind Med. 1996;29:602–608. doi: 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>;2-L.
    1. Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am. 2010;92(9):1851–1857. doi: 10.2106/JBJS.I.00968.
    1. Koenig KM, Davis GC, Grove MR, Tosteson AN, Koval KJ. Is early internal fixation preferred to cast treatment for well-reduced unstable distal radial fractures? J Bone Joint Surg Am. 2009;91(9):2086–2093. doi: 10.2106/JBJS.H.01111.
    1. Tyllianakis M, Mylonas S, Saridis A, Kallivokas A, Kouzelis A, Megas P. Treatment of unstable distal radius fractures with Ilizarov circular, nonbridging external fixator. Injury. 2010;41(3):306–311. doi: 10.1016/j.injury.2009.09.011.
    1. 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 (N Y) 2008;3(2):111–117. doi: 10.1007/s11552-007-9080-0.
    1. Drobetz H, Bryant AL, Pokorny T, Spitaler R, Leixnering M, Jupiter JB. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction–a biomechanic study in a cadaveric model. J Hand Surg Am. 2006;31(4):615–622. doi: 10.1016/j.jhsa.2006.01.011.
    1. Anderson TJ, Lucas GL, Buhr BR. Complications of treating distal radius fractures with external fixation: a community experience. Iowa Orthop J. 2004;24:53–59.
    1. Capo JT, Swan GK, Jr, Tan V. External fixation techniques for distal radius fractures. Clin Orthop. 2006;445:30–41.
    1. Margilot Z, Haase SC, Kotis SV, Kim HM, Chung KC. A metaanalysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg (Am) 2005;30(6):1185–1199.
    1. Beson EC, De Carvalho A, Mikola EA, et al. Two potential causes of EPL rupture after distal radius volar plating. Clin Orthop. 2006;451:218–222. doi: 10.1097/01.blo.0000223998.02765.0d.
    1. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237–242. doi: 10.1097/BOT.0b013e31819b24e9.

Source: PubMed

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