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

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

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.

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References

  1. Golden GN (1963) Treatment and prognosis of Colles fracture. Lancet 1:511–514. doi:10.1016/S0140-6736(63)91321-7

    Article  PubMed  CAS  Google Scholar 

  2. Uzdil T, Neumann W, Bauschke A (2001) Die palmare winkelstabile Plattenosteosynthese bei distalen Radiusextensionsfrakturen. Akt Traumatol 31:141–148. doi:10.1055/s-2001-16372

    Article  Google Scholar 

  3. Zettl RP, Ruchholtz S, Taeger G, Obertacke U, Nast-Kolb D (2001) Postoperative morbidity in surgically treated extension fractures of the distal radius. A comparative study of dorsal and volar approach. Unfallchirurg 104(8):710–715. doi:10.1007/s001130170072

    Article  PubMed  CAS  Google Scholar 

  4. Rueger M, Linhart W, Sommerfeldt DW (1998) Differentialindikation zur Behandlung der distalen Radiusfraktur. Trauma Berufskrankheit 1:6–14

    Google Scholar 

  5. Heim U (1979) Die gelenknahen Speichenbrüche des Erwachsenen. Unfallheilkunde 82:15–22

    PubMed  CAS  Google Scholar 

  6. Petracic B (1993) Treatment of distal multi-fragment joint fractures of the radius. Indications, technique and results. Chirurg 64(11):894–898

    PubMed  CAS  Google Scholar 

  7. Siebert HR (1997) Distale Radiusfraktur an typischer Stelle. Akt Traumatol 27:7–15

    Google Scholar 

  8. Majetschak M, Kock H, Neudeck F, Schmit-Neuerburg KP (1997) Unfallursachen und Verletzungsmuster bei In-line-Skating. Unfallchirurgie 23:171–178. doi:10.1007/BF02630224

    Article  PubMed  CAS  Google Scholar 

  9. Eingartner C, Müller JE, König CG, Weiser K (2000) Behandlungsergebnisse der operativen Therapie distaler Radiusfrakturen. Aktuelle Traumatol 30:32–36

    Google Scholar 

  10. Rodriguez-Merchan EC (1998) Management of comminuted fractures of the distal radius in the adult. Conservative or surgical? Clin Orthop Relat Res 353:53–62. doi:10.1097/00003086-199808000-00007

    Article  PubMed  Google Scholar 

  11. Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults: the influence or age an gender. J Bone Joint Surg Br 80(2):243–248. doi:10.1302/0301-620X.80B2.7762

    Article  PubMed  CAS  Google Scholar 

  12. Altissimi M, Antenucci R, Fiacca G, Mancini G (1986) Long term results of consercative treatment of the fractures of the distal radius. Clin Orthop Relat Res 206:202–210

    PubMed  Google Scholar 

  13. Aulicino PL, Siegel JL (1991) Acute injuries of the distal radioulnar joint. Hand Clin 7:283–293

    PubMed  CAS  Google Scholar 

  14. Bade H, Lehmann J, Schubert M (1993) Morphologische Ursachen und Konsequenzen der Fraktur des distalen Radius. Unfallchirurgie 19:195–201. doi:10.1007/BF02588053

    Article  PubMed  CAS  Google Scholar 

  15. Colles A (1814) On the fracture of the carpal extremity of the radius. Edinb Med Surg J 10:182–186

    Google Scholar 

  16. Germann G, Wind G, Harth A (1999) Der DASH-Fragebogen–Ein neues Instrument zur Beurteilung von Behandlungsergebnissen an der oberen Extremität. Handchir Mikrochir Plast Chir 31:149–152. doi:10.1055/s-1999-13902

    Article  PubMed  CAS  Google Scholar 

  17. Castaing J (1964) Recent fractures of the lower extremity of the radius in adults. Rev Chir Orthop Reparatrice Appar Mot 50:581–696

    PubMed  CAS  Google Scholar 

  18. Fernandez DL (2000) Should anatomic reduction be pursued in distal radial fractures? J Hand Surg Br 6:523–527. doi:10.1054/jhsb.2000.0516

    Google Scholar 

  19. Aro HAT, Koivunen T (1991) Minor axial shortening of the radius affects outcome of colles fracture treatment. J Hand Surg Am 16:392–398. doi:10.1016/0363-5023(91)90003-T

    Article  PubMed  CAS  Google Scholar 

  20. Kwasny O, Barisani GR, Schabus R, Hertz H (1991) Ergebnisse und Analyse von Misserfolgen der konservativen Therapie bei distaler Radiusfraktur. Handchir Mikrochir Plast Chir 23:240–244

    PubMed  CAS  Google Scholar 

  21. Carter PR, Frederick HA, Laseter GF (1998) Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg Am 23:300–307. doi:10.1016/S0363-5023(98)80131-7

    Article  PubMed  CAS  Google Scholar 

  22. Joosten U, Joist A, Frebel T, Rieger H (1999) Die Behandlung instabiler distaler Radiusfrakturen mit einem transartikulären Fixateur externe: Ergebnisse einer Langzeitbeobachtung. Chirurg 70:1315–1322. doi:10.1007/s001040050786

    Article  PubMed  CAS  Google Scholar 

  23. Klein W, Dee W, Rieger H, Joosten U (2000) Results of transarticular application in distal radius fractures. Injury 31:71–77. doi:10.1016/S0020-1383(99)00265-X

    Article  PubMed  Google Scholar 

  24. Steffen T, Eugster T, Jakob RP (1994) Twelve years follow-up of fractures of the distal radius treated with the AO external fixator. Injury 25:44–54

    Google Scholar 

  25. Thielke KH, Wagner T, Giers R, Echtermayer V (2001) Ambulante KD-Stiftung distaler Radiusfrakturen. Akt Traumatol 31:256–260. doi:10.1055/s-2001-18727

    Article  Google Scholar 

  26. Thielke KH et al (2002) Winkelstabile Plattenosteosynthese am distalen Radius: Lösung einer Problemfraktur? Akt Traumatol 32:245–250. doi:10.1055/s-2002-36384

    Article  Google Scholar 

  27. Henry MH, Griggs SM, Levaro F, Clifton J, Masson MV (2001) Volar approach to dorsal displaced fractures of the distal radius. Tech Hand upper extremity 1:31–41

    Article  Google Scholar 

  28. Sakhaii M, Groenewold U, Klonz A, Reilman H (2003) Ergebnisse nach palmarer Plattenosteosynthese mit der winkelstabilen T-Platte bei 100 distalen Radiusfrakturen. Unfallchirurg 4:272–280. doi:10.1007/s00113-002-0547-8

    Article  Google Scholar 

  29. Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2:205–215. doi:10.1053/jhsu.2002.32081

    Article  Google Scholar 

  30. Krimmer H, Pessenlehner C, Haßelbacher K, Meier M, Roth F, Meier R (2004) Palmare winkelstabile Plattenosteosynthese der instabilen distalen Radiusfraktur. Unfallchirurg 107:460–467. doi:10.1007/s00113-004-0794-y

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest statement

None of the authors will receive benefits from a commercial party related directly or indirectly to the subject of this article. There is no commercial connection between the authors and Medartis AG.

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Authors and Affiliations

  1. Trauma Center Lorenz Boehler, Donaueschingenstrasse 13, 1200, Vienna, Austria

    Markus Figl, Patrick Weninger, Michael Liska & Martin Leixnering

  2. Department of Traumatology, General Hospital Vienna, Vienna Medical School, Waehringer Guertel, 1090, Vienna, Austria

    Marcus Hofbauer

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  1. Markus Figl
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  2. Patrick Weninger
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  3. Michael Liska
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  4. Marcus Hofbauer
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Correspondence to Markus Figl.

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Figl, M., Weninger, P., Liska, M. et al. Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129, 661–669 (2009). https://doi.org/10.1007/s00402-009-0830-z

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  • DOI: https://doi.org/10.1007/s00402-009-0830-z

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