Floor plan - 2013 Annual Meeting - American Association for Hand ...

The volar aproach for fractures of the distal radius: 100 patients analysis
Institution where the work was prepared: Faculdade de Medicina do ABC, Santo Andre, Brazil
Marcio A. Aita, MD1; Gustavo M. Ruggiero, MD1; Alvaro B. Cho, MD1; Walter Y. Fukushima, MD1; W. Lino Jr, MD2;
Fabiano N. Faria, MD2; (1)Faculdade de Medicina do ABC, (2)Beneficencia Portuguesa Hospital
ABSTRACT
We review the results of 100 patients with distal radius fractures treated surgically by the volar aproach and fixation with fixed-angle volar
plate, since march 2002 to december 2005. The indications were: instability only (17%), instability and articular displacement (72%), articular
displacement only (5%) , contralateral upper limb fracture (3%) and refusal of non-operative treatment by the patient (3%). There was
58% female and 42% male, age was 46,8 years (11 to 81 years). Radiographic averages results after surgery shows Dorsal Tilt of ñ 8o (2o
to -18o), Radial Inclination of 19o (-8o to 24o), Radial Shortening of 0,5mm (0mm to 6mm) and articular surface displacement of 0,13mm
(0mm to 1mm). Compared to the contralateral wrist we found the Dorsal Tilt correction of 97% (70% to 100%) and Radial Inclination correction
of 95% (65% to 100%). The flexion-extension range of motion was 144o again 147o of oppositive side (98% of normal ROM), pronation-supination
ROM was 176o again 177o of contralateral limb (99% of normal ROM) and radial-ulnar deviation of 41o again 45o of other
wrist (91% of normal ROM). According Gartland score we found 86% of excellent, 10% good and 4% fair results. There were 2 infections,
and 2 patients with loosening of reduction. Fracture healing occurs at an average 8 weeks time in all patients. We consider the volar
aproach and fixation with volar fixed-angle plates the best treatment choice for fractures of the distal radius when surgical treatment is
indicated. This can lead to lower rates of complications and improved functional and radiographic results compared to other techniques.
Mechanical Effect of Metaphyseal Plate Stand-off in Radius Volar Plates
Institution where the work was prepared: University of Arkansas, Little Rock, AR, USA
Randy R. Bindra, MD, FRCS; Sivathan Kumar; William R Hogue; University of Arkansas for Medical Sciences
PURPOSE:
Volar fixation with a locking plate has become the standard of care for operative management of dorsally unstable distal radius fractures.
Traditional locking plates are based on screws locking into the plate upon tightening ñ the plate is not compressed against the
metaphysis and may stand off. The purpose of this study was to examine the mechanical effect of plate stand-off from the radius metaphysis
in an unstable radius fracture model. To our knowledge, this has not been previously examined.
METHODS:
An unstable extra-articular distal radial fracture was simulated using a Sawbones foam model by excising a 5mm dorsal wedge 2 cm
from the distal articular surface. Group 1 specimens (n=5) were fixed with a locking volar plate (DVO, IN) with the plate flush against the
specimen. In Group 2 (n=5),the plate was fixed with a 4mm standoff from the distal metaphysis. The specimens were vertically loaded
to failure at the rate of 0.1 mm/s using a servo-hydraulic machine (MTS Systems MN) and the stiffness, yield point and load to ultimate
failure were recorded.
RESULTS:
Axial loading resulted in fracture collapse followed by fixation failure at the most proximalscrew hole. The point of initial yield was similar
in both groups(group 1: 562 (+26) N; group 2: 549 (+48) N). The specimens in group I failed at a higher ultimate load of 1337 (+162)
N compared to 1179 (+246) N in group II but this difference did not reach statistical significance. The specimens in group 1 were significantly
stiffer at 485 (+79) N/mm versus 366 (+55) N/mm in group 2 where the plate had a 4 mm standoff (p=0.026).
SUMMARY:
Failure to seat a volar plate flush against the radius metaphysis reduces stiffness and may clinically result in fracture collapse with early
mobilization. Newer plate designs that utilize alternative locking technology instead of threaded plate holes such as the "CoverLoc"
plate may be advantageous as they allow plate compression against the metaphysis during screw insertion.
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