Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 8 , ISSUE 3 ( November, 2013 ) > List of Articles

Original Article

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

Keywords : Distal radial fractures, T-miniplate osteosynthesis

Citation Information : Skouras E, Hosseini Y, Berger V, Wegmann K, Koslowsky TC. Operative treatment and outcome of unstable distal radial fractures using a palmar T-miniplate at a non-specialized institution. 2013; 8 (3):155-160.

DOI: 10.1007/s11751-013-0170-y

License: CC BY-NC-SA 4.0

Published Online: 30-11-2013

Copyright Statement:  Copyright © 2013; The Author(s).


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.


PDF Share
  1. O'Neil TW, Cooper C, Fin JD et al (2001) Incidence of distal forearm fractures in British men and women. Osteoporos Int 12:555-558
  2. Rueger M, Linhardt W, Sommerfeld DW (1998) Differenzialindikation zur Behandlung der distalen Radiusfraktur Trauma und Berufskrankheit 1:6-14
  3. Handoll HH, Madhock R (2003) Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev, CD003209
  4. Abramo A, Kopylov P, Geijer M, Tugil M (2009) Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients. Acta Orthop 80(4):478-485
  5. Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP (2009) 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 91(7):1568-1577
  6. Gofton W, Liew A (2010) Distal radius fractures: nonoperative and percutaneous pinning treatment options. Hand Clin 26(1):43-53
  7. Rosental TD, Beredjikian PK, Bozentka GJ (2003) Function outcome and complications following two types of plating fort he distal part of the radius. J Bone Joint Surg Am 85:1956-1965
  8. Knight D, Hajducka C, Will E, McQueen M (2010) Locked volar plating for unstable distal radial fractures: clinical and radiological outcomes. Injury 41(2):184-189
  9. Jupiter JB, Marent-Huber M, LCP Study Group (2009) Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am 91(1):55-65
  10. Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M (2010) Unstable distal radius fractures in the elderly patient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma 68(4):992-998
  11. Jupiter JB, Marent-Huber M, LCP Study Group (2010) Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am 92(Suppl):1
  12. Smith DW, Henry MH (2005) Volar fixed angle plating of distal radial fractures. JAAOS 13:28-36
  13. Knirk JL (1986) Jupiter JB Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68(5):647-659
  14. Melone CP (1984) Articular fractures of the distal radius. Orthop Clin North Am 15:215-236
  15. McQueen MM, Hajducka C, Court-Brown CM (1988) Redisplaced unstable fractures of the distal radius, randomized comparison of four treatment methods. J Bone Joint Surg Br 70:649-651
  16. Sarmiento A, Pratt GW, Berry NC et al (1975) Colles fractures. Functional bracing in supination. JBJS (Am) 57(3):311-317
  17. Gardland JJ Jr, Werley CW (1951) Evaluation of healde ‘Colles’ fractures. J Bone Joint Surg 33:895-907
  18. Hudak Pl, Amadino PC, Bombardier C (1996) 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 29:602-608
  19. Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N (2010) Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am 92(9):1851-1857
  20. Koenig KM, Davis GC, Grove MR, Tosteson AN, Koval KJ (2009) Is early internal fixation preferred to cast treatment for well-reduced unstable distal radial fractures? J Bone Joint Surg Am 91(9):2086-2093
  21. Tyllianakis M, Mylonas S, Saridis A, Kallivokas A, Kouzelis A, Megas P (2010) Treatment of unstable distal radius fractures with Ilizarov circular, nonbridging external fixator. Injury 41(3):306-311
  22. Rizzo M, Katt BA, Carothers JT (2008) Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intraarticular distal radius fractures. Hand (N Y) 3(2):111-117
  23. Drobetz H, Bryant AL, Pokorny T, Spitaler R, Leixnering M, Jupiter JB (2006) 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 31(4):615-622
  24. Anderson TJ, Lucas GL, Buhr BR (2004) Complications of treating distal radius fractures with external fixation: a community experience. Iowa Orthop J 24:53-59
  25. Capo JT, Swan GK Jr, Tan V (2006) External fixation techniques for distal radius fractures. Clin Orthop 445:30-41
  26. Margilot Z, Haase SC, Kotis SV, Kim HM, Chung KC (2005) A metaanalysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg (Am) 30(6):1185-1199
  27. Beson EC, De Carvalho A, Mikola EA et al (2006) Two potential causes of EPL rupture after distal radius volar plating. Clin Orthop 451:218-222
  28. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M (2009) 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 23(4):237-242
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.