With the inauguration of fixed-angle plates, palmar plating has become a widely accepted way to treat dorsally displaced distal radius fractures. The technique by which the plate is applied to the radius varies. Such plates are primarily fixed either distally or at the proximal limbs. In this article, the standardized technique by which osteosynthesis is conducted in our institution is described step by step. The plate is first fixed to the shaft. Reduction is temporarily maintained by K-wires that run through the plate's distal margin. These K-wires are usually reliable in maintaining adequate reduction and are gradually replaced by locking screws in the distal row. Of 96 consecutive procedures, the duration of operation, the amount of fluoroscopy needed, and the intraoperative radiographic results are reported. Using this method, constantly good results can be achieved, even if the operation is done by less experienced surgeons.
[Show abstract][Hide abstract] ABSTRACT: Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency. Stable internal fixation can be achieved with two 2.0 AO titanium plates placed on each of the 'lateral' and the 'intermediate' columns of the wrist at an angle of 50 degrees to 70 degrees. This gives good stability despite the tiny dimensions of the plates, and allows early function. We report a series of 20 fractures treated by this method of internal fixation with satisfactory results in all.
The Bone & Joint Journal 08/1996; 78(4):588-92. · 3.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the presence of "tendon irritation" of flexor pollicis longus (FPL) for cases of distal radius fracture treated with volar plates to prevent FPL tendon rupture. This report details cases of 24 patients. The presence of pain or a sense of incompatibility and subdermal crepitus around the wrist with an active thumb motion were defined as symptoms of FPL tendon irritation. Twelve of 24 patients complained of FPL tendon irritation. The plates were removed in nine of these 12 patients, while tendon injury was found in three cases. The other 12 patients did not complain of FPL tendon irritation. Four of these 12 patients underwent plate removal, and tendon injury was not detected. The results of this study indicate that FPL tendon irritation is likely to appear before tendon rupture. Therefore, FPL tendon rupture might be prevented by plate removal in patients who complained of tendon irritation.
Hand Surgery 01/2011; 16(3):271-5. DOI:10.1142/S0218810411005539
[Show abstract][Hide abstract] ABSTRACT: To determine whether use of the dorsal tangential view improves the diagnostic accuracy of intraoperative fluoroscopy compared with conventional views in detecting dorsal screw penetrations during volar distal radius plating.
Dorsal cortices of 10 cadaveric distal radii were penetrated in each of the second, third, and fourth dorsal extensor compartments at 0, 1, 2, and 3 mm penetration. We obtained 4 standardized fluoroscopic images of the wrist: lateral, supination, pronation, and dorsal tangential views. Using high-definition digital images, 2 observers blinded to the experimental paradigm determined whether screws were penetrating the dorsal cortex.
For screws that penetrated the floor of the second dorsal compartment, the 45° supination view was 92% sensitive for detecting screw penetration of 2 mm, and 98% for 3 mm. For screws that penetrated the third dorsal compartment, the lateral view was 68% and 80% sensitive in detecting screw penetrations of 1 and 2 mm, respectively. However, the dorsal tangential view showed 95% sensitivity for 1 mm and 98% for 2 mm penetrations. On the floor of the fourth dorsal compartment, pronation and dorsal tangential views were both 88% sensitive for 1 mm screw penetration and 90% and 93% for 2 mm, respectively.
The standard lateral view of the wrist failed to detect all screw penetrations. The dorsal tangential view increased the accuracy of detecting screw penetrations on the floor of the third dorsal compartment, whereas we needed oblique views to detect screw penetrations on the floors of second and fourth dorsal compartments.
Routine clinical use of the dorsal tangential view has the potential to increase accuracy in detecting dorsal screw penetration during volar plating of the distal radius.
The Journal of hand surgery 04/2012; 37(5):963-7. DOI:10.1016/j.jhsa.2012.02.026 · 1.67 Impact Factor
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