Does the DVR plate recreate normal anatomy following fractures of the distal radius?

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Abstracts / Injury Extra 41 (2010) 131–166 163
2A.15
Does the DVR plate recreate normal anatomy following frac-
tures of the distal radius?
Pablo Menéndez, Shelain Patel, Henry B. Colaco
∗
, Fahad S. Hossain,
Emma J. Taylor, Marcus H. Lee
Department of Trauma & Orthopaedics, University College Hospital,
London, UK
Background: There is an increasing trend to manage distal radius
fractures with open reduction and internal fixation. Our institution
employs the DVR plate (hand innovations) for all adult patients
with unstable or malreduced fractures unless contraindicated, not
fit for anaesthesia or deemed unlikely to regain sufficient function
post-surgery. The purpose of this study is to evaluate whether this
precontoured plate with locking options can recreate normal bony
anatomy.
Patients and methods: Data on all patients admitted over a
12-month period for open reduction and internal fixation of an
unstable or malreduced distal radius fractures to our Hand Trauma
Unit was collected and analysed. Patients who had previous radial,
ulnar or carpal fractures were excluded. Standardised AP and lateral
radiographs were obtained at 2, 6, and 12 weeks and longitudinally
thereafter based upon clinical need. Assessments were made for
volar tilt (VT), radial inclination (RI) and radial length (RL). A one
sample T-test was used to evaluate the difference between radio-
logical outcomes with ‘normal’ values and an ANOVA test was used
to evaluate whether the grade of operating surgeon affected this.
Results: 48 eligible patients (18 men, 30 women, mean age 51.5
years) were identified with 8 fracture patterns (AO classification:
9:23-A2, 4:23-A3, 1:23-B1, 4:23-B2, 4:23-B3, 5:23-C1, 13:23-C2,
8:23-C3). The mean VT was 8.8
◦
(p = 0.007), RI was 21.1
◦
(p < 0.001)
and RL was 11.1 mm (p = 0.001). The operation was performed by
a consultant in 19 cases, registrar with consultant supervision in 4
cases and registrar independently in 25 cases. The grade of operat-
ing surgeon did not affect radiological parameters (VT: p = 0.28, RI:
p = 0.63, RL: p = 0.17).
Conclusions: The DVR plate is able to restore bony anatomy
within published, acceptable limits although it does not recreate
the ‘normal’ uninjured position. The implant can be used by sur-
geons of varying experience without compromising the anatomical
reduction achieved.
doi:10.1016/j.injury.2010.07.490
2A.16
Use of tutobone to augment internal fixation of three and four
part proximal humeral fractures
S. Patil
∗
, S. Ahmad, M. Ismail, R. Liow
James Cook University Hospital, Middlesbrough, United Kingdom
Introduction: Locked humeral plates have been used to fix prox-
imal humeral fractures in the past decade. It is recommended
that the locking screws should be inserted into the subchondral
bone of the humeral head in order to obtain maximal pur-
chase. However, most proximal humeral fractures in osteoporotic
patients collapse as the fracture goes on to heal. This can cause
the screws to penetrate the joint. The aim of our study was
to assess the use of tutobone (bovine cancellous bone) to aug-
ment fixation of proximal humeral fractures. Our hypothesis was
that tutobone provides structural support enabling the surgeon
to insert screws of a shorter length and thereby preventing joint
penetration.
Methods: We retrospectively reviewed patients who under-
went open reduction and internal fixation of 3 or 4 part proximal
humeral fractures between January 2002 and June 2009. All oper-
ations were performed by the senior author. In all cases, tutobone
blocks were inserted into the humeral head fragment, prior to
the reduction of the tuberosities. The fracture was then fixed
with a Philos plate. All patients were followed up for a year.
Results: 35 patients with 3 or 4 part fractures underwent the
above procedure. 1 patient developed deep infection and required
removal of metalware. 2 patients developed AVN and underwent
a hemiarthroplasty at a later date. We had no nonunions. The
mean DASH score at 1 year was 32.8. No patient developed screw
penetration.
Conclusions: Tutobone provides a good structural support in
osteoporotic proximal humeral fractures and should be used to
augment internal fixation.
doi:10.1016/j.injury.2010.07.491
2A.17
Do we need contoured plates for clavicle fractures?
S. Sadiq
∗
, T. Mahmood
Worcestershire Royal Hospital, Worcester, UK
Introduction: Clavicle fractures account for about 2–5% of all
fractures and nearly 80% of these occur in the middle 3rd of the
bone.
Management of clavicle fractures has changed over last decade.
Traditionally majority of clavicle fractures have been treated non-
operatively. This is fine for undisplaced or minimally displaced
fractures but in case of displaced fractures there is higher rate of
non-union and malunion. Displaced midshaft fractures can cause
significant persistant disability even if they have healed. There-
fore many surgeons are now getting more inclined towards early
fixation of these fractures.
We have looked at 16 patients who underwent open reduction
and internal fixation for displaced midshaft clavicle fractures. We
have accessed the surgical technique, fracture healing and func-
tional outcome.
Material and methods: We have retrospectively looked at 16
patients who underwent open reduction and internal fixation of
displaced midshaft clavicle fractures. This included 13 males and 3
females. Average age was 35 years.
12 patients were operated due to non-union where as 4 pts
underwent early surgery due to very displaced nature of there frac-
tures. All fractures were fixed using AO reconstruction plates. Bone
graft from iliac crest was used in 3 patients. All patients were fol-
lowed up until fracture healing. Functional outcome was accessed
using DASH score.
Results: Average healing time was 10 weeks. There was no infec-
tion. Three patients continue to have minor irritation from plate but
none of the 16 pts required plate removal within 2 years. Average
DASH score was 19 at the time of study.
In the non-union group average time of surgery was 6.9 months
after sustaining the fracture. 10 of the 12 pts in the non-union group
said they would have preferred an earlier operation.
On average it took 14 weeks after surgery for them to go back
to normal activities
Conclusion: We conclude that in displaced midshaft clavicle frac-
tures there should be low threshold for early fixation. Use of fancy,
precontoured and expensive plates is unnecessary. Ordinary AO
reconstruction plates do provide satisfactory results.