A novel technique for full anatomic restoration of volar tilt in distal radius fracture

Objective: The aim of this study was to present a technique that allows the surgeon to easily and reliably achieve volar tilt in dorsally displaced distal radius fractures treated with variable-angle volar locking plates. The study introduced this technique using 2.4 mm variable angle locking screws as reduction tools, and investigated the radiological outcomes of this technique.Methods: A total of 42 patients (30 female and 12 male; mean age: 58 years, range, 25 to 84 years) with unstable distal radius fractures were treated with this technique. All were patients with insufficient volar tilt in spite of primary fracture reduction through classic reduction techniques such as traction, manipulation, and direct fragment manipulation. Postoperatively, the patients were instructed to perform wrist active and passive motion exercises at home for minimum 30 minutes a day, and were allowed to perform activities of daily living after removal of splint. The patients were evaluated radiographically at minimum twelve months after surgery.Results: Mean follow-up period was 15.1 months (range: 12 to 24 months). Volar tilt of the distal radius before surgery was -11.9±10.4 (minus value means dorsal angulation), and after screw leverage was 11.5±4.3° (uninjured side: 11.7±2.3°). Mean radiological outcomes at final visit were as follows: volar tilt; 10.8±4.5°, radial inclination; 24±3.2°, radial height; 12.2±1.7 mm, and ulnar variance; 0.2±1.7 mm.Conclusion: We describe a simple, reliable technique to fine-tune volar tilt in dorsally displaced distal radius fractures fixed with variable-angle volar locking plates. This technique is especially useful when volar tilt remains insufficient in spite of primary fracture reduction through classic techniques

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Willis AA, Kutsumi K, Zobitz ME, Cooney WP 3rd. In- ternal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 2006;88:2411-7.

Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29:96-102.

Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence? J Bone Joint Surg Am 2008;90:1855-61.

Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial frac- tures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009;91:1837-46.

Park JH, Hagopian J, Ilyas AM. Variable-angle locking screw volar plating of distal radius fractures. Hand Clin 2010;26:373-80.

Ross M, Heiss-Dunlop W. Volar angle stable plating for distal radius fractures. In: Slutsky DJ, editor. Principle and practice of wrist surgery. Philadelphia: Saunders; 2010. p. 126-39.

Smith DW, Henry MH. Volar fixed-angle plating of the distal radius. J Am Acad Orthop Surg 2005;13:28-36.
Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
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