Implant Selection for Treatment of Distal Radius Fractures

Joo-Yup Lee; Seungho Bae

doi:10.4055/jkoa.2013.48.2.142

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Lee and Bae: Implant Selection for Treatment of Distal Radius Fractures

Symposium

Treatment of Distal Radius Fracture and Combined Injuries

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2013; 48(2): 142-150.

Published online: 25 April 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.2.142

Implant Selection for Treatment of Distal Radius Fractures

Joo-Yup Lee, M.D., Ph.D., Seungho Bae, M.D.

Department of Orthopedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

Correspondence to: Joo-Yup Lee, M.D., Ph.D. Department of Orthopedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 442-723, Korea. TEL: +82-31-249-8301, FAX: +82-31-254-7186, jylos1@gmail.com

Received 4 February 2013 Revised 14 February 2013 Accepted 18 February 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Anatomical reduction is essential for successful treatment of distal radius fractures. In-depth understanding of the implant is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid implant-related complications. Selection of an improper implant and screw length may lead to rupture of flexor or extensor tendon as a complication. This article will briefly discuss the pros and cons of the traditional fixation methods such as percutaneous pin fixation and external fixation, and will focus on the recent development of the volar locking plate. Variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation, may have inadequate fixation strength if screw locking is repeated. From the biomechanical study, at least four distal locking screws are enough to have strength to maintain fracture fixation. Measuring screw length may be difficult; therefore, information about the ratio of the metaphysis and diaphysis will be helpful in deciding on the proper screw length. Locking screws are recommended as they are stronger than locking pegs. In order to avoid flexor tendon ruptures, the plate should not be placed too far distally.

Keywords: distal radius fractures, volar locking plates

Figures and Tables

Figure 1

Intrafocal pin fixation to reduce and maintain the distal radius fractures.

Figure 2

Dorsal subluxation of the ulna head after external fixation results in loss of supination.

Figure 3

Dorsal plating for fixation of the large dorsal ulnar fragment involving sigmoid notch.

Figure 4

Loosening of the non-locking screws results in loss of volar tilt.

Figure 5

Various volar locking plates available in Korea. (A) DePuySynthes (West Chester, PA, USA) variable-angle two-column plate. (B) DePuySynthes extra-articular plate. (C) DePuySynthes variable-angle volar rim plate. (D) DePuy Synthes juxta-articular plate. (E) Acumed (Hillsboro, OR, USA) Acu-Loc volar distal radius plate. (F) Medartis (Basel, Switzerland) Aptus distal radius adaptive plate. (G) Medartis Aptus distal radius correction plate. (H) Stryker (Kalamazoo, MI, USA) Variax distal radius locking plate. (I) BK meditech volar distal radius plate. (J) Tradimedics APIS distal radius plate.

Figure 6

(A) White arrow indicates proposed watershed line by Imatani et al.37) Black line indicates distal bony prominence. (B) Small lunate facet fragment necessitates suture fixation.

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