Surgical Treatment of Common Osteoporotic Fracture: Distal Radius

Jong Woong Park

doi:10.12671/jkfs.2010.23.4.391

Journal List > J Korean Fract Soc > v.23(4) > 1037783

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park: Surgical Treatment of Common Osteoporotic Fracture: Distal Radius

Review Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(4): 391-398.

Published online: 31 October 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.4.391

Surgical Treatment of Common Osteoporotic Fracture: Distal Radius

Jong Woong Park, M.D., Ph.D.

Address reprint requests to: Jong Woong Park, M.D., Ph.D. Department of Orthopaedic Surgery, Ansan Hospital, Korea University College of Medicine, 516, Gojan-1-dong, Danwon-gu, Ansan 425-707, Korea. Tel: 82-31-412-6583, Fax: 82-31-412-5549, ospark@korea.ac.kr

(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.

Figures and Tables

Fig. 1

K-wire fixation for the treatment of osteoporotic distal radius fracture. Increased risk of reduction loss and wire migration. Arrows show migrated K-wire with reduction loss of the fracture site.

Fig. 2

Locking plates provide improved fixability in fixation of the osteoporotic distal radius fracture.

(A) Variable angle locking plate (VA-LCP, Synthes®).

(B) Fixed angle locking plate (Aculoc, Acumed®).

Fig. 3

Advanced design of a locking plate shows low profile and meets well with the anatomy of the distal radius.

Fig. 4

Protruded radial limb of the previously used locking plate irritates skin. An arrow shows protruded edge of the plate.

Fig. 5

(A) Too much distal positioning of the plate irritates flexor tendons. An arrow indicates too distally positioned plate over the 'watershed line'. (B) Flexor tendon ruptures due to attrition by the plate end.

Fig. 6

Anatomically precontoured design of the newly developed plate allows better fitting on the volar surface of the distal radius.

Fig. 7

Sufficient exposure is important to see the intermediate column. A dot indicates an intermediate column of the distal radius.

Fig. 8

A true lateral view (articular view) is mandatory during insertion of the distal locking screws. 20 degrees of inclination of the wrist joint usually makes a true lateral view under the C-arm.

Fig. 9

Volar locking plate fixation for the distal radius fracture.

Fig. 10

Multidimentional columnar locking plate fixation for the distal radius fracture.

Fig. 11

2.0 mm small locking plate provides sufficient stability for the comminuted distal ulna fracture.

References

1. Belloti JC, Moraes VY, Albers MB, Faloppa F, Dos Santos JB. Does an ulnar styloid fracture interfere with the results of a distal radius fracture? J Orthop Sci. 2010. 15:216–222.

2. Biyani A, Simison AJ, Klenerman L. Fractures of the distal radius and ulna. J Hand Surg Br. 1995. 20:357–364.

3. Buijze GA, Ring D. Clinical impact of United versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg Am. 2010. 35:223–227.

4. Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur Vol. 2009. 34:471–474.

5. Chao EY, Inoue N, Koo TK, Kim YH. Biomechanical considerations of fracture treatment and bone quality maintenance in elderly patients and patients with osteoporosis. Clin Orthop Relat Res. 2004. (425):12–25.

6. Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989. 149:2445–2448.

7. Earnshaw SA, Aladin A, Surendran S, Moran CG. Closed reduction of colles fractures: comparison of manual manipulation and finger-trap traction: a prospective, randomized study. J Bone Joint Surg Am. 2002. 84:354–358.

8. Iida K, Sudo A, Ishiguro S. Clinical and radiological results of calcium phosphate cement-assisted balloon osteoplasty for Colles' fractures in osteoporotic senile female patients. J Orthop Sci. 2010. 15:204–209.

9. Jakob M, Rikli DA, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br. 2000. 82:340–344.

10. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004. 35:375–382.

11. Kakuda Y, Mueller DD. Effects of net charge on the hydrogen-deuterium exchange parameters of lysozyme. Arch Biochem Biophys. 1975. 171:586–596.

12. Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture? J Bone Joint Surg Am. 2010. 92:1–6.

13. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000. 15:721–739.

14. Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989. 20:208–210.

15. Lichtman DM, Bindra RR, Boyer MI, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010. 18:180–189.

16. Lozano-Calderón S, Moore M, Liebman M, Jupiter JB. Distal radius osteotomy in the elderly patient using angular stable implants and Norian bone cement. J Hand Surg Am. 2007. 32:976–983.

17. McQueen MM. Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation. J Bone Joint Surg Br. 1998. 80:665–669.

18. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am. 2004. 29:1128–1138.

19. 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.

20. Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res. 1987. 220:241–252.

21. Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int. 2005. 16:Suppl 2. S80–S84.

22. Schnall SB, Kim BJ, Abramo A, Kopylov P. Fixation of distal radius fractures using a fragment-specific system. Clin Orthop Relat Res. 2006. 445:51–57.

23. Schumer ED, Leslie BM. Fragment-specific fixation of distal radius fractures using the Trimed device. Tech Hand Up Extrem Surg. 2005. 9:74–83.

24. Seitz WH Jr, Froimson AI, Leb R, Shapiro JD. Augmented external fixation of unstable distal radius fractures. J Hand Surg Am. 1991. 16:1010–1016.

25. Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br. 1998. 80:243–248.

26. Souer JS, Ring D, Matschke S, et al. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am. 2009. 91:830–838.

27. Strohm PC, Müller CA, Boll T, Pfister U. Two procedures for Kirschner wire osteosynthesis of distal radial fractures. A randomized trial. J Bone Joint Surg Am. 2004. 86:2621–2628.

28. Tobe M, Mizutani K, Tsubuku Y. Treatment of distal radius fracture with the use of calcium phosphate bone cement as a filler. Tech Hand Up Extrem Surg. 2004. 8:95–101.

29. Trumble TE, Wagner W, Hanel DP, Vedder NB, Gilbert M. Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg Am. 1998. 23:381–394.

30. Valbuena SE, Cogswell LK, Baraziol R, Valenti P. Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases. Chir Main. 2010. 29:109–113.

TOOLS

Similar articles