Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients

Jin-Hyung Im; Sung-Woo Huh; Min-Kyu Park; Joo-Yup Lee

doi:10.12790/jkssh.2015.20.3.96

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Im, Huh, Park, and Lee: Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients

Original Article

J Korean Soc Surg Hand 2015;20(3):96-103.

Published online: 11 September 2015

DOI: https://doi.org/10.12790/jkssh.2015.20.3.96

Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients

Jin-Hyung Im¹, Sung-Woo Huh², Min-Kyu Park¹, Joo-Yup Lee¹

¹Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Department of Orthopedic Surgery, Hong-Ik Hospital, Seoul, Korea

Correspondence to: Joo-Yup Lee Department of Orthopedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea TEL: +82-31-249-8301 FAX: +82-31-254-7186 E-mail: jylos@gmail.com

Received 26 July 201525 August 20151 September 2015 Accepted 3 September 2015

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

Purpose:

Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula.

Methods:

From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis. Scheduled hemodialysis was possible on the next day of surgery without splint. We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up.

Results:

All fractures achieved anatomical reduction and united at final followup. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22.

Conclusion:

Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don’t seem to increase the vascular complications like hematoma and fistula occlusion.

Keywords: Distal radius, Hemodyalisis, Arteriovenous fistula, Fracture, Volar locking plate

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Fig. 1.

(A) The upper arm which have distal radius fracture with ipsilateral arteriovenous fistula is on hand table. (B) Standard flexor carpi radialis (FCR) approach is performed. The FCR sheath including the radial artery is retracted to radial side. (C) Scheduled hemodyalisis was conducted on the first day after operation. (D) Wrist exercise was started without drain on the third day after operation.

Fig. 2.

Radiographic images of 64 aged female with distal radius fracture and ipsilateral arteriovenous fistula show normal radiologic parameters and union in last follow-up.

Fig. 3.

The patients showed good range of motion in last follow-up.

Fig. 4.

Doppler sonography shows normal blood flow and no occlusion of fistula.

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