Use of Miniplate for Severe Comminuted Metadiaphyseal Fractures of the Distal Radius

Jong-Ryoon Baek; Yong-Cheol Yoon; Yong-Cheol Baek

doi:10.12671/jkfs.2019.32.4.204

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Baek, Yoon, and Baek: Use of Miniplate for Severe Comminuted Metadiaphyseal Fractures of the Distal Radius

Original Article

J Korean Fract Soc 2019;32(4):204-210.

Published online: 10 January 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.4.204

Use of Miniplate for Severe Comminuted Metadiaphyseal Fractures of the Distal Radius

Jong-Ryoon Baek, M.D., Ph.D., Yong-Cheol Yoon, M.D., Ph.D.^‗, Yong-Cheol Baek, M.D.

Department of Orthopaedic Surgery, Gachon University College of Medicine, Orthopedic Trauma Division, Trauma Center Korea

^‗Department of Orthopaedic Surgery, Gachon University College of Medicine, Incheon Korea

Correspondence to: Yong-Cheol Yoon, M.D., Ph.D. Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-2140 Fax: +82-32-460-2372 E-mail: dryoonyc@gmail.com

Jong-Ryoon Baek's current affiliation: Jamsil Worldtower Orthopaedic Clinic, Seoul, Korea Financial support: None. Conflict of interests: None.

Received 24 September 2019 Revised 11 October 2019 Accepted 11 October 2019

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

This study investigated the clinical and radiological outcomes of patients undergoing provisional fixation in conjunction with locking plate fixation. Miniplates were used as the reduction plates for the surgical treatment of severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius.

Materials and Methods

The radial length, radial inclination, volar tilt, and radial intra-articular step-off were measured preoperatively, postoperatively, and at one year after surgery in 12 patients (eight males, four females, mean age 55.4 years old). The patients underwent volar locking plate fixation with miniplate as a reduction plate for severe comminuted metadiaphyseal fractures with an intra-articular fracture of the distal radius. Clinical evaluations were conducted using the modified Mayo wrist score (MMWS).

Results

Bone union was achieved in all cases. The mean MMWS was 81.8 points, including two excellent, three good, and seven fair cases. Radiological improvements were observed in the average radial length (preoperative, 6.4 mm; postoperative, 11.8 mm), average radial inclination (10.2° to 22.4°), average volar tilt (–4.5° to 10.6°), and average radial intra-articular step-off (4.8–0.8 mm) (all, p<0.05). Radiographic measurements obtained immediately after surgery and at the final follow-up revealed insignificant decreases in radial length (0.6 mm), radial inclination (0.4°), and volar tilt (0.9°) (all, p>0.05).

Conclusion

Miniplate fixation can be an effective treatment option as a reduction plate for the treatment of distal radial fractures, which is challenging to reduce and maintain due to severely comminuted metadiaphysis fractures with the intra-articular fracture.

Keywords: Distal radius fracture, Metadiaphyseal fracture, Comminuted fractures, Fracture reduction, Miniplate

References

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Fig. 1.

A 55-year-old male (patient No. 8) visited the emergency room with a distal radial fracture due to a 2-m fall. (A) Preoperative computed tomography allowed the numbering of each fragment. (B) Following the anterior Henry approach, (C) fragments 1 and 5 were reduced using 1.5-mm miniplates for radial height restoration, and (D) fragments 4 and 5 were reduced using 2.0-mm miniplates.

Fig. 2.

Intraoperative image obtained using an image intensifier. (A, B) Miniplate was used as a reduction plate. (C) Volar locking plate was used as a definitive fixation plate.

Fig. 3.

(A) Anteroposterior and (B) lateral radiographs, (C) clinical image, and (D) computed tomography image of the wrist of a 59-year-old male (patient No. 11) with a metadiaphyseal comminuted distal radial open fracture (Gustilo–Anderson classification IIIA) due to a crush injury. The associated injuries include metacarpal fractures 3, 4, and 5 and an ulnar styloid process fracture.

Fig. 4.

Meticulous debridement and irrigation were performed on the day of admission, and an external fixator was applied to the fracture site. (A) Two weeks later, definitive surgery was performed when the soft tissue was healed and infection is not evident. (B) Secure surgical fixation of the small metadiaphyseal comminuted fragments involves the use of a miniplate, (C) image intensifier confirmation, and (D) fixation using a definitive plate.

Table 1.

Radiological Data for Distal Radial Fractures Treated Using Volar Locking Plates and Reduction Plates

	Before surgery	After surgery	p-value	At final follow-up	p-value
Radial length (mm)	6.4 (2.3–9.6)	11.8 (9.5–14.9)	0.01	11.2 (9.2–14.3)	0.54
Radial inclination (°)	10.2 (6.4–25.5)	22.4 (17.3–28.8)	0.01	22.0 (16.9–27.5)	0.81
Volar tilt (°)	–4.5 (–16.1–22.8)	10.6 (2.3–16.8)	0.01	9.7 (1.3–15.8)	0.49
Intra articular step-off (mm)	4.8 (2.1–8.3)	0.8 (0.1–1.2)	0.02	0.9 (0.1–1.4)	0.39

Table 2.

Demographics, Injury Types, and Treatment Information of the 12 Patients

Patient No.	Age (yr)	Sex	Injury mechanism	AO/OTA classification	G–A classification	Combine orthopedic injury	Miniplate (mm)	Time to union (mo)	MMWS
1	50	M	Crushing injury	23C2	IIIA	Ulnar styloid process fracture	1.5	6	Good
2	44	M	Crushing injury	23C3	IIIA	Scaphoid fracture	1.5	6	Fair
3	28	F	Fall down	23C2	II	Humerus shaft fracture	1.5	6	Good
4	54	M	Fall down	23C2	Close	Ulnar head fracture, TFCC injury	1.5	8	Excellent
5	41	M	Fall down	23C3	II	Distal ulnar neck fracture	1.5	8	Fair
						Humerus surgical neck fracture,
						olecranon fracture
6	62	M	Fall down	23C3	II	Ulnar head fracture	1.5	8	Fair
7	77	F	Slip down	23C3	II	Galeazzi fracture	2.0	6	Fair
8	55	M	Fall down	23C3	Close	None	1.5	5	Excellent
9	76	F	Slip down	23C2	Close	Ulnar styloid process fracture	1.5	6	Good
10	55	F	Slip down	23C3	Close	Ulnar styloid process fracture	1.5	6	Fair
11	59	M	Crushing injury	23C2	IIIA	Ulnar styloid process fracture	1.5, 2.0	7	Fair
						3,4,5 metacarpal fracture
12	64	M	Fall down	23C3	Close	Ulnar head fracture	2.0	10	Fair

M: male, F: female, AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, G–A: Gustilo–Anderson, MMWS: modified Mayo wrist score, TFCC: triangular fibrocartilage complex.

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