Luke P. Robinson, MD, Rashad H. Usmani, MD, Victor Fehrenbacher, MD, Lauren Protzer, MD

Journal of Wrist Surgery, March 24 2021

Background: Extra-articular fractures of the distal radius are often treated with a trial of nonoperative management if radiographic parameters are within an acceptable range, especially in the elderly population. Unfortunately, some malunions become symptomatic or become grossly misaligned during nonoperative management which require corrective surgery to restore the normal osseous anatomy and restore function.

Description of Technique: We describe correction of a distal radius malunion utilizing a distraction-type volar osteotomy, a volar plate specific distraction device, and a novel resorbable calcium phosphate bone cement (Trabexus) designed to withstand compressive loads.

Patients and Methods: Twelve patients with 13 distal radius fractures were included in this study. The average patient age was 60.9 years and average time from injury to corrective osteotomy was 96.3 days. Radiographic measures (radial inclination, volar tilt, and ulnar variance) and clinical assessment (wrist/forearm range of motion and grip strength) were done pre- and postoperatively and compared.

Results: The average time from corrective surgical osteotomy to final clinical followup was 375.8 days. After surgical intervention, there was a statistically significant improvement in mean volar tilt (19.8 vs. þ0.5 degrees) and mean ulnar variance (þ2.8 vs. 0.4 mm). Improvements were also seen in grip strength (1.7 vs. 43.6 lb), wrist flexion (30.5 vs. 48.3 degrees), wrist extension (33.3 vs. 53.8 degrees), forearm pronation (75.0 vs. 88.8 degrees), and forearm supination (53.8 vs. 81.3 degrees). On average, 56.0% of Trabexus bone substitute remained on final clinical radiographs. Conclusion This simplified technique of distraction corrective osteotomy after distal radius malunion results in improved clinical and radiographic outcomes for patients.

Wang, W.L., and Tosti, R. (2018)

Techniques in Hand and Upper Extremity Surgery, 22 (3), 116-119.

Abstract: We describe a novel technique in correcting distal radius fractures deformed with significant shortening or coronal plane translation in both the acute or chronic setting. The technique involves using a modified push-pull device to assist the surgeon in correcting length and/or translation of the articular block without the use additional hardware outside of the volar plate.

Rozental, T. D., & Blazar, P. E. (2006)

The Journal of Hand Surgery, 31(3), 359–365. https://doi.org/10.1016/j.jhsa.2005.10.010

Purpose: Despite the recent popularity of volar plating for dorsally displaced distal radius fractures there is a paucity of data documenting the results of this treatment method. The purpose of this study was to determine the functional outcome of patients treated with volar fixed-angle plating for dorsally displaced, unstable distal radius fractures.

Methods: We reviewed the records of all patients treated at our institution with internal fixation using volar plates for dorsally displaced, comminuted distal radius fractures. Patients with follow-up periods shorter than 12 months were excluded from the study.

Outcomes: were evaluated at the latest follow-up examination with the Disabilities of the Arm, Shoulder, and Hand and the Gartland and Werley scoring systems.

Results: We studied 41 patients with a mean age of 53 years. The average follow-up period was 17 months. All fractures were stabilized with volar locking plates. Radiographs in the immediate postoperative period showed a mean radial height of 11 mm, mean radial inclination of 21°, and mean volar tilt of 4°. At fracture healing the mean radial height was 11 mm, mean radial inclination was 21°, and mean volar tilt was 5°. The average score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 14 and all patients achieved excellent and good results on the Gartland and Werley scoring system, indicating minimal impairment in activities of daily living. Nine patients experienced postoperative complications. There were 4 instances of loss of reduction with fracture collapse, 3 patients required hardware removal for tendon irritation, 1 patient developed a wound dehiscence, and 1 patient had metacarpophalangeal joint stiffness.

Conclusions: Patients with unstable, dorsally displaced fractures of the distal radius treated with volar fixed-angle devices have good or excellent functional outcomes despite a high complication rate. When compared with previous reports on dorsal plating volar plates appear to have a higher incidence of fracture collapse but a lower rate of hardware-related complications. Complex fracture patterns thus mandate a careful and individualized approach.

Miller, Jonathan E., Naram, Aparajit, Qin, BaiJing, and Rothkopf, Douglas M.

Annals of Plastic Surgery, Volume 82, Number 1, January 2019

Philippe Saffar, M.D.

Surgical Techniques in Orthopedics and Traumatology

Perry, J, MD, Medoff, R J, MD

Post Traumatic Reconstruction Scientific Poster #53

Lam, J., MD, PhD, Wolfe, S., MD

Operative Techniques in Sports Medicine, Volume 18, Issue 3, September 2010: 181-188

The advent of volar fixed-angle plate osteosynthesis has greatly improved the technical ability of the surgeon to treat distal radius fractures and expanded the indications for operative treatment. Nevertheless, the volar plate is not a panacea for all distal radius fractures. Increasingly, it has been recognized that the loss of fixation, secondary displacement, and lack of stability can occur after volar fixed-angle plate osteosynthesis. This article addresses the treatment of distal radius fractures with complex disruption of the articular surface and the unique ability of fragment-specific fixation to achieve stable fixation of these injuries.

Leslie, B, MD, Schumer, E, MD

Gelberman, R., M.D.,”The Wrist” 3rd edition, Lippincott, Williams and Wilkins, 2009: 75-88.

Abramo, A, MD

Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden

Philippe Saffar, M.D.