Volar marginal fragment in distal radius fractures. Pin fixation in addition to volar plate
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Published:
Aug 3, 2020
Keywords:
Volar marginal fractures, distal radius, fixation, pins, volar plates
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Abstract
Introduction: Wrist fracture management with volar locking plates may be insufficient in fractures with volar marginal fragments distal to the line insertion of the pronator quadratus, the insertion site of important ligaments. Objective: To evaluate the reproducibility and results for the treatment of volar marginal fragment in distal radius fractures with a technique of pin fixation, capturing the fragment and securing them under the distal radius volar locking plate. Materials and Methods: The surgical technique uses one or more pins for the fixation of the volar lunate facet fragment in the distal radius, securing the pins under the locking plate. We initially performed a cadaveric simulation. Then we conducted a retrospective study on 7 patients with distal radius intra-articular fractures and volar marginal fragments distal to the watershed line, treated between September 2014 and February 2015. The average age was 53 years, and the average follow-up was 16 months. Radiographs were obtained in successive controls. Range of motion, grip strength, and 2 functional scores were assessed at discharge. Results: All fractures healed successfully maintaining reduction of the volar marginal fragment. There were no cases of postoperative distal radioulnar joint instability. Conclusion: Additional fixation of volar marginal fragment in distal radius fractures with bent pins under the plate provides an easy, affordable and adequate alternative to supply the adequate fragment stabilization that plate-alone techniques do not achieve.
Level of Evidence: IV
Level of Evidence: IV
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How to Cite
Seré, I., Ortiz, E., Deimundo, M., Martínez, A., Meninato, M., & Grandoli, F. (2020). Volar marginal fragment in distal radius fractures. Pin fixation in addition to volar plate. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(3), 197-203. https://doi.org/10.15417/issn.1852-7434.2020.85.3.977
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Clinical Research
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References
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phpid=97262&rsuite_id=928237&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/86/9/1900/abstract&topics=hw#info
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7. Gerostathopoulos N, Kalliakmanis A, Fandridis E, Georgoulis S. Trimed fixation system for displaced fractures of the distal radius. J Trauma 2007;62(4):913-8. https://doi.org/10.1097/01.ta.0000219948.92935.cd
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https://doi.org/10.1177/1753193407087887
9. Moore AM, Dennison DG. Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in
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10. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 1996;10(Suppl 1):v-ix, 1-154. PMID: 8814583
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approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg 2001;5(4):204-11.
https://doi.org/10.1097/00130911-200112000-00004
12. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29(1):96-102. https://doi.org/10.1016/j.jhsa.2003.09.015
13. Imatani J, Noda T, Morito Y, Sato T, Hashizume H, Inoue H. Minimally invasive plate osteosynthesis for
comminuted fractures of the metaphysis of the radius. J Hand Surg Br 2005;30(2):220-5.
https://doi.org/10.1016/j.jhsb.2004.12.009
14. Kapandji A. L’ostéosynthèse par double embrochage intra-focal. Traitement fonctionnel des fractures non
articulaires de l’estrémité inférieure du radius [Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius (author’s transl)]. Ann Chir 1976;30(11-12):903-8.
15. Beaton DE, Wright JG, Katz JN, and the Upper Extremity Collaborative Group. Development of the QuickDASH:
Comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46. https://doi.org/10.2106/JBJS.D.02060
16. MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable
and valid measurement tool. J Orthop Trauma 1998;12(8):577-86. https://doi.org/10.1097/00005131-199811000-00009
17. Fernandez DL, Wolfe SW. Fracturas del extremo distal del radio. En: Green DP, Hotchkiss RN, Pederson WC,
Wolfe SW. Green´s Cirugía de la mano, 5a ed. Madrid: Marban Libros; 2007:645-710.
https://pdfs.semanticscholar.org/710c/a2f8be254fc9811b73b2c95a5c7fd08181f5.pdf
2. Pereira E, Seré IA, Miranda D, Arce G, Rodríguez Castells F. Osteosíntesis con placa bloqueada palmar de ángulo fijo en fracturas del radio distal. Rev Asoc Argent Ortop Traumatol 2007;72(1):24-31.
https://www.aaot.org.ar/revista/2007/n1_vol72/art6.pdf
3. Imatani U, Akita K, Yamaguchi K, Shimizu H, Kondou H, Ozaki T. An anatomical study of the watershed line on
the volar, distal aspect of the radius: implications for plate placement and avoidance of tendon ruptures. J Hand Surg Am 2012;37(8):1550-4. https://doi.org/10.1016/j.jhsa.2012.05.011
4. Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate fragment in
fractures of the distal part of the radius. J Bone Joint Surg Am 2004;86(9):1900-8. https://www.jbjs.org/reader.
phpid=97262&rsuite_id=928237&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/86/9/1900/abstract&topics=hw#info
5. Berger RA, Landsmeer JMF. The palmar radiocarpal ligaments: A study of adult and fetal human wrist joints.
J Hand Surg 1990;15(6):847-54. https://doi.org/10.1016/0363-5023(90)90002-9
6. Chin KR, Jupiter JB. Wire-loop fixation of volar displaced osteochondral fractures of the distal radius. J Hand Surg Am 1999;24(3):525-33. https://doi.org/10.1053/jhsu.1999.0525
7. Gerostathopoulos N, Kalliakmanis A, Fandridis E, Georgoulis S. Trimed fixation system for displaced fractures of the distal radius. J Trauma 2007;62(4):913-8. https://doi.org/10.1097/01.ta.0000219948.92935.cd
8. Saw N, Roberts C, Cutbush K, Hodder M, Couzens G, Ross M. Early experience with the TriMed fragment-specific fracture fixation system in intraarticular distal radius fractures. J Hand Surg Eur 2008;33(1):53-8.
https://doi.org/10.1177/1753193407087887
9. Moore AM, Dennison DG. Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in
addition to volar locked plating. Hand (N Y) 2014;9(2):230-6. https://doi.org/10.1007/s11552-013-9585-7
10. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 1996;10(Suppl 1):v-ix, 1-154. PMID: 8814583
11. Orbay JL, Badia A, Indriago IR, Infante A, Khouri RK, Gonzalez E, et al. The extended flexor carpi radialis
approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg 2001;5(4):204-11.
https://doi.org/10.1097/00130911-200112000-00004
12. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29(1):96-102. https://doi.org/10.1016/j.jhsa.2003.09.015
13. Imatani J, Noda T, Morito Y, Sato T, Hashizume H, Inoue H. Minimally invasive plate osteosynthesis for
comminuted fractures of the metaphysis of the radius. J Hand Surg Br 2005;30(2):220-5.
https://doi.org/10.1016/j.jhsb.2004.12.009
14. Kapandji A. L’ostéosynthèse par double embrochage intra-focal. Traitement fonctionnel des fractures non
articulaires de l’estrémité inférieure du radius [Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius (author’s transl)]. Ann Chir 1976;30(11-12):903-8.
15. Beaton DE, Wright JG, Katz JN, and the Upper Extremity Collaborative Group. Development of the QuickDASH:
Comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46. https://doi.org/10.2106/JBJS.D.02060
16. MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable
and valid measurement tool. J Orthop Trauma 1998;12(8):577-86. https://doi.org/10.1097/00005131-199811000-00009
17. Fernandez DL, Wolfe SW. Fracturas del extremo distal del radio. En: Green DP, Hotchkiss RN, Pederson WC,
Wolfe SW. Green´s Cirugía de la mano, 5a ed. Madrid: Marban Libros; 2007:645-710.