Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 6/2022

26-05-2021 | Distal Radius Fracture | Original Article

Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study

Authors: Marco Biondi, Andrea Poggetti, Alessandro Fagetti, Agostino Di Maro, Prospero Bigazzi, Sandra Pfanner, Giulio Lauri

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2022

Login to get access

Abstract

Purpose

Volar rim fractures of the distal radius are a spectrum of pathology that must be well identified and treated to achieve good outcomes and avoid surgical failures. New devices of fragment specific fixation have been developed during the last decades to fix this fragment. The purpose of this retrospective study was to evaluate the ability of APTUS® wrist distal radius system to securely fix different types of volar rim fractures.

Methods

Patients with at least 1 year of follow-up and a preoperative CT-scan evaluation of the fracture pattern were included in the study. Clinical, radiological and functional outcomes were assessed.

Results

Sixty-eight patients with an average follow-up of 34, 1 months (12–61) were included in the study. There were no clinical and radiological complications, including loss of reduction, device failure and tendon ruptures. No patients required hardware removal. Wrist range of motion in flexion–extension averaged 96°, while in pronation–supination 144°. At final follow-up mean visual analogue scale pain was 1,8. Questionnaires, as dissabilities of the arm, shouldder and hand (DASH) score and patient-related wrist evolution (PRWE) score were 6,6 and 3 respectively. Grip strenght measured 86% compared to the normal side.

Conclusion

APTUS® wrist presents a versatile set of fragment specific fixation plates able to easily and securely fix all types of volar rim fracture. The system can be used with other devices without any kind of interference between them. When correctly placed and used with the right indications, no late complications can be recorded.
Literature
1.
2.
go back to reference Melone CP Jr. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 1993;24(2):239–53.CrossRefPubMed Melone CP Jr. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 1993;24(2):239–53.CrossRefPubMed
3.
go back to reference Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279–88.CrossRefPubMed Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279–88.CrossRefPubMed
4.
go back to reference Jupiter JB, Fernandez DL, Toh CL, Fellman T, Ring D. Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Jt Surg Am. 1996;78(12):1817–28.CrossRef Jupiter JB, Fernandez DL, Toh CL, Fellman T, Ring D. Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Jt Surg Am. 1996;78(12):1817–28.CrossRef
5.
go back to reference Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Jt Surg Am. 2004;86(9):1900–8.CrossRef Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Jt Surg Am. 2004;86(9):1900–8.CrossRef
6.
go back to reference Mekhail AO, Ebraheim NA, McCreath WA, Jackson WT, Yeasting RA. Anatomic and X-ray film studies of the distal articular surface of the radius. J Hand Surgery Am. 1996;21(4):567–73.CrossRef Mekhail AO, Ebraheim NA, McCreath WA, Jackson WT, Yeasting RA. Anatomic and X-ray film studies of the distal articular surface of the radius. J Hand Surgery Am. 1996;21(4):567–73.CrossRef
7.
go back to reference Berger RA, Landsmeer JM. The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surgery Am. 1990;15(6):47–854.CrossRef Berger RA, Landsmeer JM. The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surgery Am. 1990;15(6):47–854.CrossRef
8.
go back to reference Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Related Res. 2001;383:32–40.CrossRef Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Related Res. 2001;383:32–40.CrossRef
9.
go back to reference Kitay A, Mudgal C. Volar carpal subluxation following lunate facet fracture. J Hand Surg. 2014;39(11):2335–41.CrossRef Kitay A, Mudgal C. Volar carpal subluxation following lunate facet fracture. J Hand Surg. 2014;39(11):2335–41.CrossRef
11.
go back to reference Zumstein MA, Hasan AP, McGuire DT, Eng K, Bain GI. Distal radius attachments of the radiocarpal ligaments: an anatomical study. J Wrist Surg. 2013;2(4):346–50.CrossRefPubMedPubMedCentral Zumstein MA, Hasan AP, McGuire DT, Eng K, Bain GI. Distal radius attachments of the radiocarpal ligaments: an anatomical study. J Wrist Surg. 2013;2(4):346–50.CrossRefPubMedPubMedCentral
12.
go back to reference Biondi M, Lauri G. Dorsal fracture-dislocation of the radiocarpal joint: a new classification and implications in surgical treatment. J Hand Surg Eur. 2020;45(7):700–8.CrossRef Biondi M, Lauri G. Dorsal fracture-dislocation of the radiocarpal joint: a new classification and implications in surgical treatment. J Hand Surg Eur. 2020;45(7):700–8.CrossRef
13.
go back to reference Andermahr J, Lozano-Calderon S, Trafton T, Crisco JJ, Ring D. The volar extension of the lunate facet of the distal radius: a quantitative anatomic study. J Hand Surg Am. 2006;31(6):892–5.CrossRefPubMed Andermahr J, Lozano-Calderon S, Trafton T, Crisco JJ, Ring D. The volar extension of the lunate facet of the distal radius: a quantitative anatomic study. J Hand Surg Am. 2006;31(6):892–5.CrossRefPubMed
14.
go back to reference Hintringer W, Rosenauer R, Pezzei C, et al. Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg. 2020;140(5):595–609.CrossRefPubMedPubMedCentral Hintringer W, Rosenauer R, Pezzei C, et al. Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg. 2020;140(5):595–609.CrossRefPubMedPubMedCentral
15.
go back to reference Biondi M, Keller M, Merenghi L, Gabl M, Lauri G. Hook plate for volar rim fractures of the distal radius: review of the first 23 cases and focus on dorsal radiocarpal dislocation. J Wrist Sur. 2019;8(2):93–9.CrossRef Biondi M, Keller M, Merenghi L, Gabl M, Lauri G. Hook plate for volar rim fractures of the distal radius: review of the first 23 cases and focus on dorsal radiocarpal dislocation. J Wrist Sur. 2019;8(2):93–9.CrossRef
16.
go back to reference Lam JW, Wolfe SW. Distal radius fractures: what cannot be fixed with a volar plate? The role of fragment-specific fixation in modern fracture treatment. Op Tech Sports Med. 2010;18(3):181–8.CrossRef Lam JW, Wolfe SW. Distal radius fractures: what cannot be fixed with a volar plate? The role of fragment-specific fixation in modern fracture treatment. Op Tech Sports Med. 2010;18(3):181–8.CrossRef
17.
go back to reference Bakker AJ, Shin AY. Fragment-specific volar hook plate for volar marginal rim fractures. Tech Hand Up Extrem Surg. 2014;18(1):56–60.CrossRefPubMed Bakker AJ, Shin AY. Fragment-specific volar hook plate for volar marginal rim fractures. Tech Hand Up Extrem Surg. 2014;18(1):56–60.CrossRefPubMed
19.
go back to reference Obata H, Baba T, Futamura K, et al. Difficulty in fixation of the volar lunate facet fragment in distal radius fracture. Case Rep Orthop. 2017;2017:6269081.PubMedPubMedCentral Obata H, Baba T, Futamura K, et al. Difficulty in fixation of the volar lunate facet fragment in distal radius fracture. Case Rep Orthop. 2017;2017:6269081.PubMedPubMedCentral
20.
go back to reference Wiesler ER, Chloros GD, Lucas RM, Kuzma GR. Arthroscopic management of volar lunate facet fractures of the distal radius. Tech Hand Up Extrem Surg. 2006;10(3):139–44.CrossRefPubMed Wiesler ER, Chloros GD, Lucas RM, Kuzma GR. Arthroscopic management of volar lunate facet fractures of the distal radius. Tech Hand Up Extrem Surg. 2006;10(3):139–44.CrossRefPubMed
21.
go back to reference Schumer ED, Leslie BM. Fragment-specific fixation of distal radius fractures using the trimed device. Tech Hand Up Extrem Surg. 2006;9(2):74–83.CrossRef Schumer ED, Leslie BM. Fragment-specific fixation of distal radius fractures using the trimed device. Tech Hand Up Extrem Surg. 2006;9(2):74–83.CrossRef
22.
go back to reference Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016;41(4):365–6.CrossRef Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016;41(4):365–6.CrossRef
23.
go back to reference Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg. 2002;27(2):205–15.CrossRef Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg. 2002;27(2):205–15.CrossRef
24.
go back to reference Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Jt Surg Am. 2011;93(4):328–35.CrossRef Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Jt Surg Am. 2011;93(4):328–35.CrossRef
25.
go back to reference Souer JS, Ring D, Jupiter JB, Matschke S, Audige L, Marent-Huber M, AOCID Prospective ORIF Distal Radius Study Group. Comparison of AO type-B and type-C volar shearing fractures of the distal part of the radius. J Bone Jt Surg Am. 2009;91(11):2605–11.CrossRef Souer JS, Ring D, Jupiter JB, Matschke S, Audige L, Marent-Huber M, AOCID Prospective ORIF Distal Radius Study Group. Comparison of AO type-B and type-C volar shearing fractures of the distal part of the radius. J Bone Jt Surg Am. 2009;91(11):2605–11.CrossRef
26.
go back to reference Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Rel Res. 2006;445:58–67.CrossRef Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Rel Res. 2006;445:58–67.CrossRef
28.
go back to reference Prommersberger KJ, Fernandez DL, Ring D, Jupiter JB, Lanz UB. Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result? Chir Main. 2002;21(2):113–23.CrossRefPubMed Prommersberger KJ, Fernandez DL, Ring D, Jupiter JB, Lanz UB. Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result? Chir Main. 2002;21(2):113–23.CrossRefPubMed
30.
go back to reference Paryavi E, Christian MW, Eglseder WA, Pensy RA. Sustentaculum lunatum: appreciation of the palmar lunate facet in management of complex intra-articular fractures of the distal radius. Am J Orthop (Belle Mead, NJ). 2015;44(9):E303–7.PubMed Paryavi E, Christian MW, Eglseder WA, Pensy RA. Sustentaculum lunatum: appreciation of the palmar lunate facet in management of complex intra-articular fractures of the distal radius. Am J Orthop (Belle Mead, NJ). 2015;44(9):E303–7.PubMed
31.
go back to reference Beck JD, Harness NG, Spencer HT. Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. J Hand Surg Am. 2014;39(4):670–8.CrossRefPubMed Beck JD, Harness NG, Spencer HT. Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. J Hand Surg Am. 2014;39(4):670–8.CrossRefPubMed
32.
go back to reference Mandziak DG, Watts AC, Bain GI. Ligament contribution to patterns of articular fractures of the distal radius. J Hand Surg Am. 2011;36(10):1621–5.CrossRefPubMed Mandziak DG, Watts AC, Bain GI. Ligament contribution to patterns of articular fractures of the distal radius. J Hand Surg Am. 2011;36(10):1621–5.CrossRefPubMed
33.
go back to reference Bain GI, Alexander JJ, Eng K, Durrant A, Zumstein MA. Ligament origins are preserved in distal radial intraarticular two-part fractures: a computed tomography-based study. J Wrist Surg. 2013;2(3):255–62.CrossRefPubMedPubMedCentral Bain GI, Alexander JJ, Eng K, Durrant A, Zumstein MA. Ligament origins are preserved in distal radial intraarticular two-part fractures: a computed tomography-based study. J Wrist Surg. 2013;2(3):255–62.CrossRefPubMedPubMedCentral
34.
go back to reference Apergis E, Darmanis S, Theodoratos G, Maris J. Beware of the ulno-palmar distal radial fragment. J Hand Surg Br. 2002;27(2):139–45.CrossRefPubMed Apergis E, Darmanis S, Theodoratos G, Maris J. Beware of the ulno-palmar distal radial fragment. J Hand Surg Br. 2002;27(2):139–45.CrossRefPubMed
35.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
36.
go back to reference Moore AM, Dennison DG. Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in addition to volar-locked plating. Hand (NY). 2014;9(2):230–6.CrossRefPubMed Moore AM, Dennison DG. Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in addition to volar-locked plating. Hand (NY). 2014;9(2):230–6.CrossRefPubMed
37.
go back to reference 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 Br. 2008;33(1):53–8.CrossRef 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 Br. 2008;33(1):53–8.CrossRef
38.
go back to reference Konrath GA, Bahler S. Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma. 2002;16(8):578–85.CrossRefPubMed Konrath GA, Bahler S. Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma. 2002;16(8):578–85.CrossRefPubMed
39.
go back to reference O’Shaughnessy MA, Shin AY, Kakar S. Volar marginal rim fracture fixation with volar fragment-specific hook plate fixation. J Hand Surg Am. 2015;40(8):1563–70.CrossRefPubMed O’Shaughnessy MA, Shin AY, Kakar S. Volar marginal rim fracture fixation with volar fragment-specific hook plate fixation. J Hand Surg Am. 2015;40(8):1563–70.CrossRefPubMed
40.
Metadata
Title
Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study
Authors
Marco Biondi
Andrea Poggetti
Alessandro Fagetti
Agostino Di Maro
Prospero Bigazzi
Sandra Pfanner
Giulio Lauri
Publication date
26-05-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01710-3

Other articles of this Issue 6/2022

European Journal of Trauma and Emergency Surgery 6/2022 Go to the issue