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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2022

01-12-2022 | Distal Radius Fracture | Research

Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study

Authors: Mariya Hadzhinikolova, Ivan Zderic, Daniel Ciric, Jan P. Barcik, Dian Enchev, Asen Baltov, Lyubomir Rusimov, Peter Varga, Karl Stoffel, Geoff Richards, Boyko Gueorguiev, Mihail Rashkov

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

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Abstract

Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.
Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.
In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).
Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).
Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).
Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.
Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.
Literature
1.
Ikeda K, Osamura N, Tada K. Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius. Hand Surg. 2014;19(1):139–44.PubMedCrossRef
2.
Miyashima Y, Kaneshiro Y, Yano K, Teraura H, Sakanaka H, Uemura T. Size and stabilization of the dorsoulnar fragment in AO C3-type distal radius fractures. Injury. 2019;50(11):2004–8.PubMedCrossRef
3.
Lans J, Alvarez J, Kachooei AR, Ozkan S, Jupiter JB. Dorsal lunate facet fracture reduction using a bone reduction forceps. J Wrist Surg. 2019;8(2):118–23.PubMedCrossRef
4.
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.CrossRef
5.
Obata H, Baba T, Futamura K, Obayashi O, Mogami A, Tsuji H, et al. Difficulty in fixation of the volar lunate facet fragment in distal radius fracture. Case Rep Orthop. 2017;2017:6269081.PubMedPubMedCentral
6.
O'Shaughnessy MA, Shin AY, Kakar S. Stabilization of volar ulnar rim fractures of the distal radius: current techniques and review of the literature. J Wrist Surg. 2016;5(02):113–9.PubMedPubMedCentralCrossRef
7.
Lee JI, Cho JH, Lee SJ. The effects of the frag-Loc((R)) compression screw on distal radius fracture with a displaced dorsoulnar fragment. Arch Orthop Trauma Surg. 2015;135(9):1315–21.PubMedCrossRef
8.
9.
Johnson NA, Cutler L, Dias JJ, Ullah AS, Wildin CJ, Bhowal B. Complications after volar locking plate fixation of distal radius fractures. Injury. 2014;45(3):528–33.PubMedCrossRef
10.
Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am. 2005;87(Suppl 1(Pt 2)):195–212.PubMed
11.
Kilian M, Simkovic P, Zamborsky R, Skoda A, Labas P. What are the ideal screw lengths in volar locking plate fixation for distal radius fractures? Bratisl Lek Listy. 2019;120(7):505–9.PubMed
12.
Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am. 2005;30(4):743–9.PubMedCrossRef
13.
Ozer K, Toker S. Dorsal tangential view of the wrist to detect screw penetration to the dorsal cortex of the distal radius after volar fixed-angle plating. Hand (N Y). 2011;6(2):190–3.CrossRef
14.
Rausch S, Klos K, Stephan H, Hoffmeier K, Gras F, Windolf M, et al. Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model--a biomechanical study. Injury. 2011;42(11):1248–52.PubMedCrossRef
15.
Windolf M, Schwieger K, Ockert B, Jupiter JB, Gradl G. A novel non-bridging external fixator construct versus volar angular stable plating for the fixation of intra-articular fractures of the distal radius--a biomechanical study. Injury. 2010;41(2):204–9.PubMedCrossRef
16.
Tencer AF, Viegas SF, Cantrell J, Chang M, Clegg P, Hicks C, et al. Pressure distribution in the wrist joint. J Orthop Res. 1988;6(4):509–17.PubMedCrossRef
17.
Trumble T, Glisson RR, Seaber AV, Urbaniak JR. Forearm force transmission after surgical treatment of distal radioulnar joint disorders. J Hand Surg Am. 1987;12(2):196–202.PubMedCrossRef
18.
Viegas SF, Patterson R, Peterson P, Roefs J, Tencer A, Choi S. The effects of various load paths and different loads on the load transfer characteristics of the wrist. J Hand Surg Am. 1989;14(3):458–65.PubMedCrossRef
19.
Viegas SF, Pogue DJ, Patterson RM, Peterson PD. Effects of radioulnar instability on the radiocarpal joint: a biomechanical study. J Hand Surg Am. 1990;15(5):728–32.PubMedCrossRef
20.
Blythe M, Stoffel K, Jarrett P, Kuster M. Volar versus dorsal locking plates with and without radial styloid locking plates for the fixation of dorsally comminuted distal radius fractures: a biomechanical study in cadavers. J Hand Surg Am. 2006;31(10):1587–93.PubMedCrossRef
21.
Kandemir U, Matityahu A, Desai R, Puttlitz C. Does a volar locking plate provide equivalent stability as a dorsal nonlocking plate in a dorsally comminuted distal radius fracture?: a biomechanical study. J Orthop Trauma. 2008;22(9):605–10.PubMedCrossRef
22.
Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am. 2003;28(1):94–104.PubMedCrossRef
23.
Peine R, Rikli DA, Hoffmann R, Duda G, Regazzoni P. Comparison of three different plating techniques for the dorsum of the distal radius: a biomechanical study. J Hand Surg Am. 2000;25(1):29–33.PubMedCrossRef
24.
Rausch S, Schlonski O, Klos K, Gras F, Gueorguiev B, Hofmann GO, et al. Volar versus dorsal latest-generation variable-angle locking plates for the fixation of AO type 23C 2.1 distal radius fractures: a biomechanical study in cadavers. Injury. 2013;44(4):523–6.PubMedCrossRef
25.
Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC. Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am. 2011;36(6):974–81.PubMedCrossRef
26.
Drobetz H, Weninger P, Grant C, Heal C, Muller R, Schuetz M, et al. More is not necessarily better. A biomechanical study on distal screw numbers in volar locking distal radius plates. Injury. 2013;44(4):535–9.PubMedCrossRef
27.
Orbay JL, Touhami A, Orbay C. Fixed angle fixation of distal radius fractures through a minimally invasive approach. Tech Hand Up Extrem Surg. 2005;9(3):142–8.PubMedCrossRef
28.
Tordjman D, Hinds RM, Ayalon O, Yang SS, Capo JT. Volar-ulnar approach for fixation of the volar lunate facet fragment in distal radius fractures: a technical tip. J Hand Surg Am. 2016;41(12):e491–500.PubMedCrossRef
29.
Majima M, Horii E, Matsuki H, Hirata H, Genda E. Load transmission through the wrist in the extended position. J Hand Surg Am. 2008;33(2):182–8.PubMedCrossRef
30.
Rikli DA, Honigmann P, Babst R, Cristalli A, Morlock MM, Mittlmeier T. Intra-articular pressure measurement in the radioulnocarpal joint using a novel sensor: in vitro and in vivo results. J Hand Surg Am. 2007;32(1):67–75.PubMedCrossRef
31.
Varga P, Zysset PK, Schefzig P, Unger E, Mayr W, Erhart J. A finite element analysis of two novel screw designs for scaphoid waist fractures. Med Eng Phys. 2016;38(2):131–9.PubMedCrossRef
32.
Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am. 2004;86-a(8):1646–52.CrossRef
33.
Sagerfors M, Bjorling P, Niklasson J, Pettersson K. Combined volar T-plate and dorsal pi-plate for distal radius fractures: a consecutive series of 80 AO type C2 and C3 cases. J Wrist Surg. 2019;8(3):180–5.PubMedPubMedCentralCrossRef
34.
Jakob M, Rikli DA, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br. 2000;82(3):340–4.PubMedCrossRef
35.
Kamath AF, Zurakowski D, Day CS. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am. 2006;31(7):1061–7.PubMedCrossRef
36.
Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg Am. 1998;23(4):737–41.PubMedCrossRef
37.
Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J. 2014;96-B(7):963–9.PubMedCrossRef
38.
39.
Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg. 2000;5(2):103–12.PubMedCrossRef
40.
Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002;27(2):205–15.PubMedCrossRef
41.
Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fractures. J Hand Surg Am. 2006;31(1):9–16.PubMedCrossRef
42.
Simic PM, Robison J, Gardner MJ, Gelberman RH, Weiland AJ, Boyer MI. Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg Am. 2006;31(3):382–6.PubMedCrossRef
43.
Trease C, McIff T, Toby EB. Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study. J Hand Surg Am. 2005;30(4):756–63.PubMedCrossRef
44.
Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br. 1996;78(4):588–92.PubMedCrossRef
45.
Hart AJ, Seepaul T, Hewitt RJ, Ang S, Hansen U, Amis AA. The palmar locking compression plate is biomechanically comparable to the dorsal pi plate for dorsally comminuted, intraarticular wrist fractures. J Hand Surg Eur. 2007;32(4):388–93.CrossRef
46.
Knox J, Ambrose H, McCallister W, Trumble T. Percutaneous pins versus volar plates for unstable distal radius fractures: a biomechanic study using a cadaver model. J Hand Surg Am. 2007;32(6):813–7.PubMedCrossRef
47.
Liporace FA, Gupta S, Jeong GK, Stracher M, Kummer F, Egol KA, et al. A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures. J Orthop Trauma. 2005;19(3):187–91.PubMedCrossRef
48.
Willis AA, Kutsumi K, Zobitz ME, Cooney WP. 3rd: internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am. 2006;88(11):2411–7.PubMedCrossRef
49.
Short WH, Werner FW, Fortino MD, Mann KA. Analysis of the kinematics of the scaphoid and lunate in the intact wrist joint. Hand Clin. 1997;13(1):93–108.PubMedCrossRef
50.
Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am. 1995;20(6):986–99.PubMedCrossRef
51.
52.
Dy CJ, Wolfe SW, Jupiter JB, Blazar PE, Ruch DS, Hanel DP. Distal radius fractures: strategic alternatives to volar plate fixation. Instr Course Lect. 2014;63:27–37.PubMed
53.
54.
Wagner WF Jr, Tencer AF, Kiser P, Trumble TE. Effects of intra-articular distal radius depression on wrist joint contact characteristics. J Hand Surg Am. 1996;21(4):554–60.PubMedCrossRef
55.
Anderson DD, Bell AL, Gaffney MB, Imbriglia JE. Contact stress distributions in malreduced intraarticular distal radius fractures. J Orthop Trauma. 1996;10(5):331–7.PubMedCrossRef
Metadata
Title
Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study
Authors
Mariya Hadzhinikolova
Ivan Zderic
Daniel Ciric
Jan P. Barcik
Dian Enchev
Asen Baltov
Lyubomir Rusimov
Peter Varga
Karl Stoffel
Geoff Richards
Boyko Gueorguiev
Mihail Rashkov
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-021-04989-w

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