J Korean Orthop Assoc.  2013 Apr;48(2):142-150. 10.4055/jkoa.2013.48.2.142.

Implant Selection for Treatment of Distal Radius Fractures

• Lee JY
• Bae S

• KMID: 1424107
• DOI: http://doi.org/10.4055/jkoa.2013.48.2.142

Abstract

Anatomical reduction is essential for successful treatment of distal radius fractures. In-depth understanding of the implant is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid implant-related complications. Selection of an improper implant and screw length may lead to rupture of flexor or extensor tendon as a complication. This article will briefly discuss the pros and cons of the traditional fixation methods such as percutaneous pin fixation and external fixation, and will focus on the recent development of the volar locking plate. Variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation, may have inadequate fixation strength if screw locking is repeated. From the biomechanical study, at least four distal locking screws are enough to have strength to maintain fracture fixation. Measuring screw length may be difficult; therefore, information about the ratio of the metaphysis and diaphysis will be helpful in deciding on the proper screw length. Locking screws are recommended as they are stronger than locking pegs. In order to avoid flexor tendon ruptures, the plate should not be placed too far distally.

Keyword

distal radius fractures; volar locking plates

MeSH Terms

Diaphyses
Fracture Fixation
Freedom
Patient Selection
Radius
Radius Fractures
Rupture
Tendons

Figure

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  Figure 1 Intrafocal pin fixation to reduce and maintain the distal radius fractures.

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  Figure 2 Dorsal subluxation of the ulna head after external fixation results in loss of supination.

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  Figure 3 Dorsal plating for fixation of the large dorsal ulnar fragment involving sigmoid notch.

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  Figure 4 Loosening of the non-locking screws results in loss of volar tilt.

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  Figure 5 Various volar locking plates available in Korea. (A) DePuySynthes (West Chester, PA, USA) variable-angle two-column plate. (B) DePuySynthes extra-articular plate. (C) DePuySynthes variable-angle volar rim plate. (D) DePuy Synthes juxta-articular plate. (E) Acumed (Hillsboro, OR, USA) Acu-Loc volar distal radius plate. (F) Medartis (Basel, Switzerland) Aptus distal radius adaptive plate. (G) Medartis Aptus distal radius correction plate. (H) Stryker (Kalamazoo, MI, USA) Variax distal radius locking plate. (I) BK meditech volar distal radius plate. (J) Tradimedics APIS distal radius plate.

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  Figure 6 (A) White arrow indicates proposed watershed line by Imatani et al.37) Black line indicates distal bony prominence. (B) Small lunate facet fragment necessitates suture fixation.

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