Role of a spanning plate as an internal fixator in complex distal radius fractures

Rolle der „spanning plate“ als Fixateur interne bei komplexen distalen Radiusfrakturen

Abstract

Objective

Minimally invasive temporary internal wrist arthrodesis as an alternative treatment method in complex distal radius fractures.

Indications

Complex distal radius fractures with dorsal and/or palmar comminution and little to no reconstruction possibilities, radiocarpal ligamentous injury, need for early weight bearing through the affected wrist (walking aids).

Contraindications

Complex hand injuries limiting the possibility to safely secure the plate at either the metacarpal or the radial shaft.

Surgical technique

Percutaneous or open reduction and fixation of the distal radius fracture. Determine the location for the two stab incisions under fluoroscopy; one over the distal radial diaphysis and one over the second or third metacarpal. A third incision over Lister’s tubercle allows transposition of the extensor pollicis longus (EPL) tendon, excision of the posterior interosseous nerve and dorsal arthrotomy. Retrograde insertion of the spanning plate. Placement of a first nonlocking screw through the glide hole into the metacarpal shaft. Under traction, a proximal screw hole is filled with a nonlocking screw into the radial diaphysis. Tightening of the cortical screws under lateral fluoroscopic view. The remaining screw holes at both the distal and proximal ends of the plate are filled with locking screws. Layered wound closure.

Postoperative management

A removable wrist splint is worn during 2 weeks. Weight bearing through the injured wrist is immediately allowed. Removal of the spanning plate is scheduled at 3 months after radiographic evidence of fracture consolidation.

Results

In total, twelve distal radius fractures were treated by dorsal spanning plate fixation between January 2018 and January 2019. Average age was 53.3 ± 24.5 years (range 22–95 years). Both 3.5 mm and 2.4/2.7 mm plates were used. All twelve fractures were healed after 3 months. The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 36.4 (range 8.3–70.0). There was one EPL tendon rupture, one case with extensor tendon adhesions, one periosteosynthetic fracture of the radial shaft and one complex regional pain syndrome. There was no implant failure and no infection.

Zusammenfassung

Ziel

Minimal-invasive temporäre Handgelenkarthrodese als alternative Behandlungsmöglichkeit bei komplexen distalen Radiusfrakturen.

Indikationen

Komplexe distale Radiusfrakturen mit dorsaler und/oder palmarer Trümmerzone und limitierten Rekonstruktionsmöglichkeiten, radiokarpale ligamentäre Begleitverletzungen, erforderliche frühe Belastungsfähigkeit des Handgelenks (Gehhilfen).

Kontraindikationen

Komplexe Handverletzung mit eingeschränkter Verankerungsmöglichkeit an Metakarpale oder Radiusschaft.

Operationstechnik

Perkutane oder offene Reposition und Fixation der Radiusfraktur. Lokalisation der 2 Stichinzisionen unter Durchleuchtung; über dem distalen Radiusschaft und über dem zweiten oder dritten Metakarpale. Eine dritte Inzision über dem Lister-Tuberkel erlaubt die Transposition des M. extensor pollicis longus (EPL), die Exzision des N. interosseus posterior und eine dorsale Arthrotomie. Retrogrades Einführen der Platte. Einbringen einer Kortikalisschraube durch ein Gleitloch in den Metakarpaleschaft. Unter axialem Zug wird eine zweite Kortikalisschraube durch ein proximales Schraubenloch eingebracht. Anziehen beider Schrauben unter seitlicher Durchleuchtung. Die verbleibenden Schraubenlöcher proximal und distal werden mit winkelstabilen Schrauben versorgt. Schichtweiser Wundverschluss.

Weiterbehandlung

Entfernbare Handgelenkorthese für 2 Wochen. Die Belastung des betroffenen Handgelenks ist sofort erlaubt. Entfernung der „spanning plate“ 3 Monate postoperativ nach radiologisch gesicherter Frakturheilung.

Ergebnisse

Zwölf distale Radiusfrakturen wurden zwischen Januar 2018 und Januar 2019 mit einer „spanning plate“ versorgt. Das mittlere Alter lag bei 53,3 ± 24,5 Jahren (22–95 Jahre). Sowohl 3,5-mm- als auch 2,4/2,7-mm-Platten wurden verwendet. Alle zwölf Frakturen waren nach 3 Monaten geheilt. Die mittlere Punktzahl des „Disabilities of Arm, Shoulder and Hand (DASH)“ Scores lag bei 36,4 (8,3–70,0). Es zeigte sich eine EPL-Ruptur, ein Fall mit Adhäsionen der Extensorensehnen, eine periosteosynthetische Radiusschaftfraktur und ein komplexes regionales Schmerzsyndrom. Es lag kein Implantatversagen und kein Infekt vor.

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Author information

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Authors

Corresponding author

Correspondence to PD Dr. med. Frank J. P. Beeres M.D. PhD.

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Conflict of interest

F. J. P. Beeres, R. Liechti, B.-C. Link and R. Babst declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

Disclaimer: The views expressed in the submitted article are not an official position of the institution or funder.

The authors Frank J. P. Beeres and Rémy Liechti share equal first authorship.

Editor

F. Unglaub, Bad Rappenau

Illustrator

H. Konopatzki, Heidelberg

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Beeres, F.J.P., Liechti, R., Link, BC. et al. Role of a spanning plate as an internal fixator in complex distal radius fractures. Oper Orthop Traumatol 33, 77–88 (2021). https://doi.org/10.1007/s00064-020-00686-4

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Keywords

  • Dorsal spanning plate
  • Temporary wrist arthrodesis
  • Internal fixator
  • Distal radius luxation fracture
  • Comminuted distal radius fracture

Schlüsselwörter

  • Dorsale „spanning plate“
  • Temporäre Handgelenksarthrodese
  • Fixateur interne
  • Distale Radiustrümmerfraktur
  • Distale Radiusluxationsfraktur