Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2017; 8(7): 567-573
Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.567
Distal radius volar rim plate: Technical and radiographic considerations
Michelle Spiteri, Darren Roberts, Wayne Ng, Jamie Matthews, Dominic Power
Michelle Spiteri, Darren Roberts, Dominic Power, Hand Unit, Queen Elizabeth Hospital, Birmingham University Hospitals, Birmingham B15 2TH, United Kingdom
Wayne Ng, Jamie Matthews, Medical School, University of Birmingham, Birmingham B15 2TT, United Kingdom
Author contributions: All authors mentioned in this paper have been involved in the construction of this paper; Ng W and Matthews J were involved in data collection; Spiteri M and Roberts D were involved in data collection, analysis and interpretation, and drafting of the manuscript; Power D was involved in the conception and design of the study and draft of the manuscript.
Institutional review board statement: Data was collected during routine clinic review appointments according to the institution’s policy.
Informed consent statement: Data was collected during participants’ routine follow up appointments, with verbal consent.
Conflict-of-interest statement: There are no conflicts of interest to report for any of the authors.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Michelle Spiteri, Hand Unit, Queen Elizabeth Hospital, Birmingham University Hospitals, Mindelsohn Way, Birmingham B15 2TH, United Kingdom. michelle.spiteri@ouh.nhs.uk
Telephone: +44-12-16272000 Fax: +44-12-13714968
Received: November 23, 2016
Peer-review started: November 24, 2016
First decision: February 17, 2017
Revised: April 18, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: July 18, 2017
Processing time: 232 Days and 8.4 Hours
Abstract
AIM

To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures.

METHODS

This review highlights technical considerations learnt using this implant since it was introduced in a major trauma unit in November 2011, including anatomical reduction and whether this was maintained radiographically.

RESULTS

Twenty-six of the 382 internally fixed distal radial fractures at our unit (6.8%) were deemed to require this plate in order to achieve optimal fracture fixation between November 2011 and May 2014. A further dorsal and/or radial plate was necessary in 35% and variable angle screws were used in 54% of cases. Post-operatively, mean radial height, inclination, volar tilt and ulnar variance restored were 11.7 mm, 21º, 4.3º and -1.2 mm respectively. There were no cases of non-union or flexor/extensor tendon rupture; one case of loss of fracture reduction. Overall incidence of plate removal was 15% with one plate removed for flexor and one for extensor tendon irritation

CONCLUSION

The use of a rim plate enables control of challenging far distal fracture patterns. However, additional plates were required to improve and maintain reduction. Variable angle screws were necessary in half the cases to avoid intra-articular screw penetration. If used judiciously, this implant can achieve stable fixation despite the complexity of the fracture pattern.

Keywords: Distal radius fractures; Volar rim plate; Volar plating distal radius

Core tip: Far distal intra-articular fractures of the distal radius are not easily treated with standard volar plates. The rim plate is designed to sit distal to the watershed line, allowing purchase of bone fragments and subchondral support of the articular surface, enabling early mobilization. In view of the implant’s design, variable angle screws are necessary to avoid intra-articular screw penetration. Intra-operatively, reduction and stable fixation should be assessed fluoroscopically during wrist movement, and if necessary, an additional dorsal plate applied to allow mobilization. Judicious use of this implant can restore anatomical reduction and stable fixation in this complex subset of fractures.