Despite the frequency of distal radius fractures, the optimal treatment remains without consensus opinion. A trend toward increased distal radius fracture open reduction and internal fixation has been identified, with biomechanical and clinical studies suggesting treatment advantages of certain fixation methods over others. Well-controlled patient trials are still missing to lend objective findings to management algorithms. This article reviews the literature over the past 5 years to guide our management regarding this common upper-extremity injury.

http://www.unionsurgical.com/pdf/distal_radius_fractures_current_concepts.pdf

Distal Radius Fractures: Current Concepts

Avoiding and Treating Perioperative Complications of Distal Radius Fractures

Background  Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws. Material and Methods  Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented. Results  No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8 mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients. Conclusion  Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation. Level of Evidence  IV

/pdf/the-utility-of-the-fluoroscopic-skyline-view-during-volar-125izxkyeb.pdf

The Utility of the Fluoroscopic Skyline View During Volar Locking Plate Fixation of Distal Radius Fractures

Background: A volar locking plate (VLP) is the most frequently used form of implant used for open reduction and internal fixation of distal radius fractures. They are known to have a complication r...

/pdf/volar-locking-plate-fixations-for-displaced-distal-radius-3ubuw53a32.pdf

Volar Locking Plate Fixations for Displaced Distal Radius Fractures: An Evaluation of Complications and Radiographic Outcomes.

Purpose We hypothesized that the lunate depth as measured on plain lateral radiographs can be used to predict distal radius depth radially and ulnarly and serve as a useful reference for intraoperative screw placement in volar plate fixation of distal radius fractures. Methods Plain radiographs and magnetic resonance imaging (MRI) of the wrists of 30 patients were reviewed. The lunate depth and the maximal depth of the distal radius were determined from plain lateral radiographs. Depth of the distal radius, measured in quartiles, was determined from axial MRI images, and the lunate depth was obtained from sagittal MRI images. The depth of the distal radius in each quartile was then calculated related to the lunate depth. Results The mean depth of the lunate on plain radiographs and MRI was 17.5 mm and 17.4 mm, respectively. The depth of the distal radius from ulnar to radial was 18.4 mm, 20.2 mm, 19.4 mm, and 15.1 mm for the 1st through 4th quartiles, respectively. The depth of the distal radius is the least radially (4th quartile), with a mean 87% of the lunate depth, and greatest in the 2nd quartile, with a mean 116% of the lunate depth. Conclusions The depth of the lunate as measured on plain radiographs can be used as a marker for drilling and placement of safe screw lengths during volar plate fixation of distal radius fractures. We recommend that surgeons use the lunate depth as an estimate for the length of their longest screw when fixing distal radius fractures with volar plate techniques to avoid extensor tendon irritation and rupture. Type of study/level of evidence Therapeutic III.

Predicting a safe screw length for volar plate fixation of distal radius fractures: lunate depth as a marker for distal radius depth

Fractures of the distal radius are commonly treated using volar locking plates Several complications have been associated with this procedure, including extensor tendon irritation and rupture It has been suggested that prominence of screws past the dorsal cortex may contribute to this complication This study aimed to determine the ability of the skyline view to demonstrate screws penetrating the dorsal cortex A volar locking plate was applied to a synthetic forearm model Lateral, oblique, and skyline views were obtained, with the distal screws both beneath and 1 mm beyond the dorsal cortex The images were shown to orthopaedic trainees who were asked to decide if screws penetrated the dorsal cortex Subjects were correct in 83% of cases using the skyline view compared with 77% (p = 005, lateral) and 50% (p < 001, oblique) This study demonstrates the skyline view of the distal radius could be a useful and accurate addition to routine intraoperative fluoroscopy views

Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation.

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Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation.