Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures.
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TL;DR: It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection.
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Abstract: Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.
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Citations
Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures.
M. Leixnering,R Rosenauer,Ch. Pezzei,J Jurkowitsch,T. Beer,T. Keuchel,D. Simon,T Hausner,S. Quadlbauer +8 more
TL;DR: The available evidence for indications, approaches, reduction, and fixation techniques in treating DRF is addressed and which operative approach and fixation technique would produce the best postoperative functional results with lowest complication rates is addressed.
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Pronator quadratus repair after volar plate fixation in distal radial fractures: evaluation of the clinical and functional outcome and of the protective role on the flexor tendons—a randomized controlled study
TL;DR: Clinical and functional short term benefits, except improved wrist extension and reduced pain in the first 3 months, were not proven in this study, and PQ repair is probably not necessary to prevent flexor tendon pathology.
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Minimally Invasive Pronator Quadratus Sparing Approach versus Extended Flexor Carpi Radialis Approach with Pronator Quadratus Repair for Volar Plating in Distal Radial Fractures
TL;DR: MIPO volar plating with PQ sparing is a surgical technique that can be chosen according to surgeon's preference and expertise, resulting in a better flexion-extension mobility and function score according to this study.
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A Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating
TL;DR: The WRIST protocol as discussed by the authors is a stepwise easy-to-remember manual that combines multiple fluoroscopic measurements to guide intraoperative decision making, which may help surgeons to optimize surgical technique, functional and radiographic outcome.
Ultrasonographic evaluation of contact configuration between flexor pollicis longus tendon and the volar prominence of volar plate in patients with distal radius fracture
TL;DR: This study demonstrated that FPL tendon attrition was significantly associated with indentation contact on US with high sensitivity and recommend selective implant removal in patients with indentations contact configuration.
References
Volar Locking Plate Implant Prominence and Flexor Tendon Rupture
TL;DR: The plate used in Group 1 is prominent at the watershed line of the distal part of the radius, which may increase the risk of tendon injury and surgeons should avoid implant prominence in this area.
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Osteosynthesis of distal radial fractures with a volar locking screw plate system
TL;DR: A locking screw plate system for the stabilisation of distal radial fractures, which can be inserted through a standard volar approach and in which the locking mechanism allows early post-operative mobilisation, is developed.
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Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature
TL;DR: Flexor tendon rupture is a recognised complication of volar plating of distal radius fracture plating and positioning of the plate proximal to the “watershed” line and early removal of the Plate prominence or warning symptoms can reduce the risk of this complication.
Femoral Derotational Osteotomies.
TL;DR: Femoral derotational osteotomy is the treatment of choice in patients with symptomatic excessive anteversion and torsional malalignment of the femur and future studies however must focus on radiographic and clinical assessment to understand different subtypes of torsion and its implication on operative therapy.
Volar Plate Position and Flexor Tendon Rupture Following Distal Radius Fracture Fixation
Alison Kitay,Morgan M. Swanstrom,Joseph J. Schreiber,Michelle G. Carlson,Joseph T. Nguyen,Andrew J. Weiland,Aaron Daluiski +6 more
TL;DR: In this paper, the plate positions associated with attritional flexor tendon tendon rupture following distal radius fracture fixation with volar plates were identified, and the plate prominence projecting greater than 2.0 mm to the critical line was associated with tendon ruptures.
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