TY - JOUR
T1 - A Prospective Observational Assessment of Unicortical Distal Screw Placement During Volar Plate Fixation of Distal Radius Fractures
AU - Dardas, Agnes Z.
AU - Goldfarb, Charles A.
AU - Boyer, Martin I.
AU - Osei, Daniel A.
AU - Dy, Christopher J.
AU - Calfee, Ryan P.
N1 - Funding Information:
Research coordinator support for this study provided by Medartis (Basel, Switzerland). Research reported in this publication was also supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 , subaward TL1TR000449, from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and Siteman Comprehensive Cancer Center and National Cancer Institute (NCI) Cancer Center Support Grant P30 CA091842, which supported the maintenance and use of REDCap electronic data capture tools, hosted in the Biostatistics Division of Washington University School of Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH . This funding did not play a direct role in this investigation.
Publisher Copyright:
© 2018 American Society for Surgery of the Hand
PY - 2018/5
Y1 - 2018/5
N2 - Purpose: Although volar plating of the distal radius is performed frequently, the necessity of distal bicortical fixation in the metaphyseal and epiphyseal areas of the distal radius has not been proven. This study aimed primarily to quantify the ability of unicortical distal screws to maintain operative reduction of adult distal radius fractures and secondarily to determine if unicortical screw lengths could be predicted based on anatomical measurements. Methods: This prospective trial enrolled 75 adult patients undergoing volar locking plate fixation of a unilateral distal radius fracture at a tertiary center. Study inclusion required screw fixation in the distal rows of the plate performed with unicortical screw placement. The primary outcome was maintenance of operative reduction, according to predefined parameters, quantified by comparing initial operative reduction to final reduction after fracture healing. Repeated measures analysis of variance analyzed for systematic change in radiographic parameters between injury, operative, and healed images. Correlation coefficients quantified the relationship of screw lengths with lunate width and other anatomical measurements. Results: Seventy-five patients (mean age, 54 years ± 15 years; 79% women) were enrolled and followed to fracture union. Fracture severity varied and included AO type A (40%), B (12%), and C (48%) fractures. There was no significant change in mean lateral translation, intra-articular gap, intra-articular stepoff, radial inclination, or lateral tilt of the radius between the time of fixation and union for the cohort. Two patients lost reduction (increased dorsal tilt, 10° 20° respectively), potentially attributable to provision of unicortical fixation (3%; 95% confidence interval [95% CI], 0%–9%). No extensor tenosynovitis or extensor tendon ruptures occurred. Eighty percent of screws were 18 mm or less and screw lengths were not correlated with lunate width or any other anatomical measurements. Conclusions: Unicortical distal fixation during volar locking plate fixation effectively maintains operative reductions of distal radius fractures while potentially minimizing the incidence of extensor tendon ruptures. Type of study/level of evidence: Therapeutic IV.
AB - Purpose: Although volar plating of the distal radius is performed frequently, the necessity of distal bicortical fixation in the metaphyseal and epiphyseal areas of the distal radius has not been proven. This study aimed primarily to quantify the ability of unicortical distal screws to maintain operative reduction of adult distal radius fractures and secondarily to determine if unicortical screw lengths could be predicted based on anatomical measurements. Methods: This prospective trial enrolled 75 adult patients undergoing volar locking plate fixation of a unilateral distal radius fracture at a tertiary center. Study inclusion required screw fixation in the distal rows of the plate performed with unicortical screw placement. The primary outcome was maintenance of operative reduction, according to predefined parameters, quantified by comparing initial operative reduction to final reduction after fracture healing. Repeated measures analysis of variance analyzed for systematic change in radiographic parameters between injury, operative, and healed images. Correlation coefficients quantified the relationship of screw lengths with lunate width and other anatomical measurements. Results: Seventy-five patients (mean age, 54 years ± 15 years; 79% women) were enrolled and followed to fracture union. Fracture severity varied and included AO type A (40%), B (12%), and C (48%) fractures. There was no significant change in mean lateral translation, intra-articular gap, intra-articular stepoff, radial inclination, or lateral tilt of the radius between the time of fixation and union for the cohort. Two patients lost reduction (increased dorsal tilt, 10° 20° respectively), potentially attributable to provision of unicortical fixation (3%; 95% confidence interval [95% CI], 0%–9%). No extensor tenosynovitis or extensor tendon ruptures occurred. Eighty percent of screws were 18 mm or less and screw lengths were not correlated with lunate width or any other anatomical measurements. Conclusions: Unicortical distal fixation during volar locking plate fixation effectively maintains operative reductions of distal radius fractures while potentially minimizing the incidence of extensor tendon ruptures. Type of study/level of evidence: Therapeutic IV.
KW - Volar plate
KW - distal radius
KW - fixation
KW - fracture
KW - unicortical
UR - http://www.scopus.com/inward/record.url?scp=85041625906&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2017.12.018
DO - 10.1016/j.jhsa.2017.12.018
M3 - Article
C2 - 29395586
AN - SCOPUS:85041625906
SN - 0363-5023
VL - 43
SP - 448
EP - 454
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 5
ER -