Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff
INDICATIONS
•
•
•
Type II distal radial shear fractures o Usually require open reduction and internal fixation Barton's fractures are almost impossible to treat by closed means. Buttress plate fixation of volar Barton's fractures is usually necessary. Type III compression injuries o Require operative treatment if Intraarticular damage is significant Radial shortening is severe o Fixation with multiple Kirschner wires or plates is often necessary, and cancellous bone grafting is frequently required to fill impacted areas. o Often a combination of open and closed techniques is necessary to satisfactorily treat type III fractures. Type IV avulsion fractures o Are usually associated with radiocarpal fracture-dislocations and are therefore unstable o Often the avulsed fracture fragments are so small that they can be repaired only with suture. o Secure reduction of the carpus to the distal radius can frequently be achieved only with Kirschner wires. Type V high-velocity fractures o Always unstable, frequently open, and difficult to treat o A combination of percutaneous pinning and external fixation is often necessary. Many of these fractures are so severely comminuted that open reduction is impossible.
•
CONTRAINDICATIONS Severe medical comorbidities that prevent surgery EQUIPMENT
• • •
Hand tray and hand table Small fragment and mini fragment set Technique-specific tray, as required
ANATOMY
•
The distal radius and ulna may be divided into three distinct columns. o The lateral and medial columns correspond to the scaphoid facet and lunate facets, respectively, of the distal radius. o The medial column is further divided into dorsomedial and volar medial parts. o The ulnar column consists of the ulnar styloid and triangular fibrocartilage complex.
Tears of the triangular fibrocartilage occur when the medial column of the distal radius, ulnar styloid, or both are intact. Distal radioulnar joint instability is associated with
•
•
•
Type II distal radial shear fractures o Usually require open reduction and internal fixation Barton's fractures are almost impossible to treat by closed means. Buttress plate fixation of volar Barton's fractures is usually necessary. Type III compression injuries o Require operative treatment if Intraarticular damage is significant Radial shortening is severe o Fixation with multiple Kirschner wires or plates is often necessary, and cancellous bone grafting is frequently required to fill impacted areas. o Often a combination of open and closed techniques is necessary to satisfactorily treat type III fractures. Type IV avulsion fractures o Are usually associated with radiocarpal fracture-dislocations and are therefore unstable o Often the avulsed fracture fragments are so small that they can be repaired only with suture. o Secure reduction of the carpus to the distal radius can frequently be achieved only with Kirschner wires. Type V high-velocity fractures o Always unstable, frequently open, and difficult to treat o A combination of percutaneous pinning and external fixation is often necessary. Many of these fractures are so severely comminuted that open reduction is impossible.
•
CONTRAINDICATIONS Severe medical comorbidities that prevent surgery EQUIPMENT
• • •
Hand tray and hand table Small fragment and mini fragment set Technique-specific tray, as required
ANATOMY
•
The distal radius and ulna may be divided into three distinct columns. o The lateral and medial columns correspond to the scaphoid facet and lunate facets, respectively, of the distal radius. o The medial column is further divided into dorsomedial and volar medial parts. o The ulnar column consists of the ulnar styloid and triangular fibrocartilage complex.
Tears of the triangular fibrocartilage occur when the medial column of the distal radius, ulnar styloid, or both are intact. Distal radioulnar joint instability is associated with