Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff

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  • Topic: Distal radius fracture, Surgery, Pain
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  • Published : May 29, 2013
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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.

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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 significant displacement of the ulnar styloid.

TECHNIQUES
• • •

Post-Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff)

Post-Procedure: Distraction Plate Fixation POST-PROCEDURE CARE • • • • •

Immediately begin finger and other joint upper extremity exercises. If a splint was applied, it should be removed at 3 weeks. Percutaneous Kirschner wires should be removed at 6 weeks. Activities of daily living are allowed, but lifting should be restricted to 5 lb. Once union is achieved, remove the distraction plate and begin range-of-motion exercises.

COMPLICATIONS
• • • • •

Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection

ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for distraction plate fixation. OUTCOMES AND EVIDENCE Ruch et al reported good to excellent outcomes in 90% of 22 patients using this technique. Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) POST-PROCEDURE CARE •

Immobilize the wrist and forearm with a plaster sugar tong splint for 2 weeks.

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Next, use a removable ball-peen splint, permitting gentle active exercises two or three times a day for the next 2 weeks. All immobilization is removed at 4 weeks and progressive motion continued until union is solid.

COMPLICATIONS
• • • • •

Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection

ANALYSIS OF RESULTS The use of buttress plating for the treatment of distal radius fractures have proven to yield excellent results when surgical intervention occurs early and care is used to obtain anatomic reduction of the fracture. OUTCOMES AND EVIDENCE • •

Smith et al: 100% union rate with 71% excellent, 18% good, and 11% fair results. Odumala et al: No difference in development of median...
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