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J Wrist Surg 2023; 12(06): 500-508
DOI: 10.1055/s-0043-1761286
Scientific Article

Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-Specific Fixation

Mitchell Bowers
1   Department of Orthopaedics, Vanderbilt University, Nashville, Tennessee
,
Eric Gruenberger 
2   Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
,
Achraf H. Jardaly
2   Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
,
Madison Wood
3   Medical College of Georgia, Medical College of Georgia, Augusta, Georgia
,
Andrew Ko
2   Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
,
Stacey D'Almeida
2   Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
,
Todd A. Rubin
4   Hand and Upper Extremity Surgery Department, Hughston Clinic Orthopaedics, TriStar Centennial Medical Center, Nashville, Tennessee
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Abstract

Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP.

Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t-Tests were used to determine differences in ROM among construct types.

Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion (p = 0.08), extension (p = 0.33), supination (p = 0.35), or pronation (p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4).

Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence.

Level of Evidence Level IV, retrospective review.

Keywords

fragment-specific fixation - distal radius fracture - intra-articular - wristhook plate - column

Ethical Review Committee Statement

Exempt because this article is a retrospective review.


Note

The surgeries were performed at Hughston Clinic Orthopaedics in Nashville, TN.




Publication History

Received: 06 July 2022

Accepted: 22 December 2022

Article published online:
22 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Letter to this article:

“Does Hook Type Matter in Articular Distal Radius Fixation? Re. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-specific Fixation”J Wrist Surg eFirst
DOI: 10.1055/s-0044-1782499

 

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