1.1 General information
From March 2017 to may 2019, a prospective study to evaluate the effectiveness of distal radial fractures using Volar Rim Distal Radius Plate confined to the volar rim of the distal radius .This study was approved by institutional review boards and informed consent was obtained from all patients.
Every patient underwent an operation with Variable Angle LCP Volar Rim Distal Radius Plate 2.4mm。The patients included 16 women and 7 men of (range, 19–71y) who were followed up for an average of 13-17 months (average 14.6 months). All fractures were assessed using a computed tomography (CT) scan in addition to plain radiographs.
From March 2017 to may 2019, and from March 2018 to may 2019, the clinical efficacy of Volar Rim Distal Radius Plate for the treatment of distal radial fractures in the Department of orthopedics of Beijing Chaoyang Hospital was retrospectively analyzed. Inclusive criteria:
1. Patients aged between 19 to 71 years with closed distal end radial fractures are displaced more than 2 mm from the anatomic position, a dorsal inclination of the distal fragment of more than 20mm, a radial shortening of 10 mm or more,
1 Patient’s age(16-18).
③distal radius fracture
④surgical treatment within 7 days after injury.
① old fracture
③previous history of wrist surgery
④previous limitation of wrist movement.
According to the inclusion and exclusion criteria, this study included 23 patients with proximal humeral fractures, aged 19-71 years, with an average of range years. According to AO classification of distal radius, there were 9 patients who are ao-23b3 type and 14 which are ao-23c3 type.All of the preoperative and postoperative data were obtained by reviewing the charts from the medical records section of the hospital. The patients were contacted by telephone of request to arrange an additional visit. All of the patients gave informed consent to participate in the study.
The study was approved by the institutional review board.
After admitting in the hospital, the patients were evaluated and treated according to the diagnosis and treatment path. Observation indexes of this study: gender, age, fracture classification, fracture healing, internal fixation failure and fracture displacement, application of Garland and Werley functional system score was used to evaluate the limb function. functional score, wound healing, etc. In this study, the categorical data was expressed by the number of patients in each category, and the measurement data was expressed by the average.
A total of 23 patients participated in this study. The mean age of the patients was 32.82 卤 11.81 years (range 19-71). There were 7 males and 16 females. There were 17 dominant and six non-dominant hands. The mode of injury was motor vehicle accident in 18 patients, fall while walking in four patients, and assault in one patient. The fractures were classified on the basis of the Arbeitsgemeinschaft fur osteosynthesefragen (AO) classification. there were 9 patients who areao-23b3 type and 14 which are ao-23c3 type.
Plate Design Features and Surgical Technique
The 2.4-mm Variable Angle LCP Volar Rim Distal Radius Plate is designed for the fractures of the distal radius volar rim with large fracture or multiple fragments. The distal aspect of this plate sits slightly over the volar rim of the distal radius which help to fit antomical position of the lunate and scaphoid facets. The orientation of the variable angle screw holes directs the screws in a proximal direction, while avoiding the entrance into the radio-carpal joint. This implant has a radial and the ulnar phalange which allows additional fixation of the radial styloid and the lunate facet fracture.While the proximal straight limb offers a wider hole to permit a screw to be placed to help for the provisional fixation. The distal and proximal limbs of this plate have small holes for temporary Kirschner wire fixation, while taking images we can confirm the position of the plate and adequacy of the reduction.We used the E models software of Depuy Synthes to evaluate the efficiancy of Volar Rim Distal Radius Plate.
All the operations were performed by senior surgeon. The patients were given brachial plexus anesthesia or general anesthesia at the discretion of the anesthesiologist, a tourniquet was placed on the affected limb with a pressure of 250 mmHg.The patients were given general/regional anesthesia at the discretion of the anesthesiologist.A Henry incision was taken and the skin was cut on the lateral side .The fracture was approached through the base of flexor carpi radialis of the distal radius as described by Henry et al. . All of the patients underwent open reduction and internal fixation with SYNTHES Variable Angle LCP Volar Rim Distal Radius Plate 2.4mm..Prior to VRF reduction, the radial column is provisionally reduced and fixed with a 2.4mm straight plate because radial column fragments are typically reduced first in the process of a fragment-specific fixation.The subcutaneous length was about 8 cm. The radial nerve and radial artery were exposed, and the radial nerve and radial artery were pulled open and protectedto the radial side. The space between flexor carpi radialis and brachioradialis was obturated to expose pronator. The pronator muscle was incised sharply along the lateral edge of radius, and the periosteal stripper was used to peel off the pronator muscle to expose the fracture end. The fracture was reduced by manipulation, fixed with Kirschner wire temporarily, and the reduction of C-arm was satisfactory by fluoroscopy. The volar locking plate was selected to adjust the position of the plate and fixed with locking screw in turn. After reduction, a distal radial plate or Kirschner wire was used for fixation. The C-arm fluoroscopy confirmed that the reduction of the joint was satisfactory and the position of the plate was appropriate. Sufficient irrigation, complete hemostasis, layer by layer suture wound, pressure bandage. Immediately after the operation, the affected limb took active functional exercise, and the patient changed dressing regularly. After about 2 weeks, the stitches were removed according to the wound healing. The patients were followed up regularly, every month for the first 3 months, and intermittently until the fracture healed . The quality of reduction was measured with a standard goniometer and then classified as satisfactory in cases with a dorsal tilt < 10掳, < 2 mm of radial shortening, and < 2 mm of joint surface step-off [21,22].