Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.567
Peer-review started: November 24, 2016
First decision: February 17, 2017
Revised: April 18, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: July 18, 2017
To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures.
This review highlights technical considerations learnt using this implant since it was introduced in a major trauma unit in November 2011, including anatomical reduction and whether this was maintained radiographically.
Twenty-six of the 382 internally fixed distal radial fractures at our unit (6.8%) were deemed to require this plate in order to achieve optimal fracture fixation between November 2011 and May 2014. A further dorsal and/or radial plate was necessary in 35% and variable angle screws were used in 54% of cases. Post-operatively, mean radial height, inclination, volar tilt and ulnar variance restored were 11.7 mm, 21º, 4.3º and -1.2 mm respectively. There were no cases of non-union or flexor/extensor tendon rupture; one case of loss of fracture reduction. Overall incidence of plate removal was 15% with one plate removed for flexor and one for extensor tendon irritation
The use of a rim plate enables control of challenging far distal fracture patterns. However, additional plates were required to improve and maintain reduction. Variable angle screws were necessary in half the cases to avoid intra-articular screw penetration. If used judiciously, this implant can achieve stable fixation despite the complexity of the fracture pattern.
Core tip: Far distal intra-articular fractures of the distal radius are not easily treated with standard volar plates. The rim plate is designed to sit distal to the watershed line, allowing purchase of bone fragments and subchondral support of the articular surface, enabling early mobilization. In view of the implant’s design, variable angle screws are necessary to avoid intra-articular screw penetration. Intra-operatively, reduction and stable fixation should be assessed fluoroscopically during wrist movement, and if necessary, an additional dorsal plate applied to allow mobilization. Judicious use of this implant can restore anatomical reduction and stable fixation in this complex subset of fractures.