In order to prevent dorsal re-displacement, it will be more important to obtain good subchondral support of the dorsal side of the radial facet with PVLP compared with buttress effect by covering the volar lunate facet fragment yellow arrow : the dislocation direction of the carpal, red line : the dorsal side of the radial facet supported by the locking screw. There were no major perioperative complications in either group.
No significant difference was noted in any evaluation between the groups Table 1. In addition, no postoperative re-displacement of VLFF was observed and the bone union was confirmed. However, many cases that were difficult to treat due to postoperative re-displacement were of volar-displaced DRF with VLFF, and re-displacement on the volar side developed after surgery because PVLP was selected for these volar-displaced fractures or DVLP was selected, but the plate placement site was inappropriate [ 12 — 14 ].
In , Harness et al. Therefore, to prevent postoperative re-displacement of VLFF, prevention of carpal dorsal displacement is necessary, for which support of the dorsal side of the radial joint surface is important [ 22 ]. Accordingly, the selection of PVLP in which distal locking screws support the dorsal side of the radial joint surface is rational. Cases of postoperative volar re-displacement of dorsal-displaced DRF with VLFF have been occasionally reported, but most may have been due to excess reconstruction of volar tilt [ 23 , 24 ].
Orbay et al. They mentioned the importance of reducing the load on VLFF even by allowing slight dorsal volar tilt. They also stated that excess reconstruction of volar tilt is a risk factor for volar re-displacement [ 23 ].
Thus, we considered that the risk for postoperative re-displacement can be prevented by avoiding loading on VLFF by not excessively moving the load axis toward the volar side through avoiding excess reconstruction of volar tilt.
In this study, the mean postoperative volar tilt was 8. When DVLP are selected for dorsal-displaced DRF with VLFF, the carpal bone may be re-displaced toward the dorsal side after surgery because the distal locking screws mainly support the center of the radial joint surface and VLFF may be secondarily displaced by being pulled by the short radiolunate ligament. Regarding the relationship between volar tilt and the flexor tendon, Wurtzel et al.
Moreover, the pronator quadratus muscle is damaged in many cases of dorsal-displaced DRF and covering the plate after repairing the pronator quadratus muscle after plate placement is often difficult. Therefore, when DVLP are selected for dorsal-displaced DRF with VLFF, they cannot be covered with the pronator quadratus muscle and volar tilt usually decreases due to re-displacement, increasing the risk for postoperative iatrogenic flexor tendon injury.
Some recent studies stated the importance of fixation of VLFF [ 26 — 28 ], but it may be difficult to fix VLFF even though additional fixation with screws, anchors, or wire is applied because the bone mass and bony tissue are insufficient. It may cause blood circulation disorder, inducing crushing and necrosis of VLFF because the surrounding soft tissue is dissected to try to fix VLFF, and screws and wire are inserted.
As a dissection of soft tissue attached to VLFF was minimized, there was no crushing or necrosis of VLFF, and the bone union was confirmed in all patients. DVLP is an implant with risks of many complications and their use should be limited to volar-displaced fractures. The study was approved by the ethics committee for medical research of our university No.
HO first author mainly wrote this manuscript, acquisition of data, analysis and interpretation of data. Surgical procedure for distal radius fractures with dorsal-displaced VLFF. The theory of osteosynthesis and surgical technique of PVLP. Data correspond to usage on the plateform after The current usage metrics is available hours after online publication and is updated daily on week days.
Open Access. J Hand Surg Am 40, 42— J Hand Surg Am 39, — Close mobile search navigation Article navigation. Volume 36, Issue Previous Article Next Article. Article Navigation. Research Article Online October 01 McPherson ; James J. McPherson, M. This Site. Google Scholar. Deborah Kreimeyer ; Deborah Kreimeyer. Marylynn Aalderks ; Marylynn Aalderks. Trese Gallagher Trese Gallagher.
Online Issn: All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. As to the measurement of fortune for the preoperative ruler and inclination angle, group A were Preoperative radial shortened Joint surface level was 4.
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