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J Wrist Surg 2021; 10(03): 229-233
DOI: 10.1055/s-0040-1722573
Scientific Article

Early Retrieval of Spanning Plates Used for Fixation of Complex Fractures of the Distal Radius

Tyler W. Henry 
1   Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Jacob E. Tulipan
2   Department of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Richard M. McEntee
1   Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Pedro K. Beredjiklian
2   Department of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
› Author Affiliations Funding None.
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Abstract

Background Spanning plates are being increasingly used for the treatment of complex fractures of the distal radius. The traditional recommendation is to leave the hardware in place for at least 12 weeks.

Questions/Purpose This study assesses the comparative outcomes of spanning plates removed at or before 10 weeks. We hypothesized that acceptable healing and functional outcomes can be achieved with earlier hardware removal to allow for earlier range of motion, rehabilitation, and return to function.

Patients and Methods All patients treated for a comminuted, intra-articular distal radius fracture with a temporary spanning plate were identified. Outcomes of bridge plates removed before 10 weeks were compared with plates removed after 12 weeks. Twenty patients in the short duration cohort were compared with 40 patients in the long duration cohort.

Results All fractures healed and there were 10 complications (4 short duration, 6 long duration) and 2 reoperations (1 short duration, 1 long duration) in the study population. There were no significant differences in final Quick-DASH scores (27.4 short duration, 20.9 long duration) or radiographic alignment. Mean values for wrist extension and ulnar deviation were significantly worse in the long duration cohort, although these differences are of unclear clinical significance.

Conclusion It may be safe to remove spanning bridge plates earlier than what is traditionally recommended. Plate removal at or before 10 weeks did not detract from healing or radiographic alignment. Prospective investigations assessing the optimal duration of fixation for this technique are needed.

Level of Evidence This is a Level IV study.

Keywords

distal radius - fracture - dorsal - spanning - bridge - plate - fixation - duration

Note

The investigation was performed at the Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107.




Publication History

Received: 28 September 2020

Accepted: 27 November 2020

Article published online:
22 January 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Hevonkorpi TP, Launonen AP, Huttunen TT, Kannus P, Niemi S, Mattila VM. Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 - too many patients are yet operated on?. BMC Musculoskelet Disord 2018; 19 (01) 70
    CrossrefPubMedGoogle Scholar
  • 2 Lauder A, Hanel DP. Spanning bridge plate fixation of distal radial fractures. JBJS Rev 2017; 5 (02) e2
    CrossrefPubMedGoogle Scholar
  • 3 Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch DS. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg Am 2012; 37 (05) 948-956
    CrossrefPubMedGoogle Scholar
  • 4 Wang WL, Ilyas AM. Dorsal bridge plating versus external fixation for distal radius fractures. J Wrist Surg 2020; 9 (02) 177-184
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Richard MJ, Wartinbee DA, Riboh J, Miller M, Leversedge FJ, Ruch DS. Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius. J Hand Surg Am 2011; 36 (10) 1614-1620
    CrossrefPubMedGoogle Scholar
  • 6 Hanel DP, Lu TS, Weil WM. Bridge plating of distal radius fractures: the Harborview method. Clin Orthop Relat Res 2006; 445 (445) 91-99
    CrossrefPubMedGoogle Scholar
  • 7 Ruch DS, Ginn TA, Yang CC, Smith BP, Rushing J, Hanel DP. Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. J Bone Joint Surg Am 2005; 87 (05) 945-954
    CrossrefPubMedGoogle Scholar
  • 8 Watson N, Haines T, Tran P, Keating JL. A comparison of the effect of one, three, or six weeks of immobilization on function and pain after open reduction and internal fixation of distal radial fractures in adults: a randomized controlled trial. J Bone Joint Surg Am 2018; 100 (13) 1118-1125
    CrossrefPubMedGoogle Scholar
  • 9 Brehmer JL, Husband JB. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study. J Bone Joint Surg Am 2014; 96 (19) 1621-1630
    CrossrefPubMedGoogle Scholar
  • 10 Ginn TA, Ruch DS, Yang CC, Hanel DP. Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical technique. J Bone Joint Surg Am 2006; 88 (01) (Suppl. 01) 29-36
    PubMedGoogle Scholar
  • 11 Christel P, Cerf G, Pilla A. Time evolution of the mechanical properties of the callus of fresh fractures. Ann Biomed Eng 1981; 9 (04) 383-391
    CrossrefPubMedGoogle Scholar
  • 12 Lill CA, Hesseln J, Schlegel U, Eckhardt C, Goldhahn J, Schneider E. Biomechanical evaluation of healing in a non-critical defect in a large animal model of osteoporosis. J Orthop Res 2003; 21 (05) 836-842
    CrossrefPubMedGoogle Scholar
  • 13 Burke EF, Singer RM. Treatment of comminuted distal radius with the use of an internal distraction plate. Tech Hand Up Extrem Surg 1998; 2 (04) 248-252
    CrossrefPubMedGoogle Scholar
  • 14 Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional outcomes following bridge plate fixation for distal radius fractures. J Hand Surg Am 2015; 40 (08) 1554-1562
    CrossrefPubMedGoogle Scholar
  • 15 Wolf JC, Weil WM, Hanel DP, Trumble TE. A biomechanic comparison of an internal radiocarpal-spanning 2.4-mm locking plate and external fixation in a model of distal radius fractures. J Hand Surg Am 2006; 31 (10) 1578-1586
    CrossrefPubMedGoogle Scholar
  • 16 Pryce JC. The wrist position between neutral and ulnar deviation that facilitates the maximum power grip strength. J Biomech 1980; 13 (06) 505-511
    CrossrefPubMedGoogle Scholar
  • 17 Dodds SD, Save AV, Yacob A. Dorsal spanning plate fixation for distal radius fractures. Tech Hand Up Extrem Surg 2013; 17 (04) 192-198
    CrossrefPubMedGoogle Scholar
  • 18 Hanel DP, Ruhlman SD, Katolik LI, Allan CH. Complications associated with distraction plate fixation of wrist fractures. Hand Clin 2010; 26 (02) 237-243
    CrossrefPubMedGoogle Scholar
  • 19 Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PRT. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury 2013; 44 (04) 409-416
    CrossrefPubMedGoogle Scholar
  • 20 Claes LE, Cunningham JL. Monitoring the mechanical properties of healing bone. Clin Orthop Relat Res 2009; 467 (08) 1964-1971
    CrossrefPubMedGoogle Scholar
  • 21 Wheeler DL, Eschbach EJ, Montfort MJ, Maheshwari P, McLoughlin SW. Mechanical strength of fracture callus in osteopenic bone at different phases of healing. J Orthop Trauma 2000; 14 (02) 86-92
    CrossrefPubMedGoogle Scholar
  • 22 Melhus G, Solberg LB, Dimmen S, Madsen JE, Nordsletten L, Reinholt FP. Experimental osteoporosis induced by ovariectomy and vitamin D deficiency does not markedly affect fracture healing in rats. Acta Orthop 2007; 78 (03) 393-403
    CrossrefPubMedGoogle Scholar
  • 23 Giannoudis P, Tzioupis C, Almalki T, Buckley R. Fracture healing in osteoporotic fractures: is it really different? A basic science perspective. Injury 2007; 38 (Suppl. 01) S90-S99
    CrossrefPubMedGoogle Scholar
  • 24 Kubo T, Shiga T, Hashimoto J. et al. Osteoporosis influences the late period of fracture healing in a rat model prepared by ovariectomy and low calcium diet. J Steroid Biochem Mol Biol 1999; 68 (5-6): 197-202
    CrossrefPubMedGoogle Scholar
  • 25 Meyer Jr RA, Tsahakis PJ, Martin DF, Banks DM, Harrow ME, Kiebzak GM. Age and ovariectomy impair both the normalization of mechanical properties and the accretion of mineral by the fracture callus in rats. J Orthop Res 2001; 19 (03) 428-435
    CrossrefPubMedGoogle Scholar
  • 26 Cao Y, Mori S, Mashiba T. et al. Raloxifene, estrogen, and alendronate affect the processes of fracture repair differently in ovariectomized rats. J Bone Miner Res 2002; 17 (12) 2237-2246
    CrossrefPubMedGoogle Scholar