Subscribe to RSS
DOI: 10.1055/s-0043-1760736
A Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating
Funding No external funding received for this project.![](https://www.thieme-connect.de/media/jws/202305/lookinside/thumbnails/10-1055-s-0043-1760736_2200109-1.jpg)
Abstract
Background Although outcome of volar plating is generally good, care should be taken to avoid specific iatrogenic and preventable complications, with an incidence reporting averaging 15%. Flexor tendon rupture due to a prominent plate, extensor tendon rupture due to a dorsal protruding screw tips, cartilage lesions due to intra-articular screw placement, loss of reduction due to insufficient stability, and persisting ulnar pain with distal radioulnar joint instability due to unstable triangular fibrocartilaginous complex lesions or unstable ulnar styloid base fractures all have been described.
Purpose We believe that a majority of these complications can be prevented by meticulous assessment of several intraoperative parameters during volar plating. Therefore, we introduce the WRIST protocol, a stepwise easy-to-remember manual that combines multiple fluoroscopic measurements to guide intraoperative decision making.
Conclusion Large prospective studies of the “WRIST” protocol are needed for validation. But we believe that it may help surgeons to optimize surgical technique, functional and radiographic outcome, and prevent complications when treating distal radial fractures.
Authors' Contributions
- Conception of the protocol: C.K.G.
- Testing and reviewing of the protocol during surgery: C.K.G., G.V.E., N.D., K.V.R.
- Main writer of manuscript: C.K.G.
- Assisting writers of manuscript: G.V.E., N.D., K.V.R.
- Review of the submission: C.K.G., G.V.E., N.D.
All authors have met the ICMJE criteria for authorship.
Publication History
Received: 11 October 2022
Accepted: 28 November 2022
Article published online:
09 February 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Orbay J. Volar plate fixation of distal radius fractures. Hand Clin 2005; 21 (03) 347-354
- 2 Salibian AA, Bruckman KC, Bekisz JM, Mirrer J, Thanik VD, Hacquebord JH. Management of unstable distal radius fractures: a survey of hand surgeons. J Wrist Surg 2019; 8 (04) 335-343
- 3 van Schaik DE, Goorens CK, Wernaers P, Hendrickx B, Scheerlinck T, Goubau JF. Evaluation of current treatment techniques for distal radius fractures amongst Belgian orthopaedic surgeons. Acta Orthop Belg 2015; 81 (02) 321-326
- 4 DeGeorge Jr BR, Brogan DM, Becker HA, Shin AY. Incidence of complications following volar locking plate fixation of distal radius fractures: an analysis of 647 cases. Plast Reconstr Surg 2020; 145 (04) 969-976
- 5 Thorninger R, Madsen ML, Wæver D, Borris LC, Rölfing JHD. Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury 2017; 48 (06) 1104-1109
- 6 Bentohami A, de Burlet K, de Korte N, van den Bekerom MP, Goslings JC, Schep NW. Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur Vol 2014; 39 (07) 745-754
- 7 Holbrook HS, Doering TA, Mauck BM. Common complications of distal radial fractures. Orthop Clin North Am 2021; 52 (03) 241-250
- 8 Aibinder WR, Izadpanah A, Elhassan BT. Ulnar shortening versus distal radius corrective osteotomy in the management of ulnar impaction after distal radius malunion. Hand (N Y) 2018; 13 (02) 194-201
- 9 Cognet JM, Mares O. Distal radius malunion in adults. Orthop Traumatol Surg Res 2021; 107 (1S): 102755
- 10 Lalone EA, Grewal R, King GJ, MacDermid JC. A structured review addressing the use of radiographic measures of alignment and the definition of acceptability in patients with distal radius fractures. Hand (N Y) 2015; 10 (04) 621-638
- 11 Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am 2006; 88 (09) 1944-1951
- 12 Walenkamp MM, Aydin S, Mulders MA, Goslings JC, Schep NW. Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg Eur Vol 2016; 41 (05) 501-515
- 13 Rhee PC, Dennison DG, Kakar S. Avoiding and treating perioperative complications of distal radius fractures. Hand Clin 2012; 28 (02) 185-198
- 14 Kamei S, Osada D, Tamai K. et al. Stability of volar locking plate systems for AO type C3 fractures of the distal radius: biomechanical study in a cadaveric model. J Orthop Sci 2010; 15 (03) 357-364
- 15 Patrick NC, Lewis GS, Roush EP, Black SS, Henderson SR, Taylor KF. Biomechanical stability of volar plate only versus addition of dorsal ulnar pin plate: a dorsal ulnar fragment, c-3-type, distal radius, cadaver fracture model. J Orthop Trauma 2020; 34 (09) e298-e303
- 16 Gavaskar AS, Parthasarathy S, Balamurugan J, Raj RV, Anurag R, Gopinath D. Volar hook plate stabilization of volar marginal fragments in intra-articular distal radius fractures. Injury 2021; 52 (01) 85-89
- 17 Goorens CK, Geeurickx S, Wernaers P, Staelens B, Scheerlinck T, Goubau J. Midterm follow-up of treating volar marginal rim fractures with variable angle lcp volar rim distal radius plates. J Hand Surg Asian Pac Vol 2017; 22 (02) 184-187
- 18 Ruch DS, Tocci FL, Grier AJ. et al. Integrated compression screw stabilization of the dorsal lunate facet in intra-articular distal radius fractures. J Hand Surg Am 2020; 45 (04) 361.e1-361.e7
- 19 Wall LB, Brodt MD, Silva MJ, Boyer MI, Calfee RP. The effects of screw length on stability of simulated osteoporotic distal radius fractures fixed with volar locking plates. J Hand Surg Am 2012; 37 (03) 446-453
- 20 Day CS, Kamath AF, Makhni E, Jean-Gilles J, Zurakowski D. “Sandwich” plating for intra-articular distal radius fractures with volar and dorsal metaphyseal comminution. Hand (N Y) 2008; 3 (01) 47-54
- 21 Bohm KC, Geissler J, Ward CM. Volar radiocarpal ligament repair with suture anchors for radiocarpal fracture dislocations: case series. J Wrist Surg 2021; 10 (02) 169-175
- 22 Potter MQ, Haller JM, Tyser AR. Ligamentous radiocarpal fracture-dislocation treated with wrist-spanning plate and volar ligament repair. J Wrist Surg 2014; 3 (04) 265-268
- 23 Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 2011; 93 (04) 328-335
- 24 Gören Y, Sauerbier M, Arsalan-Werner A. Impact of Soong grading on flexor tendon ruptures following palmar plating for distal radial fractures. J Hand Surg Eur Vol 2020; 45 (04) 348-353
- 25 Vaiss L, Ichihara S, Hendriks S, Taleb C, Liverneaux P, Facca S. The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures. J Wrist Surg 2014; 3 (04) 245-249
- 26 Goorens CK, Van Royen K, Grijseels S. et al. Ultrasonographic evaluation of the distance between the flexor pollicis longus tendon and volar prominence of the plate as a function of volar plate positioning and pronator quadratus repair - a cadaver study. Hand Surg Rehabil 2018; 37 (03) 171-174
- 27 Kaiser P, Gruber H, Loth F, Schmidle G, Arora R, Gabl M. Positioning of a volar locking plate with a central flexor pollicis longus tendon notch in distal radius fractures. J Wrist Surg 2019; 8 (06) 482-488
- 28 Onishi T, Omokawa S, Iida A. et al. Biomechanical study of distal radioulnar joint ballottement test. J Orthop Res 2017; 35 (05) 1123-1127
- 29 Xiao AX, Graf AR, Dawes A, Daley C, Wagner ER, Gottschalk MB. Management of acute distal radioulnar joint instability following a distal radius fracture: a systematic review and meta-analysis. J Hand Surg Glob Online 2021; 3 (03) 133-138
- 30 Im J, Kang SJ, Lee SJ. A comparative study between conservative and surgical treatments of triangular fibrocartilage complex injury of the wrist with distal radius fractures. Clin Orthop Surg 2021; 13 (01) 105-109
- 31 Kim KW, Lee CH, Choi JH, Ahn JM, Gong HS. Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture?. Arch Orthop Trauma Surg 2021
- 32 Chen AC, Chiu CH, Weng CJ, Chang SS, Cheng CY. Early and late fixation of ulnar styloid base fractures yields different outcomes. J Orthop Surg Res 2018; 13 (01) 193
- 33 Jones VM, Everding NG, Desmarais JM, Soong MC. Scapholunate instability after distal radius volar plating. Hand (N Y) 2015; 10 (04) 678-682
- 34 Kastenberger T, Kaiser P, Schmidle G, Schwendinger P, Gabl M, Arora R. Arthroscopic assisted treatment of distal radius fractures and concomitant injuries. Arch Orthop Trauma Surg 2020; 140 (05) 623-638