Name: Distal Radius Surgical Stabilization with the Wrist Plating System
Uploaded: 2018-03-20T00:00:00Z
Channel: Arthrex
Description: John Riehl, MD, (Gulf Breeze, FL) reviews 2 case presentations highlighting applications for volar and dorsal approaches to distal radius fractures.

<p>John Riehl, MD, (Gulf Breeze, FL) reviews 2 case presentations highlighting applications for volar and dorsal approaches to distal radius fractures.</p>

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VPT1-00994-EN | A | Distal Radius Surgical Stabilization with the Wrist Plating System

John T. Riehl

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A video of a live presentation reviewing Arthrex products or techniques.

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Distal Radius Surgical Stabilization with the Wrist Plating System

Hi, my name is John Riel. I'm an orthopedic trauma surgeon practicing on the Gulf Coast, and I have a couple of cases on distal radius fractures that I'd like to share. First case, 75 year old female was playing baseball with her grandson and had a fall on an outstretched hand onto her right wrist. She had immediate pain and deformity, was seen in the emergency department and referred to my clinic the next day. His right hand dominant, had no significant past medical history and does not use tobacco. These are x rays that she presented with with dorsal displacement of the distal radius fracture. She was found to be neurovascular intact on presentation. And she happened to be MPO that day, and so ended up taking her to the operating room that afternoon with this displaced fracture. She had a volar approach performed and a standard three hole Arthrex volar plate was placed. These are her x rays at two weeks postoperatively, and you can see the realignment of the distal radius here and the plate placed early. She was splinted after surgery and the splint was removed at two weeks, along with removal of her staples. She was on vitamin C and off of all narcotic pain medicine at her first follow up. I ordered a Dexa scan on her due to her low energy osteoporotic fracture, and her wound was healed at two weeks. She had no pain and was off of narcotic pain medication as stated above. Placed her into a wrist brace just for comfort, but allowed range of motion is tolerated. And these are her six week X-rays showing a healed fracture with restoration of alignment following the injury. The rest of her clinical course, she had full range of motion at six weeks. Fracture was healed. She had no pain at that point. Her three month x rays are seen here on the bottom of the screen, and at six months, she remained pain free. These x rays on the right are another example of the Arthrex plate. This is a narrow plate. And put this in here to note the screw spread that you can achieve with both the narrow and the standard plates. The second case, this one is a 54 year old male had a fall from standing on an outstretched hand, closed injury. He's a right hand dominant person and works as an accountant. These are his initial injury films and you can note here on the lateral view. Dorsal displacement and comminution. This is an intra-articular fracture primarily with dorsal displacement. And there's a gap in the articular surface which is also wide on the lateral view. So my plan here was for a dorsal approach with direct visualization of the articular surface and direct reduction and dorsal plating here on lateral view. We can take a little bit closer look at these x rays. And you see primarily dorsal comminution. And you see this gap in the articular surface. The articular surface is also widened from normal. And if you compare the width of the lunate versus the width of the distal radius with this fracture that can be seen here with these lines. So Intraoperatively I did a dorsal approach and had direct visualization of the articular surface here. This is the scaphoid for orientation. And these are your distal radius fracture lines. Once the fracture site was reduced and pinned again you can see the distal radius fracture fractured now, reduced back. And I placed a dorsal buttress plate here. You can see on the view here the plate in place with screws and the articular surface reduced. This is another view of the plate. And you can see the EPL tendon coming over the plate there. And these are intraoperative x rays. And so this is showing the overall alignment that was achieved with the use of the dorsal plate. This is a comparison of our pre-op views versus our post-operative views. And the difference in the articular width on the lateral view. Post-operative x rays are shown here with reduction of the displacement and overall restoration alignment of the distal radius. So some of my indications for when I go dorsal I would say the vast majority of my distal radius fractures I fix with the volar plate. But there are a few indications where going dorsal I find to be very helpful in treating these fractures. So isolated dorsal fractures. Dorsal Barton's fracture A shearing type fracture dislocation when there is primarily dorsal displacement, especially with an AP or with an apex. Volar type of fracture. If I need intra-articular visualization, going dorsal can be very helpful if I if I have traumatic wounds that preclude another approach or lead me towards a dorsal approach, that may be another indication for me to go dorsal. And if I have concurrent distal radioulnar joint and or SL injury, then I may choose to go dorsal. My primary two indications are with these isolated dorsal fractures though. And when I need to visualize intra-articular some potential advantages to dorsal plating it. Dorsal plating provides a buttress to the most common distal radius fracture pattern type, and is the more biomechanically advantageous place to place a plate, and it avoids the neurovascular structures that are encountered anteriorly. Some of the previous criticism of dorsal plating is now resolved with newer plates as far as tendon irritation and rupture, and newer low profile plates have been shown in several studies to have lower incidence of tendon rupture.

Distal Radius Surgical Stabilization with the Wrist Plating System

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