ABSTRACT
The volar locking plate is a popular implant for surgical management of unstable distal radial fractures. We routinely utilize this system for all distal radial fractures except for those with entrapped intra-articular fragments and fractures with a displaced dorsomedial facet fracture (which is hard to capture with the volar approach alone). In this video, we describe in detail the necessary steps for successful placement of the volar locking plate, starting with preoperative planning and ending with expected outcomes. The approach that we utilize is through the flexor carpi radialis tendon sheath and avoids the radial artery. In the video, we describe 4 variations on the application of a volar locking plate: (1) the standard technique after appropriate reduction and provisional fixation with Kirschner wires, (2) regaining length through a shortened distal radial fracture, (3) using the volar plate to assist in the reduction and regain volar tilt, and (4) intraoperative management of coronal shift of the distal fragment. Complications reported for the volar locking plate have decreased with newer low-profile plate designs; however, they still include volar tendon irritation and/or rupture and median neuropathy. Postoperatively, we advise a brief 2-week period of immobilization for wound-healing, which is followed by a period during which a removable wrist splint is used and patients are instructed on the performance of a hand therapy regimen.
ABSTRACT
OBJECTIVES: To document the refracture rate after removal of internal fixation at the metaphyseal region of the distal radius and to compare this rate to that associated with diaphyseal plate removal reported in the literature. DESIGN: A chart review with telephone follow-up. SETTING: Three tertiary care hospitals (in Ottawa, Burlington, Vt., and London, Ont.). PATIENTS: Fifty-three patients (54 radii) underwent elective removal of internal fixation of the distal radius after distal metaphyseal procedures. The mean follow-up was 46.8 months. MAIN OUTCOME MEASURE: The refracture rate. RESULTS: No refractures were reported after plate removal, and the overall complication rate was minimal. CONCLUSIONS: The refracture rate at the metaphvsis of the radius after plate removal is lower than the rate after diaphyseal plate removal reported in the literature.
