Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study
Abstract Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-021-04989-w |
| _version_ | 1818964046930509824 |
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| author | Mariya Hadzhinikolova Ivan Zderic Daniel Ciric Jan P. Barcik Dian Enchev Asen Baltov Lyubomir Rusimov Peter Varga Karl Stoffel Geoff Richards Boyko Gueorguiev Mihail Rashkov |
| author_facet | Mariya Hadzhinikolova Ivan Zderic Daniel Ciric Jan P. Barcik Dian Enchev Asen Baltov Lyubomir Rusimov Peter Varga Karl Stoffel Geoff Richards Boyko Gueorguiev Mihail Rashkov |
| author_sort | Mariya Hadzhinikolova |
| collection | DOAJ |
| description | Abstract Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution. Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension. In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02). Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63). Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74). Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates. Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments. |
| first_indexed | 2024-12-20T12:54:54Z |
| format | Article |
| id | doaj.art-c82a0330cdd24202a915335742084cf5 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-20T12:54:54Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-c82a0330cdd24202a915335742084cf52022-12-21T19:40:05ZengBMCBMC Musculoskeletal Disorders1471-24742022-01-0123111010.1186/s12891-021-04989-wVolar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical studyMariya Hadzhinikolova0Ivan Zderic1Daniel Ciric2Jan P. Barcik3Dian Enchev4Asen Baltov5Lyubomir Rusimov6Peter Varga7Karl Stoffel8Geoff Richards9Boyko Gueorguiev10Mihail Rashkov11AO Research Institute DavosAO Research Institute DavosAO Research Institute DavosAO Research Institute DavosDepartment of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’AO Research Institute DavosAO Research Institute DavosUniversity Hospital BaselAO Research Institute DavosAO Research Institute DavosDepartment of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’Abstract Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution. Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension. In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02). Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63). Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74). Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates. Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.https://doi.org/10.1186/s12891-021-04989-wComplex intraarticular distal radius fractureVolar plateDouble platingDorsoulnar fragment fixationBiomechanical testing |
| spellingShingle | Mariya Hadzhinikolova Ivan Zderic Daniel Ciric Jan P. Barcik Dian Enchev Asen Baltov Lyubomir Rusimov Peter Varga Karl Stoffel Geoff Richards Boyko Gueorguiev Mihail Rashkov Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study BMC Musculoskeletal Disorders Complex intraarticular distal radius fracture Volar plate Double plating Dorsoulnar fragment fixation Biomechanical testing |
| title | Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study |
| title_full | Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study |
| title_fullStr | Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study |
| title_full_unstemmed | Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study |
| title_short | Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study |
| title_sort | volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment a biomechanical study |
| topic | Complex intraarticular distal radius fracture Volar plate Double plating Dorsoulnar fragment fixation Biomechanical testing |
| url | https://doi.org/10.1186/s12891-021-04989-w |
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