Three-Dimensional Analysis of Polyaxial Volar Locking Plate Position for Distal Radius Fracture

Abstract

Background To avoid screw penetration into the joint when using the polyaxial volar locking plate (VLP) for osteosynthesis of distal radius fractures, it is important to note that the optimal screw insertion angles depending on the plate positions.

Purpose The purpose of this study was 2-fold: first, to evaluate the differences of the most distal plate position where the screw does not penetrate into the joint in the three-dimensional (3D) radius models; second, to evaluate the relationship between the plate position and the transverse diameter of the distal radius.

Patients and Methods Thirty plain X-rays and computed tomography (CT) scans of healthy wrists were evaluated. The transverse diameter was measured on plain X-rays. 3D radius models were reconstructed from CT data. A 3D image of polyaxial VLP was used to investigate the most distal plate position at three different screw insertion angles. The linear distance between the volar articular edge and the plate edge was measured and compared among different screw insertion angles. The correlations between the plate positions and the transverse diameter were also evaluated. In addition, the relationship between the most distal screw place and articular surface was confirmed with one case of distal radius fracture.

Results The optimal positions relative to the neutral were 2.7 mm proximal in the distal swing and 1.9 mm distal in the proximal swing. The linear distance was significantly correlated with the transverse diameter in each group. It was confirmed that the relationship between the most distal screw place and articular surface was applicable in the actual case.

Conclusion The results showed that the most distal position of the polyaxial VLP differed depending on the screw insertion angle and became more proximal as the transverse diameter increased. These results may be useful as a reference for preoperative planning.

Levels of Evidence III.

Keywords

distal radius fracture - volar locking plate - three dimension - computed tomography - computer-assisted

Consent for Publication

Written informed consent was obtained from the patients to participate in this study.

Availability of Data and Material

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Note

This study was performed at Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Tsukuba, Ibaraki, Japan.

Publikationsverlauf

Artikel online veröffentlicht:
08. März 2024

• References

• 1 Hoffmeier KL, Hofmann GO, Mückley T. The strength of polyaxial locking interfaces of distal radius plates. Clin Biomech (Bristol, Avon) 2009; 24 (08) 637-641
• 2 Rausch S, Klos K, Stephan H. et al. Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model–a biomechanical study. Injury 2011; 42 (11) 1248-1252
• 3 Mehrzad R, Kim DC. Complication rate comparing variable angle distal locking plate to fixed angle plate fixation of distal radius fractures. Ann Plast Surg 2016; 77 (06) 623-625
• 4 Soong M, Got C, Katarincic J, Akelman E. Fluoroscopic evaluation of intra-articular screw placement during locked volar plating of the distal radius: a cadaveric study. J Hand Surg Am 2008; 33 (10) 1720-1723
• 5 Yoneda H, Iwatsuki K, Hara T, Kurimoto S, Yamamoto M, Hirata H. Interindividual anatomical variations affect the plate-to-bone fit during osteosynthesis of distal radius fractures. J Orthop Res 2016; 34 (06) 953-960
• 6 Cho HJ, Kim S, Kwak DS. Morphological study of the anterior surface of the distal radius. BioMed Res Int 2017; 2017: 8963768
• 7 Oppermann J, Bredow J, Beyer F. et al. Distal radius: anatomical morphometric gender characteristics. Do anatomical pre-shaped plates pay attention on it?. Arch Orthop Trauma Surg 2015; 135 (01) 133-139
• 8 Gandhi RA, Hesketh PJ, Bannister ER, Sebro R, Mehta S. Age-related variations in volar cortical angle of the distal radius. Hand (N Y) 2020; 15 (04) 573-577
• 9 Yoneda H, Iwatsuki K, Saeki M, Yamamoto M, Tatebe M. Do anatomical differences of the volar rim of the distal radius affect implant design? A three-dimensional analysis of its anatomy and need for personalized medicine. Anatomia 2022; 1 (02) 177-185
• 10 Yoshii Y, Kusakabe T, Akita K, Tung WL, Ishii T. Reproducibility of three dimensional digital preoperative planning for the osteosynthesis of distal radius fractures. J Orthop Res 2017; 35 (12) 2646-2651
• 11 Yoshii Y, Totoki Y, Shigi A. et al. Computer-aided assessment of displacement and reduction of distal radius fractures. Diagnostics (Basel) 2021; 11 (04) 719
• 12 Yoshii Y, Ogawa T, Shigi A, Oka K, Murase T, Ishii T. Three-dimensional evaluations of preoperative planning reproducibility for the osteosynthesis of distal radius fractures. J Orthop Surg Res 2021; 16 (01) 131
• 13 Ikumi A, Yoshii Y, Eda Y, Ishii T. Computer-aided assessment of three-dimensional standard bone morphology of the distal radius. Diagnostics (Basel) 2022; 12 (12) 3212
• 14 Seuthe R, Seekamp A, Kurz B. et al. Comparison of a ceiling-mounted 3D flat panel detector vs. conventional intraoperative 2D fluoroscopy in plate osteosynthesis of distal radius fractures with volar locking plate systems. BMC Musculoskelet Disord 2021; 22 (01) 924
• 15 Nishiwaki M, Terasaka Y, Kiyota Y, Inaba N, Koyanagi T, Horiuchi Y. A prospective randomized comparison of variable-angle and fixed-angle volar locking plating for intra-articular distal radius fractures. J Hand Surg Am 2021; 46 (07) 584-593
• 16 Aldemir C, Duygun F. Is it possible to avoid intra-articular screw penetration with minimal use of fluoroscopy in the application of distal radius volar plate?. Eklem Hastalik Cerrahisi 2017; 28 (01) 2-6
• 17 Tanaka Y, Aoki M, Izumi T, Fujimiya M, Yamashita T, Imai T. Effect of distal radius volar plate position on contact pressure between the flexor pollicis longus tendon and the distal plate edge. J Hand Surg Am 2011; 36 (11) 1790-1797
• 18 Tokutake K, Iwatsuki K, Tatebe M, Okui N, Mizuno M, Hirata H. Usefulness of CT-based measurement of volar prominence for evaluation of risk of flexor tendon injury following fixation of a distal radius fracture. J Orthop Sci 2019; 24 (02) 263-268
• 19 Gehweiler D, Teunis T, Varjas V. et al. Computerized anatomy of the distal radius and its relevance to volar plating, research, and teaching. Clin Anat 2019; 32 (03) 361-368
• 20 Yoshii Y, Totoki Y, Sashida S, Sakai S, Ishii T. Utility of an image fusion system for 3D preoperative planning and fluoroscopy in the osteosynthesis of distal radius fractures. J Orthop Surg Res 2019; 14 (01) 342