Download PDF
CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2024; 52(01): e42-e51
DOI: 10.1055/s-0044-1787131
Artículo Original | Original Article

Locking Volar Plate in Distal Radius Fractures: Minimally Invasive Technique versus Conventional Technique

Article in several languages: español | English
Luis Antonio Ruiz Villanueva 
1   Complejo Asistencial Universitario de León, León, España
,
María Alejandra Ruiz Villanueva
2   Complejo Asistencial Universitario de Salamanca, Salamanca, España
,
Carmen Salvat Dávila 
3   Hospital Universitario de Burgos, Burgos, España
,
Noanca Alonso Fernández 
1   Complejo Asistencial Universitario de León, León, España
,
Carlos Juárez Cordero
1   Complejo Asistencial Universitario de León, León, España
,
Juan Pablo Guzmán Zapata
1   Complejo Asistencial Universitario de León, León, España
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction In recent years, surgery has gained relevance in the treatment of distal radius fractures (DRF). Among the surgical techniques, minimally-invasive plate osteosynthesis (MIPO) is becoming popular, and its indications are increasing compared to the conventional technique.

Material and Methods A retrospective study that included 81 patients who went through surgery for DRF during 2021, corresponding to fractures of types I, II, and III in the Fernández classification. Radiological, clinical, and functional results, as well as the appearance of complications, were compared at the end of the 6-month follow-up.

Results The MIPO group was composed of 21 patients (8 men and 13 women) with a mean age of 57.3 years, and the conventional group, 60 patients (11 men and 49 women) with a mean age of 60.8 years. The Castaing Radiological Scale showed a favorable overall result for the MIPO technique compared to the conventional technique (p = 0.049), with statistically significance for the MIPO group in terms of sagittal/volar inclination (10.5 vs. 7.3°; p = 0.0006). The Visual Analogue Scale (VAS) yielded a result of 1.5 for the MIPO technique and of 2.9 for the conventional technique (p = 0.0141). The score on the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was slightly higher in the MIPO group (13.5%) compared to the conventional group (19.6%), but it was not statistically significant. Similar results were found for the range of motion (ROM), except for pronation and grip strength, which were favorable for the MIPO group. Complications, including nerve injury, chronic pain, tendon injury, and esthetic sequelae, were higher in percentage with the conventional technique.

Conclusion For the treatment of DRF, the MIPO technique, using an extra-short plate through a biological approach, can achieve functional results at least as good as those achieved with the conventional technique, with better radiological results, lower levels of postoperative pain, a lower rate of complications, and better esthetic results.

Keywords

distal radius fracture - osteosynthesis - plate - minimally-invasive surgery


Publication History

Received: 09 January 2024

Accepted: 01 April 2024

Article published online:
07 June 2024

© 2024. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37 (08) 691-697
    CrossrefPubMedSearch in Google Scholar
  • 2 Corsino CB, Reeves RA, Sieg RN. Distal Radius Fractures. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Jan–
    Search in Google Scholar
  • 3 Bentohami A, Bosma J, Akkersdijk GJ, van Dijkman B, Goslings JC, Schep NW. Incidence and characteristics of distal radial fractures in an urban population in The Netherlands. Eur J Trauma Emerg Surg 2014; 40 (03) 357-361
    PubMedSearch in Google Scholar
  • 4 Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93 (23) 2146-2153
    CrossrefPubMedSearch in Google Scholar
  • 5 Song J, Yu AX, Li ZH. Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8 (10) 17023-17035
    PubMedSearch in Google Scholar
  • 6 Chen Y, Chen X, Li Z, Yan H, Zhou F, Gao W. Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis. J Hand Surg Am 2016; 41 (03) 404-413
    CrossrefPubMedSearch in Google Scholar
  • 7 Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 2009; 91 (08) 1868-1873
    CrossrefPubMedSearch in Google Scholar
  • 8 Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am 2009; 91 (06) 1313-1319
    CrossrefPubMedSearch in Google Scholar
  • 9 Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J 2014; 96-B (07) 963-969
    CrossrefPubMedSearch in Google Scholar
  • 10 Mattila VM, Huttunen TT, Sillanpää P, Niemi S, Pihlajamäki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma 2011; 71 (04) 939-942 , discussion 942–943
    CrossrefPubMedSearch in Google Scholar
  • 11 Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg Am 2008; 33 (06) 809-819
    CrossrefPubMedSearch in Google Scholar
  • 12 Oshige T, Sakai A, Zenke Y, Moritani S, Nakamura T. A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating. J Hand Surg Am 2007; 32 (09) 1385-1392
    CrossrefPubMedSearch in Google Scholar
  • 13 Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am 2005; 30 (02) 289-299
    CrossrefPubMedSearch in Google Scholar
  • 14 Williksen JH, Husby T, Hellund JC, Kvernmo HD, Rosales C, Frihagen F. External Fixation and Adjuvant Pins Versus Volar Locking Plate Fixation in Unstable Distal Radius Fractures: A Randomized, Controlled Study With a 5-Year Follow-Up. J Hand Surg Am 2015; 40 (07) 1333-1340
    CrossrefPubMedSearch in Google Scholar
  • 15 Wagner M. General principles for the clinical use of the LCP. Injury 2003; 34 (Suppl. 02) B31-B42
    CrossrefPubMedSearch in Google Scholar
  • 16 Haerle M, Schaller HE, Mathoulin C. Vascular anatomy of the palmar surfaces of the distal radius and ulna: its relevance to pedicled bone grafts at the distal palmar forearm. J Hand Surg [Br] 2003; 28 (02) 131-136
    CrossrefPubMedSearch in Google Scholar
  • 17 Haerle M, Häfner HM, Dietz K, Schaller HE, Brunelli F. Vascular dominance in the forearm. Plast Reconstr Surg 2003; 111 (06) 1891-1898
    CrossrefPubMedSearch in Google Scholar
  • 18 Dos Remedios C, Nebout J, Benlarbi H, Caremier E, Sam-Wing JF, Beya R. Préservation du muscle carré pronateur dans les ostéosynthèses des fractures de l'extrémité distale du radius par plaque palmaire verrouillée. Technique chirurgicale. Chir Main 2009; 28 (04) 224-229 French
    CrossrefPubMedSearch in Google Scholar
  • 19 Armangil M, Bezirgan U, Başarır K, Bilen G, Demirtaş M, Bilgin SS. The pronator quadratus muscle after plating of distal radius fractures: is the muscle still working?. Eur J Orthop Surg Traumatol 2014; 24 (03) 335-339
    CrossrefPubMedSearch in Google Scholar
  • 20 Imatani J, Noda T, Morito Y, Sato T, Hashizume H, Inoue H. Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius. J Hand Surg [Br] 2005; 30 (02) 220-225
    CrossrefPubMedSearch in Google Scholar
  • 21 Orbay JL, Touhami A, Orbay C. Fixed angle fixation of distal radius fractures through a minimally invasive approach. Tech Hand Up Extrem Surg 2005; 9 (03) 142-148
    CrossrefPubMedSearch in Google Scholar
  • 22 Sen MK, Strauss N, Harvey EJ. Minimally invasive plate osteosynthesis of distal radius fractures using a pronator sparing approach. Tech Hand Up Extrem Surg 2008; 12 (01) 2-6
    CrossrefPubMedSearch in Google Scholar
  • 23 Zenke Y, Sakai A, Oshige T. et al. Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma 2011; 25 (07) 425-431
    CrossrefPubMedSearch in Google Scholar
  • 24 Lebailly F, Zemirline A, Facca S, Gouzou S, Liverneaux P. Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases. Eur J Orthop Surg Traumatol 2014; 24 (06) 877-890
    CrossrefPubMedSearch in Google Scholar
  • 25 Liverneaux P, Ichihara S, Facca S, Hidalgo Diaz JJ. [Outcomes of minimally invasive plate osteosynthesis (MIPO) with volar locking plates in distal radius fractures: A review]. Hand Surg Rehabil 2016; 35S: S80-S85 French
    CrossrefPubMedSearch in Google Scholar
  • 26 Lee DY, Park YJ, Park JS. A Meta-analysis of Studies of Volar Locking Plate Fixation of Distal Radius Fractures: Conventional versus Minimally Invasive Plate Osteosynthesis. Clin Orthop Surg 2019; 11 (02) 208-219
    CrossrefPubMedSearch in Google Scholar
  • 27 Asmar G, Bellity J, Falcone MO. Surgical comfort and clinical outcomes of MIPO with an extra-short plate designed for distal radius fractures. Eur J Orthop Surg Traumatol 2021; 31 (03) 481-490
    CrossrefPubMedSearch in Google Scholar