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Complications of Distal Radius

Fractures

John Lubahn MD

History

• Colles 1814

• Smith 1847

• Barton 1838

Complications of Distal Radius Fractures

• 1979 “They all do Well”

Closed Reduction and Cast

• Cotton Loder Position

• Carpal Tunnel

• Stiff MPJ’s

• Stiff Wrist

• Stiff Elbow

• Sore Shoulder

35 year old nurse 35 year old nurse

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35 Year Old Nurse 35 Year Old Nurse

Complications of Distal Radius Fractures

• Complex Regional Pain Syndrome (Carpal Tunnel, nerve contusion)

• Radial Sensory Neuritis

• Malunion

• Non Union

• Loss of Motion

• Tendon Rupture

Complications of Distal Radius Fractures

• DRUJ

• Carpal Instability

• Mid Carpal Instability secondary to dorsal Angulation

87 year old woman, Wrist Fracture 45 years agoChief complaint of trigger finger ,

87 year old woman

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Malunion 1981

Malunion 1983

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Osteotomy/Arthrodesis 20 year follow up

Open Complex

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65 Year Old Man, Distal Radius Malunion DISI

DISI

Proximal Row Carpectomy Volar Approach, opening dorsal wedge osteotomy

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Malunion with DRUJ Dislocation

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Shear Fracture Shear Fracture

Loss of Supination Non Union

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Locking Distal Radius Plates 2.4mm Volar Plate – Buttress Plate

Thickness: 2mm

12° 5°

Screw & Hole Design

2.4mm Locking Screws • StarDrive TM recess (Torx T8)

• Depth: 1.4mm

StarDriveTM Screw Driver • Self-Retaining

Palmar Approach

Palmar Plate - Function

Distal part function like a rake through angular stability

Buttress articular surface

Malunion with Volar Plate

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Volar approach, coral bone graft Union at One Year

82yo with loss of thumb flexion

Plate or “Proud” Screw

Stable IPJ Delayed Primary Repair

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Q4. How many patients with complete flexor tendon ruptures following volar plating of distal radius fractures have you encountered over the past year?

396, 67%

132, 22%

49, 8%

12, 2%

3, 1%

2, 0% 1, 0% 0, 0%

0, 0% 0, 0% 0, 0%

Number of patients (595 Respondents)

0

1

2

3

4

5

6

7

8

9

10+

294 patients identified.

Q5. How many of each of the following flexor tendon injuries following volar plating of distal radius fractures have you encountered over the past year?

254, 75%

61, 18%

8, 3%

8, 2% 7, 2%

Number ruptured

FPL rupture

FDP to index rupture

FDS to index rupture

FDP to long rupture

FDS to long rupture

338 Flexor tendon ruptures identified.

Q7. How many of the volar plates removed for symptomatic tendon irritation or rupture over the past year were proximal and distal to the watershed line, respectively?

169, 26%

345, 54%

129, 20%

Number of plates removed

Proximal

Distal

At the line

The location of 146 volar plates removed were not assessed or remembered.

Q8. How many of the volar plates removed for symptomatic tendon irritation or rupture over the past year were classified as Grade 0, 1, or 2, respectively, according to the Soong grading system (description given below)?

204 plates were not evaluated using the Soong grading

system.

52, 17%

141, 46%

112, 37%

Number of plates removed

Grade 0

Grade 1

Grade 2

Grade 0: Plate did not extend volar to the critical line

Grade 1: Plate volar to the critical line, proximal to the volar

rim

Grade 2: Plate on the critical line, distal to the volar rim

Q10. How many of each of the following extensor tendon injuries following volar plating of distal radius fractures have you encountered over the past year?

259, 73%

30, 9%

65, 18%

Number Ruptured

EPL

EIP

EDC

354 Extensor tendon ruptures

identified.

Tips for plate removal

• Over drill screws from dorsal

• “Crown” or hollow tip drill

• Midas Rex, use ultrasound gel to collect metal shaving

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