Distal radius volar rim plate: Technical and radiographic considerations

Abstract

Aim: To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures.

Methods: This review highlights technical considerations learnt using this implant since it was introduced in a major trauma unit in November 2011, including anatomical reduction and whether this was maintained radiographically.

Results: Twenty-six of the 382 internally fixed distal radial fractures at our unit (6.8%) were deemed to require this plate in order to achieve optimal fracture fixation between November 2011 and May 2014. A further dorsal and/or radial plate was necessary in 35% and variable angle screws were used in 54% of cases. Post-operatively, mean radial height, inclination, volar tilt and ulnar variance restored were 11.7 mm, 21º, 4.3º and -1.2 mm respectively. There were no cases of non-union or flexor/extensor tendon rupture; one case of loss of fracture reduction. Overall incidence of plate removal was 15% with one plate removed for flexor and one for extensor tendon irritation.

Conclusion: The use of a rim plate enables control of challenging far distal fracture patterns. However, additional plates were required to improve and maintain reduction. Variable angle screws were necessary in half the cases to avoid intra-articular screw penetration. If used judiciously, this implant can achieve stable fixation despite the complexity of the fracture pattern.

Keywords: Distal radius fractures; Volar plating distal radius; Volar rim plate.

Figure 1

Posteroanterior and lateral radiographs of fracture fixation using a Synthes variable angle 2.4 distal radius rim plate to highlight the distal placement of the implant.

Figure 2

Axial computerised tomograms showing far distal involvement and comminution of the distal radio-ulnar joint.

Figure 3

Axial computerised tomograms showing far distal involvement and comminution of the distal radio-ulnar joint.

Figure 4

Sagittal computerized tomogram showing the pattern of significant intra-articular comminution of the far distal dorso-ulnar and volar-ulnar regions of the distal radius and the volar lip marginal fragment.

Figure 5

PA and lateral radiograph showing combined dorsal and volar plating using a volar rim plate.