Faculty Bibliography

PURPOSE/OBJECTIVE:Fixed-angle devices have been a major advancement in orthopedic fracture care and have become an attractive option for fixation of distal radius fractures. Several volar locking plates exist, but there is insufficient literature comparing the strengths of these plates. This study compares the biomechanical strength of two popular volar locking plate systems (Synthes LCP and Hand Innovations DVR-A) along with a nonlocking volar T-plate (Synthes). METHODS:Twenty-three formalin-fixed cadaveric forearms were divided into three groups with similar ages and bone densities. An unstable extra-articular fracture was created using a standardized osteotomy. Each group was fixed with one of the three plates. Each specimen was loaded in axial compression for 2000 cycles at a force of 400 N. Each specimen that completed cyclic testing was loaded to failure. Stiffness, yield point, and ultimate strength were recorded for each construct. RESULTS:Each fixed-angle construct completed all 2000 cycles. The nonlocking plates failed at an average of 560 cycles. The mean stiffness of the DVR-A, LCP, and the volar T-plates were 277.00, 343.17, and 175.67 N/mm, respectively. There was a statistically significant difference between both fixed-angle plates and the nonlocking plate (p < 0.05). The difference between each fixed-angle construct did not reach significance. Yield point and ultimate strength could only be determined for the two fixed-angle devices. There was no statistically significant difference between the constructs for both yield point (DVR-A = 855.56 N, LCP = 894.15 N) and ultimate strength (DVR-A = 1,021.97 N, LCP = 1,114.87 N). CONCLUSIONS:Given our data, fixed-angle constructs withstand cyclical loading representing normal physiologic forces encountered during post-operative rehabilitation. There was no significant biomechanical difference between the two fixed-angle constructs. Our results support that volar fixed-angle locking plates are an effective treatment for unstable extra-articular distal radius fractures, allowing early postoperative rehabilitation to safely be initiated.

We retrospectively review the cases of 5 men with closed, impacted intra-articular fractures of the middle phalanx at the proximal interphalangeal joint and describe a new technique-involving percutaneous reduction and Kirschner-wire fixation-that minimizes surgical trauma, allows fixation for early range of motion, and provides results as good as, if not superior to, those obtained with existing techniques.

In this article, we present a case of traumatic bilateral trapeziometacarpal joint dislocations treated successfully with closed reduction and immobilization. We also review the literature, describe a treatment protocol for management of trapeziometacarpal dislocations, and recommend conservative treatment for patients who have such injuries and who meet certain criteria. Conservative treatment includes immediate diagnosis and stabilization after acute reduction and then use of immobilization to maintain stabilization. Failure to maintain closed reduction, acute instability, significant swelling, or delayed presentation warrants fixation, possibly with percutaneous pinning, and then immobilization in a thumb spica cast. Loss of reduction after pinning, or failure to achieve anatomic reduction, requires open reduction, possibly with acute ligamentous reconstruction.

The case of a Maisonneuve fracture occurring in association with a triplane fracture in an adolescent wrestler is presented. In this combination of injuries, the deltoid ligament may be ruptured, and/or the medial malleolus fractured. If the proximal fibula fracture is not discovered, and the syndesmosis rupture is not treated, the resulting chronic talocrural instability may lead to chronic ankle pain and degenerative arthritis. The orthopedist should be aware of the possibility of a Maisonneuve fracture occurring in association with a triplane fracture, and should treat both injuries appropriately.