Biomechanical Stability of Four Fixation Constructs for Distal Radius Fractures

Abstract

Implants available for distal radius fracture fixation include dorsal nonlocked plating (DNLP), volar locked plating (VLP), radial–ulnar dual-column locked plating (DCPs), and locked intramedullary fixation (IMN). This study examines the biomechanical properties of these four different fixation constructs. In 28 fresh-frozen radii, a wedge osteotomy was performed, creating an unstable fracture model and the four fixation constructs employed (DNLP, VLP, DCPs, and IMN). Dorsal bending loads were applied and bending stiffness, load to yield 5 mm displacement, and ultimate failure were measured. Bending stiffness for VLP (16.7 N/mm) was significantly higher than for DNLP (6.8 N/mm), while IMN (12.6 N/mm) and DCPs (11.8 N/mm) were similar. Ultimate load to failure occurred at 278.2 N for the VLP, 245.7 N for the IMN, and 52.0 N for the DNLP. The VLP was significantly stronger than the DNLP and DCPs, and the IMN and DCPs were stronger than the DNLP. The VLP has higher average bending stiffness, ultimate bending strength, and resistance to 5 mm displacement than the other constructs and significantly higher ultimate bending strength than the DCPs and DNLP. There was no statistically significant difference between the VLP and IMN. VLP and IMN fixation of distal radius fractures can achieve comparable stability.

Keywords

Distal radius Fracture Wrist Biomechanical Fixation Intramedullary Nail Locked plate Dual plates Dorsal plate Wrist trauma Wrist fracture fixation Distal radius fracture fixation

Get full access to this article

View all access options for this article.

References

Blythe

Stoffel

Jarrett

Kuster

. Volar versus dorsal locking plates with and without radial styloid locking plates for the fixation of dorsally comminuted distal radius fractures: a biomechanical study in cadavers. J Hand Surg [Am] 2006;31 10:1587–93, PMID: 17145377. doi:10.1016/j.jhsa.2006.09.011.

Brooks

Capo

Warburton

Tan

. Internal fixation of distal radius fractures with novel intramedullary implants. Clin Orthop Relat Res 2006;445:42–50, PMID: 16505729.

Carter

Frederick

Laseter

. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg [Am] 1998;23 2:300–7, PMID: 9556273. doi:10.1016/S0363-5023(98)80131-7.

Chen

Dai

Wongworawat

. A biomechanical comparison between two volar locking plate systems for distal radius fractures. Orthopedics 2006;29 10:927–9. PMID: 17061419.

Gesensway

Putnam

Mente

Lewis

. Design and biomechanics of a plate for the distal radius. J Hand Surg [Am] 1995;20 6:1021–7, PMID: 8583051. doi:10.1016/S0363-5023(05) 80153-4.

Jakob

Rikli

Regazzoni

. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br 2000;82 3:340–4, PMID: 10813166. doi:10.1302/0301-620X.82B3.10099.

Kamath

Zurakowski

Day

. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg [Am] 2006;31 7:1061–7, PMID: 16945704. doi:10.1016/j.jhsa.2006.05.008.

Koh

Morris

Patterson

Kearney

Buford

Jr Viegas

. Volar fixation for dorsally angulated extra-articular fractures of the distal radius: a biomechanical study. J Hand Surg [Am] 2006;31 5:771–9, PMID: 16713841. doi:10.1016/j. jhsa.2006.02.015.

Liporace

Gupta

Jeong

Stracher

Kummer

Egol

. A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures. J Orthop Trauma 2005;19 3:187–91, PMID: 15758672. doi:10.1097/00005131-200503000-00006.

10.

Liporace

Kubiak

Jeong

Iesaka

Egol

Koval

. A biomechanical comparison of two volar locked plates in a dorsally unstable distal radius fracture model. J Trauma 2006;61 3:668–72, PMID: 16967005. doi:10.1097/01.ta.0000234727. 51894.7d.

11.

McCall

Conrad

Badman

Wright

. Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study. J Hand Surg [Am] 2007;32 6:806–12, PMID: 17606058. doi:10.1016/j.jhsa. 2007.04.016.

12.

Orbay

Fernandez

. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg [Am] 2002;27 2:205–15, PMID: 11901379. doi:10.1053/jhsu.2002.32081.

13.

Osada

Viegas

Shah

Morris

Patterson

. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg [Am] 2003;28 1:94–104, PMID: 12563644. doi:10.1053/jhsu.2003.50016.

14.

Peine

Rikli

Hoffmann

Duda

Regazzoni

. Comparison of three different plating techniques for the dorsum of the distal radius: a biomechanical study. J Hand Surg [Am] 2000;25 1:29–33, PMID: 10642470. doi:10.1053/jhsu.2000. jhsu025a0029.

15.

Ring

Jupiter

Brennwald

Buchler

Hastings

2nd. . Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg [Am] 1997;22 5:777–84, PMID: 9330133. doi:10.1016/S0363-5023(97)80069-X.

16.

Rozental

Blazar

. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg [Am] 2006;31 3:359–65, PMID: 16516728. doi:10.1016/j.jhsa.2005.10.010.

17.

Simic

Robison

Gardner

Gelberman

Weiland

Boyer

. Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg [Am] 2006;31 3:382–6, PMID: 16516731. doi:10.1016/j.jhsa.2005. 10.016.

18.

Tan

Capo

Warburton

. Distal radius fracture fixation with an intramedullary nail. Tech Hand Up Extrem Surg 2005;9 4:195–201, PMID: 16340580. doi:10.1097/01.bth.0000190818. 66285.b6.

19.

Trease

McIff

Toby

. Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study. J Hand Surg [Am] 2005;30 4:756–63, PMID: 16039369. doi:10.1016/j.jhsa.2005.04.017.

20.

Willis

Kutsumi

Zobitz

Cooney

3rd. . Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am 2006;88 11:2411–7, PMID: 17079398. doi:10.2106/JBJS.E.00946.

21.

Wright

Horodyski

Smith

. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg [Am] 2005;30 2:289–99, Erratum in: J Hand Surg. Am. 2005 May;30. 3.: 629. PMID: 15781351. PubMed-indexed for MEDLINE. doi:10.1016/j. jhsa.2004.11.014.