This document discusses tips and tricks for distal radius fixation. It begins by outlining radiographic criteria for determining when surgery is necessary for a distal radius fracture, such as more than 5mm of radial shortening or dorsal tilt over 20 degrees. It then discusses indications for closed versus open reduction, including sensorimotor deficits or risk of complex regional pain syndrome. Techniques and implants for fixation are presented, including use of volar locking plates and screws as well as proper surgical setup. Key points around implant design, placement of screws, and avoiding danger zones near flexor tendons are emphasized.

1. TIPS & TRICKS
in distal radius fixation
Part I
Ivan Tami
IBRA Seminar and
Workshop
Osteosynthesis of the
Hand and Wrist
January 28-29, 2016

2. I am glad to be here...

3. Distal radius fractures...
...are for hand surgeons!

4. Sibylla
… surgery or no surgery?
Tips & Tricks: decision making

5. Tips & Tricks: decision making

6. • Indication for closed
reduction:
• sensorimotor deficits
• deformation-swelling
(risk of secondary
sensorimotor deficits)
sedation/analgesia
CRPS
Tips & Tricks: decision making

7. • Indication for closed
reduction:
• sensorimotor deficits
• deformation-swelling
(risk of secondary
sensorimotor deficits)
sedation/analgesia
CRPS
Tips & Tricks: decision making

8. • Radioulnar length
• radial shortening 5 mm
• Radial inclination
• on PA film 15°
• Radial (sagittal) tilt
•  15°dorsal tilt
•  20°volar tilt
• Articular incongruity
• radiocarpal  2 mm
Radiographic criteria for surgery
Del Piñal et al. Arthroscopic Management of Distal Radius Fracture. 2010
Tips & Tricks: decision making

9. Tips & Tricks: decision making
CT scan

10. Tips & Tricks: decision making

11. N. Bizzotto, I. Tami et al. 3D Printing of bone fractures:
a new tangible realistic way for preoperative planning and education. Surg. Innov. 2015

12. N. Bizzotto, I. Tami et al. 3D Printed models of distal radius fractures. Injury 2016 (accepted)

13. Tips & Tricks: decision making

14. Tips & Tricks: decision making
• Displacement after reduction
• Irreducible fracture
• AO type C2 fracture
• Fracture with volar dislocation
• Poigenfürst
• Cooney
• Lafontaine
M. Walenkamp et al. The unstable distal radius fracture - how do we define it?
A sytematic review. JHS Eur. 2015
Dorsal angulation  20°
Dorsal comminution
Intra-articular RC fracture
Associated ulnar fracture
Age  60 years
Criteria for unstable radius fracture

15. Tips & Tricks: implants

16. Tips & Tricks: implants
SL. Zong et al. Meta-analysis for dorsally displaced distal radius fracture fixation: volar
locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. 2015

17. Tips & Tricks: implants
Titanium
Anatomical design
2 distal rows
Multidirectional
angle system

18. Tips & Tricks: implants
Locking screw
Cortical screw
Locking pin

19. Tips & Tricks: implants
J. Goldhahn et al. Implant stability is affected by local bone microstructural quality. Bone 2011
M. Leixnering et al. Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results.
Arch Orthop Trauma Surg. 2009

20. Tips & Tricks: implants

21. Tips & Tricks: implants
Video: https://www.youtube.com/watch?v=7egnpoWoIWA

22. Tips & Tricks: implants
Courtesy of Medartis
SP. Agnew et al. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am. 2015

23. Tips & Tricks: implants
Courtesy of Medartis
SP. Agnew et al. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am. 2015

24. Tips & Tricks: implants
Courtesy of Medartis
SP. Agnew et al. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am. 2015

25. Tips & Tricks: implants
Courtesy of Medartis

26. Tips & Tricks: surgical set up

27. Tips & Tricks: surgical set up

28. Tips & Tricks: surgical set up

29. Tips & Tricks: surgical set up