Technical Considerations in Volar Distal Radius Plating:
Fixed-angle versus Variable-angle Locking Screws
Craig M. Rodner, Edward Akelman, Julia A. Katarincic, and Arnold-Peter C. Weiss.
Division of Hand & Upper Extremity Surgery
Department of Orthopaedics
Brown Medical School
Rhode Island Hospital
Providence, Rhode Island
Background: Volar fixed-angle plating has gained increasing popularity for the treatment of both intra- and extra-articular distal radius fractures. Recently, variable-angle, locking distal radius plates have been introduced as an alternative. Neither system is suitable for every fracture pattern or malunion reconstruction. With appropriate and careful selection of the type of plates used relative to the fracture pattern presented, the surgeon can expect high union rates, avoidance of many of the soft tissue complications associated with dorsal plating, and a reduction in anomalous screw / plate placement..
Purpose: To discuss the technical considerations and potential pitfalls associated with volar fixed-angle and variable-angle plating of distal radius fractures.
Methods: Illustrative case examples are used to demonstrate common technical pitfalls of volar distal radius plating and the biomechanical parameters of each type of plating system are reviewed to highlight application principles..
Discussion: Three technical points will be discussed. First, it may be important to consider whether a fixed-angle or variable-angle plate should be used. This determination can be made based on the size and architecture of the distal fragment and preoperative planning to determine which device will best buttress this fragment(s). Second, beware of intra-articular or extra-osseous distal screw or peg placement through meticulous intraoperative fluoroscopic imaging and understanding the relationship of plate buttressing and screw placement which is defined by the system utilized. The 45-degree pronated oblique view may be particular helpful in this regard. Finally, it is essential to reduce large displaced fragments prior to securing them in position with distal locking screws or pegs. Failure to do so will lead to an inordinately high rate of malunion and/or nonunion.
Conclusion: Volar plating is an effective modality for treating many types of distal radius fractures. However, it is not a panacea. Careful attention to preoperative planning and the intraoperative considerations may help avoid common technical pitfalls. The selection of which type of plate to use is most commonly determined by the fracture orientation, alignment, comminution, and how distal in the radius it extends.