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Hand Trauma – Fractures and Dislocations
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Volar plate injuries occur from forced hyperextension of a digit. They are most common at the PIPJ. Patients generally present with pain and bruising over the area of the volar plate. Sometimes there is an associated avulsion fracture visible on the lateral view where a small fragment of bone has avulsed with the volar plate. If there is no fracture OR if there is a small, minimally displaced fragment not involving the articular surface, apply a dorsal blocking splint immobilising the affected joint in 20 degrees of flexion and refer the patient to hand therapy for follow up.
Distal radius osteoporotic features
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Donato Perretta, Jesse B. Jupiter
The initial design of the volar Pi plate was further adapted for fixation of dorsally displaced radius fractures. In 2002, Orbay and Ferndandez (17) reported the successful treatment of 31 distal radius fractures fixed with this method. The technique relies on indirect reduction of the dorsal fragments and provides locking screw fixation of the distal fragments. Interposition of the pronator quadratus between the flexor tendons and the plate decreases the chance of tendon irritation. Further investigation revealed that this technique was extremely useful in the elderly population as volar plates could successfully fixate osteopenic bone. This allowed early motion and good final results, with a low complication profile (18). The clinical success of the volar plate has led to its increased use over the past 15 years (1). The likelihood of tendon irritation is lower with volar plating as compared to dorsal plating, making it preferable.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The MCPJ has a shape likened to a box that can resist injury and dislocation with the support of intrinsic ligaments and surrounding structures, e.g. sagittal bands, tendons, etc. The volar plate is the floor of the joint. The shape means that with flexion there is linear stretch of the collateral ligaments, and when at >70°, the joint is laterally stable.
Biomechanical evaluation of the stability of extra-articular distal radius fractures fixed with volar locking plates according to the length of the distal locking screw
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Gyung-Hwan Oh, Hak-Sung Kim, Jung Il Lee
This fracture model was combined with the 3 D model of the volar locking plate and screws, which represent treatment by volar locking plate fixation. Three proximal screws were bi-cortically placed perpendicular to the radius shaft. Four distal locking screws were placed in the distal rows of the plate, which has four locking holes in distal row of plate. Previous biomechanical studies showed that the number of distal locking screws to produce enough stability is at least four distal screws. (Mehling et al. 2010; Moss et al. 2011) The screw-bone interfaces and the screw-plate interfaces were assumed to be fully bonded. (Cheng et al. 2007; Lin et al. 2012). According to the length of the distal locking screws, four 3 D models of a distal radius fracture fixed with a VLP were reconstructed for FE analysis; 1) bi-cortical full-length, 2) 75% length with all distal screws equaling 75% of the distance from the volar plate to the dorsal cortex, 3) 50% length, and 4) 25% length.
Refracture after plate removal following ulnar shortening osteotomy for ulnar impaction syndrome – a retrospective case–control study
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Soo Min Cha, Hyun Dae Shin, Byung Kuk Ahn
In our study, there were no significant factors for predicting refracture based on multivariate analysis, except low BMD. However, precise osteotomy/proper compression and subsequent absence of traces of osteotomy guaranteed ‘safety’ after plate removal. Furthermore, traces of osteotomy were observed on radiographs for all refractures just after plate removal, and all USOs were performed inappropriately. On the other hand, there have been no reports on the conditions after plate removal in oblique osteotomy. Biomechanical studies have shown that the structural stiffness in torsion is clearly greater with an oblique osteotomy [29,30]. In addition, oblique osteotomies have faster healing and lower nonunion rates than transverse osteotomies [20,29,30]. Rayhack et al. [30] reported a faster healing time with oblique osteotomy due to the 40% greater bone surface area. Other studies also reported 100% bony union after oblique osteotomy [9,20,31]. Although ‘not a significant factor’, the oblique osteotomy also did not result in refracture in the current study. Furthermore, Clark and Geissler emphasized the benefits of the volar plate position for minimising the need for plate removal and 100% union after oblique osteotomy [20]. In our series, nine of 11 refractures had the plate located in the dorsum. If there was no discomfort or irritation due to the dorsal position, these patients would not demand plate removal and refractures may not occur. However, the number of cases was relatively small (11 patients) for determining the statistical significance of these potential factors.
Synostosis of the interphalangeal joint: an uncommon cause of post-fracture digital stiffness
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Peter Y. W. Chan, Peter S. H. Chan
Excision of the synostosis was performed through a volar approach (Figure 4). Mobilization of the digital nerves and arteries was achieved. The distal portion of the A2 pulley was incised allowing for retraction of the flexor tendon. The synostosis involved the volar plate as well as the accessory collateral ligaments, which were excised with a combination of osteotomes and rongeur. The proper collateral ligaments were not involved and therefore were not incised. There was no instability to either radial ulnar or dorsal volar stress after bony excision. No ligament reconstruction was needed. There was no evidence of impingement or intra-articular adhesions after excision of the bony mass; passive motion was essentially full. The patient was placed on indomethacin postoperatively for 6 weeks. He resumed hand therapy at 2 days post-surgery with no use of a splint and an active and passive motion protocol with unrestricted strengthening. At 8 weeks, he had regained a functional arc of motion of 60° at the IP joint. At last follow up 6 months post-resection, he had no evidence of recurrence.