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A New Method for Effective Screw Positioning to Support the Subchondral Bone in Volar Locking Plate Fixation in Distal Radius Fractures
Kazuaki Mito, MD; Wataru Inokuchi,MD
Nerima General Hospital, Tokyo, Japan

Introduction: Volar locking plates (VLPs) are widely used for the treatment of distal radius fracture. An important technical point is that distal locking screws should be appropriately positioned to support the subchondral bone and to minimize the postoperative loss of correction, which can adversely affect clinical outcomes. However, because the line of the subchondral bone is difficult to determine using radiographs during an operation, the distal screw is often positioned inappropriately, leading to the postoperative loss of correction or joint penetration by screws, which is an important complication of VLP fixation. We devised a technique that uses cannulated screws for distal screws. This study aimed to evaluate the effectiveness of our new method for adequate positioning of distal screws to support the subchondral bone.
Materials and Methods: Our new method for effective subchondral support involved a newly developed VLP that consists of cannulated locking screws for distal locking screws. A 0.8-mm guidewire was inserted along the subchondral bone via palpation along the bone, and cannulated locking screws were set in position. Our technique was applied to 29 patients (29 wrists) treated between October 2014 and June 2015. Twenty-eight patients showed distal radius fractures. One patient underwent correction osteotomy for radius malunion. Nineteen patients showed AO type-C fractures, 3 showed type-B fractures, and 6 showed type-A fractures. The follow-¬up period was 6–250 days (average, 96 days). We evaluated screw positions to measure the minimum distance between the screws of the first row and the joint surface by sagittal computed tomography on the day after the operation; further, we evaluated the degree of loss of correction by radiography.
Results: The average minimum distance between the screws of the first row and the joint surface was 1.15 mm (range, 0–3.91 mm), and joint penetration by screws was not observed. The average degree of loss of correction was -0.075° (range, from -1.6° to 1.3°) in volar tilt and -2.78° (range, from -10.3° to 0°) in radial inclination; the ulnar variance was -0.75 mm (from -1.64 to 0 mm) .
Conclusions: Our technique of fixation of distal locking screws of VLPs can be used to achieve effective subchondral support.

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