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Cadaveric Assessment of Distal Radius Fracture Malrotation During Dorsal Spanning Plate Application
Taylor Paskey, MD, Mark Ren, MD, Joanna Kim, MD, Susanne Roberts, MD; Robert J Strauch, MD
Columbia University Medical Center, New York, NY
Introduction: To assess the effects of pronosupination during indirect distal radius fracture reduction and its role in rotational malalignment during surgical application of a dorsal spanning plate (DSP). We hypothesize that plate application in pronation or supination results in greater malrotation than application in neutral rotation.
Materials and Methods: Twelve cadaveric arms were used. Two Kirshner wires (K-wires) were placed parallel in the distal radius to assess rotation, and an extraarticular distal radius fracture was simulated using a sagittal saw. We secured a DSP to the index metacarpal and then fastened the DSP proximally to the radius in either maximal supination, maximal pronation or neutral rotation positions. The angles formed by the K-wires were measured in each position of rotation and compared to baseline. Two sets of these measurements were obtained for each forearm: 1) By rotating the radius distal to the simulated fracture (distal rotation) or 2) By rotating the forearm proximal to the simulated fracture while stabilizing the wrist distal to the fracture (proximal rotation). Rotation in each position was compared using analysis of variance and Tukey tests.
Results: The average malrotation from baseline at the fracture site, overall, was 18 degrees in supination and 12 degrees in pronation. For distal rotation only, the average malrotation compared to baseline was 23±14 degrees in supination and 18±9 degrees in pronation. For proximal rotation, the average malrotation compared to baseline was 6±6 degrees in supination and 9±7 degrees in pronation. Rotating distally produced a statistically greater degree of malrotation compared to proximal rotation (p=0.002 for pronation, p=<0.0001 for supination). When rotating proximally there was no significant malrotation comparing neutral to full supination or pronation positions.
Conclusions:
- Application of a DSP to the radius resulted in statistically significant rotation through the fracture site when pronating or supinating distal to the fracture site.
- This rotation can be mitigated by:
- (1) pronating or supinating the radius proximal to the fracture site when applying the plate to the radius or
- (2) provisionally clamping the plate to the radius with the forearm in neutral and then pronating the forearm to place the screws into the radius.
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