2.4 mm VA-LCP Volar Rim Distal Radius Plate

Jesse B Jupiter, Doug Campbell, Ladislav Nagy, Juan Gonzàlez del Pino, Tom Fischer, Fiesky Núñez

Very distal, mostly intraarticular fractures of the distal radius may require fixation very close to the volar articular lip. Proper placement of standard plates is difficult due to variances of the anatomical shape of the bone and the origins of the radiocarpal ligaments which must not be injured. Moreover, fixation options of the radial styloid and distal radioulnar joint have not been optimal so far.

The 2.4 mm VA-LCP volar rim distal radius derives from the 2.4 mm LCP distal radius plate juxta-articular, but has an anatomically preshaped design, a second distal screw row (outrigger), and variable angle locking technology. Highly polished low profile plates with round edges and fully countersunk screws minimize the risk of softtissue irritations and tendon ruptures.

Fig 1a Volar rim distal radius plate.

The anatomical plate design allows for very distal plate placement. CT scans were used to verify the fit of the precontoured plate. Bendable outriggers aid in adjusting the precontoured plate to specific anatomical need and individual variations.

The second distal screw row provides for superior fixation stability of fragments, eg, radial styloid, and especially the most ulnar corner of the lunate fossa.

Fig 1b Volar rim distal radius plate.

Nonclinical dynamic-fatigue testing to determine fatigue strength of the plate construct showed that the VA plates are stronger than the 2.4 mm LCP distal radius plate juxta-articular.

The plate is available in stainless steel and titanium (TiCp), each in four different versions: 5-hole shaft with 6-hole head in left and right versions, and 5-hole shaft with 7-hole head in left and right versions. For ease and expedience each plate version has a specific guiding block for standard screw orientation. Trial implants help determine the correct plate dimension for sterile implant use.

Fig 2a-b Comparison of anatomical bend and screw placement of volar rim DR plate (a) and DR juxta-articular plate (b).

A 74-year-old woman sustained an intraarticular distal forearm fracture of the radius and ulna after falling on her outstretched hand.

Case provided by Daniel Rikli, Basel, Switzerland

Fig 1ab Preoperative x-rays.

Fig 2ab Initial management was with closed reduction and joint bridging external fixator. There was loss of primary reduction due to inadequate positioning of the external fixator (too lateral).

Fig 3ce Radius with hyperextended palmar-ulnar key fragment.

Fig 3f Ulnar head split, displaced dorsally (CT sagittal reconstruction).

Fig 4ab X-rays 3 days postoperatively: removable splint, early motion with physiotherapy.

Fig 5ab Six weeks postoperatively: residual swelling, little pain, range of motion improving with physiotherapy; the patient uses her hand for daily activities.

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