Diapositiva 1

TIPS & TRICKSin distal radius fixationPart IIvan Tami

IBRA Seminar and Workshop

Osteosynthesis of the Hand and Wrist

January 28-29, 2016

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I am glad to be here...

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Distal radius fractures... ...are for hand surgeons!

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Sibylla

surgery or no surgery?

Tips & Tricks: decision making

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Tips & Tricks: decision making

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Indication for closed reduction:sensorimotor deficitsdeformation-swelling (risk of secondary sensorimotor deficits)

sedation/analgesiaCRPSTips & Tricks: decision making

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Indication for closed reduction:sensorimotor deficitsdeformation-swelling (risk of secondary sensorimotor deficits)

sedation/analgesiaCRPSTips & Tricks: decision making

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Radioulnar lengthradial shortening 5 mmRadial inclinationon PA film 15Radial (sagittal) tilt 15dorsal tilt 20volar tiltArticular incongruityradiocarpal 2 mmRadiographic criteria for surgery Del Pial et al. Arthroscopic Management of Distal Radius Fracture. 2010Tips & Tricks: decision making

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Tips & Tricks: decision makingCT scan

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Tips & Tricks: decision making

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N. Bizzotto, I. Tami et al. 3D Printing of bone fractures: a new tangible realistic way for preoperative planning and education. Surg. Innov. 2015

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N. Bizzotto, I. Tami et al. 3D Printed models of distal radius fractures. Injury 2016 (accepted)

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Tips & Tricks: decision making

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Tips & Tricks: decision making

Displacement after reductionIrreducible fractureAO type C2 fractureFracture with volar dislocationPoigenfrstCooneyLafontaine

M. Walenkamp et al. The unstable distal radius fracture - how do we define it? A sytematic review. JHS Eur. 2015Dorsal angulation 20Dorsal comminutionIntra-articular RC fractureAssociated ulnar fractureAge 60 yearsCriteria for unstable radius fracture

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Tips & Tricks: implants

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Tips & Tricks: implantsSL. Zong et al. Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. 2015

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Tips & Tricks: implants

Titanium

Anatomical design

2 distal rows

Multidirectional angle system

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Tips & Tricks: implantsLocking screw

Cortical screw

Locking pin

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Tips & Tricks: implantsJ. Goldhahn et al. Implant stability is affected by local bone microstructural quality. Bone 2011

M. Leixnering et al. Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results.Arch Orthop Trauma Surg. 2009

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Tips & Tricks: implants

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Tips & Tricks: implants

Video: https://www.youtube.com/watch?v=7egnpoWoIWA

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Tips & Tricks: implants

Courtesy of MedartisSP. Agnew et al. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am. 2015

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Tips & Tricks: implants

Courtesy of MedartisSP. Agnew et al. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am. 2015

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Tips & Tricks: implants

Courtesy of MedartisSP. Agnew et al. Danger zones for flexor tendons in volar plating of distal radius fractures. J Hand Surg Am. 2015

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Tips & Tricks: implants

Courtesy of Medartis

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Tips & Tricks: surgical set up

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Tips & Tricks: surgical set up

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Tips & Tricks: surgical set up

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Tips & Tricks: surgical set up

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