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Anatomic relationships in distal radius bridge plating: a cadaveric study
Jason Dahl1, Daniel J Lee2, John C Elfar2
1Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA USA.
Fixing dorsal bridge plates for distal radius fractures to the index metacarpal risks radial sensory nerve injury. Middle metacarpal fixation increases tendon-plate contact, potentially causing complications.
Area of Science:
- Orthopedic surgery
- Anatomy
- Biomedical engineering
Background:
- High-energy distal radius fractures with metaphyseal extension require internal fixation.
- Two dorsal radiocarpal spanning plate techniques exist.
- Anatomic risks associated with these techniques are not well-documented.
Purpose of the Study:
- To identify and assess the anatomic relationships and structures at risk for iatrogenic injury with two dorsal radiocarpal spanning plate fixation techniques.
Main Methods:
- Twelve fresh frozen cadaver arms were used.
- Fixation was performed with a dorsal radiocarpal spanning plate.
- Two techniques were compared: index finger metacarpal fixation and middle finger metacarpal fixation.
- Cadaveric dissection evaluated plate proximity to nerves and tendons.
Main Results:
- Superficial radial sensory nerve contact occurred with the index metacarpal plate in all specimens.
- Middle metacarpal plate fixation resulted in contact with extensor digitorum communis tendons (average 10 cm).
- Extensor pollicis longus (EPL) tendon contacted plates in both groups (12.4 mm index, 25.5 mm middle).
- One case of EPL and extensor indicis proprius (EIP) entrapment occurred in the middle metacarpal group.
Conclusions:
- Index metacarpal fixation of dorsal bridge plates poses a risk to superficial radial sensory nerve branches.
- Middle metacarpal fixation increases tendon-plate contact, raising concerns for tendon injury.
- Careful consideration of fixation site is crucial to minimize iatrogenic injury during distal radius fracture fixation.
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