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Cadaveric Assessment of Distal Radius Fracture Malrotation During Dorsal Spanning Plate Application
Taylor Paskey1, Mark Ren1, Dongyeon J Kim1
1Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York.
Objective:
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).
Materials And Methods:
Twelve cadaveric arms were used. Two Kirshner wires (K-wires) were placed proximal and distal to a surgically created fracture of the distal radius. 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 with the 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 (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 with baseline was 23 ± 14 degrees in supination and 18 ± 9 degrees in pronation. For proximal rotation, the average malrotation compared with baseline was 6 ± 6 degrees in supination and 9 ± 7 degrees in pronation. Rotating distally produced a statistically greater degree of malrotation compared with proximal rotation ( p = 0.002 for pronation and p ≤ 0.0001 for supination). When rotating proximally there was no significant malrotation comparing neutral to full supination or pronation positions.
Conclusion:
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.
