Difficulty In Fixation Of The Volar Lunate Facet Fragment -Books Download

Difficulty in Fixation of the Volar Lunate Facet Fragment
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2 Case Reports in Orthopedics, Figure 1 Patient 1 Plain radiographs a and CT b c d at the time of injury A 10 8 mm VLF fragment is observed with volar displacement. 4 weeks Figure 2 e At 1 year after surgery bone union was 3 Discussion. achieved without redisplacement Figure 2 f, The VLF fragment was first described by Harness et al in. Patient 2 A 58 year old woman presented with right distal 2004 1 That study reported difficulty in reduction and. radius fracture AO classification 23C3 1 A 12 12 mm fixation of the VLF fragment with a VLP because of the. VLF fragment was observed on plain radiography with volar anatomical structure and biomechanics in this region In 2014. displacement Figure 3 In the first surgery reduction and Beck et al reported the risk factors for displacement of VLF. fixation were achieved with a VA TCP VLP for proximal fragments based on various plain radiography parameters. placement Depuy Synthes Co Zuchwil Switzerland used 2 However plate coverage of the VLF fragment and the. as a buttress plate for the distal screw monoaxial screws were number of inserted screws were not associated with risk. inserted over the guide block however redisplacement was of displacement suggesting the presence of a rare fracture. noted after surgery Figures 4 a and 4 b Because 10 weeks type for which reduction and fixation cannot be achieved. had passed at the time of reoperation and malunion of the with VLPs There have been several reports of reduction and. displaced VLF fragment was observed corrective osteotomy fixation of VLF fragments 2 5 redisplacement resulting. was performed followed by reduction and fixation which from inappropriate early treatment because of a lack of. were achieved with an Acu Loc 2 VLP for distal placement preoperative understanding of the VLF fragment Because. Acumed Co Oregon USA Figure 4 c Concomitant it is very rare for redisplacement with appropriate plate. external fixation was applied for 5 weeks At 9 months after selection and positioning it is difficult to objectively evaluate. surgery bone union was achieved without redisplacement risk factors e g size shape and position of the fragment. Figure 4 d for VLF fragment displacement and to determine appropriate. Case Reports in Orthopedics 3, Figure 2 Plain radiographs of Patient 1 a Immediately after the first surgery b Two weeks after the first surgery redisplacement is seen. c Immediately after reoperation d Five days after reoperation redisplacement is seen e Immediately after the third surgery f One year. after the third surgery bone union was achieved without redisplacement. reduction and fixation methods Many VLPs have been Loads on the VLF fragment may be dispersed in fractures. designed to provide double tiered subchondral support their with marked joint surface crushing whereas loads may be. structures support the dorsal subchondral bone at the center concentrated in relatively simple fractures with less joint. of the joint surface because supporting the volar subchondral surface crushing In addition loads may be more markedly. bone with screws is difficult 6 Our first choice of VLP is concentrated in cases of volar displacement The following. the monoaxial mode since we think that the stability of the characteristics may be risk factors for displacement 1 a VLF. monoaxial mode is higher than the polyaxial one Both cases fragment is present 2 the joint surface is less crushed and. were stabilized by the monoaxial mode and it was possible 3 the displacement is volar. for them to cover the lunate facet fragment by preoperative Regarding the reduction and fixation method additional. template But support with a plate may also not be possible fixation with a miniscrew K wire soft wire and hook. when the VLF fragment is small On 3DCT when a VLF plate has been reported 3 However these methods are. fragment is present in the region contained within a straight likely to provide insufficient fixation force and to result. line connecting the volar radial margin of the lunate facet in refracture Therefore when instability is marked and. and the proximal end of the distal radioulnar joint and the concomitant external fixation is applied it may be appropriate. center of the distal radioulnar joint instability occurs towards to apply a suture to the articular capsule with a small buttress. the volar ulnar side because the VLF fragment provides plate and anchor as a basic procedure The conventional. the attachment sites for the short radiolunate ligament and trans FCR approach can visualize VLF fragment adequately. the distal radioulnar ligament Of 177 cases of distal radius However when we have to place the buttress plate on the. fracture treated surgically at our hospital VLF fragment juxta DRUJ dual window approach allows for the procedure. was present in five patients the AO classification was C3 in of the buttress plating This procedure cannot be achieved. each case Two had volar displacement and three had dorsal by trans FCR approach Stryker hand plating system was. displacement Two had redisplacement after surgery Both placed in bone slope towards DRUJ so the edge of this small. of these cases had volar displacement and the fracture type plate would not extend to the joint surface of DRUJ actu. was relatively simple with mild crushing of the joint surface ally Moreover intraoperatively we confirmed pronation and. 4 Case Reports in Orthopedics, Figure 3 Patient 2 Plain radiographs a and CT b c d at the time of injury A 12 12 mm VLF fragment is observed with volar. displacement, supination of the forearm smoothly without the impingement volar ulnar side is useful As to the indication for the external.
of the implant However postoperatively the limitation of fixator if the stabilization of the internal fixation may be not. supination occurred so the placement of this small plate enough we use it in order to avoid the redisplacement Both. would cause some kind of factor e g the adhesion of the cases were operated on multiple times for the displacement. soft tissue the bulkiness of the plate In fact the limitation of of the volar lunate facet fragment We had to immobilize the. the supination improved by the implant removal Thus if the wrist joint by using the external fixation system in order to. limitation of supination and pronation occurred we would avoid the redisplacement. have to remove the implant For fractures with a VLF fragment it is necessary to. Redisplacement occurred in the current patients because 1 identify the VLF fragment 2 optimally place a VLP. a lack of preoperative understanding of the volar ulnar bone for distal placement via a dual window approach and 3. fragment resulted in inappropriate plate selection Both cases apply additional fixation small plate anchor and or external. were operated on in the different institutions So the criteria fixation. for use of VLP differed in each institution Redisplacement. occurred despite optimal distal VLP placement suggesting Ethical Approval. that reduction and fixation with available VLPs alone are. difficult and that additional fixations are necessary such as a The study was carried out in accordance with the Declaration. small plate and external fixation For fractures with a volar of Helsinki and the appropriate ethical framework. lunate facet fragment it is necessary to identify the volar. ulnar bone fragment In the case of small volar lunate facet Consent. fragment we suture the ligament on to the plate hole by. using the anchor In case of relative large volar lunate facet Written informed consent was obtained from the patient for. fragment we think the small plate as a buttress plate from publication of this case report and any accompanying images. Case Reports in Orthopedics 5, Figure 4 Plain radiographs of Patient 2 a Immediately after the first surgery b Six weeks after the first surgery redisplacement is seen. c Immediately after reoperation d Nine months after reoperation bone union was achieved without redisplacement. Competing Interests 5 K R Chin and J B Jupiter Wire loop fixation of volar. displaced osteochondral fractures of the distal radius Journal. The authors declare that they have no competing interests of Hand Surgery vol 24 no 3 pp 525 533 1999. 6 K Kawasaki T Nemoto K Inagaki K Tomita and Y Ueno. References Variable angle locking plate with or without double tiered. subchondral support procedure in the treatment of intra. 1 N G Harness J B Jupiter J L Orbay K B Raskin and D L articular distal radius fracture Journal of Orthopaedics and. Fernandez Loss of fixation of the volar lunate facet fragment in Traumatology vol 15 no 4 pp 271 274 2014. fractures of the distal part of the radius The Journal of Bone. Joint Surgery American Volume vol 86 no 9 pp 1900 1908. 2 J D Beck N G Harness and H T Spencer Volar plate. fixation failure for volar shearing distal radius fractures with. small lunate facet fragments Journal of Hand Surgery vol 39. no 4 pp 670 678 2014, 3 A Marcano D P Taormina R Karia N Paksima M Posner. and K A Egol Displaced intra articular fractures involving. the volar rim of the distal radius Journal of Hand Surgery vol. 40 no 1 pp 42 48 2015, 4 A J Bakker and A Y Shin Fragment specific volar hook plate. for volar marginal rim fractures Techniques in Hand and Upper. Extremity Surgery vol 18 no 1 pp 56 60 2014,MEDIATORS of. INFLAMMATION,The Scientific Gastroenterology Journal of.
World Journal,Hindawi Publishing Corporation,Research and Practice. Hindawi Publishing Corporation,Hindawi Publishing Corporation. Diabetes Research,Hindawi Publishing Corporation,Disease Markers. Hindawi Publishing Corporation,http www hindawi com Volume 2014. http www hindawi com Volume 2014 http www hindawi com Volume 2014 http www hindawi com Volume 2014 http www hindawi com Volume 2014. Journal of International Journal of,Immunology Research.
Hindawi Publishing Corporation,Endocrinology,Hindawi Publishing Corporation. http www hindawi com Volume 2014 http www hindawi com Volume 2014. Submit your manuscripts at,https www hindawi com,PPAR Research. Hindawi Publishing Corporation,Research International. Hindawi Publishing Corporation, http www hindawi com Volume 2014 http www hindawi com Volume 2014. Journal of,Evidence Based, Journal of Stem Cells Complementary and Journal of.
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