Do 'Anatomic' Distal Ulna Plating Systems Fit the Distal Ulna Without Causing Soft Tissue Impingement?
| Autor: | Vasiliki Vardakastani, Maxim D. Horwitz, Reza Sharif-Razavian, Angela E. Kedgley, Daniel A. Shaerf, Woo Jin Chae |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Wrist Joint
anatomy tendon diagnosis extensor carpi ulnaris basic science 030230 surgery Wrist Supination biomechanics 03 medical and health sciences 0302 clinical medicine Forearm wrist Fracture fixation Extensor Carpi Ulnaris Humans Medicine Pronation Orthopedics and Sports Medicine ulna Surgery Articles Orthodontics 030222 orthopedics safe zone business.industry plate Ulna Biomechanics musculoskeletal system Tendon Orthopedics medicine.anatomical_structure Surgery specialty fracture/dislocation business Cadaveric spasm |
| Zdroj: | Hand (N Y) |
| ISSN: | 1558-9455 1558-9447 |
| DOI: | 10.1177/1558944720930302 |
| Popis: | Background: Distal ulna fracture fixation plates commonly cause irritation, necessitating removal, due to the narrow area between the ulna articular cartilage and the extensor carpi ulnaris. This study defines the safe zone for plate application and determines whether wrist position affects risk of impingement. Methods: Four different distal ulna anatomic plates (Acumed, Medartis, Skeletal Dynamics, and Synthes) were applied to 12 cadaveric specimens. Safe zone size was measured in circumferential distance and angular arc. Impingement was examined in flexion and extension in neutral, pronation, and supination. Results: The distal ulna safe zone has dimensions of a 92° arc and perimeter circumference of 15 mm. Cumulative extensor carpi ulnaris (ECU) impingement occurred in 0% of the 6 simulated wrist/forearm positions for the Acumed plate, 22% for the Synthes plate, 31% for the Skeletal Dynamics plate, and 68% for the Medartis plate. Impingement was most common in supination. Likelihood of ECU impingement significantly decreased in the following order; Medartis > Skeletal Dynamics > Synthes > Acumed. Conclusion: The ECU tendon’s mobility can cause impingement on ulnarly placed distal ulna plates. Intra-operative testing should be performed in supination. Take home points regarding each plate from the 4 different manufacturers: contouring of Medartis plates, when placed ulnarly, is mandatory. The Acumed plate impinged the least but is not designed for far-distal fractures. The Synthes plate is least bulky but not suitable for proximal fractures. The Skeletal Dynamics plate appeared the most versatile with a reduced incidence of impingement compared to other ulnarly based plates. |
| Databáze: | OpenAIRE |
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