Do "anatomic" distal ulna plating systems fit the distal ulna without causing soft tissue impingement?
File(s)Shaerf - Hand 2020 - Accepted.pdf (392.43 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2020-06-10
Date Acceptance
2020-04-30
Citation
Hand, 2020, 17 (3), pp.506-511
ISSN
1558-9447
Publisher
Springer Verlag
Start Page
506
End Page
511
Journal / Book Title
Hand
Volume
17
Issue
3
Copyright Statement
© The Author(s) 2020. Published by Sage Publication. . The final, definitive version of this paper has been published in Hand by Sage Publications Ltd. All rights reserved. It is available at: https://journals.sagepub.com/doi/10.1177/1558944720930302
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32517515
Subjects
anatomy
basic science
biomechanics
diagnosis
extensor carpi ulnaris
fracture/dislocation
plate
safe zone
specialty
surgery
tendon
ulna
wrist
Publication Status
Published
Coverage Spatial
United States
Article Number
ARTN 1558944720930302
Date Publish Online
2020-06-10