Executive Editor: Peter Trafton

Authors: Kodi Kojima, Steve Velkes

Proximal forearm 21-A2.2 ORIF

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Glossary

1 Principles top

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Indication for compression plate

In transverse or short oblique fractures of the radial neck fixation of the radial head to the diaphysis is achieved by plating.


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Positioning of the plate

The radial head is completely covered in articular cartilage. The implant is applied to the radial head in a location that causes the least compromise of full pronation and supination.

Safe zone for plate insertion:

To determine the location of the "safe zone“, reference marks are made along the radial head and neck, to mark the midpoint of the visible bone surface. Three such marks are made with the forearm in neutral rotation, full pronation, and full supination as shown in the illustration.

The posterior limit of the safe zone lies halfway between the reference marks made with the forearm in neutral rotation and full pronation. The anterior limit lies nearly two thirds of the distance between the neutral mark and the mark made in full supination.

Note

The nonarticulating portion of the safe zone for the application of implants to the radial head (or safe zone for prominent fixation) consistently encompasses a 90 degrees angle localized by palpation of the radial styloid and Lister's tubercle.

2 Reduction and preliminary fixation top

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Expose the fracture ends with minimal soft tissue dissection off the bone.

Remove hematoma and irrigate.

Reduce the fracture with the help of small pointed reduction forceps and provisionally fix it with one or two 1.0 mm K-wires or reduction clamps.

3 Choice of implant top

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As the radial head is a small fragment, a mini fragment 1.5 or 2.0 T-plate, or a locking proximal radius plate is used to allow purchase of two or three screws in the proximal fragment.

The plate should be long enough to allow insertion of three screws in the distal fragment.

Prebend the plate according to the surface anatomy of the proximal radius. A slight convex bend at the fracture site may improve compression of the opposite cortex.

4 Compression with T-plate top

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Creating compression

Insert two or three screws (1.5 mm or 2.0 mm) through the plate into the proximal fragment. These are parallel to the proximal surface and entirely within the bone.

Attach a small bone hook in the distal hole of the plate and apply distal traction to the plate, creating compression at the fracture site. At the time of application of compression, the temporary K-wires could be removed to enhance the compression effect. In this case use a small clamp to stabilize the fracture.


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Distal plate fixation

With the fracture site compressed, attach the plate distally with two or three bicortical screws (1.5 or 2 mm). Eccentric screw holes (distally) may aid compression.

5 Final assessment top

Finally, assess the range of motion in pronation, supination, flexion and extension. Check fracture reduction, stability and hardware prominence.

Check results with image intensification or x-ray.

v1.0 2016-10-24