Basic Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2023; 14(4): 207-217
Published online Apr 18, 2023. doi: 10.5312/wjo.v14.i4.207
Bridge plating in the setting of radiocarpal instability: Does distal fixation to the second or third metacarpal matter? A cadaveric study
Eloy Tabeayo, James M Saucedo, Ramesh C Srinivasan, Amita R Shah, Efstathios Karamanos, Jason Rockwood, E Carlos Rodriguez-Merchan
Eloy Tabeayo, Department of Orthopedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY 10461, United States
James M Saucedo, Houston Methodist Institute for Academic Medicine, Houston Methodist Orthopedics and Sports Medicine, Houston, TX 77479, United States
Ramesh C Srinivasan, Hand Center of San Antonio and the Department of Orthopedic Surgery, University of Texas Health Science Center, The Hand Center of San Antonio, San Antonio, TX 78240, United States
Amita R Shah, University of Texas Health Science Center at San Antonio, University of North Carolina at Chapel Hill, San Antonio, TX 78229, United States
Efstathios Karamanos, Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, UT Health San Antonio, San Antonio, TX 78229, United States
Jason Rockwood, Naval Hospital Yokosuka, Yokosuka, 96350-1600, Japan
E Carlos Rodriguez-Merchan, Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid 28046, Spain
Author contributions: Tabeayo E, Rodriguez-Merchan EC, and Srinivasan RC designed the research; Tabeayo E, Saucedo JM and Rockwood J performed the research; Karamanos E analyzed the data; Tabeayo E, Shah AR and Karamanos E wrote the paper.
Conflict-of-interest statement: Tabeayo E, Saucedo JM and Rockwood J performed the research. The cadavers and the wide plate were provided to them through a research grant awarded by Acumed (Hillsborough, Oregon). The narrow plate was provided to them on loan by TriMed (Valencia, California). Plates and screws were returned at the conclusion of the study. Karamanos E, Rodriguez-Merchan EC, Shah AR, and Srinivasan RC have no conflict of interest.
Data sharing statement: No data sharing statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: E Carlos Rodriguez-Merchan, MD, PhD, Doctor, Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, Madrid 28046, Spain. ecrmerchan@hotmail.com
Received: September 29, 2022
Peer-review started: September 29, 2022
First decision: January 17, 2023
Revised: February 15, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 18, 2023
Processing time: 201 Days and 0.8 Hours
Abstract
BACKGROUND

Radiocarpal dislocations are rare but potentially devastating injuries. Poorer outcomes are associated with inadequate or lost reduction, such as ulnar translocation, but no consensus exists on the ideal fixation technique. Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal, but its application for radiocarpal dislocations has not been established.

AIM

To determine whether distal fixation to the second or third metacarpal matters.

METHODS

Using a cadaveric radiocarpal dislocation model, the effect of distal fixation was studied in two stages: (1) A pilot study that investigated the effect of distal fixation alone; and (2) a more refined study that investigated the effect of described techniques for distal and proximal fixation. Radiographs were measured in various parameters to determine the quality of the reduction achieved.

RESULTS

The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third. The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique.

CONCLUSION

In a cadaveric radiocarpal dislocation model, anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed. When considering dorsal bridge plate fixation for radiocarpal dislocations, the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.

Keywords: Wrist; Instability; Bridge plate; Dorsal spanning plate; Radiocarpal dislocation model; Cadaveric study

Core Tip: Radiocarpal dislocations are rare but potentially devastating injuries. Poorer outcomes are associated with inadequate or lost reduction, such as ulnar translocation, but no consensus exists on the ideal fixation technique. Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal, but its application for radiocarpal dislocations has not been established. In a cadaveric radiocarpal dislocation model, anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed. When considering dorsal bridge plate fixation for radiocarpal dislocations, the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.