Skip to main content
JDRS · Open access journal

Original Article · Open access

Correction of volar tilt using the lift technique with fixed-angle volar locking plate in distal radius fractures

PDF Cite this article

Ahmet Alperen Öztürk

Department of Orthopedics and Traumatology, Ağrı Training and Research Hospital, Ağrı, Türkiye

ORCID: 0000-0002-1777-9060

Abstract

Objectives: The aim of this study is to evaluate the radiological effectiveness of restoring volar tilt in dorsally displaced distal radius fractures using the lift technique performed with a fixedangle volar locking plate.

Patients and methods: Between January 2023 and February 2025, a total of 14 patients (5 males, 9 females; median age: 46.9 years; range, 32 to 72 years) with dorsally displaced intraarticular or extra-articular distal radius fractures who underwent fixation with a fixed-angle volar plate using the visually estimated lift technique were retrospectively analyzed. Fractures were classified according to the AO classification. Pre-lift and post-lift volar tilt angles as well as plate-shaft angles were measured from fluoroscopy images, and control volar tilt angles were measured from radiographs. Actual angular correction was defined as the difference between pre-lift and post-lift volar tilt angles.

Results: Fracture types were AO Type A in nine patients, AO Type C in four patients, and AO Type B in one patient. The median volar tilt angle at the time of fracture was −24.9° (range, −4° to −56°). Following traction and reduction maneuvers, the median pre-lift volar tilt was −4.9° (range, −20° to 4°), the median post-lift volar tilt was 9.5° (range, 0° to 15°), and the median volar tilt at follow-up was 9.4° (range, 1° to 16°). Plate-shaft angles ranged from 6° to 25° (median: 14.2°). Actual angular correction ranged from 5° to 25°. In 11 cases (78.5%), intraoperative correction achieved the target range of 5° to 15°. In three cases (15.4%), volar tilt correction was insufficient, with final values of 0°, 3°, and 4°. The ratio (R) of actual angular correction to theoretical angular correction was approximately 0.67.

Conclusion: The lift technique using a fixed-angle volar plate is a reliable and effective method for intraoperative correction of volar tilt in dorsally displaced distal radius fractures. The technique provides a valuable alternative, particularly in cases where manual reduction fails to achieve sufficient volar tilt restoration.

Declarations

Conflict of Interest

The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The author received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

References

  1. Kiyoshige Y. Condylar stabilizing technique with AO/ ASIF distal radius plate for colles' fracture associated with osteoporosis. Tech Hand Up Extrem Surg 2002;6:205-8. DOI: 10.1097/00130911-200212000-00009.
  2. Mignemi ME, Byram IR, Wolfe CC, Fan KH, Koehler EA, Block JJ, et al. Radiographic outcomes of volar locked plating for distal radius fractures. J Hand Surg Am 2013;38:40-8. DOI: 10.1016/j.jhsa.2012.10.007.
  3. Dario P, Matteo G, Carolina C, Marco G, Cristina D, Daniele F, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury 2014;45 Suppl 6:S21-6. DOI: 10.1016/j.injury.2014.10.018.
  4. Jupiter JB, Fernandez DL. Comparative classification for fractures of the distal end of the radius. J Hand Surg Am 1997;22:563-71. DOI: 10.1016/S0363-5023(97)80110-4.
  5. Stevenson I, Carnegie CA, Christie EM, Kumar K, Johnstone AJ. Displaced distal radial fractures treated using volar locking plates: Maintenance of normal anatomy. J Trauma 2009;67:612-6. DOI: 10.1097/TA.0b013e3181ad8d4d.
  6. Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 2005;30:743-9. DOI: 10.1016/j.jhsa.2005.03.006.
  7. Park MJ, Cooney WP 3rd, Hahn ME, Looi KP, An KN. The effects of dorsally angulated distal radius fractures on carpal kinematics. J Hand Surg Am 2002;27:223-32. DOI: 10.1053/jhsu.2002.32083.
  8. Nishiwaki M, Welsh M, Gammon B, Ferreira LM, Johnson JA, King GJ. Distal radioulnar joint kinematics in simulated dorsally angulated distal radius fractures. J Hand Surg Am 2014;39:656-63. DOI: 10.1016/j.jhsa.2014.01.013.
  9. Park JW, Kim YH, Park KC, Lee JI. A novel technique for full anatomic restoration of volar tilt in distal radius fracture. Acta Orthop Traumatol Turc 2015;49:115-9. DOI: 10.3944/AOTT.2015.14.0247.
  10. Sreedharan S, Mohd Fadil MF, Lim WS. Intra-operative correction of volar tilt of distal radius fractures using volar locking plate as reduction tool: Review of 24 cases. Hand Surg 2014;19:363-8. DOI: 10.1142/S0218810414500282.
  11. Sechachalam S, Satku M, Wong JH, Tan LT, Yong FC. Trigonometry-Integrated 'Lift' Technique (TILT) for restoring volar tilt in distal radius fractures: Description of technique and preliminary results. J Hand Surg Asian Pac Vol 2017;22:53-8. DOI: 10.1142/S0218810417500095.
  12. Metikala S, Purudappa PP, Cheppalli NS. A simple tool for volar tilt restoration during volar plate osteosynthesis of distal radius fracture: A technical note. Trauma Case Rep 2023;43:100760. DOI: 10.1016/j.tcr.2023.100760.
  13. Roebke AJ, Martin AS, Sarmast Z, Fisk E, Goyal KS. Lift-off screw results in accurate sagittal tilt correction in a distal radius fracture model. J Hand Surg Am 2018;43:523-8. DOI: 10.1016/j.jhsa.2018.02.011.
  14. Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: Current concepts. J Hand Surg Am 2012;37:1718- 25. DOI: 10.1016/j.jhsa.2012.06.001.
  15. Park JH, Hagopian J, Ilyas AM. Variable-angle locking screw volar plating of distal radius fractures. Hand Clin 2010;26:373-80. DOI: 10.1016/j.hcl.2010.04.003.
  16. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: What the clinician wants to know. Radiology 2001;219:11-28. DOI: 10.1148/radiology.219.1.r01ap1311.
  17. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin 2005;21:279-88. DOI: 10.1016/j.hcl.2005.02.008.
  18. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32 Suppl 1:S1-170. DOI: 10.1097/BOT.0000000000001063.
  19. McQueen M, Caspers J. Colles fracture: Does the anatomical result affect the final function? J Bone Joint Surg Br 1988;70:649-51. DOI: 10.1302/0301-620X.70B4.3403617.
  20. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar lockingplate. J Orthop Trauma 2007;21:316-22. DOI: 10.1097/BOT.0b013e318059b993.
  21. Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006;31:359-65. DOI: 10.1016/j.jhsa.2005.10.010.