OPTIMAL POSITION FOR PLATE FIXATION OF COMPLEX FRACTURES OF THE PROXIMAL RADIUS - A CADAVER STUDY

Objective: To determine the optimal postion for plate fixation in comp lex fractures of the proximal radius in which head and neck dissociati on occurs. Design: Technical study. Setting: Tertiary referral center, teaching hospital, U.S. military. Subjects: Five preserved cadavers. Main Outcome Measure: Radioulnar impingement and proximity to neurovas cular structures were directly measured in elbows plated in each of th ree positions: neutral, full pronation, and full supination. Results: Application of the 2.0-millimeter T-plate to the lateral aspect of the radial head and neck with the forearm in neutral position had no impi ngement, whereas application in full pronation resulted in loss of the last 30 degrees of supination. Plate application in full supination r esulted in the loss of the last 10 degrees of pronation. In addition, there was no impingement when the 2.7-millimeter plate was applied sim ilarily in the neutral position. None of these positions resulted in i ncreased risk to neurovascular structures. Conclusions: The optimal po sition for plate fixation of complex proximal radius fractures is with the forearm in neutral position, with the plate applied directly late ral. A larger implant, 2.7 millimeters, may be used if this technique is followed without further risk of impingement and loss of motion.