Optimal Position for Plate Fixation of Complex Fractures of the Proximal Radius: A Cadaver Study

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Abstract
To determine the optimal postion for plate fixation in complex fractures of the proximal radius in which head and neck dissociation occurs. Technical study. Tertiary referral center, teaching hospital, U.S. military. Five preserved cadavers. Radioulnar impingement and proximity to neurovascular structures were directly measured in elbows plated in each of three positions: neutral, full pronation, and full supination. 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 impingement, whereas application in full pronation resulted in loss of the last 30 degrees of supination. Plate application in full supination resulted in the loss of the last 10 degrees of pronation. In addition, there was no impingement when the 2.7-millimeter plate was applied similarily in the neutral position. None of these positions resulted in increased risk to neurovascular structures. The optimal position for plate fixation of complex proximal radius fractures is with the forearm in neutral position, with the plate applied directly lateral. A larger implant, 2.7 millimeters, may be used if this technique is followed without further risk of impingement and loss of motion.