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The Medartis APTUS conventional volar plates include the Fracture, Correction, ADAPTIVE, and ADAPTIVE II plates. The outcomes associated with use of these plates in distal radius volar fracture fixation were documented in five studies comprising 1,041 cases. 

Quadlbauer et al. conducted a retrospective follow-up study of 230 distal radius fracture patients fixed with Medartis implants, dominantly correction plates. At a minimum follow-up of one year (mean, 20 months) patients returned for a follow-up investigation visit of functional, clinical and radiological outcomes. The average VAS pain score was 0.41, average range of motion of 150.0° in extension/flexion, 179.9° in pronation/supination and 52.2° in radial/ulnar deviation, grip strength of 91% of the uninjured hand, an average QuickDASH score of 11.2 points and average Patient-Rated Wrist Evaluation (PWRE) score of 9.5 points. The overall complication rate was 13.0% with 6.1% being attributable to the implant: four patients with screws placed into the distal radioulnar joint, three cases of loss of reduction, three cases with dorsally protruding screws, two cases of tendon irritation, and two cases of transient hyposensitivity. The authors conclude that this “is a safe form of treatment and results in a good clinical and radiological outcome with low complication rate.” 

Dardas et al. performed a prospective cohort study of unicortical screw fixation across 75 distal radius fractures treated with volar plate fixation at a single tertiary center. The investigators drilled to but not through the dorsal cortex and placed a screw at least 2 mm short of the dorsal cortex. Seventy-three Medartis volar plates and two DePuy Synthes plates were utilized. Two patients (2.7%) with > 30 pack-year smoking history encountered a loss of reduction, which was comparable to other studies. No extensor tenosynovitis or extensor tendon ruptures were observed. This patient series demonstrated that the Medartis Distal Radius System provides sufficient fixation of distal radius fractures with unicortical distal screw placement “while potentially minimizing the incidence of extensor tendon ruptures.” 

Esenwein et al. conducted a retrospective review of 665 unilateral distal radius fractures treated with Medartis volar plating at their institution from January 2004 to December 2009, finding an overall complication rate of 11.3%. Median nerve compression was most common (n=22, 3.3%) followed by nine cases of complex regional pain syndrome, 1.4%. Implant-related complications were limited to 9 cases of secondary dislocation (1.4%), 8 cases of ulnar impingement (1.3%), 3 cases in intraarticular screw placement (0.5%), 3 cases of hardware failure (0.5%) and three cases each of flexor or extensor tendon ruptures (0.5% each). 

Häberle et al.’s 2015 prospective randomized trial demonstrated that Medartis 2.5 volar plates could be used with or without repair of the pronator quadratus with all 60 patients (57 Medartis, 3 DePuy Synthes) achieving union and a VAS pain score of 0, 1, or 2 by 12 weeks. Repair of the pronator quadratus resulted in a greater proportion of patients with pain scores ≤ 2 at 6 weeks (84% with repair, 62% without repair, p = 0.017). 

Tokunaga and Abe’s 2017 prospective study of FPL tendon damage upon elective implant removal in asymptomatic distal radius fracture patients compared 16 patients with Acumed Acu-Loc plates versus 16 patients with Medartis APTUS Correction plates. Patient characteristics were similar, with the exception of AO classification, where more AO Type C fractures were treated with Medartis plates (A: 1; B: 1; C: 14) versus Acu-Loc plates (A: 6; B: 2; C: 8). No differences in sonographic findings were observed between the two plate groups; however, five cases of tendon erosion were noted in the Acu-Loc group versus none in the Medartis APTUS group (p=0.04). No tendon ruptures were noted at the average follow-up of 239 days. 

References 

_{Dardas AZ, Goldfarb GC, Boyer MI, Osei DA, Dy CJ, Calfee RP. A prospective observational assessment of unicortical distal screw placement during volar plate fixation of distal radius fractures. J Hand Surg Am. 2018; 43(5)448-454 https://pubmed.ncbi.nlm.nih.gov/29395586/} 

_{Esenwein P, Sonderegger J, Gruenert J, Ellenrieder B, Tawfik J, Jakubietz. Complications following palmer plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop trauma Surg. 2013; 133:1155-1162 https://pubmed.ncbi.nlm.nih.gov/23660964/} 

_{Häberle S, Sandmann GH, Deiler S, Kraus TM, Fensky F, Torsiglieri T, Rondak IC, Biberthaler P, Stöckle U, Siebenlist S. Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial. Eur J Med Res. 2015; 20:93 https://pubmed.ncbi.nlm.nih.gov/26607745/} 

_{Tokunaga S, Abe Y. Asymptomatic flexor tendon damages after volar locking plate fixation in distal radius fractures. J Hand Surg Asian-Pacific Vol. 2017; 22(1):75-82 https://pubmed.ncbi.nlm.nih.gov/28205485/} 

_{Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schättin S, Hausner T, Leixnering M. Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year. Arch Orthop Rauma Surg. 2020; 140:843-852 https://pubmed.ncbi.nlm.nih.gov/32221705/} 

The Medartis APTUS Distal Radius System includes specific plate designs intended to enable distal plate placement and capture of rim fragments. These include the FPL plate with central channel to accommodate passage of the FPL tendon, the 0.6 mm thick hook plates that can be used independently or in combination with a volar or dorsal plate, the volar rim plate with integrated 0.6 mm distal flaps that accept 1.5 mm screws or sutures, the lunate facet plate that specifically buttresses the volar lunate facet and captures distal fragments with hooks, and small fragment plates that can be used in combination with the previous options for fragment-specific fixation. These specialized plates were evaluated in 142 patients across five peer-reviewed publications. 

Biondi et al. retrospectively reviewed their first 23 cases of articular fracture with use of the hook plates in 2019. According to Medoff’s classification of articular involvement, nine patients involved all five fragments, one patient presented with four fragments, six patients with three fragments each, five patients with two fragments, and two patients with a single fragment. The plates were used in combination with either independent screws or with a volar plate, dorsal plate, or both a volar and dorsal plate. At a mean follow-up of 21 months, patients achieved a VAS pain score of 1.1, DASH of 13.5, and PRWE of 9.3. No complications related to the hook plates were observed, and all patients achieved union. No hardware failures were noted. 

Biondi et al.’s 2021 retrospective study described their fragment-specific fixation approach to volar rim fractures with the APTUS wrist system. In 68 patients with at least 12 months of follow-up (mean: 34 months), they utilized hook plates in 20 patients, double hook plates in 19 patients, the lunate facet plate in 18 patients and the volar rim plate in 11 patients. Intraoperative photos instructive for placement of each of these rim plates were presented. Despite the distal placement of hardware, no patients required hardware removal and no tendon ruptures were encountered. Patients achieved a grip strength of 86% contralateral, DASH score of 6.6, PRWE score of 3, and VAS pain score of 1.8. No loss of reduction or hardware failures were observed. The authors conclude “APTUS wrist presents a versatile set of fragment specific fixation plates able to easily and securely fix all types of volar rim fracture. The system can be used with other devices without any kind of interference between them.” 

The interaction of the FPL tendon and the Medartis FPL Volar plate have been documented by three independent research groups. Each group used ultrasound to demonstrate that the notch reduced plate-tendon contact. Kaiser et al. and Schlickum et al. each provided guidance on preferred radial-ulna positioning of the plate based upon their findings. Stepan et al. conducted a matched-cohort follow-up study of 20 patients each that were treated with either the Medartis ADAPTIVE II volar watershed plate or the Medartis FPL volar plate. Sonographic parameters were evaluated with the wrist in neutral position and 45° wrist extension. The FPL plate demonstrated a significant reduction in the percentage of tendon-plate contact with the wrist in either neutral (13% vs. 33%, p<0.001) or 45° extension (15% vs. 36.5%, p<0.001); however, the absolute measures of tendon-plate contact were not statistically different, nor was the rate of sonographic changes in the FPL tendon. No FPL tendon ruptures were detected within the study, nor were any fracture plates removed. Stepan et al. conclude “We found that the FPL volar locking plate and decreased volar tilt significantly reduced the plate-tendon contact area compared with the standard volar locking plate. In our asymptomatic cohort, we were unable to find a difference in sonographic changes in the FPL tendon.” 

References 

_{Biondi M, Keller M, Merenghi L, Gabl M, Lauri G. Hook plate for volar rim fractures of the distal radius: review of the first 23 cases and focus on dorsal radiocarpal dislocation. J Wrist Surg. 2019; 8:93-99 https://pubmed.ncbi.nlm.nih.gov/30941246/} 

_{Biondi M, Poggetti A, Fagetti A, Di Maro A, Bigazzi P, Pfanner S, Lauri G. Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study. Eur J Trauma and Em Surg. 2021 doi: 10.1007/s00068-021-01710-3 https://pubmed.ncbi.nlm.nih.gov/34041552/} 

_{Kaiser P, Gruber H, Loth F, Schmidle G, Arora R, Gabl M. Positioning of a volar locking plate with a central flexor pollicis longus tendon notch in distal radius fractures. J Wrist Surg. 2019; 8:482-488 https://pubmed.ncbi.nlm.nih.gov/31815063/} 

_{Schlickum L, Quadlbauer S, Pezzei C, Stöphasius E, Hausner T, Leixnering M. Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. 2019; 139(2):269-279 https://pubmed.ncbi.nlm.nih.gov/30506496/} 

_{Stepan JG, Marshall DC, Wessel LE, Endo, Y, Miller TT, Sacks HA, Weiland AJ, Fufa DT. The effect of plate design on the flexor pollicis longus tendon after volar locked plating of distal radial fractures. J Bone Joint Surg Am. 2019; 101:1586-1592 https://pubmed.ncbi.nlm.nih.gov/31483402/} 

The Medartis APTUS Distal Radius System includes dorsal plating options for those fractures that are best treated from a dorsal approach. Outcomes for 240 patients were documented across two studies.

Sagerfors et al. evaluated functional outcomes in combined dorsal and volar plating with Medartis Frame Plates in their 2020 publication of 74 cases of complex intra-articular distal radius fractures. The authors found one-year functional outcomes of pronation and supination at 94% the contralateral limb, flexion at 74%, extension at 76%, grip strength at 82%, median VAS pain of 0 at rest and 2 during activity and a PRWE score of 18 and a QuickDASH score of 14.8. Hardware was removed in 21 (28%) of patients for wrist pain or extensor tenosynovitis and two patients with infection resolved with antibiotic treatment alone. No cases of tendon rupture or complex regional pain syndrome were encountered by 1 year. The authors conclude that combined volar and dorsal plating “can yield a good functional and radiographic short-term outcome in patients with AO type C intra-articular distal radial fractures.” 

Ghafoor et al. demonstrated detailed radiographic outcomes in a single-center retrospective series of 166 patients with both simple and complex fractures (AO type: A, 79; B, 9; C, 78) treated with the Medartis Dorsal Plates. Two tendon ruptures were noted (1.2%), one of which was iatrogenic during the initial surgery, and the second was observed during a planned plate removal. One loss of reduction in the intermediate column was observed in an AO type C2 fracture. The authors noted a total of 15 minor clinical complications (9.0%). The authors conclude “Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature.” 

References 

_{Ghafoor H, Haefeli M, Steiger R, Honigmann P. Dorsal plate osteosynthesis in simple and complex fractures of the distal radius: a radiological analysis of 166 cases. J Wrist Surg. 2022; 11:134-144 https://pubmed.ncbi.nlm.nih.gov/35478945/} 

_{Sagerfors M, Lundqvist E, Bjorling P. Combined plating of intra-articular distal radius fractures, a consecutive series of 74 cases. J Wrist Surg. 2020; 9(5):388-395 https://pubmed.ncbi.nlm.nih.gov/33042641/} 

Medartis provides implant plus instrument solutions for malunited distal radius fractures via corrective osteotomies of both the radius and the ulna. Correction of volar tilt of the radius can be restored using a dedicated instrument with either the Correction Plate and ADAPTIVE II plates. Krimmer et al. describe the technique with intra-operative images and fluoroscopy in his 2020 technique paper. Terzis et al. described symptomatic ulnar impaction syndrome, its relevant classifications, treatment algorithm, and techniques for ulna shortening osteotomy along with outcomes of a retrospective series of 32 ulna shortening osteotomy patients. In this series, 100% of patients achieved bony union with six hardware removals (18.7%). Statistically-significant improvements in flexion/extension ROM, ulnar/radial deviation, grip strength, VAS pain score (average 7.7 reduced to 1.7) and DASH score (50.2 to 27.8) were observed. Pronation/supination was reduced to an average of 129.3° versus a preoperative 145.0° arc. Terzis et al. conclude “A modern, low profile, locking plate showed in our short-term study very good functional results and no implant-associated complications, in particular no non-union.” 

References 

_{Terzis A, Koehler S, Sebald J, Sauerbier M. Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures. Arch Orthop Trauma Surg. 2020; 140(5):681-695 https://pubmed.ncbi.nlm.nih.gov/32193682/} 

_{Krimmer H, Schandl R, Wolters R. Corrective osteotomy after malunited distal radius fractures. Arch Orthop Trauma Surg. 2020; 140:675-680 https://pubmed.ncbi.nlm.nih.gov/32193680/} 

The Medartis Distal Radius System’s arthrodesis options include total wrist fusion, carpometacarpal-sparing wrist fusion, and radioscapholunate dorsal and volar plating solutions. 

Hernekamp et al. conducted a retrospective comparison of wrist arthrodesis using either a DePuy Synthes LCP plate that bridges to the 3rd metacarpal or the carpometacarpal-sparing APTUS Wrist Fusion plate. Ten patients were included in each group. Similar functional outcomes and patient-related outcomes were observed. One plate removal was performed in each group. The APTUS plate was removed for radial nerve irritation, and a second patient had a nonunion, which was revised with the conventional AO technique of spanning to the 3rd metacarpal. The third carpometacarpal joint preservation resulted in an increase in CMCJ-3 mobility versus the non-operative side, and continuous preservation of the CMCJ-3 joint obviates removal and prevents pain upon removal, which was encountered upon removal of the DePuy Synthes plate. The authors conclude “The new implant shows similar functional results compared to the standard procedure. The main advantage of the new implant is the fact that no implant removal is necessary due to the unaffected CMCJ-3. Furthermore the mobility of the CMCJ slightly increased and showed positive impact on hand kinematics.” 

Quadlbauer et al. described functional- and patient-related outcomes after radioscapholunate (RSL) arthrodesis with a volar plate with distal scaphoidectomy. Eleven patients were included, and all achieved bony union. Final VAS pain was 2.2, 80% grip strength vs. healthy side, DASH of 27 points, and PRWE of 31 points. Range of motion increased in extension, extension/flexion, and supination after the arthrodesis procedure. Degeneration of the midcarpal joint was not observed at a mean follow-up of 63 months (minimum of 30 months). Asymptomatic radiological degeneration was observed at the radioulnar joint; however, pain was not encountered and secondary procedures were not necessary. Radioscapholunate arthrodesis can be performed through a volar approach to revise malunited distal radius fractures, utilizing the same incision as required for plate removal. The authors conclude “Volar angular stable plate RSL arthrodesis with resection of the distal scaphoid pole is a safe and effective method for treating malunited DRF. This leads to an improved ROM and low pain level” 

References 

_{Hernekamp JF, Schonle P, Kremer T, Kneser U, Bickert B. Low-profile locking-plate vs. the conventional AO system: early comparative results in wrist arthrodesis. Arch Orthop Truama Surg. 2020 140:433-439 https://pubmed.ncbi.nlm.nih.gov/31811374/} 

_{Quadlbauer S, Leixnering M, Jurkowitsch J, Hausner T, Pezzei C. Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am. 2017; 42(9):754 https://pubmed.ncbi.nlm.nih.gov/28676150/}