J Korean Orthop Assoc.  2011 Jun;46(3):179-190. 10.4055/jkoa.2011.46.3.179.

Treatment of the Unstable Distal Radius Fractures Using Volar Locking Plate Fixation

Affiliations
  • 1Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju, Korea. syjw0905@hotmail.com

Abstract

PURPOSE
The purpose of this study was to evaluate clinical and radiological results after open reduction and internal fixation of unstable distal radius fractures by using volar locking plates.
MATERIALS AND METHODS
There were 73 consecutive unstable distal radius fractures treated by open reduction internal fixation using a volar locking plate. The mean age of patients was 55.5 years (range: 17-85 years): the study included 41 women and 32 men. The mean duration of follow up was 25.5 months (6.1-63.7 months). There were 18 type A, 5 type B, and 50 type C fractures by AO classification. For clinical evaluation, Green & O'Brien's modified scoring system and Demerit Point system were used. For radiological evaluation, radiographic index (radial length and radial inclination, volar tilt and ulnar variance) and Sarmiento's Criteria for Anatomic results were assessed. And, clinical results, the difference of mentioned radiographic index at preoperation, and immediate postoperative and last follow-up were compared according to AO classification and bone mineral density (BMD).
RESULTS
Clinical results by the Green & O'Brien's scoring system were as follows: 46 excellent, 17 good, 9 fair, 1 poor by demonstrating more than good results in 86.3% of all cases. According to the Demerit point system, there were 50 excellent, 16 good, and 7, which showed more than good results in 90.4% of all cases. Bone union was achieved in all cases. Sarmiento Criteria showed 36 excellent, 21 good, and 16 fair. There were statistically significant improvements between preoperative and postoperative radial length, radial inclination, volar tilt and ulnar variance (p<0.05), whereas there were no statistically significant differences between those at immediate postoperative and last follow-up. There were no statistically significant differences in clinical results, measurements of radial length, radial inclination, volar tilt and ulnar variance between intragroup and intergroup, or in immediate postoperative and last follow-up according to fracture type and BMD.
CONCLUSION
Volar locking plate fixation for distal radius fracture offers rigid fixation with insignificant reduction loss. It enables early rehabilitation and showed satisfactory clinical and radiological results. It is considered as an effective treatment option, regardless of fracture type and osteoporosis.

Keyword

distal radius fracture; volar locking plate; surgical treatment

MeSH Terms

Bone Density
Female
Follow-Up Studies
Humans
Male
Osteoporosis
Radius
Radius Fractures

Figure

  • Figure 1 A 77-year old woman with an AO type A3.3 extra-articular distal radius fracture. (A) preoperative anteroposterior and lateral radiographs show displacement of communited fracture fragments. The fracture was classified by using computed tomography scans and plain radiography. (B) Postoperative, anteroposterior and lateral radiographs show satisfactory extra-articular alignment after application of volar locking plate. (C) Anteroposterior and lateral radiographs than 12 weeks after surgery show good bony union and alignment.

  • Figure 2 A 62-year-old woman with an AO type B3.3 partial intra-articular distal radius fracture. (A) Preoperative anteroposterior and lateral radiogpraphs show extension of communition to radiocarpal joint. (B) Postoperative anteroposterior and lateral radiographs show satisfactory articular congruity and extra-articular alignment after application of volar locking plate. (C) Anteroposterior and lateral radiographs taken 8 weeks after surgery show good bony union and alignment.

  • Figure 3 A 42-year-old woman with an AO type C3.3 intra-articular distal radius fracture. (A) preoperative anteroposterior and lateral radiogpraphs show central impaction of articular surface. (B) Postoperative anteroposterior and lateral radiographs show satisfactory articular congruity and extra-articular alignment after application of volar plate. (C) Anteroposterior and lateral radiographs made 1 year after operation show good bony union and alignment.

  • Figure 4 A 50-year old woman with an AO type B2.2 intra-articular distal radius fracture. (A) Preoperative anteroposterior and lateral radiogpraphs show displacement of comminuted fracture fragments and ulnar styloid fracture. (B) After 8 weeks, the fixation with the volar locking compression plate was satisfactory, but extensor pollicis longus tendon was ruptured by metal irritation. This photo shows extensor tendon being ruptured by screw at Lister tubercle. (C) Two months after the operation, the plate and screw were removed with transfer of extensor tendons.


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