Journal List > J Korean Orthop Assoc > v.46(3) > 1013065

Moon, Shin, Kim, and Kim: Treatment of the Unstable Distal Radius Fractures Using Volar Locking Plate Fixation

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.

Figures and Tables

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.
jkoa-46-179-g001
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.
jkoa-46-179-g002
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.
jkoa-46-179-g003
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.
jkoa-46-179-g004
Table 1
Dermographic Data of the Patients
jkoa-46-179-i001
Table 2
Dermographic Data according to Bone Mineral Density
jkoa-46-179-i002

No, number; BMD, bone mineral density.

Table 3
Clinical Results according to Green & O'Brien's Modified Scoring System and Demerit Point System
jkoa-46-179-i003

The data is analyzed by Chi-square statistical method; n, number of cases; BMD, bone mineral density.

Table 4
Radiological Outcomes at Preoperative Date and Immediate Postoperative Follow Up
jkoa-46-179-i004

Values are given the raw mean and the standard deviation; The data is independent T-test statistical method.

Table 5
Radiological Outcomes at Immediate Postoperative and Last Follow Up
jkoa-46-179-i005

Values are given as raw mean and standard deviation; The data is independent T-test statistical method; F/U, follow up.

Table 6
Radiological Results of Radiographic Index according to Fracture Type
jkoa-46-179-i006

The data value in a group is analyzed by Wilcoxon signed-rank test; The data between the group are analyzed by Kruskal-wallis teset and Mann-Whitney U test.; F/U, follow up.

Table 7
Radiological Results of Radiographic Index according to Bone Mineral Density
jkoa-46-179-i007

The data value in a group is analyzed by Wilcoxon signed-rank test; The data between the group are analyzed by Kruskal-wallis teset and Mann-Whitney test; F/U, follow up; BMD, bone mineral density.

References

1. Róbertsson GO, Jónsson GT, Sigurjónsson K. Epidemiology of distal radius fractures in Iceland in 1985. Acta Orthop Scand. 1990. 61:457–459.
crossref
2. Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg. 2000. 5:103–112.
crossref
3. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986. 68:647–659.
crossref
4. Papadonikolakis A, Shen J, Garrett JP, Davis SM, Ruch DS. The effect of increasing distraction on digital motion after external fixation of the wrist. J Hand Surg Am. 2005. 30:773–779.
crossref
5. Zhang SX, Gu FR, Peng YL, et al. External fixation and bone grafting for collapsed and comminuted distal radius fracture. Chin J Traumatol. 2005. 8:156–159.
6. Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am. 2004. 86-A:1900–1908.
crossref
7. Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am. 2003. 28:94–104.
crossref
8. Leung F, Zhu L, Ho H, Lu WW, Chow SP. Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate--a biomechanical study in a cadaveric model. J Hand Surg Br. 2003. 28:263–266.
9. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974. 14:187–196.
10. Muller ME, Nazarene S, Koch P, et al. The Comprehensive Classification of Long Bones. 1990. New York: Springer-Verlag;54–63.
11. Koh SK, Cho SH, Hwang YY, et al. Spinal bone mineral density of normal and osteoporotic women in Korea. J Korean Med Sci. 1992. 7:136–140.
crossref
12. Green DP, O'Brien ET. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am. 1978. 3:250–265.
crossref
13. Bienek T, Kusz D, Cielinski L. Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg Br. 2006. 31:256–260.
crossref
14. Sarmiento A, Zagorski JB, Sinclair WF. Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation. Clin Orthop Relat Res. 1980. (146):175–183.
15. Arora R, Lutz M, Fritz D, Zimmermann R, Oberladstätter J, Gabl M. Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures. Arch Orthop Trauma Surg. 2005. 125:399–404.
crossref
16. Cooney WP. External fixation of distal radial fractures. Clin Orthop Relat Res. 1983. (180):44–49.
crossref
17. Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005. 30:289–299.
crossref
18. Krukhaug Y, Ugland S, Lie SA, Hove LM. External fixation of fractures of the distal radius: a randomized comparison of the Hoffman compact II non-bridging fixator and the Dynawrist fixator in 75 patients followed for 1 year. Acta Orthop. 2009. 80:104–108.
19. Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning. J Bone Joint Surg Br. 2005. 87:837–840.
20. Oshige T, Sakai A, Zenke Y, Moritani S, Nakamura T. A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating. J Hand Surg Am. 2007. 32:1385–1392.
crossref
21. Herron M, Faraj A, Craigen MA. Dorsal plating for displaced intra-articular fractures of the distal radius. Injury. 2003. 34:497–502.
crossref
22. 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. 31:359–365.
crossref
23. Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 1999. 48:465–480.
24. Carter PR, Frederick HA, Laseter GF. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg Am. 1998. 23:300–307.
crossref
25. Ring D, Jupiter JB, Brennwald J, Büchler U, Hastings H 2nd. Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am. 1997. 22:777–784.
crossref
26. Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg Am. 1998. 23:737–741.
27. Murakami K, Abe Y, Takahashi K. Surgical treatment of unstable distal radius fractures with volar locking plates. J Orthop Sci. 2007. 12:134–140.
crossref
28. Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D. Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am. 2008. 90:1297–1304.
crossref
29. Martineau PA, Berry GK, Harvey EJ. Plating for distal radius fractures. Orthop Clin North Am. 2007. 38:193–201.
crossref
30. Bell JS, Wollstein R, Citron ND. Rupture of flexor pollicis longus tendon: a complication of volar plating of the distal radius. J Bone Joint Surg Br. 1998. 80:225–226.
TOOLS
Similar articles