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

Eun-Sun Moon; Young-Joo Shin; Myung-Sun Kim; Sung-Kyu Kim

doi:10.4055/jkoa.2011.46.3.179

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

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(3): 179-190.

Published online: 30 June 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.3.179

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

Eun-Sun Moon, M.D., Ph.D., Young-Joo Shin, M.D., Myung-Sun Kim, M.D., Sung-Kyu Kim, M.D.

Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju, Korea.

Correspondence to: Young-Joo Shin, M.D. Department of Orthopaedics, Chonnam National University Medical School, 8, Hak-dong, Dong-gu, Gwangju 501-757, Korea. TEL: +82-62-220-6336, FAX: +82-62-225-7794, syjw0905@hotmail.com

Received 15 July 2010 Accepted 6 February 2011

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

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.

Keywords: distal radius fracture, volar locking plate, surgical treatment

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.

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.

Table 1

Dermographic Data of the Patients

Table 2

Dermographic Data according to Bone Mineral Density

No, number; BMD, bone mineral density.

Table 3

Clinical Results according to Green & O'Brien's Modified Scoring System and Demerit Point System

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

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

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

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

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.

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