Journal List > Arch Hand Microsurg > v.24(3) > 1143608

Yoo, Lee, Han, and Kim: A Prospective, Multicenter, Observational Study to Assess Distal Radius Fracture Treatment Outcomes Using the Variable-Angle Locking Compression Plate

초록

Purpose:

The 2.4 mm variable-angle locking compression plate (VA-LCP) is designed to treat a variety of distal radius fracture patterns. The purpose of this study was to evaluate the efficacy of the 2.4 mm VA-LCP in treating unstable distal radius fractures.

Methods:

We recruited eligible patients treated with the device at two Korean sites. In total, we studied 61 enrolled patients. We assessed clinical outcomes and radiographic union, as well as the types of plates and the number of variable-angle locking screws used in the treatment of each fracture type. Radiographic parameters were evaluated at the immediate postoperative period and at 1 year after operation.

Results:

A total of five complications occurred in 61 patients (8.2%). Radiographic union was achieved in 46/51 (90.2%), 50/51 (98.0%), and 51/51 (100%) patients at 3, 6, and 12 months, respectively. Radiographic parameters evaluated at the immediate postoperative period were 22.4±4.2 degrees (radial inclination), 4.7±0.4 degrees (volar tilt) and 0.8±0.2 degrees (ulnar variance). Radiographic parameters evaluated at 1 year after operation were 21.3±3.4 degrees (radial inclination), 4.1±0.4 degrees (volar tilt) and 1.2±0.3 degrees (ulnar variance). Wrist range of motion and grip strength measure-ments, as well as self-administered patient questionnaires showed continuous improvements at all follow-up time points. The mean number of screws that were inserted through variable-angle screw guide was 3.2±0.9, while that of screws inserted through fixed-angle screw guide was 3.5±0.9. The majority of patients (85.3%) were treated with a narrow plate.

Conclusion:

The findings of this study show promising results for the treatment of unstable distal radius fractures using the VA-LCP System.

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Fig. 1.
The mean wrist range of motion in degrees including flexion/extension, pronation/supination, and radial deviation/ ulnar deviation increased continuously until the end of the study. ROM: range of motion.
ahm-24-234f1.tif
Fig. 2.
Grip strength in kilograms of the fractured limb compared to the non-fractured limb at each follow-up visit. The difference decreased between the 6- and 12-month time points, suggesting recovery of grip strength following fracture union.
ahm-24-234f2.tif
Fig. 3.
(A, B) In intra-articular fractures with sigmoid notch involvement, (C) distal fragment that involved sigmoid notch could be fixed more stably by varying the angle of the ulnar-most screw.
ahm-24-234f3.tif
Table 1.
Demographic and preoperative profile
Characteristic All (n=61)
Age (yr) 57.7±14.35
Sex  
 Male 15 (24.6)
 Female 46 (75.4)
Body mass index (kg/m2) 22.8±2.34
Underlying diseases  
 No medication 40 (65.6)
 Regular intake of medication 21 (34.4)
Fracture type (AO classification)  
 A2 6
 A3 4
 B1 0
 B2 11
 B3 2
 C1 2
 C2 31
 C3 5
Mechanism of injury  
 Low energy 56 (91.8)
 High energy 5 (8.2)
Fracture side  
 Right 32 (52.5)
 Left 29 (47.5)

Values are presented as mean±standard deviation, number (%), or number only.

Table 2.
Summary of all complications
Patient No. Complication Fracture type (AO) Relationship to plate
006 Residual pain C2 Not related
008 Residual pain A2 Related
009 Residual pain C2 Not related
012 Residual pain C3 Related
016 Residual pain B3 Probably
Table 3.
Radiographic outcomes
Radiographic parameter The immediate postoperative period 1 year after operation p-value
Radial inclination (deg) 22.4±4.2 21.3±3.4 0.58
Volar tilt (deg) 4.7±0.4 4.1±0.4 0.26
Ulnar variance (deg) 0.8±0.2 1.2±0.3 0.31

Values are presented as mean±standard deviation.

Table 4.
Summary of the PRWE scores and DASH scores
Self-administered patient questionnaire Score
PRWE scores (mo)  
 3 20.61±8.06
 6 14.24±8.84
 12 7.56±8.25
DASH scores (mo)  
 3 16.14±12.21
 6 10.16±12.89
 12 6.34±9.30

Values are presented as mean±standard deviation.

PRWE: Patient-Rated Wrist Evaluation, DASH: Disabilities of the Arm, Shoulder, and Hand.

Table 5.
Mean number and standard deviation of screw used
Screw guide used Fracture type (AO)
A2 A3 B2 B3 C1 C2 C3
Variable angle 3.3±1.6 3.5±0.6 4.1±0.3 4.0±0 3.0±1.4 2.6±1.0 4.0±0.7
Fixed-angle 3.5±1.2 3.0±0 3.0±0 3.0±0 3.5±0.7 4.0±1.1 3.0±0.5

Values are presented as mean±standard deviation.

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