Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

Abstract

Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.

Functional outcome of volar locked plate fixation in AO Type B and C fractures of distal end radius

“…As with all articular fractures, mobilization of the wrist also facilitates good joint lubrication and prevents stiffness [16] . Our results in terms of regaining the range of motion and radiological parameters correlates well with other studies [9,11,18] . Tendon related complications in our study are much less (3.8%) compared to the previous studies.…”

“…There is a layer of pronator quadratus muscle which inhibits direct contact of the tendons with the plate, 3. The volar surface is more flatter making plate application easier [11,12] . The screws lock with the plate holes, which provide angular stability, prevents backout of screws and plate, and thus minimizes the chances of secondary displacement following fracture reduction and fixation [8][9][10] .…”

Outcome of Intra-Articular Fractures of the Distal End of the Radius Managed Using Volar Variable Angle Locking Plate

“…Locking plates offer an attractive alternative for management of these fractures due to possibility of a more stable construct on account of angular stability of locking screws. Additional possible advantages of these plates include, decreased soft tissue complications and absence of secondary displacement of fracture fragments even in the absence of adequate contouring of plates [14][15][16]. The present study was therefore conducted in a prospective manner to evaluate the role of locking compression plates in distal end radius fractures.…”

Outcome of fracture distal radius treated with open reduction internal fixation with volar locking compression plate (A study of 50 cases)

“…The results are comparable with other studies. 11 showed that ulnar variance became equal to unaffected side in 77.8%(n=21)patients while 0.4mm in 22.2%(n=6)patients, radial inclination was similar to unaffected side(20-25degree) in 48.2 %( n=13)while 51.8%(n=14) showed 26.8degree,radial height similar to unaffected side(10-13mm) in 40.7%(n=11) patients Paritosh Gogna et al (2013) [13] showed palmar angulation5.86° ± 6.74°, Radial inclination 23. [14] the average palmar angulation was 6.7° (range, 2° of dorsal tilt to 15° of volar tilt), radial inclination averaged 20.2° (range, 20-25°), radial shortening averaged 0.7 mm (range, 0-2 mm) i.e radial height within 10-13mm.…”

“…R.E. Anakwe et al, (2010) [12] reported no complication and Paritosh Gogna et al (2013) [13] reported 9.9% loss of reduction, there was no hardware related complication or nonunion. Margaret W.M.…”