Surgical Management of Fractures of Distal End Radius With Locking Compression Plate

Abstract

ABSTRACT:Fractures of distal end of radius continue to pose a therapeutic challenge. Intra articular and extra articular malalignment can lead to various complications like post-traumatic osteoarthrosis, decreased grip strength and endurance, as well as limited motion and carpal instability. Open reduction and internal fixation is indicated to address the unstable distal radius fractures and those with articular incongruity that cannot be anatomically reduced and maintained through external manipulation and ligamentotaxis, provided sufficient bone stock is present to permit early range of motion. METHODS: Sixty adult patients with distal radial fractures treated at Dept. of Orthopaedics, Government General Hospital and Royal Hospital, Vijayawada between May 2010 and April 2015 were included in this study. RESULTS: In this series 9(15%) patients were between 21-30 years, 15(25%) between 31-40 years, 24(40%) between 41-50 years, 9(15%) between 51-60 years and 3(5%) patients between 61-70 years. The age of the patients ranged from 26-62 years with an average of 43.3 years. Out of 60 patients, 48(80%) were males and 12(20%) were females, showing a male preponderance with the ratio being M: F 4: 1. Right side (Dominant wrist) was involved in 42(70%) patients and the left side was involved in 18(30%) patients. In our study there were 36 (60%) patients with road traffic accidents and 24(40%) patients fell on their outstretched hand. Of the 60 cases, 12(20%) of the fractures were of Type I Frykman's classification, 6(10%) of Type II, 21(35%) of Type III, 9(15%) of Type IV, 3(5%) of Type V and 9(15%) of Type VIII. There were no cases of Type VI and VII fractures. SUMMARY: Males were predominant with right wrist affection more than left. All fractures were either due to road traffic accidents or fall on the outstretched hand, with road traffic accidents being more common of the two. Most of the fractures were of Frykman Type I, III and IV. All (100%) the patients had their range of motion within the normal functional range. None of the patients had wrist stiffness. Complications were minimal. There was 3(5%) case of extensor pollicis longus tendon irritation which was because of long volar to dorsal screw and the pain subsided once the screw was removed. There was 3(5%) case with an intra-articular fracture developed grade I radiocarpal arthritis doing well with physiotherapy.

A descriptive longitudinal study of functional outcome in intra-articular distal end radius fracture with volar displacement treated by locking compression plate

“…16 In the present study, 6 (5.3%) and 2 (1.8%) patients had superficial infection and hypertrophic scar respectively while 1 (0.9%) patient had developed malunion. This is similar to the studies of Prasath et al, Maj Chahar et al and Chavhan et al [10][11][12] In our study, on the basis of demerit point score system of Gartland and Werley, 75 (69.4%) patients had excellent score while 24 (17.5%) and 15 (13.1%) patients had good and fair score respectively. No patient had poor score.…”

“…This finding was like the studies of Prasath et al, Maj Chahar et al and Chavhan et al [10][11][12] Prasath et al prospective longitudinal study observed showed mean duration between the time of fracture and surgery was 3.3 days. 10 Maj Chahar et al prospective study showed 13 patients were operated within 5 days, 7 were operated within 10 days. 11 The average time interval between injury and surgery was 5.6 days.…”

“…The mean duration of fracture union was 2.70±0.86 months. Similar observations were noted in the studies of Prasath et al, Maj Chahar et al, MacDermid et al, Chung et al and Chavhan et al[10][11][12][13][14]…”

A clinical study to determine the functional outcome of distal end radius fracture managed with volar locking plate and screws

“…Recent studies have emphasized that better methods of identifying and classifying distal radial fracture may direct the treating surgeon to alter the treatment and to adopt open reduction of these fractures in the proper circumstances [6] . In order to treat unstable distal Radius fractures and articular incongruities that cannot be anatomically reduced and maintained through external manipulation and ligamentotaxis, open reduction and internal fixation is indicated, provided that there is enough bone stock to allow for early range of motion [7] . A tiny buttress plate, like the one Ellis described, is routinely utilised as a fixation for volar marginal fractures since loss of reduction with displacement of the carpus is so common [8] .…”