DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20212419

Radiological outcomes of AO type B and C distal radius fractures managed with 2.7 mm volar locking plate fixation in geriatric population: a retrospective analysis

Prakashappa Thamalehally Hanumanthappa, Bharath Raja B. S., Muthu Kishore Marichamy

Abstract


Background: Distal end radius fractures are one of the most common fractures. Compared to younger patients, elderly with distal radius fractures with osteoporosis and higher comminution compromise the treatment outcomes. Anatomic reduction with stable fixation is usually the choice of treatment for displaced intra-articular fractures. While osteoporosis and poor bone quality hamper fracture stabilization, locking compression plates (LCPs) provide enhanced stability and axial loading force as compared to conventional plates. The current study retrospectively analysed the postoperative radiological outcomes in a 2.7 mm volar LCP system used for internal stabilisation of intra articular distal radius fractures.

Methods: A retrospective study was conducted in the Sanjay Gandhi institute of trauma and orthopaedics, Bangalore from June 2018 to July 2020. All Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B and C distal radius fractures of patients aged 60 and above who underwent 2.7 mm volar locking plate fixation during that time period were analysed with X-rays at immediate post-operative, six weeks and three months. The radiological outcome was scored based on Sarmiento’s modification of Lindstorm criteria.

Results: The mean immediate post-operative radial shortening, decrease in radial deviation and loss of palmar tilt were 3.80±1.03, 4.38±1.05 and 3.97±1.02, respectively. The corresponding values at last follow up were 4.31±1.12, 6.19±1.02 and 4.76±0.99, respectively. No statistically significant difference (p=0.949; p=1.0; p=0.996) in radial shortening, loss of radial deviation and decrease in palmar angulation was seen till the final follow up. Sarmiento’s modification of Lindstorm criteria showed a good radiological outcome in 80% and excellent in 20%.

Conclusions: Use of 2.7 mm volar LCP showed good to excellent post-operative radiological outcomes in geriatric population. The fracture reduction achieved in the immediate post-operative period is maintained throughout the follow up duration without any significant change.


Keywords


Distal end radius fractures, AO type B and C, Geriatric population, 2.7 mm LCP, Radiological outcome, Sarmiento’s modification of Lindstorm criteria

Full Text:

PDF

References


Charnley J. The closed treatment of common fractures. 4th ed. Cambridge: Cambridge University Press; 2003.

Obert L, Rey P, Uhring J, Gasse N, Rochet S, Lepage D, et al. Fixation of distal radius fractures in adults: a review. Orthop Traumatol Surg Res. 2013;99(2):216-34.

Downing ND, Karantana A. A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br. 2008;90(10):1271-5.

Cordey J, Borgeaud M, Perren SM. Force transfer between the plate and the bone: relative importance of the bending stiffness of the screws friction between plate and bone. Injury. 2000;31(3):21-8.

Voigt C, Lill H. What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly? Unfallchirurg. 2006;109(10):845-54.

Sarmiento A, Pratt GAW, Berry NC, Sinclair WF. Colles’ fractures. Functional bracing in supination. J Bone Joint Surg Am. 1975;57(3):311-7.

Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. 1st ed. Berlin: Springer-Verlag; 1990.

Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96.

Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279-88.

Gartland JJ, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am. 1951;33(4):895-907.

Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 1992;184(1):15-24.

Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.

Rubinovich RM, Rennie WR. Colles’ fracture: end results in relation to radiologic parameters. Can J Surg. 1983;26(4):361-3.

Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19(2):325-40.

Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury. 2002;33(6):499-502.

Lee SJ, Park JW, Kang BJ, Lee JI. Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci. 2016;21(5):619–-24.

Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra articular distal radial fractures. A randomised study. J Bone Joint Surg Am. 2008;90(1):16-22.

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(3):359-65.

Konstantinidis L, Helwig P, Strohm PC, Hirschmuller A, Kron P, Sudkamp NP. Clinical and radiological outcomes after stabilisation of complex intra-articular fractures of the distal radius with the volar 2.4 mm LCP. Arch Orthop Trauma Surg. 2010;130(6):751-7.

Pradhan U, Agrawal A, Prasad P, Chauhan V, Maheshwari R, Juyal A. Clinico-radiological and functional outcome after surgical fixation of intraarticular fractures of distal end of radius by external fixator versus locked volar plate: a prospective randomised study. IOSR J Dent Med Sci. 2013;6(3):20-6.

Khan MS, Noordin S, Hashmi PM. Intra-articular distal radius fractures: postoperative roentgenographic and functional outcomes. JPMA. 2016;66(3):275.