Unstable distal radius fractures fixation with a 2.4 mm volar variable-angle locking plate: radiological and functional assessment
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20231436Keywords:
Distal radius fractures, ORIF, Plating, Variable angleAbstract
Background: The main objective of this observational study was to evaluate the functional and radiological outcome of variable angle volar plates in intra-articular distal end radius fractures.
Methods: Patients with distal end radius fractures (AO type 3C) treated operatively between Jan 2020 and Dec 2020 and then followed up for at least 12 months. A total of 32 patients (11 men and 21 women) with a mean age of 51.9 years were included in the study. The functional outcome was assessed by using modified Mayo wrist score (MMWS), disabilities of the arm, shoulder, and hand (DASH) score, wrist range of motion (ROM) and grip strength relative to the uninjured side and radiological assessment of radial height, volar tilt, and radial inclination.
Results: MMWS and DASH scores improved postoperatively over time. Signs of radiographic union started around 12 weeks after surgery. The most common complication observed was finger and wrist stiffness, which was resolved with active wrist and finger movements. Non-union or hardware-related complications/ late complications such as tendon irritation/attrition were not observed with variable angle volar locking plates.
Conclusions: Distal end radius fracture fixation with variable angle plate gives favourable radiological and clinical outcomes. These results can be owed to features such as low profile, variable locking, anatomical design and implant biomechanics. The surgeon determined angulation of the distal row of screw fixation may decrease the incidence of joint penetration and improve fixation of radial styloid and lunate facet stability.
References
Ismail AA, Pye SR, Cockerill WC. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int. 2002;13(7):565-71.
Kachooei AR, Tarabochia M, Jupiter JB. Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate. J Wrist Surg. 2016;5(1):2-8.
Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg. 2005;13(3):159-71.
Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am. 1994;19(1):143-54.
Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-8.
Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg. 1996;78(4):588-92.
Henry AK. Extensile exposures. Edinburgh. Churchill Livingston. 1973.
Soong M, Van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: Risk factors for complications after locked volar plate fixation. J Hand Surg Am. 2011;36:3-9.
Drobetz H, Bryant AL, Pokorny T, Spitaler R, Leixnering M, Jupiter JB. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction-a biomechanic study in a cadaveric model. J Hand Surg Am. 2006;31:615-22.
Seung C, Jai P, Hyung-Soo K, Soo-Tae C, Jeong-Hyun Y, Joo-Hak K, et al. Comparative Analysis of the Results of Fixed-angle versus Variable-angle Volar Locking Plate for Distal Radius Fracture Fixation. J Korean Fracture Society. 2012;25:197.
Stanbury SJ, Salo A, Elfar JC, Biomechanical analysis of a volar variable angle locking plate: the effect of capturing a distal radial styloid fragment. J Hand Surg Am. 2012;37:2488-94.
Marlow W, Singhal R, Dheerendra S, Ralte P, Ischer J, Waseem M. Distal radius volar locking plates: Does a variable angle locking system confer a clinical advantage? Acta Orthopaedica Belgica. 2012;78:309-16.
Kawasaki K, Nemoto T, Inagaki K, Tomita K, Ueno Y. Erratum to: Variable-angle locking plate with or without double-tiered subchondral support procedure in the treatment of intra-articular distal radius fracture. J Orthop Traumatol. 2020;15.
Regar C, Siddharath SP, Ramesh M, Sharma S, Jain J. A comparative study between variable and fixed angle volar locking plates in management of unstable intra-articular distal radius fractures. Int J Res Orthop. 2020;6:1222.
Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M. Unstable distal radius fractures in the elderly patient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma 2010;68(4):992-8.
Stanbury SJ, Salo A, Elfar JC. Biomechanical analysis of a volar variable-angle locking plate: the effect of capturing a distal radial styloid fragment. J Hand Surg Am. 2012;37(12):2488-94.
Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop. 2003;27(1):1-6.
Valbuena SE, Cogswell LK, Baraziol R, Valenti P (2010) Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases. Chir Main. 2010;29(2):109-13.
Orbay J. Volar plate fixation of distal radius fractures. Hand Clin. 2005;21(3):347-54.
Soong M, Earp BE, Bishop G. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011;93:328-35.
O’Shaughnessy MA, Shin AY, Kakar S. Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Re¬view of the Literature. J Wrist Surg. 2016;5(2):113-9.
Gruber G, Gruber K, Giessauf C, Clar H, Zacherl M, Fuerst F. Volar plate fixation of AO type C2 and C3 distal radius fractures, a singlecenter study of 55 patients. J Orthop Trauma. 2008;22(7):467-72.
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.
Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29(1):96-102.
Weninger P, Schueller M, Drobetz H. Influence of an additional locking screw on fracture reduction after volar fixed-angle plating-introduction of the protection screw in an extra-articular distal radius fracture model. J Trauma. 2009;67(4):746-51.
Jung HS, Jung HS, Baek SH, Lee JS. How Many Screws Are Needed for Reliable Stability of Extra-articular Nonosteoporotic Distal Radius Fractures Fixed with Volar Locking Plates? Clin Orthop Surg. 2020;12(1):22-28.
Wong TC, Yeung CC, Chiu Y. Palmar fixation of dorsally displaced distal radius fractures using locking plates with Smartlock locking screws. J Hand Surg Eur. 2009;34(2):173-8.
Hakimi M, Jungbluth P, Gehrmann S. Unidirectional versus multidirectional palmar locking osteosynthesis of unstable distal radius fractures: comparative analysis with LDR 2.4 mm versus 2.7 mm matrix-smartlock. Unfallchirurgie. 2010;113(3):210-6.
Chen M, Gittings DJ, Yang S, Liu G, Xia T. Variable-Angle Locking Compression Plate Fixation of Distal Radius Volar Rim Fractures. Iowa Orthop J. 2019;39(2):55-61.
