The purpose of this study was to evaluate the
risk of late displacement after the treatment of distal radial fractures with
a locking volar plate, and to investigate the clinical and radiological
factors that might correlate with re-displacement. From March 2007
to October 2009, 120 of an original cohort of 132 female patients
with unstable fractures of the distal radius were treated with a
volar locking plate, and were studied over a follow-up period of
six months. In the immediate post-operative and final follow-up
radiographs, late displacement was evaluated as judged by ulnar
variance, radial inclination, and dorsal angulation. We also analysed
the correlation of a variety of clinical and radiological factors
with re-displacement. Ulnar variance was significantly overcorrected
(p <
0.001) while radial inclination and dorsal angulation were
undercorrected when compared statistically (p <
0.001) with the unaffected
side in the immediate post-operative stage. During follow-up, radial
shortening and dorsal angulation progressed statistically, but none
had a value beyond the acceptable range. Bone mineral density measured
at the proximal femur and the position of the screws in the subchondral
region, correlated with slight progressive radial shortening, which
was not clinically relevant. Volar locking plating of distal radial fractures is a reliable
form of treatment without substantial late displacement. Cite this article:
The recent development of locking-plate technology has led to a potential revolution in the management of fractures of the distal radius. This review examines the evidence for pursuing anatomical restoration of the distal radius and the possible advantages and pitfalls of using volar locking plates to achieve this goal. The available evidence for adopting volar locking plates is presented and a number of important and, as yet unanswered, questions are highlighted.
In a randomised prospective study, 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning. Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning. The patients were evaluated clinically and radiologically at follow-up of 24 months. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and modified Mayo wrist score were used at 3, 9, 12 and 24 months postoperatively. In the arthroscopically- and fluoroscopically-assisted group, triangular fibrocartilage complex tears were found in 12 patients (60%), complete or incomplete scapholunate ligament tears in nine (45%), and lunotriquetral ligament tears in four (20%). They were treated either arthroscopically or by open operation. Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination, extension and flexion at all time points than those who had fluoroscopically-assisted surgery. The mean DASH scores were similar for both groups at 24 months, whereas the difference in the mean modified Mayo wrist scores remained statistically significant. Although the groups are small, it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome. Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome.
