Treatment of unstable distal radius fractures with the volar locking plate

Abstract

BackgroundOpen reduction and internal fixation using an interlocking plate system has gained popularity for the treatment of dorsally displaced distal radius fractures.PurposeTo evaluate the functional and radiological results of treating unstable distal radius fractures with the volar locking plate.Patients and methodsA retrospective review was conducted of patients from one institution using the volar locking plate to treat intra-articular and extra-articular distal radius fractures. Unstable distal radius fractures in 15 patients, comprising 3 men and 12 women with a mean age of 64.4 years (34–76 years), were treated with a volar locking compression plate (Acu-Loc distal radius plate system; Acumed, Oregon, USA) and followed up for a minimum of 1 year. Fractures were classified using the AO classification. Radiographic parameters of preoperative, postoperative, and final follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up range of motion and complications were reported.ResultsAt final functional assessment, the scores of 5 patients were excellent, 7 patients good, and 3 patients fair according to Cooney's Clinical Scoring Chart. No non-union or infection occurred. Rupture of the flexor pollicis longus tendon occurred in 1 patient.ConclusionTreatment of unstable distal radius fractures with a volar locking plate leads to satisfactory results, provided the operative technique is carefully performed to prevent complications.

Risk Assessment of Tendon Attrition Following Treatment of Distal Radius Fractures With Volar Locking Plates Using Audible Crepitus and Placement of the Plate: A Prospective Clinical Cohort Study

“…7,11,19,24,28 In the current study, the intraoperative finding of flexor tendon attrition occurred in 12 patients (10%), which was somewhat higher than the frequencies described in some previous studies. This discrepancy may be explained by the difference between the attrition measured in this investigation and the complete rupture evaluated in others; we defined attrition as an intraoperative finding of incomplete tendon rupture.…”

Functional and radiological outcome in distal radius fractures treated with locking compression plate

“…While Santiago A et al used 2.4 mm plate size. 14,[17][18][19] The use of 2 mm plate and screws allows more accurate treatment after reconstruction of joint under direct vision and reestablishment of radial length both intermediate and lateral columns can be buttressed and cancellous bone graft may be added where it is needed the 2.0 screws usually give good purchase in distal fragments. A 3.5 mm T plate can be used for the intermediate column but not for the lateral column and also this plate is too big for small fragments and it is difficult to obtain a good purchase in comminuted distal fragments.…”

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.…”

“…Volar approach has decreased risk of inducing soft tissue complications, as the dorsal approach often needs dissection of the extensor retinaculum and sometimes resection of the Lister's tubercle leading to mechanical attrition of the extensor tendons by plates and screws. On the other hand, volar anatomy of the wrist offers an advantage over the dorsal aspect, as there is more space between the volar cortex and the flexor tendons and pronator quadratus acts as a hedge to prevent soft tissue complications [14]. Minegishi et al have also used the volar approach in all their cases while Kwan et al used dorsal approach in only 9% of cases where the articular reduction could not be achieved through volar approach [14,16].…”

“…On the other hand, volar anatomy of the wrist offers an advantage over the dorsal aspect, as there is more space between the volar cortex and the flexor tendons and pronator quadratus acts as a hedge to prevent soft tissue complications [14]. Minegishi et al have also used the volar approach in all their cases while Kwan et al used dorsal approach in only 9% of cases where the articular reduction could not be achieved through volar approach [14,16]. In the present study, mean ulnar variance was -0.42 mm (p=.066).…”