Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures.

Abstract

The aim of the present study was to identify the clinical and radiologic factors affecting functional outcomes in patients with a distal radius fractures (DRFs) treated by volar locking plate fixation. Prospective cohort of patients with dorsally angulated DRFs requiring the volar locking plate fixation were recruited during one year. We evaluated wrist motion, grip strength, and DASH score at 3, 6 and 12 months after surgery. The factors assessed for their influence on functional outcomes included clinical variables representing patients' characteristics (age, gender, whether the dominant hand was fractured, the fracture mechanism, fracture classification, complications after surgery, and diabetes mellitus) and radiologic variables representing amount of displacement and quality of reduction (volar tilt angle, radial height, radial inclination, and ulnar variance) at initial injury plain radiographs before manual reduction, and at the radiographs within 1 week of surgery. We conducted a simple and multiple linear regression analysis to identify the clinical and radiologic factors affecting functional outcomes. 89 patients were recruited at 1 year after surgery. In the multivariate linear regression analysis, the significant factor affecting DASH score was diabetes (p=0.025) and the ulnar variance after surgery (p=0.042) after adjusting for age. However, Age was the only statistically significant factor affected grip strength (p=0.024) and wrist motion (p=0.012). Because the ulnar variance after surgery is the modifiable factor in contrast with other factors such as diabetes and age, surgeons should pay attention to restore ulnar variance to improve functional outcomes during volar locking plate fixation in patients with distal radius fractures.