Abstract
PurposeThis study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and identify notable findings related to treatment variations.MethodsThis is a retrospective bi-centre study collecting patient details from a district general hospital and a regional hand unit. We assessed 61 consecutive patients with distal radius fractures (Arbeitsgemeinschaft für Osteosynthesefragen (AO) grade A=19, B=9, C=33) fixed using an Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH (Disabilities of the Arm, Shoulder and Hand) score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.ResultsAll but two fractures united within six weeks. The mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8 kg, which was comparable to the contralateral side at 31.5 kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.ConclusionVariable-angle locking systems benefit from the flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.
Highlights
Fractures of the distal radius are common injuries and occur in patients of all ages [1,2]
Designed volar locking plates have seen a surge in use over the last decade with mainly good functional and radiological results being reported [4,5,6]
All operations were performed using a volar approach through the bed of the flexor carpi radialis tendon (FCR)
Summary
Fractures of the distal radius are common injuries and occur in patients of all ages [1,2]. The ageing population is causing a rapidly increased incidence of fragility fractures of the distal radius [3]. Despite the plate not providing a dorsal buttress, the angular stability afforded is mechanically strong enough to hold the reduction of dorsally comminuted and dorsally tilted fractures in fragile bone [7,8]. Stability is not dependent upon friction between the plate and bone so the periosteal blood supply is maintained [8]. Locking plates provide cantilever loading, preventing forces running through the fracture site by bridging the fracture giving comminuted and osteoporotic fractures a better chance to heal
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