Abstract
Purpose The aim of this study was to demonstrate the joint fragment that mostly affects the outcome of the distal radius fracture surgically treated with a volar locking plate (VLP). Methods The outcomes of 69 patients with the distal radius fractures were evaluated at their final follow-up. The articular surface was divided into six specific fragments, and computed tomography (CT) was used to evaluate the degree of mismatch of each fragments. A plain radiograph was also obtained for evaluation of the distal radius alignment. Clinical outcomes were measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS). Univariate analyses were performed, with subsequent multiple logistic regression analyses. Results The mean follow-up period was 14.8 (range, 12 to 52) months. The group with a worse DASH score showed significantly greater mismatch in the volar and dorsal lunate facets, as well as the central depression of the distal radius (p = 0.042, 0.031, and 0.023, respectively). There was a significant positive correlation between the DASH score and degree of mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.040 and 0.011, respectively). Groups with worse MMWS showed significantly greater mismatch in the dorsal lunate facet (p = 0.025). There was a significant negative correlation between MMWS and abnormal ulnar variance and mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.041, 0.004, and 0.018, respectively). The result of multiple logistic regression analysis demonstrated that a mismatch of the dorsal lunate facet is a significant predictor for a worse MMWS (odds ratio = 3.072, p = 0.043). Conclusions Articular surface mismatch of the dorsal lunate facet appears to mostly affect the surgical outcomes of the distal radius fractures using VLP. In cases where the dorsal lunate facet is heavily involved, surgeons should be cautious about its reduction and fixation.
Highlights
The distal radius is one of the most common fracture sites of the human skeleton [1]
Previous studies have demonstrated the superiority of computed tomography (CT) over plain radiography in assessment of articular surface congruity in the distal radius fractures [9, 10]
We reviewed the medical records of 123 consecutive patients who were surgically treated for an unstable fracture of the distal radius with a volar locking plate (VLP) at our institute between May 2012 and February 2014
Summary
The distal radius is one of the most common fracture sites of the human skeleton [1]. Surgical management is currently favoured for displaced intra-articular fractures, as accura reduction and stable fixation are considered the key for a favourable long-term clinical outcome [2, 3]. Anatomical volar locking plates (VLPs) are widely used in the surgical management of the distal radius fractures. Fragment-specific fixation devices were introduced, and their biomechanical properties and advantages in management of the complex intra-articular fractures have been reported [3–5]. Several studies have investigated the effect of specific articular fragment displacements of the distal radius on surgical outcomes [6–8]. These studies relied on plain radiographs to assess articular surface congruity. Previous studies have demonstrated the superiority of computed tomography (CT) over plain radiography in assessment of articular surface congruity in the distal radius fractures [9, 10]. Previous studies about the effect of fragmentspecific reduction status on the surgical outcome did not BioMed Research International control for the confounding effect of injuries involving multiple articular fragments
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