Fracture du radius discal chez le patient âgé par plaque à vis verrouillée polyaxiale : positionnement optimal des vis dans l’os sous-chondral à 2 niveaux avec respect de la corticale dorsale

Abstract

BackgroundDouble-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking plate system for the treatment of osteoporotic distal radius fractures in elderly patients. MethodsA total of 122 patients (mean age, 73.3 years; age range, 65–88 years) with distal radius fracture were treated using a variable-angle volar locking plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs and postoperative DDD values were compared. ResultsVolar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group. ConclusionThe use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients. Level of evidenceIII, therapeutic study.