Functional Outcome of Fixation of Complex Intra-articular Distal Radius Fractures with a Variable-Angle Distal Radius Volar Rim Plate

Abstract

Aim To evaluate the outcome of these complex fractures using a volar approach and the DePuy Synthes variable-angle 2.4-mm distal radius rim plate. This plate is precontoured to the volar rim for placement distal to the watershed line allowing purchase of the rim fragment of the lunate facet. Its low profile and smooth edges are designed to minimize flexor tendon irritation. Method We report on a consecutive series of far distal AO-23B3 and AO-23C3 fractures treated using this plate in a tertiary hand center between November 2011 and May 2014. Range of motion, grip strength, and complications were assessed at the final clinical review. Disabilities of the arm, shoulder, and hand (DASH) and patient evaluation measure (PEM) scores were assessed at 12 months after surgery. Results Twenty-six patients were included in this review. Six patients were lost to follow-up at 3 months. This plate was used in isolation in 17 cases, and in combination with a dorsal plate, in cases of dorsal instability after volar plating, in 10 patients. DASH and PEM scores 1 year after surgery were 17.6 and 27%, respectively. Visual analog scores for patient treatment satisfaction and severity of pain showed good satisfaction with treatment and mild intermittent pain on activity. Postoperative range of motion was variable and grip strength was of 71% of the uninjured contralateral side. There were no cases of flexor or extensor tendon rupture. Tendon irritation was noted in two patients. Removal of metal was performed in four patients. Loss of reduction occurred in one case and neurologic complications in two cases. Conclusion This implant is specifically designed for the management of far distal complex intra-articular fractures of the distal radius. Despite the complexity of these fracture patterns and the challenge they pose to accurate reduction and stable fixation, outcomes were satisfactory in this small series. There were no cases of tendon rupture. Removal of metal is not necessary in all cases, but prompt removal should be performed in cases of tendon irritation in view of the risk of tendon rupture.