Minimally Invasive Plate Osteosynthesis for Distal Radius Fractures: Are There Any Advantages Against Conventional Technique?

Abstract

Purpose of the study — to illustrate the potential and to evaluate the late term results of minimally invasive plate fixation for distal radius fractures (DRF) and compare it to the treatment outcomes for patients with similar injuries where internal fixation was performed through conventional volar surgical approach. Material and Methods. 96 patients with DRF fractures were included into the study who underwent volar plate fixation by with angular stability. The main group included 42 patients (29 women and 13 men) with DMR where minimally invasive volar approach was used. Mean age of patients was 38 years (from 21 to 57 years). Control group consisted of 54 patients (33 women and 21 men) with mean age of 43 years (from 26 to 64 years) who underwent fracture stabilization via conventional volar approach. Minimal follow up after surgery and discharge was 3 months. In the late period roentgenological, functional and cosmetic outcomes were evaluated as well as patients’ satisfaction by QuickDASH-9 survey. Results. 95 patients (98.9%) demonstrated fracture consolidation in terms up to 6 weeks irrespective of surgical technique which was confirmed by X-rays during control examination. In one female patient (1.1%) consolidation following minimally invasive plating was not achieved even in one year after surgery which was considered as distal radius pseudarthrosis but featuring excellent functional outcome. Surgery time for minimally invasive fixation was 47 (41;53) minutes and for conventional surgical approach – 43 (37;46) minutes (р = 0.731). Mean time of image intensifier use during internal fixation averaged 54 (47;63) seconds during minimally invasive technique and 33 (29;37) seconds for conventional open technique (р = 0.046). Statistically significant larger flexion and extension ranges, pronation and supination angles as well as higher grip force were observed in the group of minimally invasive internal fixation in 1, 2 and 3 months after the surgery (р0.001). Statistically lower scores for QuickDASH-9 survey were reported for the main group in 2 and 3 months postoperatively (р0.001). Cosmetic results were better in patients after minimally invasive approach. Conclusion. Minimally invasive plating fixation of DRF is the efficient and relatively safe surgical option for such injuries. The key arguments for such approach: preservation of bone vascularization which minimally slows down fracture healing, reduced risk of infectious complications, fast functional wrist recovery already in early postoperative period as well as satisfaction of patients with cosmetic effects.